Dr. Steve Chaney

Which Diets Are Heart Healthy?

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Which Diet Is Best For You?

Author: Dr. Stephen Chaney 

strong heartThe top 3 claims the advocates of every popular diet make are:

  • It will help you lose weight.
  • It reduces your risk of diabetes.
  • It reduces your risk of heart disease.

The truth is any restrictive diet helps you lose weight. And when you lose weight, you improve blood sugar control. Which, of course, reduces your risk of developing diabetes.

But what about heart disease? Which diets are heart healthy? When it comes to heart disease the claims of diet advocates are often misleading. That’s because the studies these advocates use to support their claims are often poor quality studies. Many of these studies:

  • Look at markers of heart disease risk rather than heart disease outcomes. Markers like LDL cholesterol, triglycerides, c-reactive protein, etc. are only able to predict possible heart disease outcomes. To really know which diets are heart healthy you have to measure actual heart disease outcomes such as heart attacks, stroke, and cardiovascular deaths.
  • Are too short to provide meaningful results. Many of these studies last only a few weeks. You need much longer to measure heart disease outcomes.
  • Are too small to provide statistically significant results. You need thousands of subjects to be sure the results you are seeing are statistically significant.
  • Have not been confirmed by other studies. The Dr. Strangeloves of the world like to “cherry pick” the studies that support the effectiveness of their favorite diet. Objective scientists know that any individual study can be wrong. So, they look for consensus conclusions from multiple studies.

A recent study (G Karam et al, British Medical Journal, 380: e072003, 2023) avoided all those pitfalls. The investigators conducted a meta-analysis of 40 high-quality clinical studies with 35,548 participants to answer the question, “Which diets are heart healthy?”

How Was The Study Done?

Clinical StudyThe authors started by searching all major databases of clinical studies for studies published on the effect of diets on heart disease outcomes through September 2021.

They then performed a meta-analysis of the data from all studies that:

  • Compared the effect of a particular diet to minimal dietary intervention (defined as not receiving any advice or receiving dietary information such as brochures or brief advice from their clinician with little or no follow-up).
  • Looked at heart disease outcomes such as all cause mortality, cardiovascular mortality, non-fatal heart attacks, stroke, and others.
  • Lasted for at least 9 months (average duration = 3 years).
  • Were high-quality studies.

Using these criteria:

  • They identified 40 studies with 35,548 participants for inclusion in their meta-analysis.
    • From those 40 studies, they identified 7 diet types that met their inclusion criteria (low fat (18 studies), Mediterranean (12 studies), very low fat (6 studies), modified fat (substituting healthy fats for unhealthy fats rather than decreasing fats, 4 studies), combined low fat and low sodium (3 studies), Ornish (3 studies), Pritikin (1 study).

One weakness of meta-analyses is that the design of the studies included in the meta-analysis is often different. Sometimes they don’t fit together well. So, while the individual studies are high-quality, a combination of all the studies can lead to a conclusion that is low quality or moderate quality.

Finally, the data were corrected for confounding factors such as obesity, exercise, smoking, and medication use.

Which Diets Are Heart Healthy?

Now that you understand the study design, we are ready to answer the question, “Which diets are heart healthy?” Here is what this study found:

Compared to minimal intervention,

  • The Mediterranean diet decreased all cause mortality by 28%, cardiovascular mortality by 45%, stroke by 35%, and non-fatal heart attacks by 52%.
  • Low fat diets decreased all cause mortality by 16% and non-fatal heart attacks by 23%. The effect of low fat diets on cardiovascular mortality and stroke was not statistically significant in this meta-analysis.
    • For both the Mediterranean and low fat diets, the heart health benefits were significantly better for patients who were at high risk of heart disease upon entry into the study.
    • The evidence supporting the heart health benefits for both diets was considered moderate quality evidence for this meta-analysis. [Remember that the quality of any conclusion in a meta-analysis is based on both the quality of evidence of the individual studies plus how well the studies fit together in the meta-analysis.]
  • While the percentage of risk reduction appears to be different for the Mediterranean and low fat diets, the effect of the two diets on heart health was not considered significantly different in this study.
  • The other 5 diets provided little, or no benefit, compared to the minimal intervention control based on low to moderate quality evidence.

The authors concluded, “This network meta-analysis found that Mediterranean and low fat dietary programs probably reduce the risk of mortality and non-fatal myocardial infarction [heart attacks] in people at increased cardiovascular risk. Mediterranean dietary programs are also likely to reduce the risk of stroke. Generally, other dietary programs were not superior to minimal intervention.”

Which Diet Is Best For You?

confusionThe fact that this study found both the Mediterranean diet and low fat diets to be heart healthy is not surprising. Numerous individual studies have found these diets to be heart healthy. So, it is not surprising when the individual studies were combined in a meta-analysis, the meta-analysis also concluded they were heart healthy. However, there are two important points I would like to make.

  • The diets used in these studies were designed by trained dietitians. That means the low fat studies did not use Big Food, Inc’s version of the low fat diet in which fatty foods are replaced with highly processed foods. In these studies, fatty foods were most likely replaced with whole or minimally processed foods from all 5 food groups.
  • The Mediterranean diet is probably the most studied of current popular diets. From these studies we know the Mediterranean diet improves brain health, gut health, and reduces cancer risk.

As for the other 5 diets (very low fat, modified fat, low fat and low sodium, Ornish, and Pritikin), I would say the jury is out. There is some evidence that these diets may be heart healthy. But very few of these studies were good enough to be included in this meta-analysis. Clearly, more high-quality studies are needed.

Finally, you might be wondering why other popular diets such as paleo, low carb, and very low carb (Atkins, keto, and others) were left out of this analysis. All I can say is that it wasn’t by design.

The authors did not select the 7 diets described in this study and then search for studies testing their effectiveness. They searched for all studies describing the effect of diets on heart health. Once they identified 40 high-quality studies, they grouped the diets into 7 diet categories.

I can only conclude there were no high-quality studies of paleo, low carb, or very low carb diets that met the criteria for inclusion in this meta-analysis. The criteria were:

  • The effect of diet on heart health must be compared to a control group that received no or minimal dietary advice.
  • The study must measure heart disease outcomes such as all cause mortality, cardiovascular mortality, non-fatal heart attacks, and stroke.
  • The study must last at least 9 months.
  • The study must be high-quality.

Until these kinds of studies are done, we have no idea whether these diets are heart healthy or not.

So, what’s the takeaway for you? Which diet is best for you? Both low fat diets and the Mediterranean diet are heart healthy provided the low fat diet consists of primarily whole or minimally processed foods. Which of these two diets is best for you depends on your food preferences.

The Bottom Line 

Many of you may have been warned by your doctor that your heart health is not what it should be. Others may be concerned because you have a family history of heart disease. You want to know which diets are heart healthy.

Fortunately, a recent study answered that question. The authors performed a meta-analysis of 40 high-quality studies that compared the effect of various diets with the effect of minimal dietary intervention (doctors’ advice or diet brochure) on heart disease outcomes.

From this study they concluded that both low fat diets and the Mediterranean diet probably reduce mortality and the risk of non-fatal heart attacks, and that the Mediterranean diet likely reduces stroke risk.

Other diets studied had no significant effect on heart health in this study. That does not necessarily mean they are ineffective. But it does mean that more high-quality studies are needed before we can evaluate their effect on heart health.

So, what’s the bottom line for you? Both low fat diets and the Mediterranean diet are heart healthy provided the low fat diet consists of primarily whole or minimally processed foods Which of these two diets is best for you depends on your food preferences.

For more information on this study, read the article above.

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

___________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

Do Omega-3s Reduce Cognitive Decline?

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Should You Supplement With Omega-3s?

Author: Dr. Stephen Chaney 

Cognitive-DeclineDo omega-3s reduce cognitive decline, or is this another nutrition myth?

There is certainly good reason to believe that the long chain omega-3s EPA and DHA are good for brain health.

  • DHA is an essential part of the membrane that coats our neurons. As such, it is a major component of our brains and plays an important role in its structural integrity.
  • While EPA is not found in the brain it reduces inflammation and improves blood flow to the brain, both of which are important for brain health.

But the role of DHA and EPA in reducing cognitive decline remains controversial. Some studies strongly support their role in slowing cognitive decline while other studies find no effect.

So, the question remains, “Do omega-3s reduce cognitive decline or not?”

The study (B-Z Wei et al, American Journal of Clinical Nutrition, 117: 1096-1109, 2023) I will review today was designed to answer that question.

This study supports the hypothesis that omega-3s, especially DHA and EPA, reduce cognitive decline and Alzheimer’s disease. But it also raises several questions that need to be resolved by future studies.

Why Is The Effect Of Omega-3s On Cognitive Decline Controversial?

ArgumentWhy is it so difficult to come up with definitive answers about whether omega-3s reduce cognitive decline? It is probably because the relationship between omega-3s and brain health is complex. For example:

  • Because omega-3’s beneficial effects are widely publicized, many people are already consuming adequate amounts of omega-3s. A supplement study that does not measure the omega-3 status of participants at the beginning of the study and does not focus on participants with inadequate omega-3 status is doomed to failure.
  • Omega-3s may benefit older people more than younger people. A study that is not large enough to measure the effect of omega-3s on both groups is doomed to failure.
  • The APOE ɛ4 genotype is associated with an increased risk of cognitive decline and Alzheimer’s. Some studies suggest omega-3s are more beneficial for people with the APOE ɛ4 genotype, while other studies come to the opposite conclusion. This is a critical variable that needs to be resolved.
  • The ability of DHA to cross the blood-brain barrier and accumulate in our brain may be influenced by our genetics, especially our APOE ɛ4 status, and adequate levels of other nutrients, especially B vitamins. Unless studies are large enough to separate out these variables, they are doomed to failure. This study suggests accumulation of DHA in the brain is a critical variable that needs to be resolved.
  • Multiple studies suggest that higher doses of omega-3s are more effective at reducing cognitive decline than low doses of omega-3s. This study confirms that effect and identifies a threshold dose that is needed to provide measurable benefits. Studies providing supplemental omega-3s at doses below that threshold are likely to fail. And meta-analyses that combine low dose studies with high dose studies are also likely to come up empty.
  • Finally, people who take omega-3s for years are likely to benefit more than those who take omega-3s for just a few months. Again, this study confirms that effect, which means that studies involving short-term supplementation with omega-3s are likely to fail. And meta-analyses that combine short-term and long-term studies are likely to come up empty.

With so many potential pitfalls, it is easy to understand why many studies come up empty, and the effect of omega-3s on cognitive decline remains controversial.

How Was This Study Done?

clinical studyThis study consisted of two parts:

Part 1 used data from the Alzheimer’s Disease Neuroimaging Initiative (ADNI). The ADNI study is a multicenter study designed to develop clinical, imaging, genetic, and biochemical markers for early detection and tracking of Alzheimer’s Disease.

Participants undergo standardized neuroimaging, psychological assessments, in-person interviews for medical history, and cognitive evaluations on entry into the study and at the end of the study.

This study followed a cohort of 1135 participants (average age = 73, 46% females) without dementia at entry into the study for 6 years.

Omega-3 supplement use was determined based on a questionnaire at the beginning of the study. Participants who used omega-3 supplements for over a year were considered omega-3 users. They were further divided into medium-term users (1-9 years) and long-term users (>10 years).

Alzheimer’s Disease was diagnosed by neurologists based on brain scans, cognitive scores, and the ability to live independently.

Part 2 was a meta-analysis of 31 studies with 103,651 participants. The studies included in the meta-analysis all:

  • Measured the relationship of omega-3 intake with the risk of Alzheimer’s Disease, all-cause dementia, or cognitive decline.
  • Were cohort studies (studies that follow a group of people over time) or case control studies (studies that compare people who develop a disease with those who do not).
  • Provided risk estimates or data that could be used to calculate risk.
  • Were original publications, not reviews or meta-analyses.

Do Omega-3s Reduce Cognitive Decline?

omega 3 supplementsThe results from Part 1 (data from the ADNI study) were as follows:

  • Omega-3 supplement users had a 37% lower risk of developing Alzheimer’s Disease than non-users.
  • Long-term (>10 years) omega-3 supplement users fared even better. They had a 64% lower risk of developing Alzheimer’s Disease than non-users.
  • When they broke the results for long-term omega-3 supplement users into subgroups:
    • Males (67% risk reduction) benefitted more than females (50% risk reduction).
    • People over 65 (65% risk reduction) benefited more than those under 65 (22% risk reduction).
    • People with the APOE ɛ4 genotype (71% risk reduction) benefitted more than those who were APOE ɛ4 negative (55% risk reduction).

The results from Part 2 (data from the meta-analysis) were as follows:

  • Dietary omega-3 intake lowered the risk of cognitive decline by 9%.
    • People with the APOE ɛ4 genotype fared better (17% risk reduction).
    • Their data suggested that a threshold of 1 gm/day omega-3s was needed before significant risk reduction was seen.
  • Dietary DHA intake lowered the risk of dementia by 27% and Alzheimer’s Disease by 24%.
  • Each 100 mg/day increase in DHA and EPA was associated with a significant reduction in the risk of cognitive decline (8% for DHA and 9.9% for EPA).

The authors concluded that,

1) “Long-term omega-3 supplementation may reduce risk of Alzheimer’s Disease; and

2) Dietary omega-3 fatty acid intake, especially DHA, may lower risk of dementia or cognitive decline…

3) However, further investigation is needed to understand the gene environment interactions involved in…[these effects of omega-3 fatty acids].”

Should You Supplement With Omega-3s?

QuestionsThis study provides strong support for the hypothesis that omega-3 supplementation reduces the risk of cognitive decline, dementia, and Alzheimer’s Disease as we age. It also suggests that a dose of 1 gram/day may be needed to obtain a significant benefit.

However, it also highlights the difficulty in designing definitive experiments to test this hypothesis. This study shows that gender, age, genetics (especially the APOE ɛ4 genotype), type of omega-3s, dosage, and duration of supplementation all exert a significant influence on the effect of omega-3s on cognitive decline.

It is extremely difficult to design a study that optimizes all these variables, which almost guarantees that the effect of omega-3s on cognitive decline will remain controversial for the foreseeable future.

However, omega-3s lower blood pressure, lower triglycerides, reduce inflammation and are heart-healthy. And the threshold for all these effects is around 1 gram/day or more. If omega-3s also reduce cognitive decline, you can consider that a side-benefit.

The Bottom Line 

The role of omega-3s in reducing cognitive decline remains controversial. Some studies strongly support their role in slowing cognitive decline while other studies find no effect.

So, the question remains, “Do omega-3s reduce cognitive decline or not?”

A recent study was designed to answer that question. Among other things the study showed:

  • Omega-3 supplement users had a 37% lower risk of developing Alzheimer’s Disease than non-users.
  • Long-term (>10 years) omega-3 supplement users fared even better. They had a 64% lower risk of developing Alzheimer’s Disease than non-users.
  • Dietary DHA intake lowered the risk of dementia by 27% and Alzheimer’s Disease by 24%.
  • Each 100 mg/day increase in DHA and EPA was associated with a significant reduction in the risk of cognitive decline (8% for DHA and 9.9% for EPA).
  • The threshold for observing a significant effect of omega-3s on cognitive decline was around 1 gram/day.

This study provides strong support for the hypothesis that omega-3 supplementation reduces the risk of cognitive decline, dementia, and Alzheimer’s Disease as we age. It also suggests that a dose of 1 gram/day may be needed to obtain a significant benefit.

However, it also highlights the difficulty in designing definitive experiments to test this hypothesis. This study shows that gender, age, genetics (especially the APOE ɛ4 genotype), type of omega-3s, dosage, and duration of supplementation all exert a significant influence on the effect of omega-3s on cognitive decline.

It is extremely difficult to design a study that optimizes all these variables, which almost guarantees that the effect of omega-3s on cognitive decline will remain controversial for the foreseeable future.

However, omega-3s lower blood pressure, lower triglycerides, reduce inflammation and are heart-healthy. And the threshold for all these effects is around 1 gram/day or more. If omega-3s also reduce cognitive decline, you can consider that a side-benefit.

For more information on this study read the article above.

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

 ___________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

 

 

Does Hormone Replacement Therapy Cause Dementia?

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The Dark Side Of Hormone Replacement Therapy

Author: Dr. Stephen Chaney 

When I was still teaching, a physician and I were co-directors of one of the first courses medical students took at UNC. In his opening lecture to these brand-new medical students, one of his pearls of wisdom was the statement, “The only safe drug is a new drug.”

After a pause to let the students think about it, he followed up with, “That’s because the side effects haven’t been discovered yet.”

He would then go on to explain that every drug must go through rigorous clinical trials, and some side effects are discovered then. But some of the most serious side effects aren’t discovered until years later after 100’s of thousands of patients had used the drugs.

Hormone replacement therapy is a perfect example of this principle. Hormone replacement therapy was first introduced in the 1960s. At first it seemed to be an almost miraculous solution to menopausal symptoms.

Millions of women were overjoyed. After all, menopause symptoms can make life miserable. They include:

  • Hot flashes
  • Night sweats
  • Sleep disturbances
  • Mood swings
  • Depression
  • Anxiety
  • Forgetfulness
  • Food cravings
  • Tiredness

Just to name a few. While only 25% of women experience severe symptoms, why would anyone want to experience any of these symptoms?

And doctors were only too happy to oblige. Why not? The known side effects were mild. Why should any woman experience menopause symptoms?

But that was before the dark side of hormone replacement therapy started to emerge.

The Dark Side Of Hormone Replacement Therapy

Darth VaderThe popularity of hormone replacement therapy peaked in the 1990s. It was around that time that reports started to emerge suggesting that hormone replacement therapy increased the risk of heart disease and breast cancer. Those risks were confirmed in a major study called the Woman’s Health Initiative that was published in 2002.

That study caused a major shift in how the medical community regarded hormone replacement therapy. Within a few years doctors shifted from recommending hormone replacement therapy for every woman with menopausal symptoms to recommending it only in cases where the symptoms were debilitating and only for the shortest possible time.

The effect on women’s health was huge. In fact, switching from universal hormone replacement therapy to targeted hormone replacement therapy remains the single most effective public health measure for reducing the incidence of breast cancer. It is more effective than any of new drugs and measures to improve breast cancer screening since then.

I wish I could tell you that was the end of the story. But recent studies have suggested that hormone replacement therapy also increases the risk of dementia. Unfortunately, most of those studies have had flaws, so the link between hormone replacement therapy and dementia has remained controversial – until now.

The study (N Pourhadi et al, British Medical Journal, 382, e072770, 2023) I will describe today was designed to provide a more definitive test of this hypothesis.

How Was This Study Done?

clinical studyThis was done in Denmark and used the Danish health registries. As Americans, you might not be aware of what a rich resource those health registries are. One advantage of socialized medicine is that every aspect of your health is tracked and recorded from cradle to grave.

[I’m not sure I would be comfortable with our government knowing that much about me, but it is a treasure-trove of information if you want to conduct a study like this one.]

The authors used the Danish National Health registries to:

  • Identify all Danish women aged 50-60 who had no incidence of dementia and were not on hormone replacement therapy as of January 1, 2000.
  • Identify 5589 women (1.8% of the population) from this group who were diagnosed with dementia between January 1, 2000 and December 31, 2018 and match them with 55,890 controls who remained dementia-free through the end of 2018.
  • Using the National Prescription registry, they were able to track which women used hormone-replacement therapy, what kind of therapy it was (there are several variations of hormone replacement therapy), and how long they remained on hormone replacement therapy.

The average age at which hormone replacement therapy began was 53, and the average duration of use was 3.8 years. The average age of a dementia diagnosis was 70.

Does Hormone Replacement Therapy Cause Dementia?

Dementia-WomanWhen the authors compared women who used an estrogen-progestin combination hormone replacement therapy (the most common kind) with women who never used hormone replacement therapy, the hormone replacement therapy users were:

  • 24% more likely to develop dementia of any kind.
  • 21% more likely to develop late-onset dementia.
  • 22% more likely to develop Alzheimer’s disease.

Longer duration of hormone replacement use was associated with an increased risk of dementia. The increased risk of dementia was:

  • 21% for ≤ 1 year duration.
  • 39% for 8-12 years duration.
  • 74% for > 12 years duration.

The age at which hormone replacement therapy was begun had a slight effect on dementia risk. The increased risk of dementia was:

  • 26% when it was started at age 45-50.
  • 21% when it was started at age 51-60.

Finally, other forms of hormone replacement therapy such as progestin only therapy and vaginal estrogen treatment did not have a statistically significant effect on dementia risk. But it was not clear whether this was due to a smaller sample size or whether it was a true null effect.

The authors concluded, “Menopausal hormone replacement therapy was positively associated with the development of all cause dementia and Alzheimer’s disease, even in women who received treatment at the age of 55 years or younger.”

The Pros And Cons Of This Study

pros and consThe pros are obvious. This was a large, well-designed study. And its use of the Danish National Health registry and National Prescription registry allowed it to address the dementia risk of hormone replacement therapy in a comprehensive manner.

The cons are also obvious. This was an observational study. It can only show associations, not prove cause and effect. [I should note that it would be impossible to do a double-blind study to prove cause and effect. The size of the population group and the length of time required would make that kind of study unworkable.]

As I have said in previous issues of “Health Tips From the Professor”, the Achilles heel of observational studies is the possibility that a confounding variable (something else about the women who developed dementia) was the true cause of the observed outcome (in this case, increased dementia risk).

The authors did an excellent job of identifying known confounding variables that might have contributed to dementia and statistically correcting for them. However, the authors identified one potential confounding variable I would not have thought of.

In the words of the authors, “Further studies are warranted to determine whether these findings represent an actual effect of menopausal hormone therapy on dementia risk, or whether they reflect an underlying predisposition in women in need of these treatments.”

In case you need a translation, the authors are saying that it is possible that certain women have an underlying disease state or genetic predisposition that makes them very sensitive to menopausal symptoms (which increases the likelihood that they would receive hormone replacement therapy to reduce their symptoms) and increases their risk of dementia. In that case, it would be the underlying medical condition or genetic predisposition that was responsible for the increased dementia risk, not the hormone replacement therapy.”

I consider that unlikely, but it does warrant future studies.

Is Hormone Replacement Therapy Right For You?

Questioning WomanUltimately, this is your decision. But this is a decision you should make with your health care provider.

It is clear that hormone replacement therapy increases your risk of heart disease, breast cancer, and may increase your risk of dementia.

In part, your decision depends on the severity of your symptoms and your willingness to accept the risks associated with alleviating those symptoms.

But your health care provider can also help you consider family history and unrelated health conditions that may also increase your risk of these diseases. If your underlying disease risk is low, would you be more willing or less willing to accept the risks associated with hormone replacement therapy? Again, this is your decision.

And, if you decide to proceed with hormone replacement therapy, your health care provider can recommend the type of therapy and length of therapy that will minimize your risks.

The Bottom Line 

Several recent studies have suggested that hormone replacement therapy may increase the risk of dementia, but this has remained controversial.

In this issue of “Health Tips From the Professor” I share a very large, well designed study that supports the link between hormone replacement therapy and dementia.

When the authors of this study compared women who had used hormone replacement therapy with women who never used hormone replacement therapy, the hormone replacement therapy users were:

  • 24% more likely to develop dementia of any kind.
  • 21% more likely to develop late-onset dementia.
  • 22% more likely to develop Alzheimer’s disease.

The authors concluded, “Menopausal hormone replacement therapy was positively associated with the development of all cause dementia and Alzheimer’s disease, even in women who received treatment at the age of 55 years or younger.”

For more information on the strengths and weaknesses of this study and a discussion of whether hormone replacement therapy might be right for you, read the article above.

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

___________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

 

Your Pectineus Muscle And Groin Pain

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Treating Groin Pain Naturally

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

The holidays are inching up on us, and this month is one of my favorites.  I love Halloween because the children have so much fun dressing up and going to parties.

Back when I was a child we could roam around the neighborhood, knocking on doors and having our candy dropped into the pumpkin basket or pillowcase our moms gave us.  We traveled in a pack, and our parents knew we were safe as long as we stayed in our neighborhood because everyone knew everyone.

Nowadays children go to “Trunk or Treat” parties, often with mom or dad in tow. They’re still having fun, and it’s great to see their excitement when they’re sharing with each other how many goodies they have collected.

Now, even just LOOKING at that candy makes me gain 5 lbs!  Oh well!

Happy October to you and your family!

Your Pectineus Muscle And Groin Pain

Today, we will be discussing how a small muscle that most people aren’t even aware of can cause groin pain. I’ve been working with athletes since 1989 and I’ve seen this small muscle cause such pain that it was preventing the athlete from continuing with his/her sport.  And it’s so simple to treat!

The pectineus muscle is in your adductor muscle group. The adductors are responsible for hip flexion and adduction.

Adduction is when you bring your leg closer to the opposite leg, such as when you cross your legs when you are sitting down.  Athletes who play soccer, or who ride a horse, are heavily using their adductor muscles.

As you look at the graphic on the left, the muscles on the left side (right leg) are the larger adductor muscles.

The pectineus is shown on the right side (left leg) so that it is more visible, helping you see the location of the muscle.  In reality, all the muscles are on both sides.

Since the pectineus muscle is so close to the pubic bone, it is more difficult to self-treat. You need to sit on the floor and twist yourself, so the sore side is pressing into the floor.

The pectineus muscle is often overlooked, but it can cause significant pain when in spasm or injured. Here are some of the symptoms, causes, and a simple self-treatment I have developed for a tight pectineus.

Quick Facts About Groin Pain And Your Pectineus Muscle

Causes of Spasms of the Pectineus and Adductors:

  • Muscular injuries of the adductors, the iliopsoas muscle, and abdominal musculature are the most frequent causes of acute groin pain in sportsmen and sportswomen.
  • Spasms in your pectineus muscle are also a common cause of groin pain and are often overlooked.
  • Pectineus pain often stems from an injured groin muscle. Common causes include running, kicking a soccer ball, riding a horse, and sitting with a crossed leg.

Symptoms Of Groin Pain Caused By Your Pectineus Muscle:

  • Groin pain is any discomfort in the area between your abdomen and thigh, located where your abdomen ends, and your legs begin.
  • Localized pain on the pubic bone, in the groin area, on one side or the other, is a primary indication of injury to the pectineus.
  • Pain on palpation of the involved muscle and pain on adduction (moving your legs closer together against resistance) is also an indication of injury to the pectineus.

Treating Groin Pain Naturally

You are trying to be pressing close to your pubic bone, which is shown in the graphic above.

Sit as shown and use a ball to press deeply into your adductors. Start the treatment at the very top of the muscles, close to your pubic bone, and move down toward your knee.

If you find any tender points, called “trigger points,” hold  the pressure on the spasm until it stops hurting.

You can also “pump” the trigger point, applying pressure for 15 seconds, then stay where you are but release the pressure for 5 seconds, and repeat this sequence several times until the pain point stops hurting.

You may get better leverage if you lift up your opposite hip (lift up the right hip in this demonstration), bending your right leg so you can press your right elbow into your thigh to get better pressure.

If it’s difficult with the ball, use your right hand fingertips to press on the muscle on your left side.

In conclusion, the pectineus muscle can cause groin pain when injured.

If this simple self-treatment doesn’t help, it would be important to seek medical attention to determine the underlying cause, especially if it is severe or accompanied by other symptoms.

Wishing you well,

Julie Donnelly

www.FlexibleAthlete.com

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 Time-Restricted Eating Better Than Other Diets?

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Is Time-Restricted Eating Right For You?

Author: Dr. Stephen Chaney 

Time-restricted eating is the latest fad. If you read Dr. Strangeloves’ blogs, he or she will tell you that eating for 8-10 hours and fasting the rest of the day will change your metabolism. They tell you that:

  • You don’t need to change what you eat.
  • You don’t have to restrict calories.
  • You don’t have to restrict fats or carbs.
  • You will feel fuller and naturally eat less.
  • The pounds will just drop away magically.

And you will have benefits like:

  • Better blood sugar control.
  • Lower levels of heart-unhealthy lipids like LDL and triglycerides.
  • Enhanced cellular repair, which might help you live longer.

Are these claims true? Is there something special about time-restricted eating, or is it simply another way to cut calories?

Two recent studies (EA Thomas et al, Obesity; 30: 1027-1038, 2022) and (D Liu et al, New England Journal of Medicine, 386: 1495-1505, 2023) answered these questions by cutting calories to the same extent for people following a time-restricted eating pattern and people who had no restrictions on when they ate.

How Were These Studies Done?

clinical studyStudy 1: The authors enrolled 81 adults aged 18 to 50 years (average = 38 years, 69% female) with BMIs of 27 to 45 (overweight to morbidly obese).

The study lasted 39 weeks with measurements taken at baseline, 12 weeks, and 39 weeks.

The participants were divided into two groups:

  • A time-restricted eating group that was advised to restrict their eating to start eating within 3 hours of waking and restrict their eating to 10 hours.
  • A calorie restricted group that was given no time limitations on when they could eat.

Both groups were:

  • given a personalized calorie goal which represented a 35% caloric restriction based on measurements of their resting energy expenditure.
  • enrolled in a 39-week, group-based, comprehensive weight-loss program. Groups were taught by registered dietitians and met weekly through the first 12 weeks, and monthly between weeks 13 and 39.

Study 2: The authors enrolled 139 adults 18 to 75 years (average age = 32, 64% female) with BMIs of 28 to 45. The study lasted 12 months.

The participants were divided into two groups:

  • A time-restricted eating group that was advised to restrict their eating to between 8 AM and 4 PM (an 8-hour window) each day.
  • A calorie restricted group that was given no time limitations on when they could eat.

Both groups:

  • Were told to reduce calories by 25% which represented a 1500-1800 calorie/day diet for men and a 1200-1500 calorie/day diet for women.
  • Received dietary information booklets that provided portion advice and sample menus.
  • Were required to write in a daily dietary log, photograph the food they ate, and note the time they ate it using a mobile app.
  • Received follow up phone calls or app messages twice per week and met with trained health coaches every two weeks.

Is Time Restricted Eating Better Than Other Diets?

Here are the results of the two studies.

Study 1: There was no difference between the time-restricted group and the group who were just told to cut calories at either 12 or 39 weeks for:

  • Weight loss.
  • Body composition (fat loss and lean muscle mass loss).
  • Appetite and eating behaviors.
  • HDL cholesterol, LDL cholesterol, total cholesterol, and HbA1c (a measure of blood sugar control).

The authors concluded two things:

  1. “Time-restricted eating with caloric restriction was found to be an acceptable dietary strategy, resulting in similar levels of adherence and weight loss compared to caloric restriction alone.”

2) “The addition of behavioral support and caloric restriction to a time-restricted eating intervention results in a clinically significant weight loss, a reduction in caloric input, and an improvement in diet quality.”

Study 2: There was no difference between the time-restricted group and the group who were just told to cut calories at 12 months for:

  • Weight loss, BMI, and waist circumference.
  • Body composition (fat loss and lean muscle mass loss).
  • Appetite and eating behaviors.
  • Blood pressure, HDL cholesterol, LDL cholesterol, total cholesterol, fasting blood sugar levels, and several measures of blood sugar control.

The authors concluded, “Among patients with obesity, a regimen of time-restricted eating was not more beneficial with regard to reduction in body weight, body fat, or metabolic risk factors than daily caloric restriction.”

Is Time-Restricted Eating Right For You?

Questioning WomanThe take-home lessons are the same for both studies.

  1. You can forget the metabolic mumbo-jumbo of the Dr. Strangeloves of our world. When you restrict calories to the same extent, time-restricted eating is no more successful and no healthier than any other diet.”

2) Like any other diet, time-restricted eating works best when you focus on eating healthy foods and reducing your caloric intake.

So, what does this mean for you? I have two thoughts:

1) If you find it easier to cut calories by restricting the time you eat, then time-restricted eating is right for you. If not, choose a healthy, reduced calorie diet that best fits your food preferences and lifestyle.

2) Time-restricted eating works best when you are in complete control of when and what you eat. They don’t work as well for travel, holidays with friends and family, and other social occasions. If your lifestyle is such that you are often not in control of when and what you eat, you might want to choose a more flexible diet.

The Bottom Line 

Time-restricted eating is the latest fad. If you read Dr. Strangeloves’ blogs, he or she will tell you that eating for 8-10 hours and fasting the rest of the day will change your metabolism, the weight will fall away effortlessly, and your health will be better.

But is this true? Two recent studies tested the hypothesis that time-restricted eating offers a special advantage by cutting calories to the same extent for people following a time-restricted eating pattern and people who had no restrictions on when they ate.

Both studies found there was no difference between the time-restricted group and the group who were just told to cut calories for:

  • Weight loss.
  • Body composition (fat loss and lean muscle mass loss).
  • Appetite and eating behaviors.
  • HDL cholesterol, LDL cholesterol, total cholesterol, and HbA1c (a measure of blood sugar control).

The take-home lessons are the same for both studies.

  1. You can forget the metabolic mumbo-jumbo of the Dr. Strangeloves of our world. When you restrict calories to the same extent, time-restricted eating is no more successful and no healthier than any other diet.”

2) Like any other diet, time-restricted eating works best when you focus on eating healthy foods and reducing your caloric intake.

For more information on this study and a discussion of whether time-restricted eating might be right for you, read the article above.

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

 ___________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

Do Produce Prescriptions Improve Health?

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What Are The Pros And Cons Of Produce Prescriptions?

Author: Dr. Stephen Chaney 

Can you imagine a world in which doctors asked their patients how many fruits and vegetables they were eating rather than how many drugs they were taking? Can you imagine a world in which doctors advised their patients to try a healthier diet before they put them on drugs?

Unfortunately, that world doesn’t exist currently and is unlikely to exist in the foreseeable future.

But what if there were another approach to encourage healthier eating? And what if it made a meaningful impact on people’s health?

There is such an approach, and it’s called a “produce prescription”.

“What are produce prescriptions?”, you might ask. Simply put, produce prescriptions are government programs that provide lower-income Americans with food insecurity extra income that can only be spent on fresh fruits and vegetables.

And it isn’t a lot of extra income. Previous studies have shown that lower-income Americans only need an extra $63 to $78/month to afford the recommended 3-5 servings of fresh fruits and vegetables a day.

But do produce prescriptions work? Do they significantly improve the diet and health of lower-income Americans who participate in programs offering produce prescriptions?

These are the questions that the authors of the current study (K Hager et al, Circulation: Cardiovascular Quality And Outcomes; 16:e009520, 2023) set out to answer.

How Was The Study Done?

clinical studyThe authors evaluated the results from 9 pilot produce prescription studies that were administered at 22 sites in 12 states between 2014 and 2020. These pilot studies were generally funded as experimental programs through Medicare and SNAP.

The pilot programs enrolled:

  • Adults at risk for poor cardiometabolic health (at risk for both heart disease and diabetes). The enrollment criteria included being overweight or obese and having either diabetes or elevated blood pressure.
  • Children who were overweight or obese.
  • People recruited from health centers serving predominantly low-income neighborhoods who were food insecure.

The authors of the study only included pilot studies that collected data on food intake and measured at least 1 biomarker of improved health (BMI (a measure of obesity), HbA1c (a measure of blood sugar control) and blood pressure).

The income incentive to purchase more fruits and vegetables varied from state to state but averaged $63/month.

With these criteria the study included 1817 children and 2064 adults.

The adults:

  • Averaged 54.4 years old.
  • Were 70.7% female, 29.8% non-Hispanic White, 45.1% non-Hispanic Black, 21.4% Hispanic, 3.6% other.

The children:

  • Averaged 9.2 years old.
  • Were 51.4% female, 9.2% non-Hispanic White, 13.1% non-Hispanic Black, 75.5% Hispanic, 2.3% other.

Overall:

  • 3% of families enrolled in the program experienced food insecurity.
  • 7% of families enrolled in the program were involved in SNAP.

Finally, the programs lasted an average of 6 months.

Do Produce Prescriptions Improve Health?

The results were encouraging:

  • At the beginning of the study fruit and vegetable intake was 2.7 cups/day for adults and 3.4 cups/day for children.
  • By the end of the study fruit and vegetable intake increased by 0.85 cups/day for adults and 0.26 cups/day for children.

Note: It is unfortunate that the authors chose to report fruit and vegetable consumption as cups/day because most of us think in terms of servings per day and the relationship between servings and cups varies with each fruit and vegetable. For example, one cup represents:

  • One serving of raw spinach.
  • Two servings of cooked spinach.
  • Two servings of most fruits.
  • One serving of bananas.

I could go on, but you get the point.

  • So, perhaps a better way to think about these results would be to say both adults and children in these low-income households were eating around 3.6 cups/day of fruit and vegetable intake – a 31% increase for adults and a 7.6% increase for children.
  • Another way of thinking about it would be to say that produce prescription programs got both adults and children in food-insecure households up to a healthier 3.6 cups/day of fruits and vegetables.

As for other outcomes:

  • Food insecurity dropped by one third for families participating in these programs.
  • The families reported that they felt healthier.
  • BMI (a measure of overweight and obesity) decreased for both adults and children.
  • HbA1c (a measure of blood sugar control) and blood pressure decreased in adults with cardiometabolic disease (heart disease and diabetes) at the beginning of the programs.

In the words of the authors, “In this large, multisite evaluation, produce prescriptions were associated with significant improvements in fruit and vegetable intake, food security, and health status for adults and children, and clinically relevant improvements in glycated hemoglobin (HbA1c), blood pressure, and BMI for adults with poor cardiometabolic health.”

What Are The Pros And Cons Of Produce Prescriptions?

pros and consThe pros are obvious.

Food insecurity in low-income neighborhoods is a major problem. In the words of the authors:

  • “Food insecurity is strongly associated with poor health outcomes and higher health care costs.
  • Food-insecure individuals under use medications and choose cheaper, unhealthful foods due to costs.
  • [There are] stark disparities in household food insecurity…by race/ethnicity, with 7.1% of White, non-Hispanic households experiencing food insecurity compared with 21.7% of Black, non-Hispanic households, and 17.2% of Hispanic households.”

The authors do not claim that food insecurity is the only cause of health disparities in this country, but a simple program that reduces food insecurity and improves health outcomes is an obvious plus.

But there are cons as well.

  • While the results of these programs were statistically and clinically significant, they were relatively modest. In the words of the authors, “Produce prescriptions may need to be of longer duration or combined with additional components…”
  • Most Americans have the income to buy more fruits and vegetables but chose not to. Programs like this can reduce health disparities but are unlikely to improve the health of the American population as a whole.
  • There was no mention of the cost of implementing this program nationwide in the article, but that is likely to be a major stumbling block.

Unfortunately, government agencies never think of replacing old programs that don’t work with new programs that do work. They only think of adding the cost of the new program to their current budget.

Unfortunately, once you start talking about programs that increase government spending, they become political footballs. Because of this many beneficial programs end up in the dustbin of history.

The Bottom Line 

Food insecurity among low-income households is a major cause of health disparities in this country. Several states across the country have piloted an idea called produce prescription programs. Simply put, these programs provide high-risk families who have food insecurity and poor health with a monthly stipend that can only be used to purchase fresh fruits and vegetables from grocery stores and farmers markets.

A recent study evaluated the effectiveness of these pilot programs and found the produce prescription programs:

  • Improved fruit and vegetable intake for the families who participated in the programs.

In addition:

  • Food insecurity dropped by one third for families participating in these programs.
  • The families reported that they felt healthier.
  • BMI (a measure of overweight and obesity) decreased for both adults and children.
  • HbA1c (a measure of blood sugar control) and blood pressure decreased in adults with cardiometabolic disease (heart disease and diabetes) at the beginning of the programs.

In the words of the authors, “In this large, multisite evaluation, produce prescriptions were associated with significant improvements in fruit and vegetable intake, food security, and health status for adults and children, and clinically relevant improvements in glycated hemoglobin (HbA1c), blood pressure, and BMI for adults with poor cardiometabolic health.”

For more information on this study and a summary of the pros and cons of produce prescription programs, read the article above.

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

____________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

Which Diets Are Heart Healthy?

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What Does A Heart Healthy Diet Look Like?

Author: Dr. Stephen Chaney 

heart attacksHeart disease is a big deal. According to the CDC, “Heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups in the United States. One person dies every 33 seconds in the United States from cardiovascular disease. About 695,000 people in the United States died from heart disease in 2021 – that’s 1 in every 5 deaths”.

This doesn’t have to happen. According to the Cleveland Clinic, “90 percent of heart disease is preventable through healthier diet, regular exercise, and not smoking”. For this issue of “Health Tips From the Professor”, I will focus on the role of diet on heart health.

The problem is many Americans are confused. They don’t know what a heart-healthy diet is. There is so much conflicting information on the internet.

Fortunately, the American Heart Association has stepped in to clear up the confusion.

In 2021 they reviewed hundreds of clinical studies and published “Evidence-Based Dietary Guidance to Promote Cardiovascular Health”.

And recently they have published a comprehensive review (CD Gardner et al, Circulation, 147: 1715-1730, 2023) of how well popular diets align with their 2021 dietary guidelines.

I will cover both publications below. But first I want to address why Americans are so confused about which diets reduce heart disease risk.

Why Are Americans Confused About Diet And Heart Disease Risk?

I should start by addressing the “elephant in the room”.

  • As I discussed in last week’s “Health Tips From the Professor” article, Big Food Inc has seduced us. They have developed an unending supply of highly processed foods that are cheap, convenient, easy to prepare, and fulfill all our cravings. These foods are not heart-healthy, but they make up 73% of our food supply.

The Institute of Medicine, the scientific body that sets dietary standards, states that a wide range of macronutrient intakes are consistent with healthy diets. Specifically, they recommend carbohydrate intake at 45% to 65%, fat intake at 20% to 35%, and protein intake at 10% to 35% of total calories. (Of course, they are referring to healthy carbohydrates, fats, and proteins.)

The authors of this article pointed to several reasons why Americans have been misled about heart-healthy diets.

  • Many of the most popular diets fall outside of the “Acceptable Macronutrient Range”.
  • Many popular diets exclude heart-healthy food groups.

And, the words of the authors,

  • “Further contributing to consumer misunderstanding is the proliferation of diet books, [and] blogs [by] clinicians with limited understanding of what the dietary patterns entail and the evidence base for promoting cardiometabolic health.” I call these the Dr. Strangeloves of our world.

What Does A Heart Healthy Diet Look Like?

Let me start by sharing the American Heart Association’s 10 “Evidence-Based Dietary Guidelines to Promote Cardiovascular Health.

#1: Adjust energy intake and expenditure to achieve and maintain a healthy body weight
#2: Eat plenty of vegetables and fruits; choose a wide variety
#3: Choose foods made mostly with whole grains rather than refined grains
#4: Choose healthy sources of protein
Mostly from plants (beans, other legumes, and nuts)
Fish and seafood
Low-fat or fat-free dairy products instead of full-fat dairy products
If meat or poultry are desired, choose lean cuts and avoid processed forms
#5. Use liquid plant oils (olive, safflower, corn) rather than animal fats (butter and lard) and tropical oils (coconut and palm kernel)
#6. Use minimally processed foods instead of highly processed foods
#7: Minimize intake of beverages and foods with added sugars
#8: Choose and prepare foods with little or no salt
#9: If you do not drink alcohol, do not start; if you choose to drink alcohol, limit intake
#10: Adhere to this guidance regardless of where food is prepared or consumed

Here are my comments on these guidelines:

  • If you have been reading my “Health Tips From the Professor” blog for a while, you probably realize that these aren’t just guidelines to promote heart health. These guidelines also reduce the risk of diabetes, cancer, inflammatory diseases, and much more.
  • If you have read my post on coconut oil, you will know that I have a minor disagreement with the AHA recommendation to avoid it. There is no long-term evidence that coconut oil is bad for the heart. But there is also no long-term evidence that it is good for the heart. My recommendation is to use it sparingly.
  • And you probably know there has been considerable discussion recently about whether full fat dairy is actually bad for the heart. In my most recent review of the topic, I concluded that if full fat dairy is heart healthy, it is only in the context of a primarily plant-based diet and may only be true for fermented dairy foods like unpasteurized yogurt and kefir.
  • Finally, guideline 10 may need some translation. Basically, this guideline is just asking how easy it is to follow the diet when you are away from home.

Which Diets Are Heart Healthy?

confusionIn evaluating how well diets adhered to the American Heart Association guidelines the authors ignored item 1 (energy intake) because most of the diets they evaluated did not provide any guidelines on how many calories should be consumed.

Each diet was given a score between 0 (Fail) and 1 (A+) for each of the other 9 guidelines by a panel of experts. The points for all 9 guidelines were added up, giving each diet a rating of 0 (worst) to 9 (best). Finally, a score of 9 was assigned 100%, so each diet could be given a percentage score for adherence to heart-healthy guidelines.

Here are the results:

Tier 1 diets (the most heart healthy diets) received scores of 86% to 100%. Going from highest (100%) to lowest (86%), these diets were:

  • DASH, Nordic, Mediterranean, Pescetarian (vegetarian diets that allow fish), and Ovo-Lacto Vegetarian (vegetarian diets that allow dairy, eggs, or both).
  • You will notice that these are all primarily plant-based diets.

Tier 2 diets were Vegan and other low-fat diets (TLC, Volumetrics). They both received scores of 78%.

  • The Vegan diet received 0 points for category 10 (ease of following the diet when eating out). It was also downgraded in category 7 for not having clear guidance for the use of salt when preparing foods.
  • The other low-fat diets were downgraded in categories 7, 10, and 5 (use of tropical oils).

Tier 3 diets received scores of 64% to 72%. They included very-low fat diets (<10% fat, very strict vegan diets) and low-carb diets (Zone, South Beach, Low-Glycemic Index).

  • They received 0 points for category 10 and were downgraded for eliminating heart-healthy food groups (liquid plant oils for the very low-fat diets, and fruits, vegetables, whole grains, and plant proteins for the low-carb diets).

Tier 4 diets (the least heart healthy diets) were the Paleo diet with a score of 53% and very low-carb diets (Atkins and Ketogenic) with a score of 31%.

  • The Paleo diet received 0 points for categories 10, 3 (choose whole grains), and 5 (using liquid plant oils rather than animal fats or tropical oils). It was also downgraded for lack of healthy plant-based protein sources.
  • The very low-carb diets were the least heart healthy. They received 0 points for categories 2 (eat plenty of fruits and vegetables), 3 (choose whole grains), 3 (healthy protein sources), 5 (use liquid plant oils instead of animal fats), 7 (minimize salt consumption), and 10 (ease of following the diet away from home).

The authors concluded, “Numerous [dietary] patterns [are] strongly aligned with 2021 American Heart Association Dietary Guidance (ie, Mediterranean, DASH, pescetarian, vegetarian) [and] can be adopted to reflect personal and cultural preferences and budgetary constraints.

Thus, optimal cardiovascular health would be best supported by developing a food environment that supports adherence to these patterns wherever food is prepared or consumed.”

Given our current food environment that last statement is wildly optimistic. But at least you have the information needed to make the best food choices for you and your family

The Bottom Line 

In 2021 the American Heart Association published 10 guidelines for evaluating heart-healthy diets. A recent study looked at how well popular diets adhered to those guidelines. The authors separated the diets into four categories (tiers) based on how heart-healthy they were. The results were not surprising:

  • Tier 1 diets (the most heart healthy diets) were DASH, Nordic, Mediterranean, Pescetarian (vegetarian diets that allow fish), and Ovo-Lacto Vegetarian (vegetarian diets that allow dairy, eggs, or both).
  • Tier 2 diets were Vegan and other low-fat diets (TLC, Volumetrics).
  • Tier 3 diets included very-low fat diets (<10% fat, very strict vegan diets) and low-carb diets (Zone, South Beach, Low-Glycemic Index).
  • Tier 4 diets (the least heart healthy diets) were the Paleo diet and very low-carb diets (Atkins and Ketogenic).

The authors concluded, “Numerous [dietary] patterns [are] strongly aligned with 2021 American Heart Association Dietary Guidance (ie, Mediterranean, DASH, pescetarian, vegetarian) [and] can be adopted to reflect personal and cultural preferences and budgetary constraints.

Thus, optimal cardiovascular health would be best supported by developing a food environment that supports adherence to these patterns wherever food is prepared or consumed.”

Given our current food environment that last statement is wildly optimistic. But at least you have the information needed to make the best food choices for you and your family.

For more information on this study, read the article above.

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

____________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

Repetitive Motion Can Cause Eye Pain

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Relief From Eye Pain 

Author: Julie Donnelly, LMT –The Pain Relief Expert

Editor: Dr. Steve Chaney

SunIt’s been hot this summer! High temperature records were broken not just in the USA, but all over the world!  The funny thing is it was sometimes hotter up north than down here in Florida.

A snowbird client came in several weeks ago and told me they came back to Florida because they don’t have central air in their house up north (never needed it before).  That’s pretty incredible.

For those of us who are old enough to remember the days before air conditioning, we are even more grateful for air conditioning.

I remember being pregnant with my son in 1967, when we were living in San Antonio, Texas.  Most people didn’t have air conditioning yet, and we certainly didn’t.

I came to realize why Southerners talk so slow (remember, I’m a New Yorker).  It was so hot we just didn’t talk at all. It took too much effort!

Fortunately, this time of year seems to pass quickly, and we’ll be getting back into cooler weather before we know it.  At least, that’s what I’m telling myself.

Repetitive Motion And Eye Pain

eye musclesThis week I had a client come to the office with a situation that is pretty rare.  He described his pain as on his eyeball, which then referred to the entire top half of his skull.  It was like drawing a line that went under his eyes, through his ears, and around his head.  It was definitely a headache but concentrated on his eyes.

This client works in an industry that has the computer screen changing frequently and he’s needing to locate information on the new screen quickly.  He has experienced eye strain before, but other times just having the weekend off has resolved the problem.  This time the pain didn’t go away.

We don’t ever think about the muscles that move our eyes, but they can get repetitively strained just like any other muscle in the body.  This especially happens if you are watching something that has your eye moving back and forth rapidly, like a game on your computer or phone.

The muscles that are most prone to a repetitive strain injury are the ones on the top of the eye and on the outside of the eye.  I’m not an eye doctor so I can’t explain why these two muscles cause more problems than the others, but my experience has shown this to be the truth.

Relief From Eye Pain

eye pain relief massageThe treatment is simple, but you need to do it cautiously.  If you wear contacts, you’ll need to remove them. The pressure is VERY light.

Put your fingertip directly onto your eyeball and press down GENTLY.

Slide your finger from the top of your eyeball to the outside of your eyeball.

If you find a point where it is tender, that’s the spasm that is putting a strain on your eyeball.  Just leave your fingertip on that point for 30 seconds. You may even get a light show while doing this, with different shapes and colors.

You’ll find that this simple treatment will soothe tired eyes at the end of the day.  But remember, the pressure needs to be light and gentle.

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.

 

Do Processed Foods Cause Cancer?

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How Can You Reduce Your Cancer Risk?

Author: Dr. Stephen Chaney 

We are facing a food crisis in this country. Big Food Inc is taking over our diet. Currently, 73% of our food supply is processed. And because these are manufactured foods, not real foods, they are 52% cheaper than the whole unprocessed foods we should be eating.

And Big Food Inc has seduced us. They know our weaknesses. The foods they make are convenient and easy to prepare. They also know our bodies were created with an ingrained craving for sweet, salty, and fatty foods. These cravings served us well in prehistoric times, but in today’s world Big Food Inc has weaponized them. Their foods are designed to satisfy every craving. They have done their best to make their processed foods irresistible!

The result is no surprise. In 2018 (LG Baraldi et al, BMJ Open, 2018, 8(3) e020574 60% of the calories the Average American consumes came from processed foods, and the percentage has only increased since then.

This is alarming because higher consumption of processed foods has been linked to increased risk of obesity, diabetes, and all-cause mortality.

Some studies have suggested that higher consumption of processed foods may also be linked to increased risk of cancer. The authors of the current study (K Chang, eClinicalMedicine 2023;56: 101840) set out to test this hypothesis.

How Are Processed Foods Defined In This Study?

Before I proceed with describing the findings of this study, I should probably contrast the common definition of processed foods with the current scientific definition of processed foods. The scientific community has recently developed something called “The NOVA food classification system” to describe the various levels of food processing.

The NOVA system categorizes foods into four groups according to the extent of processing they have undergone:

  1. Unprocessed or minimally processed foods.
    • This category includes foods like fruit, vegetables, milk, and meat.

2) Processed culinary ingredients.

    • This category includes foods you might find in restaurants or prepare yourself to which things like sugar, vegetable oils, butter, or cream were added in the preparation.

3) Processed foods.

    • This category includes foods like canned vegetables, freshly made breads, and cheeses.

4) Ultra-processed foods.

    • This category includes foods like soft drinks, chips, packaged snacks, most breakfast cereals, chicken nuggets & fish sticks, fast food burgers, hot dogs, and other processed meats.

The actual list is much longer, but you get the idea. What we call processed foods, scientists call ultra-processed foods. Since the term “ultra-processed foods” has not yet entered the popular vocabulary, I will use the term “processed foods” in describing the results of this study because it is more understandable to the average reader.

How Was This Study Done?

clinical studyThe authors of this study started by using data from the UK Biobank study. The UK Biobank study is a long-term study in the United Kingdom that is investigating the contributions of genetics and environment to the contribution of disease.

The authors focused on 197,426 (54.6% women) participants in the study who completed up to five 24-hour dietary recalls between 2009 and 2012. The participants were age 58 (range 40 to 69) when they entered the study and were followed for an average of 9.8 years. None of the participants had been diagnosed with cancer at the time of their enrollment in the study.

The purpose of this study was to examine the correlation between percent of “processed food” in the participant’s diets and both the frequency of newly diagnosed cancer and the frequency of cancer deaths during the 9.8 years of follow-up.

More importantly, the size of this study allowed the authors to examine associations between processed food consumption and both the risk of cancer and cancer mortality for 34 site-specific cancers – something most previous studies were unable to do.

  • The percentage “processed food” in their diets was calculated from the 24-hour dietary recalls using the NOVA scoring system.
  • The frequency of newly diagnosed cancers and cancer deaths was obtained by linking the data in this study with the national cancer and mortality registries, provided by the National Health Service.

Do Processed Foods Cause Cancer?

CancerThe authors started by dividing participants into four equal quartiles based on their consumption of processed foods:

  • For quartile 1 processed foods made up between 0 and 13.4% of calories (average = 9.2%).
  • For quartile 2 processed foods made up between 13.5 and 20% of calories (average = 16.7%).
  • For quartile 3 processed foods made up between 20.1 and 29.4% of calories (average = 24.3%).
  • For quartile 4 processed foods made up between 29.5 and 100% of calories (average = 41.4%).

They started by looking at the risk of developing cancer during the 9.8-year follow-up period. A total of 15,921 participants developed cancer during that time. When the authors compared the group consuming the most processed foods with the group consuming the least processed foods:

  • The risk of overall cancer of any type increased by 7%.
  • The risk of lung cancer increased by 25%.
  • The risk of ovarian cancer increased by 45%.
  • The risk of diffuse large B-cell lymphoma increased by 63%.
  • The risk of brain cancer increased by 52%.

Furthermore, every 10% increase in processed food consumption was associated with:

  • A 2% increase in overall cancer incidence…and…
  • A 19% increase in ovarian cancer incidence.

A total of 4,009 participants died from cancer during that time. When the authors compared the group consuming the most processed foods with the group consuming the least processed foods:

  • Overall cancer mortality increased by 17%.
  • Lung cancer mortality increased by 38%.
  • Ovarian cancer mortality increased by 91%.

Furthermore, every 10% increase in processed food consumption was associated with:

  • A 6% increase in overall cancer mortality.
  • A 16% increase in breast cancer mortality.
  • A 30% increase in ovarian cancer mortality.

The authors concluded, “Our UK-based study suggests that higher [processed food] consumption may be linked to an increased [frequency] and mortality for overall and certain site-specific cancers especially ovarian cancer in women…These findings suggest that limiting [processed food] consumption may be beneficial to prevent and reduce the modifiable burdens of cancer.”

How Can You Reduce Your Cancer Risk?

American Cancer SocietyLet’s start with the American Cancer Society recommendations to limit cancer risk:

1) Avoid tobacco use. 

2) Get to and stay at a healthy weight.

If you are already at a healthy weight, stay there. If you are carrying extra pounds, try to lose some. Losing even a small amount of weight can reduce your risk of cancer and have other health benefits. It is a good place to start.

3) Be physically active and avoid time spent sitting.

Current recommendations are to get at least 150-300 minutes of moderate intensity or 75-150 minutes of vigorous intensity activity each week. Getting to or exceeding 300 minutes is ideal.

In addition, you should limit sedentary behavior such as sitting, lying down, watching TV, and other forms of screen-based entertainment. This is especially important if you spend most of your working day sitting.

4) Follow a healthy eating plan.

A healthy eating pattern includes a variety of vegetables, fiber-rich legumes (beans and peas), fruits in a variety of colors, and whole grains. It is best to avoid or limit red and processed meats, sugar-sweetened beverages, highly processed foods, and refined grain products. This will provide you with key nutrients in amounts that help you get to and stay at a healthy weight.

5) It is best not to drink alcohol.

It is best not to drink alcohol. People who choose to drink alcohol should limit their intake to no more than 2 drinks per day for men and 1 drink a day for women.

This study adds an exclamation point to the American Cancer Society’s recommendation to avoid or limit “processed meats, sugar-sweetened beverages, highly processed foods, and refined grain products”.

You may be asking, “What is so harmful about processed foods?” The most obvious harm is that they are replacing healthier foods that reduce cancer risk, such as “a variety of vegetables, fiber-rich legumes (beans and peas), fruits in a variety of colors, and whole grains” that the American Cancer Society recommends for reducing cancer risk.

But there are other reasons as well. In the words of the authors:

  • “Evidence has been accumulating on the strong obesity and type-2 diabetes-promoting potential of [processed foods], both of which are risk factors for many cancers including those of the digestive tract and some hormone-related cancers in women.
  • Emerging research has suggested other common properties of [processed foods] that may contribute to adverse cancer outcomes, including the use of controversial food additives, contaminants such as acrylamide that form during [food processing], and toxic contaminants such as phthalates and bisphenol-F that migrate from food packaging [into the food].”

The Bottom Line 

You probably know that processed foods are bad for you. But do processed foods cause cancer? A very large study (197,426 people followed for 9.8 years) suggests the answer to that question appears to be yes.

When the authors of the study compared the group consuming the most processed foods with the group consuming the least processed foods:

  • The risk of overall cancer of any type increased by 7%.
  • The risk of lung cancer increased by 25%.
  • The risk of ovarian cancer increased by 45%.
  • The risk of diffuse large B-cell lymphoma increased by 63%.
  • The risk of brain cancer increased by 52%.

And when they looked at cancer deaths and did the same comparison:

  • Overall cancer mortality increased by 17%.
  • Lung cancer mortality increased by 38%.
  • Ovarian cancer mortality increased by 91%.

The authors concluded, “Our study suggests that higher [processed food] consumption may be linked to an increased [frequency] and mortality for overall and certain site-specific cancers especially ovarian cancer in women…These findings suggest that limiting [processed food] consumption may be beneficial to prevent and reduce the modifiable burdens of cancer.”

These results are alarming because the most recent study shows that 60% of calories in the American diet comes from processed foods, and the percentage is increasing each year. We need to reverse this trend!

For more information on this study, why processed foods increase your risk of cancer, and what the American Cancer Society recommends to reduce your risk of cancer, read the article above.

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

____________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

 

 

Are Sustainable Diets Nutritionally Complete?

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How Do Sustainable Diets Compare With Meat-Based Diets?

Author: Dr. Stephen Chaney 

Earth DayIn a previous issue of “Health Tips From the Professor” I have discussed a sustainable diet popularly known as the planetary diet. Here is a brief synopsis of that article:

  • The planetary diet came from an international commission called the “EAT-Lancet Commission on Healthy Diets From Sustainable Food Systems” (Bureaucrats and scientists love long names.)
  • They were commissioned to recommend a diet that was both healthy and sustainable (good for the environment) through the year 2050.
  • The commission reported that the methods of food production required to support our current diets:
    • Occupy 40% of global land.
    • Are responsible for 30% of global greenhouse gas production and 70% of freshwater use.
  • They further reported that:
    • Reaching the Paris Agreement of limiting global warming…is not possible by only decarbonizing the global energy systems (In other words, we cannot limit global warming just by switching to electric cars and stoves.).
    • Transformation to healthy diets from sustainable food systems is essential to achieving the Paris Agreement.”
    • The world’s population is expected to reach 10 billion by 2050. The current system of food production is unsustainable.
  • The planetary diet they recommended is a primarily plant-based diet. But it is not any plant-based diet. It limits animal foods to an extent that approaches a vegan diet.

That raises two important questions:

  1. Are sustainable diets like the planetary diet healthy? The answer to that question is a resounding, “Yes”. Numerous studies have shown that primarily plant-based diets are healthier than meat-based diets long term.

2) Are sustainable diets nutritionally complete? That is the question the authors of the current study (N Neufingerl and A Eilander, Nutrients, 14: 29, 2022) set out to answer.

How Was This Study Done?

clinical studyThe authors searched the literature and identified 147 high-quality articles published between 2000 and January 2020 that compared the nutritional adequacy of primarily plant-based diets or vegan diets with meat-based diets.

They excluded:

  • Intervention studies because the nutritionists designing those studies assured the nutritional adequacy of the plant-based diet used in the study.
  • Overly restrictive plant-based diets such as the raw food diet or macrobiotic diet.
  • Primarily plant-based diets for disease prevention like the Mediterranean or DASH diets because they were too unlike the planetary diet.
  • Studies with pregnant or lactating women, populations with specific diseases, and athletes.

They chose diets that measured intakes of energy (calories), protein, PUFA (polyunsaturated fats), total omega-3 fats, ALA, EPA, DHA, fiber, vitamins A, B1, B6, B12, niacin, folate, C, D, E, iron, zinc, calcium, iodine, magnesium, and phosphorous. [Note: Not all studies measured intakes of all the nutrients in this list.]

Their goal was to compare the nutritional adequacy of the diets, not the health of the diets. So, they did not report on the saturated fat, cholesterol, sugar, or percent processed food content of the diets.

How Do Sustainable Diets Compare With Meat-Based Diets?

Food ChoicesThe Study showed that:

Vegan diets:

  • Tended to be inadequate in EPA, DHA, vitamins B12, D, calcium, iodine, iron, and zinc.
  • Tended to have favorably high intakes of fiber, PUFA, ALA, vitamins B1, B6, C, E, folate, and magnesium.

Vegetarian diets:

  • Tended to be inadequate in fiber, EPA, DHA, vitamins B12, D, E, calcium, iodine, iron, and zinc.
  • Tended to have favorably high intakes of PUFA, ALA, vitamin C, folate, and magnesium.

Meat-eaters:

  • Tended to be inadequate in fiber, PUFA, ALA, vitamins D, E, folate, calcium, and magnesium.
  • Tended to have favorably high intakes of protein, niacin, vitamin B12, and zinc.

Other observations:

  • Pesco-vegetarians (vegetarians who include fish as a major protein source) had the highest intake EPA and DHA of any of the groups studied.
  • Both vegetarians and vegans had lower protein intake than meat-eaters, but their average protein intake was adequate.

Finally, there are two important reminders as you look at the data.

  • The data for each nutrient was based on average intake of that nutrient in the diet group. The authors did not report the percent of people consuming that diet who had inadequate intake.
  • The authors were comparing the nutritional completeness of each diet, not the effect of the diets on diseases like heart disease and diabetes. However, this comparison is important because nutritional inadequacies left untreated for a long period of time can have significant health consequences.

Are Sustainable Diets Nutritionally Complete?

The authors concluded “…there are dietary inadequacies in any [restrictive] diet.” This is no surprise.

With respect to sustainable plant-based diets, the authors said, “In people following self-selected plant-based diets, especially vegan diets, intake of certain nutrients is lower compared to meat-containing diets.”

So, the answer to the question, “Are sustainable diets nutritionally complete?”, is clearly, “No. They do not provide 100% of the essential nutrients you need.”

Long-term nutritional deficiencies can have serious health implications. So, what should you do about it?

The authors made the following recommendations, “As plant-based diets are generally better for health and the environment, public health strategies should facilitate the transition to a [more] balanced diet…through consumer education, food fortification, and possible supplementation.”

Let me comment on the three recommendations they listed:

  • Consumer education is a great idea, but it is usually drowned out by Big Food Inc’s advertising budgets and the misleading information provided by the Dr. Strangeloves of the world.
  • Food fortification is also a useful idea. After all, it has eliminated several deficiency diseases in the past. But it is hard to fortify fruits and vegetables. And eating more highly processed plant-food products is not the way to better health – even if they are fortified. Besides, I wouldn’t hold my breath waiting for the USDA to act.
  • That leaves responsible supplementation as the only viable option for anyone wanting to switch to a plant-based diet to save the planet. And if the environment is important to you, you will probably want to choose a supplement company that follows sustainable practices and is certified carbon neutral.

The Bottom Line 

Primarily plant-based diets are healthier for you and healthier for the planet. But are they nutritionally complete?

A recent systemic review of 147 published studies was designed to answer that question. As you might suspect, the answer was a clear, “No”.

Vegan diets:

  • Tended to be inadequate in EPA, DHA, vitamins B12, D, calcium, iodine, iron, and zinc.

Vegetarian diets:

  • Tended to be inadequate in fiber, EPA, DHA, vitamins B12, D, E, calcium, iodine, iron, and zinc.

The authors concluded, “As plant-based diets are generally better for health and the environment, public health strategies should facilitate the transition to a balanced diet…through consumer education, food fortification, and possible supplementation.”

Let me comment on the three recommendations they listed:

  • Consumer education is a great idea, but it is usually drowned out by Big Food Inc’s advertising budgets and the misleading information provided by the Dr. Strangeloves of the world.
  • Food fortification is also a useful idea. But it is hard to fortify fruits and vegetables. And eating more highly processed plant-food products is not the way to better health – even if they are fortified.
  • That leaves responsible supplementation as the only viable option for anyone wanting to switch to a plant-based diet to save the planet. And if the environment is important to you, you will probably want to choose a supplement company that follows sustainable practices and is certified carbon neutral.

For more information on this study, and the science behind my summary of the study, read the article above.

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

___________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

 

Health Tips From The Professor