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Vitamin E And Heart Disease

February 9, 2016 by Dr. Steve Chaney

Does Vitamin E Reduce Heart Attack Risk?

Author: Dr. Stephen Chaney

Since February is “Heart Health Month”, I thought I would share some information with you that might change how you think about vitamin E and heart disease risk. You’ve seen the headlines: “Vitamin E Does Not Reduce the Risk of Heart Disease”. In fact, these headlines have been repeated so many times that virtually every expert thinks that it has to be true. Let me share the opinion of one expert who disagrees. This week I’m going to share some information with you that I learned from a seminar by Dr. Jeffrey Blumberg from Tufts University.

But first let me tell you who Dr. Blumberg is. Dr. Blumberg is a Professor in the Friedman School of Nutrition Science and Policy at Tufts. Dr. Blumberg has over 200 publications in peer-reviewed scientific journals. He is considered one of the world’s top experts on supplementation.

Now back to what I learned at his seminar. Dr. Blumberg’s specialty is conducting and analyzing clinical studies, and his perspective on some very influential clinical studies is a bit different from what you may have heard from media reports. He believes that the media has seriously misinterpreted several recent studies. You might call this “The Rest of the Story” because you (and your doctor) definitely did not hear this part of the story in the news.

Does Vitamin E Reduce Heart Disease Risk In Women?

Let’s start with vitamin E and the risk of cardiovascular disease in women. The most influential study on this subject was the Women’s Health Study (Lee et al., JAMA, 294:56-65, 2005). This was a major study in which 39,876 women were given either 600 IU of vitamin E every other day or a placebo and followed for 10 years.

The headlines said “Vitamin E Supplements Do Not Reduce Risk Of Cardiovascular Death, Heart Attack And Stroke In Women”. That was true if you looked at the total population of women in the study.

But Dr. Blumberg pointed out that when you looked at women who were 65 or older in that study vitamin E supplementation caused a…

24% decrease in cardiovascular deaths,

26% decrease in major cardiovascular events,

21% decrease in venous thromboembolism (blood clots forming in the veins),

…and all of these decreases were statistically highly significant. That’s important because the risk of heart disease in pre-menopausal women is extremely low. It’s the over 65 group who have a high risk of heart disease.

Perhaps the headlines should have said: “Vitamin E reduces the risk of cardiovascular disease and cardiovascular deaths in those women at high risk of heart attacks”. But, of course, they didn’t. Perhaps that wasn’t considered newsworthy.

Other Studies On Vitamin E and Heart Disease Risk In Women

If this were the only study suggesting the vitamin E might benefit women at high risk of having a heart attack or stroke, it might be easy to dismiss it, but it’s not the only study showing this effect.

For example, a subsequent study called the “Women’s Antioxidant Cardiovascular Study” looked at the effect of 600 IU of vitamin E every other day on cardiovascular events in 8171 women health professionals (Cook et al, Archives of Internal Medicine, 167:1610-1618, 2007).

Once again the headlines said that vitamin E supplementation had no effect on cardiovascular events in women. But, when the authors looked at those women who already had cardiovascular disease at the beginning of the study (and were, therefore, at high risk of suffering a cardiovascular event during the study) vitamin E supplementation caused a 23% decreased risk of heart attack, stroke and cardiovascular death.

Another important study was the HOPE (Heart Outcomes Prevention Evaluation) study (Levy et al, Diabetes Care, 27: 2767, 2004). The overall study results were similar to several other recent trials – no significant effect of vitamin E supplementation on cardiovascular health in the population group as a whole.

However, by the time that study was performed it was clear that a particular genetic variation in the haptoglobin gene called the haptoglobin 2-2 genotype lead to a significant increase in oxidative damage to the vascular wall (the professor will collect your quizes at the end of this email).

When the data were reanalyzed by genotype, it became clear that people with the haptoglobin 2-2 genotype experienced a significant decrease in both heart attack and cardiovascular death with vitamin E supplementation. This finding has been confirmed by a subsequent double-blind, placebo-control study specifically designed to look at the cardioprotective effects of vitamin E in people with different haptoglobin genotypes (Milman et al, Arterioscler. Thromb. Vasc. Biol., 24: 136, 2008).

In short, the headlines from all three studies should have said: “Vitamin E reduces the risk of cardiovascular disease and cardiovascular deaths in those women at high risk of heart attacks” – and, it doesn’t appear to matter whether the increased risk is due to age, pre-existing disease, or genetic predisposition.

Does Vitamin E Reduce Heart Disease Risk In Men?

For men the most influential study was called the “Physician’s Health Study II” (H. D. Sesso et al, JAMA, 300: 2123-2133, 2008). In this study male physicians aged 40-84 were invited to participate in a double-blind clinical trial in which they were randomly assigned into groups who were given 400 IU of vitamin E every other day or placebo. They were followed for an average of 8 years during which data on both total mortality and cardiovascular mortality were obtained.

Once again, the headlines read “Vitamin E Does NotPrevent Cardiovascular Disease in Men”. But let me tell you what Dr. Blumberg said so that you understand “The Rest of the Story”. It starts by looking at the selection process for the Physician Health Studies.

Dr. Sesso and his colleagues sent out a letter asking 261,248 male physicians in the US if they would be willing to participate in the study. Only 112,528 responded and, of those responding, only 59,272 indicated that they were willing to participate. Of those who said that they were willing to participate only 32,223 met the selection criteria.

The exclusion criteria eliminated anyone who already had suffered a heart attack, stroke, angina or was on a blood thinner – in other words those people who were at greatest risk of suffering a heart attack or stroke during the study.

Finally, the study had an 18 week “run in” period to eliminate those people who were unwilling or unable to comply with the study protocol. This eliminated another 10,000 participants, leaving only 22,071 participants – less than 10% of the original.

This is where it gets really interesting. Dr. Sesso and his colleagues used publicly available databases to evaluate total and cardiovascular mortality in each group (H. D. Sesso et al, Controlled Clinical Trials, 23: 686-702, 2002). It turns out that at each stage of the selection process the incidence of both total and cardiovascular mortality during the 8-year period decreased.

In fact, the doctors who were actually included in the study were 67% less likely to die from all causes and 73% less likely to die from cardiovascular disease than the male physician population as a whole.

The bottom line is that the selection process eliminated almost all of the physicians at significant risk of having a heart attack or stroke during the study. The only ones who were actually enrolled in the study were those physicians who were at very low risk for having a fatal heart attack or stroke – or dying from any cause – during the study.

So the headlines describing this study should have read “Vitamin E Does Not Prevent Cardiovascular Disease in Men Who Are At Very Low Risk Of Heart Attack And Stroke”.The irony is that there was nothing wrong with the design of the study. It’s probably just a male ego thing. Guys who were unhealthy just didn’t want to participate in a study that might show how unhealthy they really were.

What Does This Mean For You?

These studies illustrate the true story of supplementation. For those of us who are at low risk of disease, supplementation is just a form of health insurance. But for those of us at high risk of disease, supplementation can make a huge difference in our health. That increased risk can be due to many things, as we have seen in the studies above. It can be due to poor diet, age, pre-existing disease, and/or genetic predisposition.

The problem is that most of us don’t really know whether we are at low risk or high risk until it’s too late. For millions of Americans the first sign of heart disease is sudden death.

The Bottom Line

The experts have been saying for years that vitamin E does not reduce the risk of heart disease. That claim is true, if you look at the general population, most of which is at low risk of developing heart disease – at least during the time frame of the clinical studies. However, when you look at people who are at high risk of developing heart disease, the answer is different.

For example, when you look at clinical studies with women, vitamin E significantly decreased the risk of heart attacks in women who…

Were over 65,

Had pre-existing heart disease at the beginning of the study,

Or, had a genetic predisposition to heart disease.

The headlines from these studies should have read “Vitamin E reduces the risk of cardiovascular disease in those women at high risk of heart attacks”, but they didn’t.

For men the story is a bit different. The Physician’s Health Study is considered the definitive study on the subject. However, most of the unhealthy male physicians either didn’t enroll in the study or dropped out before its completion. In fact, the doctors who were actually included in the study were 67% less likely to die from all causes and 73% less likely to die from cardiovascular disease than the male physician population as a whole. The headlines describing this study should have read “Vitamin E Does Not Prevent Cardiovascular Disease in Men Who Are At Very Low Risk Of Heart Attack And Stroke”.

These studies illustrate the true story of supplementation. For those of us who are at low risk of disease, supplementation is just a form of health insurance. But for those of us at high risk of disease, supplementation can make a huge difference in our health. That increased risk can be due to many things, as we have seen in the studies above. It can be due to poor diet, age, pre-existing disease, and/or genetic predisposition.

The problem is that most of us don’t really know whether we are at low risk or high risk until it’s too late. For millions of Americans the first sign of heart disease is sudden death.

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 Calcium Supplements Prevent Bone Fractures? – Part2: Preventing Osteoporosis

February 2, 2016 by Dr. Steve Chaney

Creating A “Bone Healthy” Lifestyle

Author: Dr. Stephen Chaney

$prevent bone fractures$ A recent study (Tai et al, British Medical Journal, BMJ/2015; 351:h4183 doi: 10.1136/bmj.h4183)reported that calcium supplementation for women over 50 resulted in only a very small increase in bone density, which translated into a very small (5-10%) decrease in the risk of bone fractures. They concluded that the standard RDA recommendation of 1,000 – 1,200 mg/day of calcium for adults over 50 is unlikely to help in preventing osteoporosis or reducing the risk of bone fractures.

In last week’s issue of “Health Tips From the Professor,” I discussed the many flaws of the study. In brief:

The study was a meta-analysis of 51 published clinical studies. Normally, meta-analyses are very strong, but they have an “Achilles Heel” – something called the Garbage-In, Garbage-Out Simply put, this means that the meta-analysis is only as strong as the individual studies that went into it. The authors included 40 years of clinical studies in their meta-analysis, and most of those studies had an inadequate design by today’s standards.

The study also made a number of what I would call apples to oranges comparisons that were of questionable validity.

In this week’s issue of “Health Tips From The Professor”, I would like to explore the other side of the coin. I would like to consider the possibility that the study might be correct and discuss what that might mean for you.

What Is A “Bone Healthy” Lifestyle?

Despite the concerns I just mentioned, let’s assume for a minute that the study might just be correct in spite of its many flaws. Let’s assume that the “one size fits all” RDA recommendation of 1,000 – 1,200 mg/day of calcium if you are over 50 may actually be flawed advice. If so, perhaps it’s time to say good riddance! It may finally be time to put away the “magic bullet”, “one size fits all” thinking and start seriously considering holistic approaches.

Now that I have your attention, let’s talk about what you can do to prevent osteoporosis – and the role that supplementation should play. Let’s talk about a “bone healthy” lifestyle.

#1: Let’s start with supplementation: Bone is not built with calcium alone. Bone contains significant amounts of magnesium along with the trace minerals zinc, copper and manganese – and all of these are often present at inadequate levels in the diet. Most of us know by now that vitamin D is essential for bone formation, but recent research has shown that vitamin K is also essential (Kanellakis et al, Calcified Tissue International, 90: 251-262, 2012). An ideal calcium supplement should contain all of those nutrients.

#2: Next comes diet: Many of you probably already know that some foods are acid-forming and other are alkaline-forming in our bodies – and that it is best to keep our bodies on the alkaline side. What most of you probably don’t know is that calcium is alkaline and that our bones serve as a giant buffer system to help keep our bodies alkaline. Every time we eat acid-forming foods a little bit of bone is dissolved so that calcium can be released into the bloodstream to neutralize the acid. (My apologies to any chemists reading this for my gross simplification of a complex biological system).

Consequently, if we want strong bones, we should eat less acid-forming foods and more of alkaline-forming foods. Among acid-forming foods, sodas are the biggest offenders, but meat, eggs, dairy, and grains are all big offenders as well. Alkaline-forming foods include most fruits & vegetables, peas, beans, lentils, seeds and nuts. In simple terms, the typical American diet is designed to dissolve our bones. Calcium from diet or supplementation may be of little use if our diet is destroying our bones as fast as the calcium tries to rebuild them.

#3: Test your blood 25-hydroxyvitamin D level: 25-hydroxy vitamin D is the active form of vitamin D in our bloodstream. We need a sufficient (20-50 ng/mL) blood level of 25-hydroxy vitamin D to be able to use calcium efficiently for bone formation. We now know that some people who seem to be getting adequate vitamin D in their diet still have low 25-hydroxyvitamin D levels. In fact, various studies have shown that somewhere between 20-35% of Americans have insufficient blood levels of 25-hydroxy vitamin D. You should get your blood level tested. If it is low, consult with your health professional on how much vitamin D you need to bring your 25-hydroxy vitamin D into the sufficient range.

#4: Beware of drugs:The list of common medications that dissolve bones is a long one. Some of the worst offenders are anti-inflammatory steroids such as cortisone & prednisone, drugs to treat depression, drugs to treat acid reflux, and excess thyroid hormone.

I’m not suggesting that you avoid prescribed medications that are needed to treat a health condition. I would suggest that you ask your doctor or pharmacist (or research online) whether the drugs you are taking adversely affect bone density. If they do, you may want to ask your doctor about alternative approaches, and you should pay a lot more attention to the other aspects of a “bone healthy” lifestyle.

#5: Exercise is perhaps the most important aspect of a bone healthy lifestyle:Whenever our muscles pull on a bone it stimulates the bone to get stronger. I’ll put the benefits of exercise in perspective in the next section.

Exercise Is A Critical Part of Preventing Osteoporosis

Instead of just quoting more boring studies, I’m going to share a couple of stories that help put the importance of exercise into perspective.

The first is my wife’s story. She ate a very healthy diet with minimal meat and lots of fruits and vegetables for years. She took calcium supplements on a daily basis. She walked 5 miles per day and took yoga classes several days each week. Yet when her doctor recommended a bone density scan in her early sixties she discovered she had low bone density. She was in danger of becoming osteoporotic!

Her doctor prescribed Fosamax. My wife tried it for one day and decided the side effects were worse than the disease. So she started asking holistic health practitioners what she should do. They recommended she find a personal trainer and start pumping iron. That was not an easy solution, but it was the right one. When she went in for her second bone scan 3 months later, her doctor excitedly announced that her bone density had increased by 7%. Her doctor said “We never get results that good with Fosamax”. When my wife told her she wasn’t taking Fosamax, her doctor became even more excited. (Most doctors actually do prefer holistic approaches. They just don’t recommend them.)

The moral of this story is that you can be doing everything else right, but if you’re not doing weight bearing exercises – if you’re not pumping iron, everything else you are doing may be for naught. Weight bearing exercise is an absolutely essential part of a “bone healthy” lifestyle!

But, can exercise do it alone? Some people seem to think so. That brings up my second story. About 30 years ago one of my UNC colleagues, who was an expert on calcium metabolism, was doing a bone density study on female athletes at UNC. One of the tennis players was nicknamed “Tab.” Tab was a popular soft drink at that time, and Tab was all she drank – no milk, no water, only Tab. When my colleague measured the bone density of her playing arm, it was normal for a woman of her age. When he measured the bone density of her non-playing arm, it was that of a 65 year old woman. The reason is simple. When we exercise a particular bone, our body will add calcium to that bone to make it stronger. If we are not getting enough calcium from our diet, our body simply dissolves the bones elsewhere in our body to get the calcium that it needs.

The moral of this story is that exercise alone is not enough. In terms of bone health, we absolutely need exercise to take advantage of the calcium in our diet, and we absolutely need sufficient calcium in our diet to take advantage of the exercise.

This is the most glaring deficiency of the meta-analysis I described last week. None of those studies included exercise. No wonder the increase in bone density was minimal!

Putting It All Together – A “Bone Healthy” Lifestyle

If you seriously want to minimize your risk of osteoporosis, there are a few simple steps you can take (simple, but not easy).

Consume a “bone healthy” diet that emphasizes fresh fruits and vegetables, minimizes meats, and eliminates sodas and other acidic beverages. For more details on whether your favorite foods are acid-forming or alkaline-forming, you can find plenty of charts on the internet.

Minimize the use of medications that adversely affect bone density. You’ll need to work with your doctor on this one.

Get plenty of weight bearing exercise. This is an absolutely essential part of a bone healthy lifestyle. Your local Y can probably give you guidance if you can’t afford a personal trainer. Of course, if you have physical limitations or have a disease, you should consult with your health professional before beginning any exercise program.

Get your blood 25-hydroxy vitamin D level tested. If it is low, take enough supplemental vitamin D to get your 25-hydroxy vitamin D level into the sufficient range – optimal is even better. Sufficient blood levels of 25-hydroxy vitamin D are also absolutely essential for you to be able to utilize calcium efficiently.

Consider a calcium supplement. Even when you are doing everything else correctly, you still need adequate calcium in your diet to form strong bones. “I’m not necessarily recommending a “one-size fits all” 1,000 to 1,200 mg/day. Supplementation is always most effective when you actually need it. For example:

If you are not including dairy products in your diet (either because they are acid-forming or for other health reasons), it will be difficult for you to get adequate amounts of calcium in your diet. You can get calcium from other food sources such as green leafy vegetables. However, unless you plan your diet very carefully you will probably not get enough.

If you are taking medications that decrease bone density, that may increase your need for supplemental calcium. Unfortunately, we don’t yet have guidelines on how much is needed.

If you do use a calcium supplement, make sure it is complete. Don’t just settle for calcium and vitamin D. At the very least you will want your supplement to contain magnesium and vitamin K. I personally recommend that it also contain zinc, copper, and manganese.

Unfortunately, we don’t really have good guidelines for how much calcium you need. Studies like the one described above are challenging the old RDAs, but we don’t yet have enough studies to know how much calcium we need to build strong bones when we are following a “bone healthy” lifestyle that includes proper diet, sufficient 25-hydroxy vitamin D blood levels and plenty of exercise.

What About Medications For Preventing Bone Loss?

The danger is that, as the conclusions of this meta-analysis get widely publicized and doctors stop prescribing calcium supplements, they probably aren’t going to recommend a holistic approach. They probably won’t recommend a “bone healthy” lifestyle. Instead, they will most likely recommend drugs to prevent bone loss. In fact, the authors of the study described last week specifically praised the use of bisphosphonate drugs (Fosamax and Zometa), and a related drug (Xgeva) that works by a similar mechanism because they increased bone density by 5-9% over 3 years.

However, these drugs have a dark side, and it’s not just the acid reflux, esophageal damage and esophageal cancer that you hear about in the TV ads. These drugs all act by blocking bone resorption, the ability of the body to break down bone. In the short term, this prevents the bone loss associated with aging and reduces the risk of bone fractures.

However, you might remember from last week’s article that bone resorption is also an essential part of bone remodeling, the process that keeps our bones young and strong. When these drugs are used for more than a few years you end up with bones that are dense, but are also old and brittle. Long term use of these drugs is associated with jaw bones that simply dissolve and bones that easily break during everyday activities. This is yet another example of drugs with side effects that look a lot like the disease you were taking the drug for in the first place.

The Bottom Line

A recent study has reported that the RDA recommendation of 1,000 – 1,200 mg/day of calcium for people over 50 provides only a minimal increase in bone density (0.7-1.8%) over the first year or two. This translates into a very small (5-10%) decrease in risk of bone fractures. It did not matter whether the calcium came from dietary sources or from supplementation. The authors concluded that adding extra calcium to the diet, whether from foods or supplements, was not a very efficient way to increase bone density and prevent fractures.

2. This study suffers from some serious flaws, which I discussed in last week’s “Health Tips From the Professor”

3. Unfortunately, many doctors are likely to take this study to heart. They are likely to stop recommending calcium and other natural approaches and start relying even more heavily on drugs to preserve bone mass. That’s bad news because, while the most frequently proscribed drugs do increase bone mass and prevent fractures short term, they also cause your bones to age more rapidly. After a few years you end up with bones that are dense, but are also incredibly brittle and fracture very easily. That’s right. If you use these drugs long enough, they will cause the very condition you were trying to prevent.

4. We should also consider the possibility that this study may just be correct. Let’s assume for a minute that the RDA recommendation of 1,000 – 1,200 mg/day of calcium for everyone over 50 may actually be flawed advice. If so, it may finally be time to put away the “magic bullet” thinking and start seriously considering holistic approaches to preserving bone mass.

5. A far better choice is to follow a “bone healthy” lifestyle.

Start with a “bone healthy” diet. Avoid acid-forming foods like sodas, meats, eggs, dairy, and grains. Instead choose alkaline-forming foods like most fruits & vegetables, peas, beans, lentils, seeds and nuts.

Check on the medicines you are using. If they are ones that adversely affect bone density, ask your health professional if there are bone-healthier options.

Check your blood level of 25-hydroxy vitamin D on a regular basis. If it is low, consult with your health professional on the amount of vitamin D you need to take to bring your 25-hydroxy vitamin D into the optimal range.

Get plenty of weight bearing exercise. This means pumping iron. It is an absolutely essential part of a bone healthy lifestyle. Of course, if you have physical limitations or have a disease, you should consult with your health professional before beginning any exercise program.

If you are not getting sufficient calcium from your diet, consider a complete calcium supplement. In addition to calcium and vitamin D, a bone-healthy calcium supplement should at the very least contain magnesium and vitamin K. I also recommend it contain zinc, copper, and manganese.

Just don’t rely on a calcium supplement alone to keep your bone density where it should be. If your 25-hydroxy vitamin D isn’t where it should be and/or you aren’t doing weight bearing exercise on a regular basis, your calcium supplement may be almost useless. All the aforementioned may aid in preventing osteoporosis. In my opinion, that may be the biggest take-home lesson from the recent meta-analysis.

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 Calcium Supplements Prevent Bone Fractures? – Part1

January 26, 2016 by Dr. Steve Chaney

Why The Recent Headlines May Be Misleading

Author: Dr. Stephen Chaney

Does calcium help prevent bone fractures? Osteoporosis is a debilitating and potentially deadly disease associated with aging. It affects 54 million Americans. It can cause debilitating back pain and bone fractures. 50% of women and 25% of men over 50 will break a bone due to osteoporosis. Hip fractures in the elderly due to osteoporosis are often a death sentence.

For that reason, the RDA for calcium has been set at 1,000 to 1,200 mg/day to reduce the risk of osteoporosis, and calcium supplements are often recommended to reach that target.However, recent headlines are proclaiming that calcium supplements do not actually prevent bone fractures and might increase your risk of a heart attack. Are the RDA recommendations wrong? Should you throw out your calcium supplements?

In this article I will review the article behind the study and help you put it into perspective. After all, you don’t really want to know whether calcium supplementation is beneficial for the average adult. You want to know whether it will be beneficial for you.

Let me start by putting the heart attack myth to rest. I have covered this in detail in a previous “Health Tips From The Professor” article, Calcium Supplements Increase Heart Attack Risk . If you don’t want to go to the trouble of reading my previous article, the short version is that:

Most of the studies suggesting an increased risk of heart attacks are flawed.

A very large study (74,000 women followed for 24 years) has shown fairly convincingly that calcium supplements do not increase heart attack risk. If anything, they decrease heart attack risk.

Unfortunately, like most other nutrition myths, this one is still being repeated – even after it has been refuted by subsequent studies.

Bone Metabolism and Osteoporosis

Before you can truly understand osteoporosis and how to prevent it, you need to know a bit about bone metabolism. We tend to think of our bones as solid and unchanging, much like the steel girders in an office building. Nothing could be further from the truth. Our bones are dynamic organs that are in a constant change throughout our lives.

Cells called osteoclasts and osteoblasts constantly break down old bone (a process called resorption) and replace it with new bone (a process called accretion). Without this constant renewal process our bones would quickly become old and brittle (I’ll discuss more about this next week when I talk about the side effects of drugs commonly used to increase bone density).

When we are young the bone building process exceeds bone resorption and our bones grow in size and in density. During most of our adult years, bone resorption and accretion are in balance so our bone density stays constant. However, as we age bone the bone building process (accretion) slows down and we start to lose bone density. Eventually our bones look like Swiss cheese and break very easily. This is called osteoporosis.

We should also think of our bones as calcium reservoirs. We need calcium in our bloodstream 24 hours a day for our muscles, brain, and nerves to function properly, but we only get calcium in our diet at discrete intervals. Consequently, when we eat our body tries to store as much calcium as possible in our bones. Between meals, we break down bone material so that we can release the calcium into our bloodstream that our muscle, brain & nerves need to function.

If we lead a “bone healthy” lifestyle, all of this works perfectly. We build strong bones during our growing years, maintain healthy bones during our adult years, and only lose bone density slowly as we age – maybe never experiencing osteoporosis. We always accumulate enough calcium in our bones during meals to provide for the rest of our body between meals.

What is a “bone healthy” lifestyle, you might ask. Because calcium is a major component of bone, the medical and nutrition communities have long focused on calcium as a “magic bullet” that can assure bone health. Once the importance of vitamin D was understood, it was added to the equation. For years we have been told that if we just get enough calcium and vitamin D in our diets, we would build strong bones when we were young, maintain bone density most of our adult years, and lose bone density as slowly as possible as we age.It is this paradigm that the current study challenges.

Do Calcium Supplements Prevent Bone Fractures?

$prevent bone fractures$ Let’s start by looking at the study behind the headlines (Tai et al, British Medical Journal, BMJ/2015; 351:h4183 doi: 10.1136/bmj.h4183). This was a meta-analysis that included 15 studies (1533 participants) looking at dietary sources of calcium and 51 studies (12,257 participants) looking at calcium supplementation in women.

The results of the meta-analysis were thought provoking, but do not exactly support the headlines you have been reading. For example:

The headlines say “Calcium Supplements Do Not Prevent Broken Bones”.

This study did not actually look at calcium supplementation and the risk of bone fractures. That was a previous study (Boland et al, BMJ 2015, 351:h4580) by the same authors.
This study showed that calcium supplementation increased bone density by 0.7-1.8%, which the authors concluded was sufficient to reduce fracture risk by about 5-10%. That’s a disappointingly small effect, but it is not zero – as the headlines suggested.

The headlines say “It’s better to get your calcium from food than from supplements”.

This study showed that it did not matter whether the calcium came from food or from supplements. The increase in bone density was identical.

Garbage-In, Garbage-Out

Meta-analyses such as this one can be very strong, but they can also suffer from the “garbage-in, garbage-out” phenomenon. In short, if most of the studies that went into the meta-analysis were poorly designed, the conclusions of the meta-analysis will be unreliable.

The problem is that many of the individual studies were conducted 10, 20, 30 or 40 years ago when our knowledge of bone metabolism was incomplete.

Thirty or 40 years ago it was “state of the art” to just use a calcium supplement. Then we learned that adequate vitamin D was essential for efficient calcium utilization.

Most of the studies included in this meta-analysis looked at calcium supplementation without vitamin D. Only 13 of the studies (25%) included vitamin D.

Ten or 20 years ago it was “state of the art” to just use a calcium supplement with vitamin D. Then we learned that the blood level of 25-hydroxyvitamin D (the active form of vitamin D in the bloodstream) did not necessarily reflect vitamin D intake from the diet. In today’s world a study in which the 25-hydroxy vitamin D level is not measured should be considered sub-standard.

Only 18 (35%) of the studies measured baseline 25-hydroxy vitamin D levels.

If dietary calcium intake at baseline is already adequate, it is illogical to expect additional calcium to significantly increase bone density.

The baseline calcium intake was <800 mg/day (clearly inadequate) in only 26 (51%) of the studies. Baseline calcium intake was either not determined in the other studies or was already in the adequate range prior to supplementation.

In the future, we will probably want to include exercise as a component in the study (more about that next week). None of the studies included exercise as a component

In short, by today’s standards many, if not most, of the studies included in the meta-analysis had an inadequate design.

If I had designed the meta-analysis, I would have been a lot more restrictive in the studies I included.

I would have started by including only studies in which the baseline intake of calcium was <800 mg/day. If you want to critically evaluate whether calcium supplementation has a beneficial effect, you need to start with people who have an inadequate dietary intake of calcium. If their diets are already calcium sufficient, supplementation is unlikely to have any benefit.

At the very least I would only include studies that used calcium supplements containing 400-800 IU of vitamin D as well. In fact, based on the latest data, I would make sure that the calcium supplement I used also contained adequate levels of magnesium, vitamin K, zinc, copper and manganese. All of those have been shown to be important for bone formation and we cannot assume they are present at sufficient levels in their diet (more about that next week).

I would only include studies that measured blood levels of 25-hydroxy vitamin D at baseline and following supplementation with vitamin D so that we knew that the 25-hydroxy vitamin D level was sufficient to support optimal calcium utilization.

Finally, I would only include studies that specifically measured the effect of exercise on calcium utilization or included exercise as an integral part of their study.

The number of studies included in the meta-analysis would be much less, but they would all be high quality studies.

Finally, the authors also noted that a number of studies in the supplement group showed significantly greater (2.5 – 5.0%) increase in bone density. They dismissed them as outliers. I would have preferred a closer look at those studies to see if there was anything about the population group or study design that might explain the greater bone density increase in those studies.

Apples and Oranges

Because the authors included a wide variety of clinical studies, they were able to state that “Increases in bone mineral density were similar in trials of calcium monotherapy [calcium by itself] versus co-administered calcium and vitamin D…and in trials where baseline dietary calcium intake was <800 [clearly insufficient] versus >800 [probably sufficient] mg/day.” This could be considered a strength of their meta-analysis, but they are only valid comparisons if other important features of the studies being compared were uniform – i.e. they were comparing apples to apples.

But what if they were comparing apples and oranges?

For example, we know that vitamin D is required for efficient calcium utilization. When the authors compared studies having a baseline calcium intake of <800 mg/day with studies having a baseline calcium intake of >800 mg/day, they did not even check to see whether use of vitamin D was evenly distributed between the two groups. If most of the studies with a baseline calcium intake of <800 mg/day did not include vitamin D with their calcium supplements, the authors would be comparing apples and oranges. The comparison would be invalid.

Similarly, we also know that if calcium intake at baseline is adequate, adding more calcium is unlikely to increase bone density significantly. When the authors compared studies with and without vitamin D, they did not even check to see whether baseline calcium intake was evenly distributed between the two groups. If the participants in most of the studies utilizing supplements providing both calcium and vitamin D were already consuming sufficient calcium at baseline, they would be comparing apples to oranges. Again, the comparison would be invalid.

The authors of the meta-analysis simply did not provide the detail needed to determine whether their comparisons were apples to apples or apples to oranges. Thus, what seemed to be a strength of their study is actually a major weakness.

The Bottom Line

A recent study has reported that the RDA recommendation of 1,000 – 1,200 mg/day of calcium for people over 50 provides only a minimal increase in bone density (0.7-1.8%) over the first year or two. This translates into a very small (5-10%) decrease in risk of bone fractures. It did not matter whether the calcium came from dietary sources or from supplementation. The authors concluded that adding extra calcium to the diet, whether from food or supplements, was not a very efficient way to increase bone density and prevent fractures.

This study suffers from some serious flaws. It is a meta-analysis of previous clinical trials looking at the effects of calcium on bone density. Meta-analyses can be very strong studies because they average the effects of many individual studies. However, meta-analyses can also suffer from the “garbage-in, garbage-out” phenomenon. Simply put, the quality of the meta-analysis is only as good as the studies that go into it. In this case the meta-analysis included many clinical studies that were done 10, 20, 30 and even 40 years ago. Based on what we now know about bone metabolism, the design of many of those early studies was clearly inadequate (details are given in the article).

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.

Should You Eat Often to Lose Weight?

January 12, 2016 by Dr. Steve Chaney

6 Small Meals a Day Plan?

Author: Dr. Stephen Chaney

Should you eat often to lose weight? A friend, your doctor, or your favorite health guru may have told you with some conviction that eating 6 small meals a day, as opposed to 2 or 3 large meals, can help you lose weight. If you are like most people, you are probably wondering whether something so simple might be the secret to permanent weight control. Should you really eat like a bird?

The advocates of eating frequent, small meals argue that large meals cause a much larger spike in insulin resulting in more of the calories being stored as fat. They also argue that a long time between meals leads to excessive hunger and overeating when you do sit down to a meal. The opponents of this idea claim that those arguments are nonsense and that eating frequent meals can cause you to lose track of the calories you have consumed.

The clinical studies on this subject have not been much help. Some studies show that more frequent food consumption during the day is associated with lower body weight, while other studies find no association between frequency of food consumption and weight.

Your friend may have also told you that consuming your calories earlier in the day will help prevent weight gain. You’ve probably heard the saying: “Eat breakfast like a king, lunch like a prince, and dinner like a pauper”. This hypothesis is on a bit stronger footing, but there are far too few studies on the subject.

With both of those concepts in mind, a recent study provides an excellent perspective.

Should You Eat Often to Lose Weight?

A recent study (Aljuiraban et al., Journal of the Academy of Nutrition and Dietetics, 115: 528-536, 2015) used data from the International Study on Macro/Micronutrients and Blood Pressure to evaluate the relationship between frequency of eating and time of eating with caloric density (calories/serving), nutrient quality and BMI (a measure of body weight). The study included 2,696 men and women aged 40 to 59 years from both the United States and England. The dietary data were obtained from each participants on two consecutive days at the beginning of the study and again 3 weeks later.

The results of the study were:

BMI was significantly less for those individuals consuming >6 meals per day than for those consuming <4 meals/day.

BMI was also significantly less for those individuals consuming their calories early in the day than for those consuming most of their calories late in the day.

What Is The “Rest Of The Story”?

Those of you old enough to have heard the Paul Harvey radio show might remember that he would tell a fairly ordinary story. Then, after the commercial break, he would come back and tell “The Rest Of The Story”, and that was always the most interesting part of the story. This study is no different.

If this study had just measured associations with BMI, it would have been just another boring food frequency study that just happened to show an association between more frequent food consumption and lower body weight. However, it also evaluated the association of food frequency and food timing with many other parameters. This was the most interesting part of the study. This was “the rest of the story”.

Those individuals consuming >6 meals/day had higher intakes of low fat dairy products, fruits and vegetables and lower intake of alcohol and red meats than those consuming <4 meals/day.

Those individuals consuming >6 meals/day also consumed less energy dense foods, fewer total calories, and more nutrient rich foods than those individuals consuming <4 meals/day.

Those individuals consuming >6 meals per day were much less likely to have their evening meal at a restaurant or cafeteria than those individuals consuming <4 meals/day.

Similarly, those individuals consuming the majority of their calories early in the day also had higher intake of low fat dairy products, fruits and vegetables and lower intake of alcohol and red meat than those consuming the majority of their calories late in the day. They also consumed less energy dense foods, fewer total calories, and more nutrient rich foods.

Although the difference was not statistically significant, it is perhaps worth noting that individuals consuming >6 meals/day tended to eat a higher percentage of their calories early in the day compared to individuals consuming <4 meals/day.

In other words, it was not necessarily the frequency or time of eating that was associated with body weight. It could simply have been the quality of the diet that determined body weight. It’s no secret that eating fewer calories, more fresh fruits and vegetable, eating lower fat dairy products, and consuming less alcohol and red meat is associated with a lower body weight. In today’s world of supersized portions, it’s also not surprising that frequently eating your dinner at restaurants is associated with higher weight.

What’s not clear from this study is why there was such a strong association between consuming a healthy, low calorie diet and frequency/timing of eating. It’s also not clear whether this is a universal association, or whether it was unique to this clinical study.

The Bottom Line

A recent study has shown that BMI was significantly less for those individuals consuming >6 meals per day than for those consuming <4 meals/day. BMI was also significantly less for those individuals consuming the bulk of their calories early in the day compared to those consuming their calories late in the day.

In both cases, it turns out that the individuals with lower BMI were also consuming healthier diets as measured by lower calorie intake, greater consumption of fruits, vegetables and low fat dairy and reduced consumption of alcohol and red meats.

Consequently, it isn’t clear from this study whether low BMI is associated with frequency of eating, timing of eating, or simply the quality of the diet.

The jury is still out on whether consuming frequent, small meals can help you lose weight. This just may be one of those approaches that works better for some people than for others.

The preponderance of evidence suggests that consuming the bulk of your calories early in the day may help you lose weight, but the evidence is far from definitive at this point.

However, there is universal agreement that eating a healthy, low calorie diet will help you lose weight. My money is with a healthy, low calorie diet.

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.

Skinny Fat

January 5, 2016 by Dr. Steve Chaney

Overweight Vs. Obesity

Author: Dr. Stephen Chaney

Are you skinny fat? Weight loss season is upon us. Many of you are jumping on your bathroom scales so that you can decide how much weight you need to lose this year. For some the motivation for these New Year’s resolutions to lose weight is purely cosmetic. You just want to look better. For others the motivation for losing weight is better health. Obesity is a killer. It is associated with increased risk of diabetes, heart attack and stroke – and that’s just the tip of the iceberg.

But what if your bathroom scale says that you are normal weight? Are you off the hook? Maybe not. A recent study suggests that if you are normal weight but have central obesity (a fancy scientific term for belly fat), you are more likely to die prematurely than someone with normal fat distribution regardless of how overweight they are. That’s a pretty scary thought. It has even generated a new risk category called “skinny fat”.

How Can You Be Obese Without Being Overweight?

In recent years there has been some controversy about the health risks of obesity. Part of that controversy has arisen because obesity can be defined in multiple ways. Most of us simply hop on the scale and rely on actuarial tables to tell us what a healthy weight is for our height. Scientists, on the other hand use two very different measures of obesity.

#1 is Body Mass Index or BMI.BMI is a person’s weight in kilograms (kg) divided by his or her height in meters squared. By this measure:

Normal body weight is defined as a BMI of 18.5-24.9 kg/m².

Overweight is defined as a BMI of 25-29.9 kg/m².

Obesity is defined as a BMI of ≥30 kg/m².

#2 is waist to hip ratio or WHR. WHR is a measure of central adiposity (belly fat). By this measure:

Obesity is defined as excess central adiposity (excess belly fat), which is a waist to hip ratio ≥0.85 in women and ≥0.90 in men.

In general BMI and WHR correlate. However:

11% of men and 3.3% of women are normal weight according to BMI measurements, but have excess belly fat according to WHR measurements.These are the individualswho are obese according to their WHR measurements without being overweight according to their BMI measurements. These are the individuals often referred to as “skinny fat”.

There are similar percentages of men and women who are overweight or obese according to BMI measurements, but have low WHR measurements. These are often referred to as “pear shaped” obese individuals to distinguish them from the “apple shaped” obese individuals with a lot of belly fat.

Being Skinny Fat Can Kill You

Numerous studies have shown that “apple shaped” obesity is much more likely to be associated with disease and premature death than “pear shaped” obesity, but there have been very few studies comparing health outcomes for normal weight individuals who have excess belly fat (people who are “skinny fat”) with health outcomes of overweight and obese individuals. This study (Sahakyanet al, Annals of Internal Medicine, 2015 Nov 10 doi: 10.7326/M14-2525) was designed to fill that void.

These scientists analyzed data from the National Health and Nutrition Survey III (NHANES III). NHANES III collected BMI, WHR and health data from 15,184 Americans (52.8% women) aged 18 to 90 years (average age 45) and followed the study participants for 14.3 years. By that time 3222 of them had died, with 1413 of those deaths being due to heart disease. The results were enlightening:

Normal weight individuals with excess belly fat (“skinny fat” individuals) were 1.5 – 2.0 fold more likely to die during the 14.3 year follow up period than individuals who were normal weight and had little belly fat (“skinny lean” individuals). This was expected because this had been shown in several previous studies.

However, the surprising finding was that normal weight individuals with excess belly fat were also more likely to die than individuals who were overweight or obese. Specifically:

Men who were “skinny fat” were 2.2 – 2.4 fold more likely to die prematurely than men who were either overweight or obese, but did not have excess belly fat (men with a “pear shaped” fat distribution). “Skinny fat” women were 1.3 – 1.4 fold more likely to die prematurely than overweight or obese women with “pear shaped” fat distribution.

Men who were “skinny fat” were even slightly more likely to die prematurely than overweight or obese men with excess belly fat (men with “apple shaped” fat distribution). “Skinny fat” women were just as likely to die as overweight or obese women with “apple shaped” fat distribution.

When they looked at deaths due to cardiovascular disease the results were essentially the same.

These results were novel and should, perhaps serve as a wake-up call for normal weight individuals with excess belly fat.

The authors concluded:

“Our analysis of data…show that normal-weight U.S. adults with central obesity [excess belly fat] have the worst long-term survival compared with participants with normal fat distribution, regardless of BMI category.”

“To our knowledge, our study is the first to show that normal-weight central obesity, measured by WHR, is associated with an increased risk of cardiovascular mortality.”

“Our findings suggest that persons with normal-weight central obesity may represent an important target population for lifestyle modification and other preventative strategies.”

Why Is Being Skinny Fat So Dangerous?

As the authors of this study pointed out, it is well established that excess belly fat is associated with:

Insulin resistance, which can lead to diabetes and predispose to heart disease.
High triglycerides and high levels of “bad” cholesterol, which can lead to heart disease.
Inflammation, which can lead to a number of deadly diseases.

The metabolic effects of excess belly fat are sufficient to explain why someone who is “skinny fat” is more likely to die prematurely than someone who is “skinny lean”. However, the effect of excess belly fat is not sufficient by itself to explain why a “skinny fat” individual is more likely to die prematurely than someone who is overweight or obese.

To understand this we need to recognize that both fat and muscle contribute to body weight (and to BMI). The “skinny fat” individual has more fat mass AND less muscle mass than a “skinny lean” individual of the same weight. That is a huge factor because metabolically speaking muscle is protective. It opposes all of the bad metabolic effects of belly fat.

Simply put, being “skinny fat” is extremely dangerous because you have increased all the bad metabolic effects of excess belly fat, ANDyou have decreased the protective metabolic effect of muscle mass.

How Do You Go From Being “Skinny Lean” To “Skinny Fat”?

Most of us were lean in our younger years. For those of us who end up as “skinny fat” as we age, it is pretty obvious that there are two processes going on simultaneously.

#1: Loss of Muscle Mass:It would be easy to say that becoming “skinny fat” is a natural part of aging. The natural tendency is to loose muscle mass and replace it with fat mass as we age. If we “just go with the flow” all of us will end up being “skinny fat” at some point. However, the loss of muscle mass as we age is accelerated by our sedentary lifestyle and our diet (more on that below).

#2: Gain of Belly Fat:To some extent whether we store excess fat as “pears” or “apples” is genetically determined. However, what we eat can also exert a major influence. For example:

Alcohol: The term “beer belly” says it all. Excess alcohol consumption is associated with an increase in belly fat. Once you understand the metabolism of alcohol the explanation is pretty simple. Alcohol causes blood sugar to drop, which increases appetite. Alcohol also interferes with our judgement, which can cause us to make poor food choices.

Excess saturated fat tends to be stored preferentially as belly fat.

Excess sugars and simple carbohydrates are rapidly converted to fat stores and stored as belly fat.

What Can You Do If You Are Already Skinny Fat?

Let’s start with what you shouldn’t do. You should not go on a reduced calorie weight loss diet to get rid of your excess belly fat. The last thing you want to do is to end up being underweight with excess belly fat! Here is what you should do:

#1: Increase Your Muscle Mass:I said that loss of muscle mass was a natural part of aging. I didn’t say that it was an inevitable part of aging. If you want to prevent or reverse loss of muscle mass you need to:

Get really serious about exercise. I’m talking about 30 minute workouts at least 3-5 times per week. These workouts need to include strength training as well as aerobics and flexibility exercises. I would suggest you ask your health professional what kind of exercise program is best for you and start your exercise program under the guidance of a personal trainer or physical therapist.

Make sure that your diet contains enough protein and enough of the essential amino acid leucine to maximize the gain of lean muscle mass following your workouts. I have covered the latest age-appropriate recommendations in, leucine and muscle gain, a previous “Health Tips From The Professor.”

#2: Lose Your Belly Fat:To some extent you will start to lose your belly fat naturally if you follow the recommendations above. In addition, you will want to:

Drink alcohol in moderation.

Make food choices that allow you to replace saturated fat with monounsaturated fat and polyunsaturated fats, especially the omega-3 polyunsaturated fats.

Replace excess sugars and simple carbohydrates with complex carbohydrates from fresh fruits and vegetables along with modest amounts of whole grain foods.

The Bottom Line

A recent study has shown that being “skinny fat” (having normal body weight, but excess belly fat) is more likely to result in premature death than if you were overweight, or even obese.

The most likely explanation for this alarming statistic is that someone who is “skinny fat” has excess belly fat, which predisposes to a number of diseases, and a loss of muscle mass, which protects against those same diseases.

If you are overweight or obese, you need to reduce your caloric intake to lose weight. However, if you are “skinny fat”, you don’t want to reduce your caloric intake. You need to change your exercise and diet habits.

Loss of muscle mass and gain of fat mass is a normal part of aging. However, you can slow or reverse the age-related loss of muscle mass with an exercise program and enough protein and leucine in your diet to maximize the effects of that workout program (details above).

You can prevent or get rid of excess belly fat by:

Following the exercise program and nutritional support of that exercise program described above.

Making food choices that replace saturated fats with monounsaturated fats and polyunsaturated fats, especially omega-3 polyunsaturated fats.

Replacing foods high in sugar and simple carbohydrates with fresh fruits and vegetables and whole grains in moderation.

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.

8 Tips on How to Eat Less

December 29, 2015 by Dr. Steve Chaney

Avoid Mindless Eating

Author: Dr. Stephen Chaney

Weight loss season is just around the corner. In just a few days you will probably be making your New Year’s resolutions, and weight loss will probably be near the top of the list. You may be considering the latest new diet fad – never mind that you’ve tried lots of diets in the past and have always regained the weight you lost.

What if you could learn just a few tricks that would help you discover how to eat less every day? Would that be of interest to you? Do you think it might help you lose some weight and keep it off?

This week I’m going to share 8 tips for eating less every single day from Professor Brian Wansink of Cornell University. He is Director of their Food and Brand Lab. He has devoted his career to studying how external clues influence our eating patterns. He is the author of the best-selling books “Mindless Eating” and “Slim by Design”. He is the world expert on this topic.

A few years ago I had the pleasure of attending a seminar he gave. Here’s a quick summary of what I learned.

8 Tips on How to Eat Less

Tip #1: The Size Of The Container Matters

In one of his research studies he gave moviegoers who had just eaten dinner either a big bag or a small bag of stale popcorn. Those given the big bag ate 34% more. Think about that for a minute. The subjects in his study weren’t hungry. They had just eaten dinner. The popcorn wasn’t particularly tasty. It was stale. Yet they ate 34% more based solely on the size of the bag!

The take home lesson is always to choose the smallest container when given a choice. This is also why you want to serve your meals on small plates and drink your beverages in small glasses or cups. If you want to snack while you watch TV, place your snack food in a very small container and store the rest out of sight.

Tip #2:Don’t Fall For Marketing Hype

He was asked to consult for a cafeteria serving health food because they weren’t attracting enough customers. He just advised them to change the names of their menu items (e.g. “Succulent Tuscany Pasta” instead of “Italian Pasta”). Sales increased by 27%.

The take home lesson is not to fall for the marketing hype. Restaurants and food manufacturers know all the tricks. They know how to make even ordinary foods sound delicious. Make your food choices based on the ingredients of the food, not on the marketing description.

Tip #3: Make Junk Food Inconvenient

In another study he put clear glass dishes of candy either on a secretary’s desk or 6 feet away on a cabinet. The secretaries consumed 125 more calories/day from candy when it was on their desk. Think about that for a minute. 125 excess calories/day could amount to around one pound of weight gain/month, 12 pound/year, 60 pounds every 5 years, and a whopping 120 pounds over 10 years!

The take home lesson is to make high calorie snacks and junk foods inconvenient. Put them in the back of your refrigerator, on the top shelf of your cabinets, or other out of the way places. Even better, don’t bring them home in the first place.

Tip #4: Watch The Refills.

When he used a refillable soup bowl (it never goes below half full) people ate 73% more soup than those given a regular bowl of soup. When he asked the people with the refillable bowl if they were full, they replied “How could I be? I only ate half a bowl of soup”.

Of course, most of us will never experience a refillable soup bowl. However, if you are having a meal with friends and enjoying the conversation, it is easy to ignore the refills – either from your waiter at a restaurant or your favorite aunt at a family gathering.

Tip #5: Low Fat Doesn’t Mean “Eat More”

When he took a batch of trail mix and labeled some as “low fat” and some as “regular” people ate 21% to 46% more calories of the “low fat” trail mix. This was not an idle exercise. In fact, many low fat foods aren’t low calorie, but people assume that they are and use that as an excuse to eat more.

The take home lesson is to not assume you can eat more just because a food is labeled low fat, gluten free or some other healthy sounding description. In many cases, it has just as many calories as the full fat version. Even if it is, in fact, lower in calories, the only way you benefit from the reduced calories is when you consume the same portion size as you would for the full fat food it replaces.

Tip #6: Health Foods Are Not Necessarily Healthy

When he showed people an Italian sandwich and told them that it was from either “Jim’s Hearty Sandwich Shop” or from “Good Karma Healthy Foods”, people estimated the calories as 24% lower if they thought it came from Good Karma.

The take home lesson is that health foods are not necessarily healthier. Food manufactures know that health food is in, and they market their products accordingly. If you walk down the aisles of your favorite health food store, you will find foods that are just as high in sugar, fat and calories as the junk food you can buy at the convenience store down the street. They may contain “natural” fats and sugars, but those have just as many calories as the “unhealthy” fats and sugars in the junk foods. You still need to read labels and choose unprocessed fruits, vegetables and whole grains whenever possible.

Tip #7: Don’t Call It Exercise

When he took students on a walk around a lake before dinner, they ate more calories at dinner if they were told that it was an exercise walk than if they were told that it was a sight-seeing walk – and most of the extra calories came from dessert. Think about that for a minute. It is a human tendency to reward ourselves for virtuous behavior, but when that reward involves eating, it becomes self-defeating.

The take home lesson is two-fold.

Reframe our virtuous behavior. If we call it exercise or a work-out, it implies that we have done something virtuous and deserve a reward. If we call it a nature walk or think of it as a sport, it becomes its own reward. If we think of substituting a salad for a dinner of fried chicken and mashed potatoes with gravy as virtuous behavior, we may think we deserve a dessert as a reward. If we think of the salad as a gourmet experience, it can become a reward in its own right.

Rethink our rewards. The reward doesn’t need to be food related. It could involve reading a book, watching a show, or whatever you favorite activity might be.

Tip #8: Knowing This Stuff Isn’t Enough.

The fascinating thing is that his research shows it doesn’t matter how intelligent or well informed you are.

He did a study with 60 graduate students. Just before winter break, he gave them a lecture on external eating cues in which he specifically told them that they would eat more from a big bowl of Chex Mix than from a small bowl. The students then spent 90 minutes in small group exercises designed to show them how to overcome external eating cues.

After winter break he invited those same students to a Super Bowl party in which he divided them into two rooms and gave them, you guessed it, either large or small bowls of Chex Mix. The ones given the large bowls ate 53% more!

He later gave the same lecture to a meeting of The American Diabetes Association (Those are the experts) and then repeated the same experiment with them – and they still ate more from the large bowls.

How Can You Avoid Mindless Eating?

Dr. Wansink’s research clearly shows that overeating is mindlessly dependent on external eating cues, AND that you can’t avoid being influenced by those external clues even if you are intelligent and motivated! How to eat less?

Dr. Wansink recommends planning ahead. For example:

Serve your food on small plates and don’t leave food lying around where you can see it or get to it easily.

If you bring home a box or bag of snack food (hopefully healthy snack food), divide it up into healthy portion sizes as soon as you bring it home.

Put the healthy food choices in the front of your refrigerator or cupboard where you will see them easily and hide the unhealthy foods in the back (or don’t bring them home to begin with).

However, the most important thing is to realize most of this behavior is mindless. It is not enough to simply understand these external eating cues at an intellectual level. We need to be constantly vigilant for external eating cues, or we will find ourselves overeating without really understanding why.

Hopefully, these tips will help you eat less and attain a healthier weight next year than you did this year. However, these 8 tips are just the tip of the iceberg. If this article has piqued your interest and you’d like to learn more, I recommend you read one of Dr. Wansink’s books.

The Bottom Line

Brian Wansink’s research has shown that overeating, to a large extent, is mindlessly dependent on external eating cues, and that you can’t necessarily avoid being influenced by those external clues even if you are intelligent and motivated!

I have distilled his research into 8 simple tips to help you eat less and attain a healthier weight next year than you did this year.

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

The Fake Chocolate Study

December 8, 2015 by Dr. Steve Chaney

How To Game The Peer Review Process

Author: Dr. Stephen Chaney

Peer review is supposed to assure that clinical studies are well designed, well executed, and correctly interpreted before they are accepted for publication. That is why I frequently advise you, my readers, to look for clinical studies on their nutritional products that are published in peer reviewed scientific journals as a criteria for choosing a supplement company that you can trust.

But, can the system be gamed? Sadly, the answer is yes. There are journals that only pay lip service to the peer review process. Earlier this year an investigative reporter set out to prove just how easy it is to game the peer review process. It is a fascinating story of how a journalist created the fake chocolate study.

Creating The Fake Chocolate Study Hoax

The fake chocolate study was a hoax put together by John Bohannon, an investigative journalist and correspondent to Science (a very well respected scientific journal) to test the peer review system. The study was real, but it was seriously flawed. For example, it had only 16 subjects, there was no effort made to determine what the subjects were eating other than chocolate, and the conclusions were not supported by the data. In short, it was a very bad study—one that would have been rejected by any reputable journal.

For the purposes of the test he called himself Dr. Johannes Bohannon from the “Institute of Diet and Health”, a nonexistent entity that consisted of nothing more than a fake website he set up. He then wrote up the study and titled it “Chocolate with High Cocoa Content as a Weight Loss Accelerator” with the conclusion (not supported by the data) that “Long-term weight loss, however, seems to occur easier and more successfully by adding chocolate. The effect of chocolate, the so-called ‘weight loss turbo’, seems to go hand in hand with personal well-being, which was significantly higher than in the control groups.”

Journals Take The Bait

In March 2015 he submitted the article to 20 online journals. Several accepted it within 24 hours. He chose to publish it in the “International Archives of Medicine.” His paper was published online without any revisions a mere two weeks later. [Note: You should not assume the fact that several out of just 20 journals accepted his paper as in indication that a significant percentage of journals accept sub-standard papers without serious peer review. He had, in fact, done previous research for Science magazine identifying those journals most likely to accept flawed studies. It was those types of journals he sent his study to.]

John Bohannon was later quoted as saying “Editors of reputable journals reject [these kinds of studies] out of hand without even sending them to peer reviewers. But there are plenty of journals that care more about money than reputation.” [It costs $650 to have an article published in the International Archives of Medicine.]

The Media Fans The Flames

If this study had just been published in an obscure journal and had been ignored, that would have been bad enough. But the story gets even worse. He then created a press release that he sent to news outlets. The press release made some pretty outrageous statements and even contained a link to an unrelated music video. However, the study made news headlines in more than 20 countries in half a dozen languages. For example, headlines from the Daily Express in England blared: “Chocolate Accelerates Weight Loss: Research Claims it Lowers Cholesterol and Aids Sleep.”

John Bohannon’s take was: “The key is to exploit journalist’s incredible laziness. If you lay out the information just right, you can shape the story that emerges in the media almost like you were writing those stories yourself. In fact, that’s literally what you are doing, since many reporters just copied and pasted our text.”

For the complete story of how John Bohannon pulled off this hoax, read his blog post about the “fake study.”

The Bottom Line

An investigative reporter for Science magazine demonstrated recently just how easy it is to get a fake study published in a peer-reviewed journal.

He created a completely bogus study about chocolate aiding weight loss.

He submitted it to several journals that he had previously identified as having substandard peer review processes.

Several journals accepted it within 24 hours without any peer review process. One published it two weeks later without any revisions.

The story of a new “study” showing that chocolate aids weight loss was picked up by the new media and made the headlines in more than 20 countries in half a dozen languages.

The vast majority of journals have a very exacting peer review process, which means that most published clinical studies have been thoroughly reviewed and edited prior to publication. For the most part the peer review process works exactly as it is supposed to.

However, this hoax shows just how easy it would be for an unethical supplement company to subvert the peer review process and publish bogus studies to support their product claims. That is why when you are choosing a supplement company it is important to choose one with a reputation for scientific integrity.

This hoax also shows just how easy it is for bogus information to be picked up by the media and make it into the headlines. You simply cannot believe everything you read in the press, see on the TV and view online. That is why I created “Health Tips From The Professor.” I wanted to create a place where you can go for accurate information.

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 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.