current health articles

Magnesium Supplements Benefits | Reduce Diabetes Risk?

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Author: Dr. Stephen Chaney

 

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

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

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

 

Do Magnesium Supplements Improve Blood Sugar Control?

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

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

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

At the end of 16 weeks:

  • Improvement in blood sugar control was observed in 50% of the people in the magnesium group compared to 7% in the placebo group. This was significantly different.
  • Triglyceride levels were significantly decreased while HDL and blood magnesium levels were significantly increased in the magnesium group compared to the placebo group.
  • Side effects of magnesium supplementation were mild abdominal pain (7.6%) and diarrhea (6.0%).

The authors concluded:

  • “Our present results demonstrate the efficacy and safety of magnesium supplementation in the reduction of plasma glucose levels and in the improvement of glycemic status [blood sugar control] of pre-diabetic individuals who have low serum magnesium levels.”
  • “Our results support the hypothesis that, as a complement to lifestyle intervention programs, people with pre-diabetes and low blood levels of magnesium also should take magnesium supplements to decrease plasma glucose levels and potentially decrease the transition rate from pre-diabetes to diabetes.”

Magnesium and Blood Sugar Control

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

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

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

  • A meta-analysis of 13 studies with 536,318 people (Dong et al, Diabetes Care, 34: 2116-2122, 2011) concluded that the risk of diabetes was decreased by 14% for every 100 mg of magnesium consumed.
  • Most, but not all, intervention studies like the one described above have shown that magnesium supplementation reduced blood glucose levels and improved blood sugar control.

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

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

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

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

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

 

The Bottom Line

  • A recent study showed that magnesium supplementation improves blood sugar control in pre-diabetics with low blood magnesium levels. The authors concluded that magnesium supplementation along with lifestyle change may be effective in slowing the progression from pre-diabetes to type 2 diabetes.
  • This study is consistent with a number of previous studies suggesting that increased magnesium intake is associated with decreased risk of developing type 2 diabetes.
  • This study is also consistent with the principle that supplementation works best in situations where there is a demonstrated need for a particular nutrient, in this case magnesium (the study participants were selected in part on the basis of low blood levels of magnesium).
  • Other studies have shown that around 60% of the population is getting inadequate magnesium from their diet.Dietary recall studies probably overestimate the percentage of the population that is magnesium deficient, but most experts agree that a significant percentage of the US population likely have less than optimal magnesium status.
  • You probably don’t need mega-doses of magnesium to support good blood sugar control. The clinical study described above used 382 mg/day of magnesium, but most dietary recall studies suggest that dietary intake of magnesium in this country is only 100-200 mg/day below RDA recommendations.
  • Assuring an adequate intake of magnesium is only one component of a holistic approach for reducing the risk of developing type 2 diabetes. Other important components are weight control, exercise, and a healthy diet that restricts sugars and starches.
  • Good dietary sources of magnesium include leafy green vegetables (5-6 servings = RDA), nuts (5-6 servings = RDA), orwhole wheat bread or brown rice (8-9 servings = RDA).
  • Supplementation with ≥300 mg of magnesium can cause gas, bloating and diarrhea in sensitive individuals. If you are supplementing with magnesium, I recommend a sustained release supplement.

 

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

ADHD Diet VS Medication for ADHD

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Author: Dr. Stephen Chaney

 

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

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

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

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

 

Is an ADHD Diet Better Than Medication For ADHD?

 

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

  • Medicines fail or there are adverse reactions (side effects).
  • The parents or the patients prefer a more natural approach.
  • There are symptoms or signs of a mineral deficiency (more about that below).
  • There is a need to substitute an ADHD-free healthy diet for an ADHD-linked diet (Simply put, if the child’s diet is bad enough, there are multiple benefits from switching to a healthier diet – a possible reduction in ADHD symptoms is just one of them.)

I will summarize their key findings below:

Do Omega-3 Fatty Acids Reduce ADHD Symptoms?

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

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

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

Does the Elimination of Food Additives Reduce ADHD Symptoms?

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

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

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

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

Food Sensitivities

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

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

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

Sugar

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

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

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

Does Eliminating Iron and Zinc Deficiencies Reduce ADHD Symptoms?

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

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

Does Eating A Healthy Diet Reduce ADHD Symptoms?

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

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

 

The Bottom Line

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

  • Use of omega-3 supplements. They recommended 300-600 mg/day.
  • Removal of food additives (particularly food colors) from the diet.
  • Identification of food sensitivities and removal of those foods from the diet.
  • Reducing the amount of simple sugars in the diet.
  • Elimination of iron and zinc deficiencies if they exist (Iron deficiency is relatively common in American children. Zinc deficiency is not.) Alternatively, I recommend a children’s multivitamin to prevent iron and zinc deficiencies in the first place.
  • Eating a healthy diet rather than a Western diet. This also has the benefit of reducing the amount of food additives and sugars in the diet.

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

  • If you are a parent who is interested in a natural alternative to ADHD stimulant medications this means you may need to be patient and try several natural approaches until you find the one(s) that work(s) best for your child. The benefit of making the effort is that all of these approaches will also improve the health of your child in other important ways, and none of them have any side effects.
  • Unfortunately, the physician with only about 10 minutes to spend with each patient (which is increasingly the medical model in this country), may not have time to explore natural options. Medications are much easier to prescribe. You may need to be the one who takes the responsibility of exploring natural alternatives for your child.

 

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

Is Vitamin E Deficiency Common in the US

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 Does Vitamin E Matter?

Author: Dr. Stephen Chaney

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

  • Is the latest study valid? Are most Americans vitamin E deficient?
  • Does it matter? Vitamin E has been described as “a vitamin in search of a disease”. If there are no diseases associated with vitamin E deficiency, should we even be concerned if most Americans are vitamin E deficient?
  • Is there any value to vitamin E supplementation? You will see claims that vitamin E supplementation has been proven not to work. Are these claims valid?

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

Are Americans Vitamin E Deficient?

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

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

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

  • People who did not use supplements had lower blood levels of vitamin E (24.9 umol/L) than those who used supplements (33.7 umol/L). No surprise here.
  • Only 0.6% of Americans were clinically deficient in vitamin E (blood levels < 12 umol/L). The prevalence of vitamin E deficiency did not vary significantly with age, gender or ethnicity.
  • When they looked at the people not using supplements, the percentage with suboptimal vitamin E status (blood levels < 30 umol/L) varied significantly by age, but was not significantly affected by gender or ethnicity. In this analysis the percentage with suboptimal vitamin E status was:
  • 7% for ages 20-30.
  • 8% for ages 31-50
  • 2 % for ages 51 and above

Were The Headlines Correct?

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

  • There is no internationally recognized standard for adequate blood levels of vitamin E. The authors had a reasonable rationale for choosing 30 umol/L as their standard for adequate blood levels, but they also acknowledged that the Estimated Average Requirement of vitamin E from food (12 mg/day) would result in a blood level of 27.9 umol/L, so their standard may be a bit high.
  • The average blood level of vitamin E for non-supplement users was 24.9 umol/L. While that is less than adequate, it is only slightly low – especially if the lower standard of 27.9 umol/L is used.

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

Does Vitamin E Matter?

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

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

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

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

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

Is There Any Value To Vitamin E Supplementation?

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

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

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

  • In the Women’s Health Study (JAMA, 294: 56-65, 2005) vitamin E supplementation had no effect on heart attack or stroke in the general population. But when they looked at women over 65 (those at highest risk for heart disease), vitamin E supplementation reduced heart attack and stroke by 25% and cardiovascular deaths by 49%
  • In the Heart Outcome Prevention Evaluation Study (Diabetes Care, 27: 2767, 2004; Atherosclerosis, Thrombosis & Vascular Biology, 24: 136, 2008) vitamin E supplementation had no effect overall on heart attacks or cardiovascular deaths. But when they looked at a population who had a haptoglobin genotype that significantly increases the risk of heart disease, vitamin E supplementation significantly decreased the risk of both heart attacks and cardiovascular deaths.

 

The Bottom Line

  • Recent headlines saying that over 90% of young Americans have suboptimal vitamin E status are technically correct, but a bit overstated. It probably would have been more accurate to say that most Americans have slightly suboptimal vitamin E status.
  • The important question then becomes “Do marginal nutritional deficiencies matter?” The answer is pretty simple. Marginal nutritional deficiencies do not matter for everyone. However, they matter very much for those people who have increased needs for that nutrient due to genetic predisposition, risk factors for disease or pre-existing disease.
  • If we had a good way of assessing individual nutritional needs, it would be easy to say who needed supplements and who didn’t. However, we don’t have a good way of assessing increased needs for most nutrients, which is why many Americans use supplements on a daily basis.
  • As for all of those studies saying that vitamin E supplementation has no benefit, they are a bit misleading because they are asking the wrong question. They are asking whether vitamin E supplementation benefits everyone. They are not asking whether vitamin E supplementation benefits people with increased needs. When you ask that question the answer is very different (see examples in the article above).

 

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

Leucine And Muscle Gain

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Should Your Post-Workout Protein Shake Contain Added Leucine?

Author: Dr. Stephen Chaney

 

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

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

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

  • How much protein is optimal?
  • What kind of protein is optimal?
  • What amount of branched chain amino acids is optimal?
  • Are some branched chain amino acids more important than others?
  • Does the optimal amount of branched chain amino acids depend on the amount of protein?

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

How Much Protein Do You Need and What Kind?

  • Recent research has shown that the optimal protein intake for maximizing muscle gain post workout is 15-20 gm for young adults (Katsanos et al, Am J Clin Nutr 82: 1065-1073, 2005; Moore et al, Am J Clin Nutr, 89: 161-168, 2009) and 20-25 gm for older adults (Symons et al, Am J Clin Nutr 86: 451-456, 2007).
  • More protein isn’t necessarily better. The effect of protein intake on post workout muscle gain maxes out at around 25 gm for young adults and 30 gm for older adults (Symons et al, J Am Diet Assoc 109: 1582-1586, 2009).
  • Whey protein is the best choice for enhancing muscle gain immediately after a workout. Other protein sources (soy, pea, casein, chicken) are better choices for sustaining muscle gain over the next few hours.

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

  • branched chain amino acidIt turns out that leucine is the only branched chain amino acid that actually stimulates muscle protein synthesis (Am J Physiol Endocrinol Metab 291: E381-E387, 2006). And protein is what gives muscles their strength and their bulk.
  • Recent research has shown that 2-3 gm of leucine (2 gm for young adults; 3 gm for older adults) is sufficient to maximize post workout muscle gain if protein levels are adequate (Am J Physiol Endocrinol Metab 291: E381-E387, 2006).

Unanswered Questions About Optimizing Muscle Gain Post-Workout

  • Do the other branched chain amino acids play a supporting role, or is leucine alone sufficient to drive post-workout muscle gain?
  • Can leucine still help maximize post-workout muscle gain if protein intake is inadequate? If so, how much leucine is needed?

Does Leucine Enhancement Improve Low Protein Shakes?

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

  • 25 gm of whey protein, which naturally contains 3 gm of leucine (high protein)
  • 6.25 gm of whey protein, which naturally contains 0.76 gm of leucine (low protein)
  • 6.25 gm of whey protein with 3 gm of leucine (low protein, low leucine)
  • 6.25 gm of whey protein with 5 gm of leucine (low protein, high leucine)
  • 6.25 gm of whey protein with 5 gm of leucine + added isoleucine and valine (the other branched chain amino acids). (low protein, branched chain amino acids).

The results were clear cut:

  • The high protein shake (25 gm of protein) was far superior to the low protein shake (6.25 gm of protein) at enhancing post workout protein synthesis. This is consistent with numerous other published clinical reports.
  • Adding 3 gm of leucine to the low protein shake had no effect on post-workout protein synthesis, but 5 gm of added leucine made the low protein shake just as effective as the high protein shake at supporting post-workout protein synthesis.

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

  • Adding extra branched chain amino acids actually suppressed the effectiveness of leucine at enhancing post-workout protein synthesis. These data suggest:
    • Leucine probably is the major amino acid responsible for the muscle gain reported in many of the previous studies with branched chain amino acids.
    • If the other branched chain amino acids play a supporting role in the muscle gain, the quantities that occur naturally in the protein are probably enough. Adding more may actually reduce the effectiveness of leucine at stimulating muscle gain.

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

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

 

The Bottom Line

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

  • If you are a young adult (17-30), you should aim for 15-20 gm of protein and about 2 gm of leucine after your workout.
  • If you are an older adult (50+), you should aim for 20-25 gm of protein and 3 gm of leucine after your workout.
  • If you are in between you are on your own. Studies haven’t yet been done in your age group, but it’s reasonable to assume that you should aim for somewhere between the extremes.
  • If you are getting the recommended amounts of whey protein, the leucine level may also be optimal. If you are using other protein sources you may want to choose ones with added leucine.
  • The research cited above shows that you can make a low protein supplement effective by adding lots of leucine, but that’s going to require artificial flavors and sweeteners to cover up the taste of that much leucine. I would recommend choosing one that provided adequate protein to begin with.
  • While the research in this area is still somewhat fluid, I would avoid protein supplements with added branched chain amino acids other than leucine. If the paper I cited above is correct, you probably get all of the other branched chain amino acids you need from your protein and adding more may actually interfere with the effect of leucine on muscle gain.
  • I’d pretty much forget all the other “magic ingredients” in post-workout supplements. If you’re a novice there is some evidence that arginine and HMB may be of benefit, but if you have been working out for more than 6 months, the evidence is mixed at best. As for the rest, the clinical studies are all over the map. There’s no convincing evidence that they work.
  • Whey protein is the best choice for enhancing muscle gain immediately after your workout. Soy, pea, and casein are better choices for sustaining muscle gain over the next few hours. If you’re looking at meat protein, chicken is a particularly good choice. Four ounces of chicken will provide the protein and leucine you need to sustain muscle gain for several hours.

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

 

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

Emergency Treatment for Calf Cramps

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To Stretch or Not To Stretch

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

 

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

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

 

Emergency Treatment for Calf Cramps

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

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

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

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

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

Follow These Steps To Release Your Calf Cramps

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

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

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

 

Wishing you well,

Julie Donnelly

 

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

 

About The Author

Julie DonnellyJulie Donnelly is a Deep Muscle Massage Therapist with 20 years of experience specializing in the treatment of chronic joint pain and sports injuries. She has worked extensively with elite athletes and patients who have been unsuccessful at finding relief through the more conventional therapies.

She has been widely published, both on – and off – line, in magazines, newsletters, and newspapers around the country. She is also often chosen to speak at national conventions, medical schools, and health facilities nationwide.

Soy and Hot Flashes

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Will Soy Put Out The Fire?

Author: Dr. Stephen Chaney

 

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

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

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

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

Will Soy Put Out The Fire?

However, clear guidance in this area was sorely needed, so Taku et al (Menopause, DOI: soy10.1097/gme.0b013e3182410159, 2012) performed an even larger meta-analysis that included 19 published clinical trials – some of which had been published after the previous two meta-analyses were performed.

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

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

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

  • were not double blind, placebo controlled and designed in such a manner that the placebo was indistinguishable from the soy isoflavone preparation.
  • contained other substances in addition to the soy isoflavones (The presence of other substances in the preparation might have influenced the response).

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

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

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

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

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

That’s the good news.

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

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

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

Soy and hot flashes; the bottom line.

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

The Bottom Line

  • A recent meta-analysis of 19 published clinical studies showed that soy isoflavones reduced the frequency of hot flashes by 21% and the severity of hot flashes by 26%.
  • The results were highly statistically significant, but 21-26% reduction in symptoms is not a huge effect.
  • When they looked at the individual clinical studies it was apparent that the response is highly variable. Some women experienced major relief from hot flashes and other menopause symptoms, while other women experienced little or no relief.
  • My take on this is that soy isoflavones should not be thought of as a “magic bullet” that will make hot flashes go away by themselves, but rather as a proven part of a holistic approach that encompasses a healthy diet, exercise, weight control and stress reduction

 

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

How To Prevent Memory Loss?

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

Author: Dr. Stephen Chaney

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The results were pretty striking:

  • B vitamin treatment reduced brain shrinkage by up to 70% over a two year period in adults over the age of 70.
  • The B vitamin treatment was only effective when the subjects were deficient in B vitamins at the beginning of the study, as indicated by elevated homocysteine levels.
  • The B vitamin treatment was also only effective in subjects with high omega-3 status. The B vitamin treatment had no benefit in subjects with low omega-3 status.

What Is The Significance Of This Study?

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

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

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

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

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

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

Does It Matter?

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

omega-3s help prevent cognitive declineOur oceans and rivers are becoming more and more polluted, and many people are avoiding fish because of concerns about heavy metal or PCB contamination. There is also an increasing emphasis on eating “sustainable” fish. That usually means the fish are farm raised, and farm raised fish are the most likely to be contaminated with PCBs, which is unfortunate. For example, I recently went to a nice restaurant that had a delicious sounding salmon dish on their menu. They could guarantee that the salmon was sustainably raised, but they couldn’t guarantee it was PCB-free. I chose not to eat the salmon.

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

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

  • The most frequent cause of B12 deficiency is the age related loss of the ability to absorb vitamin B12 in the upper intestine. This affects 10-30% of people over the age of 50.
  • Chronic use of acid-suppressing medications such as Prilosec, Nexium, Tagamet, Pepcid and Zantac also decreases B12 absorption and increases the risk of B12 deficiency. Millions of Americans use those drugs on a daily basis.
  • Overall, B12 deficiency has been estimated to affect about 40% of people over 60 years of age.
  • Deficiency of the enzyme methylenetetrahydrofolate reductase (MTHFR) substantially increases the requirement for folic acid. About 10% of the US population has this enzyme deficiency.
  • About 25% of Americans have low blood levels of B6

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

 

The Bottom Line

  • A recently published study looked at the effect of high dose B vitamin supplementation on brain shrinkage over a two year periods in adults over 70 (average age 77) with mild cognitive impairment at the beginning of the study. This study differed from all previous studies in that it also measured omega-3 fatty acid levels in the blood at the beginning of the study to assess omega-3 status.
  • B vitamin treatment reduced brain shrinkage by up to 70% over the two year period compared to placebo.
  • The B vitamin treatment was only effective when the subjects were deficient in B vitamins at the beginning of the study, as indicated by elevated homocysteine levels.
  • The B vitamin treatment was also only effective in subjects with high omega-3 status at the beginning of the study. If they had low omega-3 status, the B vitamin supplementation was ineffective.
  • This study has the potential to forever shift the paradigm for preventing cognitive decline in the elderly. Past studies have looked at the effect of B vitamins and omega-3s at reducing cognitive decline separately, and these studies have been inconsistent. If this study is correct, consistent benefits will only be seen when both B vitamins and omega-3 fatty acids are present at adequate levels.
  • This is a concern because millions of older Americans are deficient in B vitamins or omega-3s or both.
  • How to prevent memory loss? Of course, B vitamins and omega-3s are just part of a holistic approach for preventing cognitive decline. Weight control, exercise, a healthy diet, adequate sleep, socialization, and memory training (mental exercise) are also important if we want to retail our full mental capacity into our 90s and beyond.

 

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

Hamstring Stretches

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 What To Do For Tight Hamstrings

Author: Julie Donnelly, LMT –The Pain Relief Expert

Editor: Dr. Steve Chaney

 

You are about to begin your run, or maybe you have just finished running. Your hamstring feels really tight. Maybe it is even painful. It seems obvious that you need to stretch it, but that could be exactly the wrong thing to do!

You Need To Release Muscle Fiber Knots Before You Do Hamstring Stretches!

hamstring exercisesStretching can be dangerous if the muscle is shortened by spasms.  A spasm (also called a muscle knot or trigger point) is like tying a knot in the center of the muscle.  And while each spasm may only involve a few fibers; there can be multiple spasms throughout the muscle.

Each spasm feels like a bump when you slide your fingers deeply down the length of the muscle. These spasms normally form over an extended period of time, often from repetitive strain on the muscle fibers.

Muscle Spasms Are At The Heart of the Stretching Misconception

It is important that you think of a spasm as a knot in the muscle fibers in order to understand why it can hurt to stretch.

A muscle begins on a stationary bone, crosses over a joint, and then inserts into a moveable bone.  When the muscle pulls on the moveable bone, the joint moves, however, if the muscle has a “knot” in it you can cause micro-tears to the fibers as you stretch.

As you stretch, knots within the muscle get tighter, this also causes the fibers on either side of the spasm to overstretch.  Overstretching can cause fiber tears either along the length of the muscle or where the fibers attach to the bone.  In most cases this can be avoided by simply applying pressure to the muscle to release the spasm before you stretch.

What Do Hamstrings Do?

Your hamstrings are responsible for bending your knee.  Every time you take a step, sit down, or climb stairs, you contract your hamstrings.

The only time your hamstrings aren’t contracting is when you are standing up straight.  This means they are frequently repetitively strained and contain multiple spasms along the muscle fibers.  These tight muscles put a strain on the back of your knee and at the origination point (the bottom of your posterior pelvis).

What Causes Tight Hamstrings?

The hamstrings are a bit unique from other muscles because while they can certainly have spasms in the fibers from repetitive strain injuries, they are also overstretched because of two major muscles that rotate the pelvis down in the front.

The two muscles that cause tight muscles to be overstretched are the iliopsoas (a muscle on the front side of the lumbar vertebrae) and the quadriceps (front of the thigh).

As these muscles get tight, primarily from sitting, they cause the pelvis to rotate forward and down.  As your pelvis rotates down in the front, it rotates up in the back.

Since your hamstrings originate on the bottom of the posterior pelvis, as it is moving up, the muscle fibers are already overstretched – so you don’t need to stretch them further.  In fact, if you stretch them they could potentially tear.

What Should You Do Before Your Hamstring Stretches?

relieve muscle knotsIt’s actually a 3-step process.  The key is to release tension in the front of the body before you can safely stretch the hamstrings.

First you need to release the tension in your quadriceps, this will take the tension off the front of the pelvis. You do this by rolling out your quadriceps muscles which releases trigger points (muscle spasms).

hamstring stretchesNext, stretch your iliopsoas. A low lunge is a great way to stretch the iliopsoas. This causes the pelvis to rotate up in the front and down in the back. As that happens tension is removed from the hamstrings.

tight hamstringsNow you can release the spasms in the hamstrings. You do this by sitting on a trigger point therapy ball, ironing out your hamstrings. Stay on specific points of pain; these are the knots in the muscle fibers you need to release. The direct pressure forces out the toxins, draws in blood and causes muscle fibers to lengthen.

Releasing muscle knots in your quadriceps, stretching your iliopsoas and releasing muscle knots in your hamstrings MUST be done before you can safely perform your hamstring stretches.

Do yourself a big favor and take these short steps; you will notice a difference!

Wishing you well,

Julie Donnelly

 

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

 

About The Author

julie donnellyJulie Donnelly is a Deep Muscle Massage Therapist with 20 years of experience specializing in the treatment of chronic joint pain and sports injuries. She has worked extensively with elite athletes and patients who have been unsuccessful at finding relief through the more conventional therapies.

She has been widely published, both on – and off – line, in magazines, newsletters, and newspapers around the country. She is also often chosen to speak at national conventions, medical schools, and health facilities nationwide.

Do Statins Cause Memory Loss?

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Is the Cure Worse Than the Disease?

Author: Dr. Steve Chaney

 

statins and diabetesDo statins cause memory loss?  They are at it again. The medical profession is telling us that yet another study shows that statins are safe, so almost everyone should be taking a statin drug. There is only one problem. That’s not what the study really showed.

Let’s start at the beginning. For people who have already had a heart attack it is pretty clear that statin drugs save lives. If stain drugs were only prescribed for people who have had a heart attack or were at high risk of having a heart attack, I would be a proponent of their use.

However, the guidelines developed by the pharmaceutical and medical industry recommend statin use for millions of Americans who have never had a heart attack and who are at low to moderate risk of ever having a heart attack. That is problematic.

As I documented in a recent “Health Tips From the Professor”  the benefits of statins are marginal at best in healthy people who have not yet had a heart attack.

In addition, statins have some significant side effects. For example, up to 5% of people taking statins develop muscle pain and weakness. For most people the muscle pain is merely an inconvenience, but in a small percentage of cases it can lead to serious complications.

More concerning are the required label warnings that statins can lead to memory loss, mental confusion, high blood sugar and type 2 diabetes. In fact, a recent study described in “Health Tips From the Professor” suggests that statins may increase diabetes risk by as much as 46%.

In other words, statins may not kill you, but they sure can make life miserable. For many people, the most troubling aspect of statin use is memory loss. One of the most terrifying aspects of aging is the thought that you might be able to keep your body healthy but lose your mind.

However, recent headlines have proclaimed that we can “forget” about statins causing memory loss (Pardon the pun. I couldn’t resist it). They claim that a recent study has shown that statins don’t actually cause memory loss. The problem is that is not exactly what the study showed. It is only the medical profession’s interpretation of what the study showed.

Why Might Statins Cause Memory Loss?

iron and brain developmentStatin drugs block cholesterol synthesis, and cholesterol is an integral part of the myelin sheath that coats our neurons. You can think of myelin as being like the plastic coating on an electrical wire. It is that plastic coating that allows the electrical current to travel from one end of the wire to the other without shorting out. Myelin plays essentially the same role for our neurons.

Because of the importance of cholesterol in maintaining the integrity of myelin, there was concern from the earliest days of statin development that it might adversely affect memory. Thus, multiple clinical studies have been performed to determine whether statin use adversely affects memory.

Unfortunately, the previous clinical studies have been inclusive. Some suggested that statins cause memory loss. Others found no correlation between statin use and memory loss. A few actually suggested that statins improved memory. There are a number of reasons why the previous studies came to different conclusions including use of different statin drugs, different duration of the studies, and differences in how memory was measured.

Do Statins Cause Memory Loss?

blood pressure medicationsThis study (Strom et al, JAMA Internal Medicine, doi: 10.1001/jamainternmed.2015.2092) differed from previous studies in that:

  • It focused on short term memory loss, and
  • It also included a group of patients who were using non-statin cholesterol lowering drugs.

The study drew on patient data from the online Health Improvement Network database collected from general practitioners offices throughout England between July 7, 2013 and January 15, 2015. The study compared 482,543 statin users with 482,543 matched controls using no cholesterol lowering medication and 26,484 patients using non-statin cholesterol lowering medications. The average age of the participants in this study was 63. Memory loss within the first 30 days after initiation of drug therapy was assessed by scanning the medical records in the database for codes related to memory loss.

The results were stunning!

  • Stain drug users were 4-fold more likely to experience short term memory loss within the first 30 days than non-users, and the likelihood of memory loss was dose dependent.
  • The users of non-statin cholesterol lowering drugs were also 4-fold more likely to experience short term memory loss within the first 30 days than non-users.
  • As you might expect there was no significant difference in memory loss between users of the statin and non-statin cholesterol lowering drugs.

How Were The Results Interpreted?

The results seemed to be pretty clear cut, but it was a somewhat misleading interpretation of the results that was widely publicized. The authors of the article correctly pointed out that there are two possible interpretations of these results. Either…

  • All cholesterol lowering drugs cause acute memory loss….or
  • The association of memory loss with cholesterol lowering drugs is the result of something called “detection bias”.

Let me explain. Some memory loss is fairly common for people in their 60s and beyond. The term “detection bias” simply means that the patients might have been more acutely aware of memory loss because they were monitoring themselves for side effects to the drug they just started taking.

Of course, the medical profession is so confident in the benefits of statins that they focused on the second interpretation, and that is the one that you heard about in all of the press releases about this study. If you believe that the self-reported memory loss in this study was entirely due to detection bias, then the most logical interpretation of the study is that statin drugs really don’t cause memory loss.

However, I consider the first interpretation to be the most likely of the two. If use of cholesterol lowering drugs were associated with a 25% or 50% increase in memory loss, detection bias could have been a credible interpretation of the data. However, a 4-fold increase in memory loss is hard to ascribe to detection bias alone.

Furthermore, the first explanation is fully consistent with what we know about myelin. Because of the importance of cholesterol in maintaining the integrity of the myelin sheath, it is logical that any drug that dramatically lowers cholesterol levels could have an adverse effect on cognitive function.

Are There Other Options Besides Statin Drugs?

Because of the marginal benefits in healthy people and the multiple side effects, some experts are starting to step up and say that statins may be overprescribed. For example, Dr. Roger Blumenthal, MD, a professor and director of the Ciccarone Preventive Cardiology Center at Johns Hopkins recently said: “Statin therapy should not be approached like diet and exercise as a broadly based solution for preventing coronary heart disease. These are lifelong medications with potential, although rare, side effects, and physicians should only consider their use for those patients at greatest risk…”

So, what are the alternatives?

#1: Lower Cholesterol Naturally With Some TLC

healthy livingsThe National Heart Lung & Blood Institute recommends that something called Therapeutic Lifestyle Change or TLC should always be tried first for patients with elevated cholesterol, and that statins only be used if the lifestyle approach fails – a message that seems to have gotten lost in the translation in many doctor’s offices. The TLC recommendations are:

  • Add 2 grams per day of plant stanols and sterols to your diet. In most cases some that will require some degree of supplementation.
  • Eat less than 7 percent of your daily calories from saturated fat
  • Eat less than 200 mg a day of cholesterol
  • Make sure that you get 10-25 grams per day of soluble fiber.
  • Get only 25–35 percent of daily calories from total fat (this includes saturated fat calories)
  • Consume only enough calories to reach or maintain a healthy weight
  • In addition, you should get at least 30 minutes of a moderate intensity physical activity, such as brisk walking, on most, and preferably all, days of the week.

There is ample evidence that implementation of these lifestyle changes will reduce cholesterol levels and reduce the risk of heart attack and stroke without any side effects. The reduction in cholesterol levels is more modest than what can be achieved with cholesterol lowering medications, but perhaps that is the point. Perhaps the medical profession is being too aggressive in reducing cholesterol levels with drug therapy.

If you are a bit overwhelmed by the TLC recommendations, there is good news. Even one or two of the lifestyle changes mentioned above can substantially reduce your risk of heart attack or stroke. For example, in a previous “Health Tips From the Professor,” apple a day keeps statins away, I reported on a study claiming that simply eating one apple a day would be just as effective as statins at reducing cardiovascular deaths.

#2: Reduce Other Risk Factors Associated with Heart Disease

Elevated cholesterol is not the only risk factor associated with heart disease. In fact, many experts feel that it isn’t even the most important risk factor. High blood pressure, high triglycerides, inflammation and damage to the endothelial lining of our arteries are other important risk factors for heart disease. If you are leery about using statins to reduce your cholesterol levels, you might want to explore other natural approaches to reducing heart disease risk. For example:

  • Nitrate from foods such as beetroot and spinach reduce blood pressure and improve endothelial health. This is also a topic I have covered in a previous “Health Tips From the Professor” Nitric Oxide Benefits Side Effects.
  • Resveratrol and related polyphenols reduce inflammation and improve endothelial health.

I could go on, but you get the point. There are other natural approaches for reducing heart attack risk. Statins and other cholesterol lowering drugs are not the only game in town.

     Red Yeast Rice Yeast Rice Side Effects?

red yeast rice side effectsHowever, just because a supplement is natural doesn’t necessarily mean that it is either safe or effective. Red yeast rice is a perfect example. Many people think of red yeast rice as a natural way to reduce cholesterol levels. They believe red yeast rice side effects are non-existent. Nothing could be further from the truth!

The active ingredients in red yeast rice are a class of compounds called monacolins, which are close analogs of the statin drugs. In fact, the most abundant monacolin, monacolin K, is identical to the statin drug lovastatin.

That destroys one myth. If a red yeast rice product contains as much monacolin K as a lovastatin pill, it would have the same benefits and the same side effects.

It only gets worse! In fact, you have no way of knowing how much monacolin K is in your red yeast rice supplement. Because lovastatin is a drug the manufacturers are caught in a Catch-22 situation. If the manufacturers were to actually standardize or disclose the levels of monacolin K in their product, the FDA would consider it an unapproved drug.

When manufacturers don’t standardize their active ingredients bad things happen. How bad, you might ask? A recent study analyzed the concentration of active ingredients in 12 commercially available red yeast rice supplements (R. Y. Gordon et al, Archives of Internal Medicine, 170: 1722-1727, 2015). The results were appalling:

  • Total monacolins in the supplements ranged from 0.31 to 11.15 mg/capsule.
  • Monacolin K (lovastatin) ranged from 0.10 to 10.09 mg/capsule.
  • To put that into perspective therapeutic doses of lovastatin range from 10 to 80 mg/day.

It gets even worse! The study also measured levels of a toxin called citrinin that is produced by a fungus and is potentially toxic to the kidneys. This is not a toxin that you would find in a pharmaceutical product like lovastatin, but it was present in high levels in one third of the red yeast rice formulations tested.

To sum it all up, if you were to go out and purchase a red yeast rice supplement.

  • You might get a batch with no active ingredients. It wouldn’t have any of the side effects of a statin drug, but it wouldn’t have any efficacy either.
  • You might get a batch that would have the same efficacy and the same side effects as a low dose statin drug.
  • You would have a 33% chance of getting a batch that was contaminated with a toxin that you would never find in a statin drug.

I don’t know about you, but after reading that study I have no desire to ever try a red yeast rice supplement.

Do statins cause memory loss?

 

 

The Bottom Line

  • For people who have already had a heart attack statin drugs are clearly beneficial. They save lives.
  • If you haven’t already had a heart attack and your doctor prescribes a statin, you may want to have a serious discussion with your doctor about alternative approaches for reducing heart attack risk. You may even want to seek a second opinion from a doctor with a more holistic orientation. Recent research suggests that statin drugs:
  • Are of marginal efficacy in low to moderate risk individuals who have not suffered a heart attack.
  • Can cause muscle pain and weakness, which can lead to serious illness in a small percentage of the cases.
  • May increase the risk of developing type 2 diabetes by up to 46%.
  • May cause memory loss and mental confusion.
  • A recent study showed that both statin and non-statin cholesterol lowering drugs caused 4-fold greater short term memory loss in older adults compared to matched patients who were not taking statin medications.
  • The medical profession has chosen to interpret this study as showing that statin drugs don’t cause short term memory loss, and that is the interpretation that has been widely reported in the press. I feel that the more logical interpretation of the data is that both statin and non-statin cholesterol lowering drugs cause short term memory loss.
  • Fortunately, there are natural approaches for reducing cholesterol levels and heart disease risk without any side effects. For example, the National Heart Lung and Blood Institute recommends a natural approach called Therapeutic Lifestyle Change or TLC .
  • There are also natural approaches for reducing other risk factors for heart disease such as high blood pressure, high triglycerides, and inflammation. These include things like omega-3 fatty acids, nitrate from vegetables like beetroots and spinach, and polyphenols like resveratrol just to name a few.
  • However, natural is not always better. Red yeast rice, for example, is neither safe nor effective. For more details, read the article above.

 

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

Are All Calories Created Equal?

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Are Food Choices More Important Than Calories?Author: Dr. Stephen Chaney

 

Most adult Americans gain a pound or two each year. That may not sound like much on a yearly basis, but over a lifetime it is huge – if you’ll pardon the pun.

are all calories created equalBecause the health consequences of weight gain are so devastating, everyone has their favorite dietary advice for keeping those extra pounds away. For some it is diet plans – low fat, low carb, paleo, Mediterranean – you name it. For others it is counting calories or avoiding sugars of all kinds. The list goes on. Are all calories created equal?

But what if all of these approaches were wrong? What if we could keep our weight under control solely based on the foods we eat? A recent study seemed to suggest that we just might.

How Was The Study Designed?

A group of scientists from Tufts University and Harvard decided to look at how the food choices we make on a daily basis influence our weight gain or loss over time (Smith et al, AJCN 101: 1216-1224, 2015). However, they designed their study in a very unique way, and it is important that I explain the study design so that you can understand the strengths and limitations of the study.

Most studies of this kind look at what foods people are eating and compare that to how much they weigh. These scientists looked at changes that people made in their diets and correlated that with how much weight they gained or lost over time.

When you think of it, that’s the information most of us really want to know. We are less interested in why the foods we used to eat got us into trouble in the first place than we are in how the changes we make in our diet might influence future weight loss or gain.

This study combined the data from three very large, long term studies – the Nurses’ Health Study, the Nurses’ Health Study II, and the Health Professionals Follow-Up Study. Altogether that is a group of 120,784 men and women who were followed for 16-24 years. All three of these studies measured weight and evaluated dietary habits using food-frequency questionnaires every 4 years.

The scientists conducting the study measured changes in food choices and changes in weight for each individual in 4-year increment over the total time duration of the studies. In analyzing the data, they looked at choices of protein foods, total carbohydrate, and the glycemic load (GL) of the carbohydrates.

Glycemic load is the glycemic index (effect on blood sugar) of the carbohydrates in a particular food times the total amount of carbohydrate in that food. You can think of glycemic load as a measure of carbohydrate quality. For example, white bread, pastries, muffins, pancakes, white rice, chocolates, candy bars, cookies, brownies, cakes, pies, and pretzels would all be examples of foods with a high glycemic load. Fruits, whole grain foods and starchy vegetables would be examples of foods with a moderate glycemic load. Vegetables and beans would be examples of foods that generally have a low glycemic load.

The authors of the study did not measure calories or fat intake for this study, but those factors are indirectly included in food choices – more about that later.

Are All Calories Created Equal?

Now let’s get to the good stuff – the results of this study. When the authors analyzed the data they found that:

  • Most of the subjects did not exchange one protein food for another over the course of the study. They exchanged protein foods for carbohydrate-rich foods and vice versa.

This was a surprise. Since many experts have been recommending that people substitute chicken and fish for red meat, they had expected to see that kind of dietary shift when they analyzed the data. Apparently, people have not been listening to the experts!

  • high carbohydratesWhen the subjects replaced a serving of carbohydrate-rich foods with a serving of red meats, processed meats, chicken with skin or most cheeses they gained between 0.5 to 2.3 pounds per year. Within this category the greatest weight gain was seen when hamburgers were substituted for carbohydrates, and the least weight gain was seen when cheese was substituted for carbohydrates.
  • When the subjects replaced a serving of carbohydrate-rich foods with a serving of milk, peanuts or eggs there was no net change in weight. These appear to be substitutions that are good for weight maintenance.
  • When the subjects replaced a serving of carbohydrate-rich foods with a serving of yoghurt, peanut butter, beans, walnuts, other nuts, chicken without skin, low-fat cheese or seafood they lost between 0.5 and 1.5 pounds/year. Within this category the greatest weight loss was seen when plain yoghurt was substituted for carbohydrates, and the least weight loss was seen when low-fat cheese was substituted for carbohydrates.
  • When they focused on carbohydrate-rich foods, replacing one serving of high glycemic load foods with low glycemic load foods was associated with one pound of weight loss per year. Simply put, if you switch from cookies, pastries and candies to fruits and vegetables, you are likely to lose weight. No surprise here.

The study really got interesting when they looked at the effect of adding different proteins in the context of the carbohydrate-rich foods that the subjects were eating. For example,

  • When the subjects added a serving of red meat to a diet containing carbohydrate foods with a high glycemic load, they gained an average of 2.5 pounds per year. When they added that same serving of red meat to a diet containing carbohydrate foods with a low glycemic index, they gained only around 1.5 pounds per year.

Simply put, that means eating a hamburger on a white flour bun with fries is going to pack on more pounds than a hamburger patty with brown rice and a green salad.

  • The effect of glycemic load was particularly interesting when you looked at the protein foods that were good for weight maintenance overall. For example, adding a serving of eggs to a high glycemic load diet resulted in a 0.6 pound/year weight gain, while adding that same serving of eggs to a low glycemic load diet resulted in a 1.75 pound/year weight loss. The results were similar for cheeses.
  • Finally, glycemic load also influenced the effectiveness of protein foods associated with weight loss. For example, addition of a serving of beans to a high glycemic load diet resulted in 0.5 pound/year weight gain loss, but adding a serving of beans to a low glycemic load diet resulted in a 1.5 pound/year weight loss.

New Insights From This Study

good proteinThis study broke new ground in several areas. For example,

  • We have heard over and over that substituting beans, chicken and fish for red meats is healthier. This is the first study I have heard of that says those same substitutions can prevent or reverse weight gain.
  • Many people advocate a high protein diet for weight control or weight loss, but many of them will tell you the type of protein doesn’t matter. This study suggests that the type of protein foods we eat are important in determining whether we lose or gain weight.
  • Everyone knows that switching from white grains, pastries and candy to whole grains, fruits and vegetables will help you lose weight, but this is the first study I’m aware of that suggests those same changes will influence whether the protein foods we eat lead to weight gain or weight loss.
  • Many people focus on fats and calories when trying to avoid weight gain. While this study is not really fat and calorie neutral (see below), it does suggest that if we focus on eating healthy foods we don’t need to be counting every fat gram and every calorie.
  • Finally, this study suggests that if we forget all of those crazy diets and focus on eating healthy foods, our weight will take care of itself. Not exactly a novel concept, but one worth repeating.

Limitations of the Study

The head author of this study stated in an interview “The idea that the human body is just a bucket for calories is too simplistic. It’s not just a matter of thinking about calories or fat. What’s the quality of the foods we are eating? And how do we define quality.” This has been picked up by the media with statements like “not all calories are created equal”.

That is a bit of a hyperbole, because this study is not really fat and calorie neutral. The protein foods (red and processed meats) that pack on the most calories are higher in fat and calories per serving than those protein foods (skinless chicken, fish and beans) that cause the least weight gain. Similarly, the carbohydrate foods with the highest glycemic load (pastries, cakes and candy) are higher in fat and calories per serving than those carbohydrate foods with the lowest glycemic load (fruits and vegetables).

The real message is not that fat content and calories don’t count. Nor is it that calories in some foods count more than the same calories in other foods. The take home lesson from this study should be that we don’t have to focus on fat and calories. If we focus on healthy foods, the fat and calories tend to take care of themselves.

But, even that message is a bit too simplistic. Choosing healthy foods is not all that there is for weight control. We also need consider:

  • Portion sizes. Half a chicken could easily add more calories than a small hamburger.
  • How the food is cooked. Fish cooked in a cream sauce may not be any better for weight control than a slab of red meat.
  • Exercise. We need to maintain muscle mass to keep metabolic rate high.

 

The Bottom Line

  • A recent study has broken new ground and provided some new insights into how to prevent those extra pounds from sneaking up on us over time. This study evaluated how some simple changes we could make in the foods we eat can influence whether we gain or lose weight.
  • One part of the study looked at the effects of replacing a serving of carbohydrate rich foods with a serving of protein rich foods. If that protein rich food were a hamburger, we could expect to gain about 2.3 pounds/year. If that protein rich food were seafood, we could expect to lose about 1.5 pounds/year. Other protein foods fall in between those extremes. The specifics are covered above.

This a new insight. Many people advocate a high protein diet for weight control or weight loss, but many of them will tell you the type of protein doesn’t matter. So, are all calories created equal?  This study suggests that the type of protein foods we eat are important in determining whether we lose or gain weight.

  • Another part of the study looked at the effect of different carbohydrate foods based on their glycemic load (the effect they have on blood sugar). Simply replacing 1 serving of high glycemic load foods (refined grain foods, cookies, cakes, candy) with low glycemic load foods (whole grains, fruits and vegetables) was associated with a one pound/year weight loss. This should surprise no one.
  • Finally, one part of the study looked at the influence of glycemic load on the effect that various proteins have on weight gain or loss. For example, adding a serving of eggs to a high glycemic load diet resulted in a 0.6 pound/year weight gain, while adding that same serving of eggs to a low glycemic load diet resulted in a 1.75 pound/year weight loss. Other examples are given above.

This is also a new insight. Everyone knows that switching from white grains, pastries and candy to whole grains, fruits and vegetables will help you lose weight, but this is the first study I’m aware of that suggests those same changes will influence whether the protein foods we eat lead to weight gain or weight loss.

  • Some in the media have interpreted this study as saying that fat and calories don’t count. However, this study was not really fat and calorie neutral. The protein and carbohydrate rich foods that packed on the most calories were also the foods highest in fat and calories. The real take home message from this study is that we may not need to focus so much on fat and calories. When we focus on eating healthy foods the fat and calories tend to take care of themselves.
  • Even that message is a bit too simplistic. It is not enough to just focus on healthy foods. We need to consider things like portion size, how the food is prepared, and our exercise habits among other things.

 

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.

Health Tips From The Professor