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7 Easy Ways To Spot Fad Diets

December 30, 2014 by Dr. Steve Chaney

If It Sounds Too Good To Be True…

Author: Dr. Stephen Chaney

I think it was P. T. Barnum who said “There’s a Sucker Born Every Minute”. That’s particularly true in the diet world where hucksters seem to be all around us – especially this time of year.

You’ve seen the weight loss ads touting:

Pills or powders that suppress your appetite or magically prevent you from absorbing calories.

Fat burners that melt the pounds away.
New discoveries (juices, beans, foods) that make weight loss effortless.
The one simple thing you can do that will finally banish those extra pounds forever.

You already know that most of those ads can’t be true. You don’t want to be a sucker. But, the ads are so compelling:

Many of them quote “scientific studies” to “prove” that their product or program works.

Their testimonials feature people just like you getting fantastic results from their program. [You can do wonders with “computer enhanced” photographs.]
Many of those products are endorsed by well known doctors on their TV shows or blogs. [It is amazing what money can buy.]

So it is easy to ask yourself: “Could it be true?” “Could this work for me?”

Fortunately, the Federal Trade Commission (FTC) has stepped up to the plate to give you some guidance. Just in time for weight loss season, they have issued a list of seven claims that are in fact too good to be true. If you hear any of these claims, you should immediately recognize it as a fad diet and avoid it.

7 Easy Ways To Spot Fad Diets

Here are the seven statements in ads that the FTC considers as “red flags” for fad diets that should be avoided:

Causes weight loss of two pounds or more a week for a month or more without changing your diet and exercise routine.

Causes substantial weight loss no matter what or how much you eat.

Causes permanent weight loss without lifestyle change even after you stop using the product.

Blocks absorption of fat or calories to enable you to lose substantial weight.

Safely enables you to lose more than 3 pounds per week for more than 4 weeks.

Causes substantial weight loss for all users

Causes substantial weight loss by wearing a product on your body or rubbing it on your skin.

I’m sure you have heard some of these claims before. You may have actually been tempted to try the products or program. You should know that the FTC said that it considers these to be “Gut Check” claims that simply can’t be true.

The Bottom Line

There are no magical pills or potions that will make the pounds melt away. You need to change your diet, change your activity level and make significant lifestyle changes if you want to achieve long term weight control.

For more science-based health tips visit https://www.chaneyhealth.com/healthtips

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 Diets Work?

December 16, 2014 by Dr. Steve Chaney

Obesity in America?

Author: Dr. Stephen Chaney

If you are like most Americans, you are either overweight yourself or have close friends and family who are overweight. That’s because 69% of Americans are currently overweight, and 36% of us are obese. Worldwide the latest estimates are that 1.5 billion adults are overweight or obese.

A new report, How The World Could Better Fight Obesity, estimates that obesity is a $2 trillion drain on the world’s economy. That is equivalent to the global cost of war & terrorism and of smoking – and is double the global costs of alcoholism and global warming!

If you are like most Americans you have tried a number of diets over the years. All of them promised that they had the “secret” to permanent weight loss. You lost some weight initially, but here you are a few years later weighing as much as ever.

You are probably beginning to wonder whether any diets work long term. According to the latest study, the answer may just be “no”.

Really, Do Diets Work?

This study (Atallah et al, Circulation Cardiovascular Quality and Outcomes, 7: 815-827, 2014) was a systemmatic review of all of the randomized controlled studies of the four most popular diet plans – Weight Watchers, Akins, Zone and South Beach.

In case, you are unfamiliar with these diets, here is their philosophy:

Weight watchers is a food, physical activity and behavior modification plan that utilizes a point system to control calorie intake and features weekly group sessions.
Atkins is based on very low carbohydrate intake, with unlimited fat and protein consumption.
South Beach is relatively low carbohydrate, high protein diet that focuses on low-glycemic index carbohydrates, lean proteins, and mono- and polyunsaturated fats.
Zone is a low carbohydrate diet that focuses on low-glycemic load carbohydrates, low-fat proteins and small amounts of good fats.

The investigators restricted their analysis to studies that were greater than 4 weeks in duration and either compared the diets to “usual care” or to each other. (The term usual care was not defined, but most likely refers to a physician giving the advice to eat less and exercise more).

Twenty six studies met their inclusion criteria. Fourteen of those studies were short-term (< 12 months) and 12 were long-term (>12 months). Of the long-term studies, 10 compared individual diet plans to usual care and 2 were head-to-head comparisons between the diet plans (1 of Atkins vs Weight Watchers vs Zone and 1 of Weight Watchers vs Zone vs control). The majority of participants in these studies were young, white, obese women. Their average age was 45 years and their average weight at the beginning of the studies was 200 pounds.

What Did This Study Show?

If you have struggled with your weight in the past, you probably won’t be surprised by the result of the study.

Short-term weight loss was similar for Atkins, Weight Watchers and Zone in the two head-to-head studies.
At 12 months, the 10 studies comparing individual diets to usual care (physician’s advice to eat less and exercise more) showed that only Weight Watchers was slightly more effective than usual care (physician’s advice to lose weight). The average weight loss at 12 months was 10 pounds for Weight Watchers and 7 pounds for usual care. That is a 3 pound difference for all of the additional effort and expense of Weight Watchers!
When they looked at the two head-to-head studies at 12 months, there was no significant differences between the diets. Average weight loss in these studies was 7 pounds for Weight Watchers, 7 pounds for Atkins, 5 pounds for Zone and 5 pounds for usual care. There was only one study comparing the South Beach diets with usual care. It was a study comparing the results with severely obese patients following gastric bypass surgery, and it also found no difference between the diet program and usual care. Based on hype about these diets, you were probably expecting more than a 5 to 7 pound weight loss 12 months later!
By 24 months 30-40% of the weight had been regained for the Atkins and Weight Watchers diets, which was comparable to the results for patients who were just told to eat less and exercise more. Not only was the weight loss modest, it also did not appear to be permanent.
Finally, many of the studies included in this review also looked at improvement in other health parameters such as HDL cholesterol levels, LDL cholesterol levels, triglycerides, blood pressure and blood sugar control. The Atkins diet gave slightly better results with HDL levels, triglyceride levels and blood pressure in the short-term studies, but there was no significant differences for any of these parameters in the long-term head-to-head studies. None of the diets were any healthier than the others.

The investigators concluded: “Our results suggest that all 4 diets are modestly efficacious for short-term weight loss, but that these benefits are not sustained long-term.

A similar study in 2005 compared the Weight Watchers, Jenny Craig and LA Weight Loss diets (Tsai et al, Annals of Internal Medicine, 142: 56-66, 2005) and concluded “…the evidence to support the use of major commercial and self-help weight loss programs is suboptimal”.

A Weight Loss Diet That Actually Works?

My personal recommendation for the initial weight loss is a high protein diet – one that provides about 30% of calories from healthy protein and moderate amounts of healthy carbohydrates and healthy fats. The protein should be high enough quality so that it provides 10-12 gram of the essential amino acid leucine because leucine specifically stimulates muscle growth. The combination of high protein and leucine preserves muscle mass while you are losing weight. That is important because it keeps your metabolic rate high without dangerous herbs or stimulants.

However, the high protein, high leucine diet is still just a diet. It is an excellent choice for the initial weight loss, but what about long-term weight control?

The authors of this study said: “Comprehensive lifestyle interventions aimed at curbing both adult and childhood obesity are urgently needed. Interventions that include dietary, behavioral and exercise components…may be better suited to [solve] the obesity epidemic.” I agree.

The Bottom Line:

Your suspicions are correct. Diets don’t work!

A recent systematic review of 26 randomized controlled clinical trials of the Weight Watchers, Atkins, Zone & South Beach diets compared to the usual standard of care (recommendations to eat less and exercise more) concluded:

1) Contrary to what the advertisements promise, after 12 months all four diets gave comparable and very modest (5-7 pounds) total weight loss. The results with the diets were not significantly different than for patients who were simply told to eat less and exercise more.

2) By 24 months 30-40% of the weight had already been regained.

3) A previous systematic review of the Weight Watchers, Jenny Craig, and LA Weight Loss diet programs came to a similar conclusion.

4) My personal recommendation for the initial weight loss is a diet that is high in protein and the amino acid leucine because that type of diet preserves muscle mass.

5) For permanent weight control the authors of the recent systematic review recommended comprehensive lifestyle interventions that include permanent changes in diet, behavior and exercise. I agree. Diets never work long term – lifestyle change does!

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.

Can Antioxidant Supplements Cause Cancer?

December 2, 2014 by Dr. Steve Chaney

The Truth About Vitamins C & E

Author: Dr. Stephen Chaney

I am always amazed at how certain nutrition myths take on a life of their own. A single study gets sensationalized. The study may not be very good, but some nutrition guru publicizes it even though it may be contradicted by other studies that come to the opposite conclusion.

Other blogs and news feeds pick it up. It gets repeated over and over until it becomes generally accepted as true. It becomes what I call an “urban nutrition myth”. Once these myths become well established they are hard to correct. When contrary information is published, it is ignored because everyone already knows the “truth”.

Can Antioxidant Supplements Cause Cancer?

The risks of antioxidant supplements are a perfect example. Most web sites and health experts warn that you should be careful about using antioxidant supplements. You are told that they may just increase your risk of cancer. They may just kill you!

The antioxidant vitamins C and E have generated the most scrutiny in recent years. There were a number of reasons to suspect that they might decrease cancer risk:

1) They destroy free radicals.
2) They decrease cancer risk in animal studies.
3) Increase consumption of vitamins C & E is associated with decreased risk of cancer in human population studies.

Because there was so much circumstantial evidence that vitamins C & E might decrease cancer risk, there have been a number of double-blind, placebo controlled human clinical trials to test that hypothesis.

• 6 clinical studies showed no effect of vitamin C and/or E on cancer incidence.
• 1 study suggested that vitamin E might decrease prostate cancer risk, and another study suggested that vitamin E might decrease colon cancer risk.
• 1 study (Kristal et al, Journal of the National Cancer Institute, doi: 10.1093/jnci/djt456, 2014) suggested that vitamin E alone might increase prostate cancer risk, but when vitamin E was combined with selenium there was no increased risk. I have discussed a likely explanation of those confusing results in a previous “Health Tips From the Professor” (https://www.chaneyhealth.com/healthtips/selenium-vitamin-e-increase-prostate-cancer-risk/).

That’s it. Six clinical studies show no effect of vitamins C & E on cancer risk, two studies suggest that vitamin E decreases cancer risk and one study suggests that vitamin E increases cancer risk. Yet all the “experts” are warning that antioxidant supplements might increase your cancer risk. It has become an urban nutrition myth.

You may remember that I said that the final characteristic of an urban nutrition myth is that when contrary information is published, it is ignored. In fact, an excellent study showing no effect of vitamins C and E on cancer risk has just been published – and it is being ignored because it doesn’t fit the “truth” that most experts have come to believe.

What Does the Latest Study Show?

The study in question (Wang et al, American Journal of Clinical Nutrition, 2014; doi: 10.3945/ajcn.114.085480) was a post-trial follow-up to the Physicians’ Health Study II. It followed 14,641 US male physicians (average age 64 at the beginning of the trial) for 10.3 years. The subjects were randomly assigned to receive 400 IU of vitamin E every other day, 500 mg of vitamin C daily, or their respective placebos.

The investigators in charge of the study recognized that cancer takes many years to develop and that the effects of supplementation might not be recognized until years later. Because of that, the subjects were followed for an additional 2.8 years after the close of the trial to allow additional time for cancers to develop.

The results were clear cut:

• Vitamin E supplementation had no effect on the incidence of prostate cancer or total cancers.
• Vitamin C supplementation also had no effect on the incidence of prostate cancer or total cancers.
• Vitamin C supplementation decreased the incidence of colon cancer during the post-trial period by 46%, which was marginally significant.

The Bottom Line:

1) Can antioxidant supplements cause cancer? You can ignore the dire warnings that antioxidant supplements may increase your risk of cancer. The only case where this appears to be true is for high dose beta-carotene supplements in smokers. The weight of evidence for vitamins C and E suggests that they are unlikely to increase your risk of cancer.

2) As I have said previously if there is any risk of antioxidant supplements, it is most likely to arise from using high purity individual antioxidant supplements. I recommend vitamin E supplements containing the full spectrum of tocopherols and tocotrienols, carotenoid supplements containing all the naturally occurring carotenoids, and supplements that combine complementary antioxidant nutrients – vitamin E and selenium, for example.

3) That doesn’t mean that you should run out and stock up on antioxidant supplements in the hope that they will prevent cancer. The same clinical studies that showed no harm from vitamin C and E supplementation also showed no consistent benefit.

4) This is also consistent with my comments in previous “Health Tips from the Professor”. For example:

• It is very difficult to prove, and unreasonable to expect, that supplementation will have a measurable effect on risk of a particular disease like cancer for everyone. People who are healthy and have very low risk of cancer, may experience other benefits from supplementation but are unlikely to experience a measurable decrease in cancer risk.

• Supplementation is most likely to be advantageous in select populations, generally populations with increased need for a particular nutrient or at highest risk of disease. It is clinical studies looking at the effect of supplementation in these select populations that often show the greatest benefit of supplementation.

• Supplementation is just one component of a holistic approach for reducing disease risk. Diet, weight control, exercise, adequate rest and stress reduction all play a major role as well. You can’t weigh 250 pounds and eat all your meals at McDonalds and expect supplementation to save you from disease.

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 Soda One of The Causes of Arthritis?

November 4, 2014 by Dr. Steve Chaney

Author: Dr. Stephen Chaney

Recently, I came across an article which claimed an association between soda and arthritis. So, is soda one of the causes of arthritis? In previous health tips from the professor I have shared that soda consumption can cause weight gain and heart disease . As if that weren’t reason enough to avoid sodas, recent headlines suggest that sodas can also cause rheumatoid arthritis. That is a pretty strong claim, so let’s look at the study behind those headlines.

Do Sodas Cause Arthritis?

This study (Hu et al., American Journal of Clinical Nutrition, 100: 959-967, 2014) followed 79, 570 women enrolled in the first Nurse’s Health Study (NHS) and 107,330 women enrolled in the second Nurse’s Health Study (NHS II) – that’s a total of 186,900 women – for at least 20 years. The women were aged 25-55 at the beginning of the studies and 857 of them developed rheumatoid arthritis over the next 20+ years.

All of the participants in the study filled out a questionnaire covering medical history, lifestyle and chronic disease at entry into the study and every two years afterwards. Compliance to this protocol was >90%, which is excellent for this type of study. The results were pretty impressive:

· Women who consumed ≥ 1 serving of sugar sweetened soda/day had a 63% higher risk of developing rheumatoid arthritis compared to women who consumed no sugar sweetened soda or consumed < 1 serving/month.

· The association between sugar-sweetened soda consumption and rheumatoid arthritis was much stronger for late-onset rheumatoid arthritis than it was for early-onset rheumatoid arthritis. When the authors restricted their analysis to women who developed rheumatoid arthritis after age 50, consumption of sugar sweetened sodas was associated with a 2.64-fold higher risk of developing rheumatoid arthritis (That’s a 264% increase).

· The type of sugar did not appear to matter. Sodas sweetened with sucrose and high-fructose corn syrup were equally likely to increase the risk of rheumatoid arthritis.

· There was no association between diet soda consumption and rheumatoid arthritis.

What Are The Strengths and Weaknesses Of The Study?

Strengths of The Study: The strengths of the study are fairly obvious.

This was a very large study and the effects (64%) and (264%) were also large. Those aren’t trivial differences. The size of the study and the magnitude of the effects bolster confidence in the outcome of the study.

Weaknesses of The Study:

This type of study measures associations. It doesn’t prove cause and effect. Therefore, the headlines saying “Soda Consumption is Associated With Arthritis” are more accurate than those saying “Sodas May Cause Arthritis”.

In studies of this kind we can never be sure whether the variable that was measured (soda consumption in this case) was responsible for the outcome or whether it was some other variable that wasn’t measured that was responsible for the outcome. In particular, the women who developed rheumatoid arthritis were also more likely to:

· Have lower incomes.
· Exercise less.
· Have higher energy (calorie) intake.
· Have poorer diets.
· Take fewer multivitamins and other supplements.

The authors tried their best to compensate for these differences statistically, and the fact that the very large effects of soda consumption on rheumatoid arthritis occurrence were not significantly affected when these differences were taken into account adds confidence to their conclusions. However, it is never possible to exclude the possibility that some other variable they did not measure was responsible for the increase in rheumatoid arthritis.

Are Diet Sodas Off the Hook? Or,could They Be One of The Causes of Arthritis?

Could diet sodas be one of the causes of arthritis? This study showed no association between diet soda consumption and rheumatoid arthritis. Previous studies have suggested that diet sodas don’t increase the risk of heart disease to the same extent as sugar-sweetened sodas. Does that mean that you should just start drinking diet sodas rather than sugar sweetened sodas?

The answer is probably not. As I have pointed out in an earlier issue of “Health Tips From the Professor” , and has been confirmed by a recent meta-analysis of 24 clinical studies (Miller and Perez, American Journal of Clinical Nutrition, 100: 765-777, 2014), double blind studies in which all other caloric intake is carefully controlled generally show that people tend to gain slightly less weight when consuming diet sodas than when consuming sugar sweetened sodas.

But in the real world, people consuming diet sodas are just as likely to be overweight as people consuming sugar sweetened sodas. People seem to compensate for the calories saved with diet sodas by consuming more Big Macs, Mrs. Fields cookies and extra large Stabucks Lattes. In the real world, water is the only non-caloric beverage that is actually associated with lower weight.

Is It Enough To Just Stop Drinking Sodas?

I have often paraphrased that famous line from Western movies: “Just put down that soda and back away, and nobody gets hurt”. But is it that simple? Can you prevent rheumatoid arthritis just by drinking less soda?

Once again, the answer is probably no. There are a number of factors that can increase your risk of developing rheumatoid arthritis. Experts will tell you that the causes of rheumatoid arthritis are largely unknown, but that genetic predisposition, smoking and excessive alcohol use can increase your risk.

However, because rheumatoid arthritis is an inflammatory disease I would add overweight; diets high in animal protein, saturated fats, trans fats and sugar; food allergies; gut health issues; stress & exhaustion and chronic infections – and lack of fresh fruits and vegetables, omega-3 fatty acids and regular exercise.

The clinical study I described above found that soda consumption was much more strongly associated with late onset rheumatoid arthritis than early onset rheumatoid arthritis. Based on those data I would speculate that early onset rheumatoid arthritis may be more strongly influenced by genetics and other lifestyle factors, whereas late onset rheumatoid arthritis may be more strongly influenced by sugar sweetened sodas and other sugary foods. Only time will tell if my hypothesis is true.

Is soda one of the causes of arthritis?

The Bottom Line:

1) A recent study reported that women who consume ≥ 1 serving of sugar sweetened soda/day have a 63% higher risk of developing rheumatoid arthritis compared to women who consume no sugar sweetened soda or consume < 1 serving/month.

2) The association between sugar-sweetened soda consumption and rheumatoid arthritis is much stronger for late-onset rheumatoid arthritis than for early-onset rheumatoid arthritis. For women who first develop rheumatoid arthritis after the age of 50, consumption of sugar sweetened sodas is associated with a 2.64-fold higher risk of developing rheumatoid arthritis (That’s a 264% increase).

3) The type of sugar does not appear to matter. Sodas sweetened with sucrose and high-fructose corn syrup are equally likely to increase the risk of rheumatoid arthritis.

4) There was no association between diet soda consumption and rheumatoid arthritis. However, this does not mean that diet sodas are a good thing. Consumption of diet sodas is just as likely to be associated with obesity as is consumption of sugar sweetened sodas, and some recent studies suggest that consumption of diet sodas is associated with high blood pressure.

5) This was a very large and well done study, but it only measures associations, not cause and effect. Further studies will be needed to confirm this observation. However, we already know that sodas are bad for us. This may be just one more reason to minimize our consumption of sodas.

6) We shouldn’t assume that we can prevent rheumatoid arthritis by simply cutting sodas out of our diet. Arthritis has multiple causes (see article above). We should aim for a healthier overall lifestyle if we wish to reduce our risk of developing rheumatoid arthritis and other diseases.

7) Osteoarthritis is much more common than rheumatoid arthritis. This study did not include women with osteoarthritis, so it is uncertain whether these results will apply to osteoarthritis as well.

8) Men are much less likely to develop rheumatoid arthritis than women, so it will be difficult to do a comparable study in men. However, it is likely that the same association between soda consumption and rheumatoid arthritis would be seen in men as well.

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 There Health Benefits of Beetroot Juice for Athletes?

October 28, 2014 by Dr. Steve Chaney

Should You Add Beetroot Juice To Your Training Diet?

Author: Dr. Stephen Chaney

When I saw the headline “Beetroot Juice May Boost Aerobic Fitness For Swimmers” I did a double take. Could something as simple as eating more beets actually improve exercise performance? Are there real health benefits of beetroot juice for athletes? So I looked up recent papers on the topic. But, before I review those I should give you a little science behind the idea that beetroot juice might affect performance.

The Science Behind Beetroot Juice And Exercise

Nitric oxide is a colorless, odorless gas that serves as an important signaling molecule in the human body. Among its many beneficial effects is increased blood flow to muscle. This increased blood flow appears to be preferentially distributed to the type 2 muscle fibers which support moderate to high intensity exercise. Thus, nutrients that enhance nitric oxide levels might be expected to improve moderate to high intensity exercise.

There are two naturally occurring pathways for producing nitric oxide in the body. The first pathway utilizes arginine, an amino acid found in dietary protein. The second pathway utilizes nitrates, which are found in fruits and vegetables. The best dietary sources of nitrates are beetroot, spinach and other leafy green vegetables.

Arginine has been widely used in sports supplements for some time to enhance performance. However, clinical studies on arginine have been mixed, with some showing small enhancements in performance and others showing no significant effect. Most experts now think that the benefits of arginine are primarily seen with untrained or moderately trained athletes (people like you and me) – not for highly trained or elite athletes.

It is logical that natural sources of nitrates, such as beetroot juice, would have a similar beneficial effect on exercise, but it is only in the last couple of years that scientists have started to evaluate that possibility. I looked up six recent publications for this review.

Does Beetroot Juice Improve Exercise Performance?

Study # 1: In this study (Bailey et al, J. Appl. Physiol., 107: 1144-1155, 2009) untrained men (aged 19-38) were given beetroot juice or a placebo for 6 days and then put through a series moderate-intensity and severe-intensity step exercise tests on days 4-6. The amount of oxygen required to support the moderate intensity exercise was decreased by 19% in the beetroot juice group. For severe intensity exercise, the amount of oxygen needed to support the exercise was decreased by 23% and the time to exhaustion was increased by 16% in the beetroot juice group. Those effects were statistically significant.

Study # 2: In this study (Kelly et al, Am. J. Physiol. Regul. Integr. Comp. Physiol., 304: R73-83, 2013) untrained older adults (aged 60-70) were given beetroot juice or a placebo for 3 days and then put through a treadmill exercise test. Resting blood pressure and oxygen uptake kinetics during exercise were significantly improved in the beetroot group.

Study # 3: In this study (Breese et al, Am. J. Physiol. Regul. Integr. Comp. Physiol., 305: R1441-14505, 2013) physically active subjects were given beetroot juice or a placebo for 6 days and then put through a double step exercise protocol involving a transition from stationary to moderate intensity exercise followed immediately by a transition from moderate intensity to severe intensity exercise. No significant differences were observed between the beetroot juice group and the placebo group during the transition from stationary to moderate intensity exercise. However, for the transition from moderate intensity to high intensity exercise both efficiency of oxygen utilization and endurance were increased by 22% in the beetroot juice group.

Study # 4: In this study (Pinna et al, Nutrients, 6: 605-615, 2014) moderately trained male master swimmers were given beetroot juice for 6 days. Swimming tests were conducted at the beginning and end of the 6 day period. After 6 days of beetroot juice supplementation, the workload was increased by 6% and the energy cost was decreased by 12% when the swimmers were performing at their maximal capacity.

Studies # 5 & 6: These studies (Lanceley et al, British Journal of Sports Medicine, 47: doi: 10.1136/bjsports-2013-093073.8; Hoon et al, Int. J. Sports Physiol. Perform., 9: 615-620, 2014) were both done with highly trained athletes and no significant improvement in performance was observed. This is fully consistent with previous studies utilizing arginine supplements.

In short, these studies suggest that beetroot juice is similar to arginine supplements in that:

It improves exercise performance at moderate to severe exercise levels, but not at low exercise levels.

It improves exercise performance for untrained or moderately trained athletes, but not for highly trained athletes.

The effects are modest. However, you should keep in mind that even a 20% increase in endurance during high intensity exercise can result in a significant incremental increase in muscle mass if the exercise is repeated on a regular basis.

What Are The Strengths & Weaknesses Of These Studies?

Strengths: The strengths of these studies are:

Most of the studies were double-blind, placebo controlled studies

The studies were internally consistent and were consistent with previous studies done with arginine supplements.

Weaknesses: The weaknesses of these studies are:

The studies were all very small and were of short duration. Larger, longer term studies are needed to validate the results of these studies.

So, are there health benefits of beetroot juice for athletes?

The Bottom Line:

Nitrates and arginine are both converted to nitric oxide in the body, so it is plausible that they will have similar effects.

Arginine supplements have been around for years and appear to have a modest affect on exercise performance with untrained and moderately trained athletes, but not with highly trained athletes. This is most likely because one of the effects of training is to increase blood supply to the muscles. Thus, highly trained athletes already have enhanced blood flow to the muscles, and the effect of arginine supplementation on blood flow is less noticeable.

Nitrate supplements are just starting to be evaluated for their effects on exercise performance. Most of the research so far has been with beetroot juice, but the results should be similar for any naturally sourced nitrate supplement.

The clinical studies published so far suggest that nitrate supplements are similar to arginine supplements in that they have a modest effect on high intensity exercise in untrained and moderate trained athletes (people like most of us). They appear to have little or no effect for highly trained athletes. Thus, the effect of nitrate supplements on exercise appears to be very similar to the effect of arginine supplements on exercise.

Most of the studies performed to date have been small, short duration studies. They need to be validated by larger, longer term studies.

If the effects of nitrate supplementation published to date are accurate they should be most beneficial for weight training and high intensity exercise because even modest increases in exercise endurance can result in an incremental increase in muscle mass and strength over time.

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 I Get a Flu Shot?

October 21, 2014 by Dr. Steve Chaney

The Truth About About Flu Shots That Nobody Else Is Telling You

Author: Dr. Stephen Chaney

It is flu season again, and the annual debate about whether everyone should get a flu shot is heating up. On the one hand we are told that the flu shot saves thousands of lives and everyone should be vaccinated. On the other hand we are being told that the flu shot is deadly and we should avoid it. As usual, the truth is somewhere in between.

When you examine the scientific literature it is clear that:

The risks of the flu shot have been greatly exaggerated.
The benefits of the flu shot have been greatly exaggerated.
The medical profession has not leveled with us about the real reason they recommend that everyone get a flu shot.

Flu Shot Side Effects

The greatest fear of vaccination and therefor flu shot side effects for children has been the claim that the flu vaccine causes autism. It is easy to understand how the hypothesis arose that vaccinations and autism might be linked, because the first symptoms of autism usually appear around the time that children are completing their initial series of vaccinations.

However, clinical research has not substantiated that any causal relationship between vaccinations and autism. It isn’t that scientist haven’t looked. A number of clinical studies have looked for a link between vaccinations and autism and have failed to find any. The age of onset and prevalence of autism are virtually identical in vaccinated and unvaccinated children.

However, most vaccines still contain mercury, and mercury is a neurotoxin. So if you are getting your child vaccinated, I recommend that you insist on getting a mercury free vaccine. You may want to inquire about the preservatives and additives in the flu vaccine as well, because some of them are also toxic.

Beyond that the biggest concerns are severe allergic reactions and an autoimmune response called Guillian-Barré syndrome which causes symptoms ranging from muscle weakness and fatigue to partial paralysis. These side effects are real and they are serious, but they are also quite rare. They affect somewhere between 1 in a million to 1 in 100,000 children, depending on the vaccine.

In short, flu shot side effects risks are real, but they have been greatly exaggerated by some in the media.

Let’s Talk Science

It turns out that the benefits of the flu shot have been greatly exaggerated by health professionals and the media as well. However, to properly understand why the messages you hear are a bit misleading you need to understand some scientific jargon, namely the difference between relative risk and absolute risk.

Relative risk describes the effect of an intervention for people with a certain condition. In this case, relative risk would be the effect of the flu shot (intervention) for people who have been infected with the flu virus (condition). Relative risk is often used in media reports because it magnifies the effect of the intervention. In short, it makes the intervention look really good.

Absolute risk describes the effect of an intervention on the probability that you will develop a certain condition. In this case absolute risk would be the effect of the flu shot on you actually getting the flu. Since this takes into account your probability of being infected by the flu virus as well as the relative risk reduction once you have become infected, it is a much smaller number. Absolute risk is a much better measure of the actual benefit you can expect to receive.

Is The Flu Shot Effective?

There is always year to year variation in the severity of the flu and the effectiveness of flu vaccines. In addition, many other viruses that cause flu-like symptoms and are completely unaffected by the flu vaccine.

For example, both enterovirus D68 and the Ebola virus are in the headlines – enterovirus D68 because it has hospitalized so many kids this fall and Ebola virus because it is so deadly. Unfortunately, the flu vaccine has no efficacy against either of those viruses.

In addition, there is also significant variation in both the efficacy and evidence for efficacy in different population groups that is generally not acknowledged during the annual campaigns recommending that everyone should get a flu shot. To better understand that we need to look at the efficacy of the flu shot in each population group individually.

Is The Flu Shot Effective in Children Age 6 Months To 2 Years?

In 2010, the US Advisory Committee on Immunization Practices began recommending flu vaccination for all healthy children older than 6 months. However, in 2012 the Cochrane Collaboration conducted a systematic review of all published clinical studies and concluded that for children in that age group currently licensed flu vaccines “are not significantly more effective than placebo”. [To fully understand the significance of that statement you need to know that the Cochrane Collaboration is an independent, non-profit organization that promotes evidence-based medicine. In fact, in the medical community Cochrane Collaboration systematic reviews are considered to be the gold standard for evidence based medicine.]

Summary: This is one of the groups at greatest risk for developing severe complications to the flu, so it is disappointing that the flu vaccine is not more effective for this group. I will talk about the best way to protect this group below.

Is The Flu Shot Safe & Effective in Healthy Children Age 2 To 7 Years?

This is the age group for which immunization makes the greatest sense, and the nasal spray gives the best results for this group. According to the 2012 Cochrane Collaboration review the flu shot reduces the relative risk of the flu by 48% and the nasal spray with attenuated live virus reduces the relative risk by 83%.

Since around 16% of unvaccinated children catch the flu in an average year this translates to an absolute risk reduction of 3.6% for the flu shot and 17% for the nasal spray. That is a smaller number, but still significant. This, of course, varies from year to year dependent on how well the vaccine matches the strains of virus that are actually circulating through the population.

Summary: The science behind vaccination for this group has shifted significantly in the past few years. The evidence for the efficacy of the flu shot in this age group has increased while the evidence for harm has deceased. The fear of the flu shot causing autism has been largely disproven by recent clinical studies. That leaves severe allergic reactions and the Guillian-Barré syndrome as the major complications of the flu vaccination.

Proponents of the flu vaccinations have estimated that if all children in this age range were vaccinated, around 200 would develop severe complications to the flu shot, and if all children in this age range were unvaccinated 20,000 would develop severe complications from the flu. I have not been able to independently substantiate those statistics. We also need to keep in mind that in those rare years, such as during the 1976 swine flu epidemic, when approximately 1 in 100,000 vaccinated children developed Guillian-Barré syndrome the incidence of severe complications to the flu shot could have reached the 2-3,000 range if the vaccination program had not been terminated early.

I realize that this is an emotional issue for parents, and there is no perfect answer. However, at present the weight of evidence is slightly in favor of vaccination for this age group.

Is The Flu Shot Effective in Healthy Children Age 8 To 18 Years?

According to a recent meta-analysis of all available clinical studies (Oosterholm et al, The Lancet Infectious Diseases, 12: 36-44, 2012), we simply don’t know whether the flu vaccine will be effective in this age group because no reliable studies have been conducted.

Even worse than that, we may never know whether the flu shot offers any protection for this age group because of a Catch 22 situation in modern clinical research. Once a particular treatment becomes “the standard of care” it is considered unethical to withhold that treatment in a clinical trial. Since the CDC is now recommending the flu shot for everyone over age 2, it would be considered unethical to conduct a clinical trial in which half the population received flu shots and half did not.

Summary: I suspect that the flu shot may offer some protection in this age group, but there is no convincing clinical evidence to support that belief at present and for the foreseeable future.

Is The Flu Shot Effective in Healthy Adults Age 18 To 65 Years?

Here the answer is yes. According to a 2012 meta-analysis of 31 published clinical studies (Oosterholm et al, The Lancet Infectious Diseases) the flu shot gives an impressive 75% reduction in the relative risk of catching the flu. However, in an average year only 4% of this population will catch the flu if unvaccinated, so the absolute risk reduction is a modest 3%.

This is also the group that has the least to fear from the flu. Only about 1 in 100 people in this age range develop severe complications as a result of getting the flu, and these are usually the people with severe diseases and/or compromised immune systems. For most healthy adults in this age range, the flu is merely a one or two day inconvenience.

Summary: For healthy adults in this age range the flu vaccine offers only a modest decrease in the absolute risk of catching the flu, and this group has a relatively low risk of developing severe complications from the flu. If the self interest of this group were the only consideration, it is hard to understand the insistence of the medical community that everyone in this age range get a flu shot. It would appear to be a matter of personal choice.

Is The Flu Shot Effective in Seniors Age 65 And Older?

Flu shot proponents will tell you that flu shots cut the risk of death in this group by 50% based on a meta-analysis published in 2002 (Vu et al, Vaccine, 20: 1831-1836, 2002).

However, more recent research has come to the opposite conclusion. A recent meta-analysis (Oosterholm et al, The Lancet Infectious Diseases, 12: 36-44, 2012) concluded “Evidence for protection in adults aged 65 years or older is lacking”. The 2010 Cochrane Collaboration systematic review concluded “Due to the poor quality of available evidence, any conclusions regarding the affects of influenza vaccines for people aged 65 years or older cannot be drawn.”

The lack of protection of the flu virus in seniors is most likely due to the fact that, in many cases, their immune systems have weakened with age.

Summary: This is another group where you would most like to see protection by the flu shot, because this group is likely to suffer severe complications and death from the flu, so it is disappointing that the flu vaccine is not more effective for this group.

Who Has Most To Fear From The Flu?

When you hear that the flu shot significantly reduces the risk of severe complications and death from the flu, you should know that the risks are not spread evenly over the population. The very young are at risk because their immune systems haven’t fully developed. The very old are at risk because their immune systems have weakened with age and they may already be in precarious health because of other diseases. And, of course, anyone at any age who is in precarious health because of disease or who has a compromised immune system is at risk as well.

Why Do Health Professionals Recommend That Everyone Get A Flu Shot?

If you are a healthy adult in the 18-65 age range, your risk of severe complications and death is from the flu is very low. It is not zero, but it is low. So why are health professionals so insistent that you need to get a flu shot?

The reason is straight forward, but it is not the reason that they are giving you. It is a public health measure, pure and simple.

The very young, the very old, the sick and the infirm are the ones most likely to develop severe complications and die from a flu infection. However, the flu shot doesn’t offer them much protection because their immune systems are often compromised. The best way to protect those groups is to immunize everyone else. If the flu virus can’t gain a foothold in the rest of the population, those at greatest risk will never be exposed to the flu.

So the constant warnings that you need to get a flu shot is less about protecting you than it is about protecting those whom you might infect. Now you know the truth. If you decide to get a flu shot it will be for the right reason, not the reason you are being given by the medical profession.

In a similar vein, many health departments are warning about hospitalizations and deaths from enterovirus D68 infections and urging people to get flu shots. They are not telling people that the flu shot has no efficacy against enterovirus D68.

I understand the concept that the rare combination of the regular flu and enterovirus D68 infection in the same patient would be particularly deadly. But, I also believe in truth in advertising. The medical profession needs to level with people about why they are recommending flu shots, not use scare tactics that make promises the flu shot can’t deliver.

Should I Get A Flu Shot?

As you can see, your decision about whether or not the flu shot is the right thing for you is not an easy one. Both the benefits and risks of the flu shot have been greatly exaggerated in the media. I have tried not to be an advocate either for or against flu vaccinations. I have evaluated the scientific literature and tried to give you the unvarnished truth. It is now up to you to make an educated decision – one that is right for you.

My personal decision about the flu shot is influenced by my father’s example. He dutifully got his flu shot every year, and every year he came down with the flu shortly after getting the flu shot. I’ve seen the same phenomenon with several of my friends who work at area hospitals and are required to get an annual flu shot. I know that the experts claim you can’t get the flu from the flu shot. I don’t know about that. I only know what I have observed.

In addition, I do not have young children or elderly parents at home who might be compromised if I were to develop even a mild case of the flu. So I chose to follow the kind of lifestyle that keeps my immune system strong rather than relying on a flu shot to protect me from the flu. That immune-healthy lifestyle, of course, will be a topic for a future “Health Tips From the Professor”.

The Bottom Line:

Both the effectiveness and risks of the flu shot have been greatly exaggerated.
The flu shot has no proven effectiveness in children ages 6 months to 2 years, children aged 8-18 years and seniors 65 years and older.
In children, aged 2 to 7, nasal sprays with partially inactive flu virus give a 17% decrease in absolute risk of catching the flu. Side effects of the flu vaccine in this population group are severe allergic reactions and an autoimmune response called Guillian-Barré syndrome. Both severe complications from the flu virus and side effects of the flu vaccine are very rare, but complications from the flu virus are several fold more common than side effects from the vaccine.
Fears that the flu vaccine could trigger autism have not been validated by clinical studies. However, mercury is a neurotoxin so I recommend that you insist on mercury-free vaccines for your children. You may also wish to inquire about other preservatives and additives in the vaccine, because some of them are toxic.
In healthy adults, aged 18 to 65, flu shots give a 3% decrease in absolute risk of catching the flu. This is also the population group with the lowest risk of severe complications from the flu. For most adults in this age group the flu is nothing more than a one or two day inconvenience.
The groups most likely to develop severe complications and die from flu infections are the very young, the very old, and the sick. They are also the groups least likely to benefit from the flu shot because their immune systems are weak.
If you are a healthy adult in the 18 to 65 age group, the constant warnings that you need to get a flu shot is less about protecting you than it is about protecting those whom you might infect if you catch the flu. It is a public health measure to protect the very young, the very old, and the sick. Now you know the truth. If you decide to get a flu shot it will be for the right reason, not the reason you have been given by the health profession.
In addition, the flu shot has no efficacy against either enterovirus D68 or Ebola virus. Although both of these viruses are real concerns, neither is a justification for recommending that people get flu shots.
As for me, I am influenced by the example of my father who got the flu from the flu shot every year. I chose to follow the kind of lifestyle that keeps my immune system strong rather than relying on a flu shot to protect me from the flu. That, of course, will be a topic for a future “Health Tips From the Professor”.

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

Does The Green Coffee Bean Extract Work?

October 14, 2014 by Dr. Steve Chaney

Author: Dr. Stephen Chaney

Does the green coffee bean extract work? The claims sounded so appealing. You could just take this green coffee bean extract and the pounds would melt away. You didn’t need to exercise or change your diet.

Your first reaction when you heard those claims was probably “Right, when pigs fly. I’ve heard this kind of stuff before. It’s just too good to be true.”

But then you were given a pseudo-scientific explanation about how it was the chlorogenic acid in the green coffee bean extract that was responsible for its amazing properties (What they didn’t tell you was that chlorogenic acid is present in all roasted coffees). You were told that it was backed by a clinical study showing that people lost 17.7 pounds, 10.5% of their body weight and 16% of their body fat in 22 weeks without diet and exercise.

To top it all off you were told that it was endorsed by Dr. Oz on his TV show and provided with a video clip to prove it. After all of that you were probably tempted to say “Maybe…just maybe… these amazing claims might be true.” You may have even been tempted to try it.

Were the claims true? Is green coffee bean extract the miracle weight loss product that everyone has been looking for? Or was it just another bogus weight loss product?

Is Green Coffee Bean Extract Bogus?

Evidently the Federal Trade Commission did not consider the claims about green coffee bean extract to be true. The FTC sued one of the companies that manufactured and sold green coffee bean extract for promoting a “hopelessly flawed study” to support the weight loss claims for their product.

The FTC alleged that:

The study was too small, at 16 subjects, to provide convincing data.

The study contained a number of critical flaws in the design and results of the study. For example, the greatest weight loss actually occurred in the placebo group.

The lead investigator in India actually falsified the results.

The company knew or should have known that this botched study didn’t prove anything.”

The manufacturer eventually agreed to pay $3.5 million to the FTC to settle their complaint. Basically, the company agreed with the FTC that there was no evidence to back their weight loss claims.

How Did Dr. Oz Get It So Wrong?

What about Dr. Oz’s endorsement? In Dr. Oz’s 2012 show segment he called green coffee bean extract “the magic weight loss cure for any body type.” The most puzzling aspect of this whole saga is how Dr. Oz got it so wrong.

After all, he is a trained neurosurgeon. He is Vice Chair of the Department of Surgery at Columbia University. He understands the principles of evidence-based medicine. Evidence-based medicine simply means that it is a physician’s responsibility to check the scientific evidence before recommending a treatment to a patient. Yet he never even looked into the supposed “clinical study” backing green coffee bean extract’s weight loss claims.

In a Senate hearing this past June Dr. Oz apologized. He said: “For my colleagues at the FTC, I realize I have made their jobs more difficult.”

How Can You Protect Yourself Against Weight Loss Scams?

There are dozens, if not hundreds, of new weight loss products appearing on the market every year. The FTC is doing its best to police the claims that are being made, but they are clearly overwhelmed. And even when they have an airtight case, it can take years for them to force a company to stop making false claims.

So, how can you protect yourself against weight loss scams? How can you avoid wasting your money on products that don’t work, or may even harm your health? I advise a little healthy skepticism.

Be skeptical about the claims. The old adage “If it sounds too good to be true, it probably is [too good to be true]” is always good advice. In a previous “Health Tips From the Professor” I discussed the the FTC’s recommendation for “7 Easy Ways To Spot Fad Diets”. That one is probably worth printing out and keeping handy so that you can review it the next time a new diet program comes out.

Be skeptical about the studies. The bottom line is that not all clinical studies are reliable. I realize that it is extremely difficult for a non-scientist to evaluate the validity of clinical studies. My best advice is to go online and see what other experts are saying about the study and the claims. There are a number of “fact checker” blogs online that focus on careful scientific analysis of product claims and the “studies” that support them.

Be skeptical about the endorsements. Unfortunately, there are far too many examples of well known doctors who have endorsed bogus product claims on their TV shows or in their blogs. That makes it even more difficult for the layman to separate fact from fiction. My advice is to simply ask the question: “Does their blog or TV show feature something novel, something spectacular, and/or something sensational…every single week?”

My belief is that these experts all start out with good intentions. However, to develop a really big audience and keep them engaged they feel pressured to deliver novel and sensational health news every single week. The reality is that there are not advances every single week that are novel, sensational… and scientifically accurate. Eventually, they feel pressured to sacrifice accuracy for novelty.

That is why my blog is different. I don’t promise you spectacular and sensational news every week, but I do promise you accuracy. I will share the latest headlines, but I will tell you both their strengths and their weaknesses. Ultimately, it is your responsibility to protect yourself against weight loss scams and I tell you how below. Fortunately, what you can always count on from me is I will be honest with you.

So, does the green coffee been extract work?

The Bottom Line

According to the FTC the green coffee bean extracts that were so widely promoted a couple of years ago were yet another example of bogus weight loss products. The FTC sued one of the companies that markets and sells green coffee bean extract for promoting a “hopelessly flawed” clinical study to advertise their product, and the company has recently settled with the FTC for $3.4 million.
The only way that you can protect yourself from bogus weight loss products is to be skeptical. I discuss the questions you should ask in more detail above, but in short:
- Be skeptical of claims that sound too good to be true.

Be skeptical of the clinical studies the companies quote to support their claims.

Be skeptical of expert endorsements. This product was even endorsed by Dr. Oz on his TV show.

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

Soy and Breast Cancer

October 7, 2014 by Dr. Steve Chaney

The Soy Controversy

Author: Dr. Stephen Chaney

Soy and breast cancer: the wars are heating up again. You may have seen the recent headlines saying: “Soy protein found to speed the growth of breast cancer!” “Eating soy may turn on genes linked to [breast] cancer growth!” “Women with breast cancer should avoid high soy diets!” It all sounds pretty scary.

If this is true, it is big news. In recent years the consensus in the scientific community has been that soy is not harmful for women with breast cancer, and that it might even be beneficial. However, some skeptics have never accepted that consensus view. Those skeptics are once again claiming that soy protein may be risky for women with breast cancer.

Let’s look at the study behind the recent headlines and see if it is compelling enough to challenge the prevailing consensus on the safety of soy for women with breast cancer.

Does Soy Protein Turn On Breast Cancer Growth Genes?

This study (Shike et al, Journal of the National Cancer Institute, Sep 4 2014, doi: 10.1093/jnci/dju 189) looked at 140 women (average age 56) with invasive breast cancer. They were randomly divided into two groups of 70 and either given soy protein or a placebo between the initial biopsy and the time that surgery was performed to remove the tumor (a period of 7 to 30 days). A second biopsy was obtained at the time of surgery.

The activity of a number of genes associated with breast cancer survival was measured in the two biopsy samples. The observation that made the headlines was:

For some of the women in the study the activity of several genes associated with breast cancer growth and survival was increased in the group consuming soy protein compared to the placebo group. The authors concluded: “These data raise concern that soy may exert a stimulatory effect on breast cancer in a subset of women.”

What Are The Limitations Of The Study?

The authors acknowledged the many limitations of the study, but the press has largely ignored them.

The increased activity of the cancer growth genes was only seen in 20% of the women studied. For 80% of the women studied soy protein consumption had no effect on the activity of genes associated with breast cancer growth and survival.

This effect was only seen for some of the genes associated with breast cancer growth and survival. Other breast cancer growth genes were not affected in any of the women enrolled in the study. The authors conceded that it was unknown whether these limited genetic changes would have any effect on tumor growth and survival.

There was no effect of soy consumption on actual tumor growth in any of the women studied.

This was a very short term study so it is not known whether these changes in gene expression would have continued if soy supplementation were continued for a longer period of time. There are numerous examples in the literature of initial changes in gene expression in response to a radical change in diet that disappear once the body becomes accustomed to the new diet.

There is absolutely no way of knowing if the observed changes in gene expression would actually affect clinical outcomes such as survival, response to chemotherapy or tumor recurrence.

Should Women With Breast Cancer Avoid Soy?

Even with all of the limitations listed above, if this were the only study to test the soy-breast cancer hypothesis, I and most other experts would probably be warning women with breast cancer to be very cautious about consuming soy.

However, as I discussed in a previous “Health Tips From the Professor” (https://www.chaneyhealth.com/healthtips/soy-and-breast-cancer-recurrence/) at least five clinical studies have been published on the effects of soy consumption on the recurrence of breast cancer in women who are breast cancer survivors, both in Chinese and American populations. The studies have shown either no effect of soy on breast cancer recurrence or a protective effect. None of them have shown any detrimental effects of soy consumption by breast cancer survivors.

A meta-analysis of all 5 studies was published last year (Chi et al, Asian Pac J Cancer Prev., 14: 2407-2412, 2013). This study combined the data from 11,206 breast cancer survivors in the US and China. Those with the highest soy consumption had a 23% decrease in recurrence and a 15% decrease in mortality from breast cancer.

Another meta-analysis of 18 clinical studies found that soy slightly decreases the risk of developing breast cancer in the first place (J Natl Cancer Inst, 98: 459-471, 2006). To date there is absolutely no clinical evidence that soy increases the risk of breast cancer.

The Bottom Line

What does this mean for you if you are a woman with breast cancer, a breast cancer survivor or someone who is concerned about your risk of developing breast cancer?

The study that has generated the recent headlines has so many limitations that I would not recommend any changes in soy consumption at present. It raises an interesting hypothesis that requires further study and validation. If this hypothesis holds up it may result in changes in dietary recommendations for a very small subset of women with invasive breast cancer.

There are many reasons to include soy protein foods as part of a healthy diet. Soy foods are one of the highest quality vegetable protein sources and provide a great alternative to many of the high fat, high cholesterol animal proteins in the American diet.

I personally feel that these studies are clear cut enough that women who are concerned about their breast cancer risk, women with breast cancer, and breast cancer survivors no longer need to fear soy protein as part of a healthy diet.

The responsible websites agree with this assessment. For example, WebMD and the American Institute for Cancer Research (AICR) both say that breast cancer survivors need no longer worry about eating moderate amounts of soy foods.

The irresponsible websites (I won’t name names, but you know who they are) are still warning breast cancer survivors to avoid soy completely. They are citing the latest study, with all of its limitations, as proof that they were right all along. As a scientist I really have a problem with people who are unwilling to change their opinions in the face of overwhelming scientific evidence to the contrary.

Finally, I want to emphasize that the published studies merely show that soy does not increase the risk of breast cancer and is safe to use for breast cancer survivors. None of those studies suggest that soy is an effective treatment for breast cancer. The protective effects of soy are modest at best. If you have breast cancer, consult with your physician about the best treatment options for you.

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 Omega-3 Uptake Gender Specific?

September 30, 2014 by Dr. Steve Chaney

Do We Need To Reexamine Everything We Thought We Knew About Omega-3s?

Author: Dr. Stephen Chaney

Some of you may remember the book from a few years ago titled “Men are from Mars, Women are from Venus”. The book proposed that men and women communicate differently (Who would have guessed?), and understanding that fact would help husbands and wives communicate with each other more effectively. I know that some people complained that it was an overly simplistic viewpoint, but I know it sure helped me communicate more effectively with my wife.

I came across a very interesting article recently that suggested the omega-3 fatty acid EPA might be metabolized and utilized differently by men and women. You might say that the statement “Men are from Mars, Women are from Venus” applies to omega-3 utilization as well.

The Science Behind the Study

Now that I’ve captured your interest, perhaps I should fill in a few details. We have known for years that the long chain omega-3 fatty acids EPA and DHA appear to be beneficial at reducing the risk of heart disease. There are several mechanisms for that protective effect:

Omega-3s reduce the stickiness of platelets so that platelet aggregation, a fancy name for blood clotting, occurs less readily. Of course, we want our blood to clot when we cut ourselves, but we don’t want it to clot inside our arteries, because that is the very process that can lead to heart attacks and stroke.

Omega-3s lower triglycerides and reduce inflammation, two important risk factors for heart disease.

Omega-3s help keep the walls of our blood vessels elastic, which enhances blood flow and reduces the risk of hypertension.

However, for any of those things to occur, the omega-3 fatty acids must first be incorporated into our cell membranes. Thus, it is not just how much omega-3s we get in our diet that is important. We need to know how many of those omega-3s are actually incorporated into our membranes.

What if the efficiency of omega-3 uptake into cellular membranes were different for men and women? That would change everything. It would affect the design of omega-3 clinical studies. It would affect omega-3 dietary recommendations for men and women. The implications of gender-specific uptake of omega-3s would be far reaching.

Is Omega-3 Uptake Gender Specific?

The authors of this week’s study (Pipingas et al., Nutrients, 6, 1956-1970, 2014) hypothesized that efficiency of omega-3 uptake might differ in men and women. They enrolled 160 participants in the study (47% male and 53& female) with an average age of 59 years. The study excluded anybody with pre-existing diabetes or heart disease and anybody who was significantly overweight. The study also excluded anyone taking drugs that might mask the effects of the omega-3 fatty acids and anybody who had previously consumed fish oil supplements or more than two servings of seafood per week.

This was a complex study. In this review I will focus only on the portion of the study relevant to the gender specificity of omega-3 uptake. For that portion of the study, both male and female participants were divided into three groups. The first group received 3 gm of fish oil (240 mg EPA and 240 mg DHA); the second group received 6 gm of fish oil (480 mg EPA and 480 mg of DHA); and the third group received sunflower seed oil as a placebo. The study lasted 16 weeks, and the incorporation of omega-3 fatty acids into red blood cell membranes was measured at the beginning of the study and at the end of 16 weeks.

When they looked at men and women combined, they found:

A dose specific increase in EPA incorporation into red cell membranes compared to placebo. That simply means the amount of EPA that ended up in the red blood cell membrane was greater when the participants consumed 6 gm of fish oil than when they consumed 3 gm of fish oil.

Very little incorporation of DHA into red blood cell membranes was seen at either dose. This was not unexpected. Previous studies have shown that EPA is preferentially incorporated into red cell membranes. Other tissues, such a neural tissue, preferentially incorporate DHA into their membranes.

When they looked at men and women separately, they found:

The efficiency of EPA incorporation into red cell membranes compared to placebo was greater for women than for men. In women increased EPA uptake into red cell membranes was seen with both 3 gm and 6 gm of fish oil. Whereas, with men increased EPA incorporation into red cell membranes was only seen at with 6 gm of fish oil.

What Is The Significance Of These Observations?

The authors concluded “This is an important area for future research because dietary recommendations around long chain omega-3 polyunsaturated fatty acid intake may need to be gender specific.”

However, there are a number of weaknesses of this study:

It was a very small study. Obviously, this study needs to be repeated with a much larger cohort of men and women.

This study was just looking at incorporation of omega-3s into red cell membranes. We don’t yet know whether the specificity of omega-3 uptake will be the same for other tissues. Nor do we know whether there will be gender specificity in the biological effects of omega-3s.

Most importantly, not all previous studies have reported the same gender specificity in omega-3 uptake seen in this study.

So what does this mean for you? Should men be getting more omega-3 fatty acids in their diet than women, as the authors suggested? That is an intriguing idea, but based on the weaknesses I described above, I think it’s premature to make this kind of recommendation until these results have been confirmed by larger studies.

The Bottom Line

A recent study has suggested that women may be more efficient at incorporating the omega-3 fatty acids EPA into their cellular membranes than men. The authors of the study concluded that “…dietary recommendations around long chain omega-3 polyunsaturated fatty acid intake may need to be gender specific.”

However, the study has a number of weaknesses:

It was a very small study. Obviously, it needs to be repeated with a much larger cohort of men and women.

This study was just looking at incorporation of omega-3s into red cell membranes. We don’t yet know whether the specificity of omega-3 uptake will be the same for other tissues. Nor do we know whether there will be gender specificity in the biological effects of omega-3s.

Most importantly, not all previous studies have reported the same gender specificity in omega-3 uptake seen in this study.

The idea that men and women may differ in their needs for omega-3 fatty acids is intriguing, but based on the weaknesses described above, it is premature to make this kind of recommendation until the results of the current study have been confirmed by larger studies.

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.

Best Diet For Weight Loss

September 23, 2014 by Dr. Steve Chaney

The Diet Wars Heat Up Again

Author: Dr. Stephen Chaney

What is the best diet for weight loss? One week the headlines say that low-carbohydrate diets are better. The next week it’s low-fat diets that are better. There is even the occasional headline proclaiming that it doesn’t matter which diet you follow as long as you control your calories. It is no wonder that you are confused.

It is unusual, however, to have conflicting headlines within the same week, but that is exactly what happened last week. Let me take you behind the headlines to the actual clinical studies and help you sort through the conflicting headlines.

Are Low-Carbohydrate Diets Best For Weight Loss?

The manuscript behind this headline was published September 2nd in the Annals of Internal Medicine (Bazzano et al, Annals of Internal Medicine, 161: 309-318, 2014). This study was designed to determine which was the best diet for weight loss, low carb diet or low fat diet. The study recruited 148 overweight participants (mean age, 46.8, 88% female, 51% black) and randomly assigned them to either a low-fat diet or low-carbohydrate diet.

The participants on the low-fat diet were instructed to consume <30% of their calories from fat, while the participants on the low-carbohydrate diet were told to limit carbohydrates to <40 g/day. Neither group was told to limit calories. They met with a dietitian 10 times during the 12-month study and received information on dietary fiber (target = 25 g/day) and healthy fats (target = <7% saturated fat and little or no trans fats).

At the end of 12 months the low-carbohydrate diet resulted in significantly greater…

Weight loss (7.7 pounds)…

Decrease in triglyceride levels…

Increase in HDL cholesterol…

Decrease in the ratio of total to HDL Cholesterol…

…than the low-fat diet. In short, the results suggested that the low-carbohydrate diet was not only better than the low-fat diet for weight loss, but that it was also more effective in reducing risk factors for cardiovascular disease.

Case closed, you might be tempted to say. The low carb diet is the best the diet for weight loss. But there have been lots of other studies that have come to the opposite conclusion. So we have to ask the question: “Is this study significantly better than all of the studies that have failed to find any difference between the low-fat and low-carbohydrate diets with respect to weight loss and cardiovascular risk?”

What Are The Strengths & Weaknesses Of the Study?

Strengths of the Study: This was a very well designed study. In particular:

Dietitians met with the participants at multiple times during the program to assure adherence to the diet, which was very good.

The study utilized multiple dietary recalls, both during the week and on weekends.

The study had a diverse population.

Weaknesses of the Study:

The study did not control calories. In fact, the caloric intake was ~160 calories/day greater for the low-fat group than the low-carbohydrate group for at least the first 6 months of the study. That alone would be enough to account for the 7.7 pounds difference in weight loss.The reason for the higher caloric intake of low-fat group is not known. It could be due to the lower palatability of the low-carbohydrate diet. Alternatively, it could be due to the lower satiety of the low-fat diet. It was low in both fat and protein, both of which contribute to satiety (the feeling of fullness after we eat).
The study did not specify the type of carbohydrates consumed. The dietitians instructed the participants on the type of fat they should be eating, but not the type of carbohydrate. That was a significant omission. Diets high in sugars and refined carbohydrates provide less satiety and adversely affect cardiovascular risk factors compared to diets where the carbohydrate comes primarily from fresh fruits, vegetables and legumes.
The study did not control protein intake. In fact, the low-fat group consumed significantly less protein than the low-carbohydrate group. As I pointed out in a previous “Health Tips From the Professor” High Protein Diets and Weight Loss , higher protein intakes are essential for maintaining muscle mass during weight loss. That is important because loss of muscle mass can decrease metabolic rate (the rate at which we burn calories 24 hours a day – even at rest).

The amount of protein consumed by the low-carbohydrate group was close to the amount shown to maintain muscle mass during weight loss, while the amount of protein consumed by the low-fat group was close to the amount associated with loss of muscle mass during weight loss. That was reflected in the results. The low-fat group lost muscle mass while the low carbohydrate group actually gained muscle mass. The resulting difference in muscle probably meant that the low-carbohydrate group was burning more calories on a daily basis than the low-fat group.

In short, this is a good study, but it has important flaws. It is not a game changer.

Do Low-Carbohydrate & Low-Fat Diets Result In Identical Weight Loss?

The study behind this headline was published in the September 3rd edition of the Journal of the American Medical Association (Johnson et al, JAMA, 312: 923-933, 2014). This study was a meta-analysis that combined the results of 48 studies with 7286 participants. When the authors combined the data from all of the published studies there was no difference in weight loss for the low-fat and low-carbohydrate diets over a one or two year period.

The strength of the study is that it combines the results of multiple studies. That increases the statistical power of the observations and smoothes over the effect of outlier studies, such as the one described above. This is the study I would trust.

What Do The Experts Say?

Dr. Walter Willett, Chair of the Department of Nutrition at the Harvard School of Public Health was quoted as saying: “…some people [would] do well on either diet. The key issue for each person is finding a way of eating that is healthy and can be maintained for the long term.”

Dr. Bradley Johnson (the author of the meta-analysis) was quoted as saying: “The take home message is that people should choose a diet they can adhere to…”

The Bottom Line

1) Ignore the recent headlines suggesting that low-carbohydrate diets may be more effective than low-fat diets for weight loss. When you control for calories and protein intake there is no difference between the two diets with respect to long term weight loss.

2) You can also ignore the headlines telling you that low-carbohydrate diets are better for cardiovascular health. You don’t need to avoid carbohydrates to have a healthy heart. You just need to make healthy carbohydrate choices – fruits, vegetables, legumes and whole grains instead of refined flour products and sugary junk food.

3) Experts will tell you that the best diet is a healthy diet that you can stick with long term.

4) My personal recommendations are to avoid extremes (either low-fat or low-carbohydrate). Instead:

Aim for moderate amounts of healthy fats and healthy carbohydrates.

Don’t ignore protein. Make sure you get enough protein to maintain your muscle mass.

Control calories by reducing portion sizes and choosing healthy snacks.

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.