Best Way To Reduce Risk Of Breast Cancer

What Does The American Cancer Society Say About Reducing Breast Cancer Risk? 

Author: Dr. Stephen Chaney

breast cancerBreast cancer is a scary disease. The American Cancer Society tells us:

  • 281,000 women will be diagnosed with invasive breast cancer in 2021.
  • 43,000 women will die from breast cancer in 2021.
  • The good news is that both prevention and treatment of breast cancer have gotten much better:
    • The 5-year survival rate is 90%.
    • The 10-year survival rate is 84%.
    • For women over 50 the death rate has decreased by 1%/year between 2013 and 2018 (mainly due to recognition that hormone replacement therapy is a risk factor for breast cancer).
  • The bad news is:
    • The cost of breast cancer treatment can range from $50,000 to over $180,000.
    • The side effects of breast cancer treatment can be brutal.
      • For example, there is an effective treatment to prevent breast cancer recurrence for some forms of breast cancer, but many women discontinue the treatment after a few years because of the side effects.

So, wouldn’t it be wonderful if there were some simple changes you could make that would dramatically reduce your risk of developing breast cancer in the first place? There are lots of options for reducing your risk of developing breast cancer, but which one(s) should you choose?

  • Dr. Strangelove and his friends are only too happy to recommend their favorite potion, food, or diet.
  • There are long lists of foods you should avoid if you want to reduce your risk of breast cancer.
  • There are also lists of harmful chemicals in cleaners and other household products that you should avoid.

It can become confusing. It can become overwhelming. It would be easy to just throw up your hands and say, “I give up. I don’t know what to do.”

You may be thinking, “Why doesn’t someone simplify things by identifying the top few lifestyle changes that are most effective for reducing my risk of developing breast cancer?”

It turns out someone has. Today I will share two recent studies that have identified the top 6 strategies for reducing your risk of breast cancer, and I have ranked them from 1 to 6 in order of effectiveness.

What Is The Best Way To Reduce Risk Of Breast Cancer?

AwardThe first study (RM Tamimi et al, American Journal of Epidemiology, 184: 884-893, 2016 was designed to identify the major modifiable risk factors for invasive, postmenopausal breast cancer (The term “modifiable risk factors” refers to those risk factors that are under your control.

The study utilized data collected from the Nurses’ Health Study between 1980 and 2010. During that time 8,421 cases of invasive breast cancer were diagnosed in 121,700 postmenopausal women in the study. The study looked at the effect of nonmodifiable and modifiable risk factors on the development of invasive breast cancer in these women.

  • Nonmodifiable risk factors included current age, age at which menstruation began, height, age of first birth, number of births, weight at age 18, family history of breast cancer, and prior benign breast disease.
  • Modifiable risk factors included weight change since age 18, alcohol consumption, physical activity level, breastfeeding, and postmenopausal hormone therapy use.

Here were the results from the study:

  • All the risk factors included in this study accounted for 70% of the risk of developing invasive breast cancer in postmenopausal women.
  • Modifiable risk factors accounted for 34.6% of the risk of developing invasive breast cancer in postmenopausal women.

When they analyzed the effect of modifiable risk factors on the risk of developing invasive breast cancer separately:

  • 44 pounds of weight gain since age 18 increased the risk by 50%.
  • Postmenopausal hormone replacement use increased the risk by 35%.
  • More than one alcoholic beverage/day increased the risk by 32%.
  • Low physical activity increased the risk by 7%.
  • Lack of breastfeeding increased the risk by 5%.

What About The Effect Of Diet On Breast Cancer Risk?

You may be wondering, “What about the effect of a healthy diet on my risk developing invasive breast cancer?” Unfortunately, the study I described above completely disregarded the effect of diet on breast cancer risk.

However, the second study (MS Farvid et al, International Journal of Cancer, 144: 1496-1510, 2019) I will discuss today partially addresses this issue. It uses the same database as the first study and looks at the effect of fruit and vegetable consumption on the risk of developing invasive breast cancer.

When this study compared high versus low intake of fresh fruits and vegetable on the risk of developing invasive breast cancer:

  • Women eating >5.5 servings/day of fruits and vegetables had a 11% lower risk than women consuming ≤2.5 servings/day.
  • Women consuming >2.5 servings/day of fruit had a 9% lower risk than women consuming ≤0.5 servings/day.
  • Women consuming >4.5 servings/day of vegetables had a 9% lower risk than women consuming ≤0.5 servings/day.

While all fresh fruits and vegetables contributed to this effect:

  • The most protective fruits were berries and cantaloupe & melons.
  • The most protective vegetables were yams & sweet potatoes, green leafy vegetables (such as kale, mustard greens, and chard), and cruciferous vegetables (such as Brussels sprouts).

The authors concluded, “Our findings support that higher intake of fruits and vegetables, and specifically cruciferous and yellow/orange vegetables, may reduce the risk of breast cancer, especially those that are more likely to be aggressive tumors.”

Now we are ready to answer your question, “Which lifestyle changes are most effective for reducing your risk of developing breast cancer?” If we combine the two studies and rank order the modifiable risk factors, it would look like this.

#1: Minimize weight gain during your adult years.

#2: Don’t use postmenopausal hormone replacement therapy unless absolutely necessary.

#3: Drink little or no alcohol.

#4: Eat a healthy diet with lots of fresh fruits and vegetables.

#5: Be physically active.

#6: Breastfeed when possible.

What Does The American Cancer Society Say About Reducing The Risk Of Breast Cancer?

American Cancer SocietyThe advice of the American Cancer Society is remarkably similar. Here are their recommendations:

  1. Get to and stay at a healthy weight.

After menopause, most of your estrogen comes from fat tissue. Having more fat tissue increases the amount of estrogen your body makes, raising your risk of breast cancer. Also, women who are overweight tend to have higher levels of insulin. Higher insulin levels have also been linked to breast cancer.

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

3) Be physically active and avoid time spent sitting.

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

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

3) Follow a healthy eating plan.

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

4) It is best not to drink alcohol.

Research has shown that drinking any alcohol increases the risk of breast cancer. If you choose to drink alcohol, the American Cancer Society recommends that women have no more than 1 alcoholic drink on any given day. A drink is 12 ounces of regular beer, 5 ounces of wine, or 1.5 ounces of hard liquor.

5) Think carefully about using hormone replacement therapy.

Studies show that HRT using a combination of estrogen and progestin increases the risk of breast cancer. This combination can also lead to increased breast density making it harder to find breast cancer on mammogram.

Talk with your doctor about all the options to control your menopause symptoms, including the risks and benefits of each. If you decide to try HRT, it is best to use it at the lowest dose that works for you and for as short a time as possible.

The Bottom Line

Breast cancer is a scary disease. The good news is that detection and treatment of breast cancer has improved over the past decade. The bad news is that treatment is expensive, and the side effects can be brutal.

There are lots of options for reducing your risk of developing breast cancer, but which one(s) should you choose?

  • Strangelove and his friends are only too happy to recommend their favorite potion, food, or diet.
  • There are long lists of foods you should avoid if you want to reduce your risk of breast cancer.
  • There are also lists of harmful chemicals in cleaners and other household products that you should avoid.

It can become confusing. It can become overwhelming. It would be easy to just throw up your hands and say, “I give up. I don’t know what to do.”

You may be thinking, “Why doesn’t someone simplify things by identifying the top few lifestyle changes that are most effective for reducing my risk of developing breast cancer?”

It turns out someone has. Today I will share two recent studies that have identified the top 6 strategies for reducing your risk of breast cancer, and I have ranked them from 1 to 6 in order of effectiveness in the article above.

For more details about these studies, my ranking of the top 6 strategies for reducing your risk of breast cancer, and the American Cancer Society recommendations, 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 Carnitine Supplements Good For You Or Bad For You?

What Is The Truth About Carnitine And TMAO?

BodybuilderIf you are a weightlifter or bodybuilder, chances are you are taking an L-carnitine supplement or a protein shake fortified with L-carnitine. That is because L-carnitine has been promoted for increasing muscle mass and physical performance for so long that most people have come to believe it must be true. Is it true, or is it just another food myth?

If you visit Dr. Strangelove’s website, you may also be told that carnitine supplementation is beneficial for weight loss, migraines, baldness, ADHD and autism, chronic fatigue syndrome, and/or low energy, muscle loss, and cognitive decline in older adults. Are these claims fact or fiction?

On the flip side, recent studies have suggested that the carnitine in red meat might be bad for your heart. Could the same be true for carnitine supplements? Could they also be bad for your heart?

A recent systematic review (AG Sawicka et al, Journal of the International Society of Sports Nutrition, 17: 49, 2020) of L-carnitine supplementation answers these important questions. The authors called their study “The bright and dark sides of L-carnitine supplementation” because they set out to systematically investigate the benefits and potential risks of L-carnitine supplementation.

But before I share the results of this study, I need to give you a little background on L-carnitine. It is time for another Biochemistry 101 segment.

Biochemistry 101: What You Need To Know About Carnitine

professor owlCarnitine plays an essential role in human metabolism. It is required for transport of fatty acids into our mitochondria so they can be used to generate energy. Without carnitine we would be unable to utilize most of the fats in our diet as an energy source.

As you might expect, carnitine is essential for any tissues that have mitochondria, but it is particularly important for high energy tissues like skeletal and heart muscle.

For most of us, our liver and kidneys make all the carnitine we need. So, we don’t really need carnitine from food or supplements.

However, we do get significant amounts of carnitine from red meat, much smaller amounts of carnitine from other animal foods, and almost no carnitine from plant foods. Adults consuming diets with red meat and other animal foods get about 60-180 mg of carnitine a day from their diet, whereas vegans only get around 10-12 mg/day.

Uptake of carnitine from the blood into muscle tissues requires insulin. Thus, carnitine uptake into muscle is significantly less on a low-carbohydrate or keto diet than it is on a mixed diet containing carbohydrates.

Finally, our kidneys do an excellent job of regulating blood carnitine levels, with excess carnitine being excreted into the urine. Thus, total body carnitine levels are virtually the same with high-carnitine and low-carnitine diets.

Question MarkThis raises the question: “Are L-carnitine supplements good for you?”

Now, let’s talk about the dark side of carnitine. I have discussed this in a previous issue of “Health Tips From the Professor”. Here is a brief summary:

  • People who eat a lot of red meat harbor a species of bacteria in their intestine that converts carnitine to trimethylamine (TMA). We don’t know whether this species of gut bacteria is favored by the presence of red meat in the diet or the absence of certain fruits, whole grains, and legumes from the diet of meat eaters.
  • The TMA is reabsorbed into the bloodstream, and the liver converts TMA to TMAO (trimethylamine N-oxide).
  • TMAO is associated with an increased risk of heart attack, stroke, and heart failure.

When you think about it, this is a perfect example of double jeopardy. Red meat is high in carnitine, and red meat eaters have gut bacteria that result in carnitine being converted to a compound that may increase the risk of heart disease.

This raises the question: “Are L-carnitine supplements bad for you?”

Let’s look at these two questions. First, I will discuss the recent review. Then I will put the conclusions of that review into perspective by looking at what other health experts say.

Are Carnitine Supplements Good For You Or Bad For You?

good news bad newsMost previous studies of carnitine supplementation have lasted only two or three weeks, which may not be long enough to measure an effect of carnitine supplementation on performance. So, the authors of this review paper selected studies that lasted 11 weeks or more for their review.

The review included 11 studies. They lasted either 12 or 24 weeks. Participants received doses ranging from 1 gm to 4.5 gm of L-carnitine per day. Here are the conclusions of the review:

  • Participants receiving L-carnitine alone had no increase in muscle carnitine content.
  • Participants receiving L-carnitine + 80 grams of carbohydrate had around a 10% increase in muscle carnitine content. [To put that into perspective, 80 grams of carbohydrate is roughly equivalent to 2 cups of white rice or two medium potatoes.]
  • One study compared male vegetarians with male omnivores. The omnivores had no increase in muscle carnitine content, but the vegetarians did. [The study did not analyze the diets of the omnivores and vegetarians, but it is probably safe to assume that the carbohydrate content was higher on the vegetarian diet.]
  • There was no significant effect of L-carnitine on muscle mass or physical performance. [This is logical, given the minimal effect of L-carnitine supplementation on muscle carnitine levels.

Thus, this review found little evidence that L-carnitine supplementation was good for you. It resulted in little or no increase in muscle carnitine levels or in physical performance.

  • Two of the 11 studies measured plasma TMAO levels. These studies found that L-carnitine supplementation resulted in a significant increase in plasma TMAO levels.

Thus, this review found some evidence that L-carnitine supplementation might be bad for you.

What Is The Truth About Carnitine And TMAO?

the truth signIs carnitine good for you? With respect to this question, the conclusions of this review are similar to the conclusions of other health experts. For example, in their Fact Sheet On Carnitine For Health Professionals the NIH states “Some athletes take carnitine to improve performance. However, twenty years of research finds no consistent evidence that carnitine supplements can improve exercise or physical performance in healthy subjects—at doses ranging from 2–6 grams/day administered for 1 to 28 days. For example, carnitine supplements do not appear to increase the body’s use of oxygen or improve metabolic status when exercising, nor do they necessarily increase the amount of carnitine in muscle.”

The NIH fact sheet goes on to list some diseases causing muscle loss or muscle weakness, for which L-carnitine supplementation is appropriate. However, in these cases, the carnitine supplementation should be recommended by health professionals.

Is carnitine bad for you? The TMAO story is a bit more complicated. As I mentioned above, there is an association between red meat consumption and blood TMAO levels and an association between blood TMAO levels and heart disease.

Is it TMAO that increases the risk of heart disease or is it some other component (saturated fat, for example) of red meat that increases the risk of heart disease? Nobody knows. More research is needed.

There is also a “red herring” that complicates the TMAO story. It turns out that TMAO helps fish survive the high pressures they encounter in the deep ocean. Thus, many fish are high in TMAO, and fish consumption also increases blood TMAO levels.

Are the bad effects of TMAO in fish outweighed by the heart healthy components in fish (omega-3s, for example)? Nobody knows. More research is needed.

To summarize:

  • There is no reason to take L-carnitine supplements unless directed by your health professional. There is little evidence they will help your physical performance. There is also no good evidence to support the other benefits of L-carnitine you find listed on Dr. Strangelove’s blog or the website of your favorite supplement company.
  • L-carnitine supplements may be bad for your heart, but much more research will be needed to be sure. [Note: Based on what we know about the role of gut bacteria in TMAO production, vegans could probably take l-carnitine supplements without causing an increase in TMAO levels. However, that is probably a moot point. There is no evidence that L-carnitine is more effective for vegans than it is for omnivores.]

The Bottom Line 

If you are a weightlifter or bodybuilder, chances are you are taking an L-carnitine supplement or a protein shake fortified with L-carnitine. That is because L-carnitine has been promoted for increasing muscle mass and physical performance for so long that most people have come to believe it must be true. Is it true, or is it just another food myth?

On the flip side, recent studies have suggested that the carnitine in red meat might be bad for your heart. Could the same be true for L-carnitine supplements? Could they also be bad for your heart?

A recent review looked at these questions. Here are the conclusions of the review:

  • Participants receiving L-carnitine alone had no increase in muscle carnitine content.
  • Participants receiving L-carnitine + 80 grams of carbohydrate had around a 10% increase in muscle carnitine content. [To put that into perspective, 80 grams of carbohydrate is roughly equivalent to 2 cups of white rice or two medium potatoes.]
  • There was no significant effect of L-carnitine on muscle mass or physical performance. [This is logical, given the minimal effect of L-carnitine supplementation on muscle carnitine levels.

Thus, this review found little evidence that L-carnitine supplementation was beneficial. It resulted in little or no increase in muscle carnitine levels or in physical performance.

  • This review also found that L-carnitine supplementation resulted in a significant increase in plasma TMAO, a compound that has been associated with an increased risk of heart disease.

Thus, this review found some evidence that L-carnitine supplementation might be bad for you.

The NIH has also issued a fact sheet for health professionals summarizing research on L-carnitine over the past 20 years. The conclusions from their fact sheet can be best summarized as:

  • There is no reason to take L-carnitine supplements unless directed by your health professional. There is little evidence they will help your physical performance. There is also no good evidence to support the other benefits of L-carnitine you find listed on Dr. Strangelove’s blog or the website of your favorite supplement company.
  • L-carnitine supplements may be bad for your heart, but much more research will be needed to be sure.

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.

Is The Keto Diet Best For Endurance Exercise?

Where Do Food Myths Come From?

ketogenic dietI don’t need to tell you that the keto diet is popular right now. It is touted for weight loss, mental sharpness, and improved health. I discuss the accuracy of those claims in my book, “Slaying the Food Myths”.

Perhaps more surprising has been the adoption of the keto diet by so many endurance athletes. As I point out in my book, there is a kernel of truth for that idea. Fats and ketone bodies are a very efficient energy source for low to moderate intensity exercise, and we have a virtually unlimited source of stored fat that can be converted to ketone bodies.

However, I always add this caveat, “The keto diet is perfect for endurance exercise – as long as you don’t care how fast you get there”. That is because high intensity exercise requires muscle glycogen stores, which come from the carbohydrates we eat. When you cut carbs from the diet, you deplete your glycogen stores.

And, if you are running a marathon and you want to sprint to the finish line, you will need those muscle glycogen stores. Or, if you are in a cycling event and you want to power up a mountain, you will need those glycogen stores.

Of course, you are probably asking, “Why do so many endurance athletes swear by the keto diet?” There is a dirty little secret behind athlete endorsements. I’m not talking about the money that top athletes get paid for endorsements, although that is also a problem.

I’m talking about the testimonials you hear from your friend who runs marathons or your personal trainer. Unfortunately, testimonials from athletes are notoriously unreliable. The problem is that the placebo effect approaches 70% for athletes.

Competitive athletes are strong willed. If they think a diet or sports nutrition product will help them, they will themselves to a higher level of performance. And this happens subconsciously. They aren’t even aware that their mind is influencing their performance.

So, just because your favorite athlete endorses the keto diet doesn’t mean it is the perfect diet for you. Testimonials can be very misleading.

The important question to ask is, “Do clinical studies support the keto diet as the best diet for endurance exercise?” But, before I answer that question, let me frame the question by asking. “Where do food myths come from?” because the belief that keto diets are best for endurance exercise is a classic food myth.

Where Do Food Myths Come From?

I discussed this question at length in my book, “Slaying The Food Myths”. Let me summarize it briefly here.

Secrets Only Scientists Know: First you need to know the secrets only scientists know. Here are the top 2:

#1: Scientists design their studies to disprove previous studies. There is no glory for being the 10th person to confirm the existing paradigm. The glory comes from being the first to show the existing paradigm might be wrong. While this may seem to be a contrary approach, it is actually the strength of the scientific method.

However, it means that there will be published clinical studies on both sides of every issue.

#2: Every study has its flaws. There is no perfect study.

This is why the scientific community doesn’t base their recommendations on 2 or 3 published studies. We wait until there are 10 to 20 good quality studies and base our recommendations on what 90% of them show.

Now, let me contrast the scientific approach with how food myths are born.

Where Do Food Myths Come From? Food myths usually originate on blogs or websites. Often the articles are written by people with no scientific credentials. But some of them are written by doctors (I will call them Dr. Strangelove to “protect the guilty”). The articles they write have these things in common:

cherry picking studies

  • The articles are based on the biases of the author. No effort is made to look at the other side of the story.
  • The authors “cherry pick” studies that support their bias and ignore studies that contradict them.
  • They use scientific-sounding mumbo jumbo to make their hypothesis sound credible.
  • Their articles are usually spectacular. For example, they say things like, “A particular diet, food, or supplement will either cure you or kill you”, and/or “The medical community is hiding the truth from you.”
  • They never let the facts get in the way of a good story.

Since the idea sounds credible it is picked up by other blogs and websites without any fact checking (social media at its worst). Once it has been repeated often enough, it becomes generally accepted as true. It becomes a food myth. From that point on, studies that disprove the myth are often ignored.

How do you know whether a common belief is true, or just another myth? The only way to be sure is to take a balanced look at all the clinical studies, not just the studies that support the belief.

That is what the authors of a recent review paper (CP Bailey and E Hennessy, Journal of the international Society of Sports Nutrition, 17, Article number: 33, 2020) did for the belief that the keto diet is the best diet for endurance exercise.

Is The Keto Diet Best For Endurance Exercise?

CyclistsBefore I discuss the findings of the review article, there are two things you should know:

#1: There is little scientific research on the effectiveness of the keto diet on endurance exercise. After an exhaustive search of the literature, the authors were only able to find 7 published studies on the topic.

#2:Most sports nutrition studies are of poor quality. In general, they are very small studies, are of short duration, and do not use common test procedures to measure a successful outcome. These studies on keto diets were no different. For example:

    • The number of subjects in these studies ranged from 5 to 29 (average = 14).
    • The duration of time on the diet in these studies ranged from 3 weeks to 12 weeks (average = 5 weeks).
    • Tests used to measure the effectiveness of specific diets on endurance exercise were VO2max (the maximum amount of oxygen you can utilize during exercise), Time to exhaustion (how long you can exercise before you are exhausted), Rating of perceived exertion (feeling of fatigue at the end of the exercise), Race time (time required to complete an event), and Peak power output during the event.
    • Four studies used a treadmill to simulate endurance exercise. The other three used a stationary bike.
    • Five of the studies compared the keto diet to a high carbohydrate diet. Two studies used the keto diet only.

The results were all over the place:

Question Mark

  • Two studies reported an increase in VO2max for both the keto diet and the high carbohydrate diet. One study reported a decrease in VO2max for both diets. The other studies reported no change in VO2max. In short, there was no difference between the diets for VO2max.
  • One study reported a decrease in race time for the high carbohydrate diet and a non-significant increase in race time for the keto diet. Two other studies reported no effect of either diet on race time. In short, one study suggested the high carbohydrate diet was more effective at shortening race time. The other two studies found no effect of either diet.
  • Two studies showed an increase in time to exhaustion for both diets. One study showed a decrease in time to exhaustion for the keto diet (participants got tired more quickly). That study did not include the high carbohydrate diet for comparison. In short, there was no clear difference between the two diets for time to exhaustion.
  • One study showed that the group on the keto diet reported a higher rating of perceived exertion (were more tired) at the end of the endurance event than the group on the high carbohydrate diet. Another study found no difference between the two diets. In short, one study suggested the high carbohydrate diet was better with respect to perceived exertion (tiredness) at the end of the endurance event. Another study found no difference between the two diets.
  • One study reported that peak power was significantly greater for the group on the keto diet than the group on the high carbohydrate diet. One of the studies with the keto group reported that peak power decreased for 4 out of 5 subjects on the keto diet. In short, one study suggested that the keto diet was more effective at increasing peak power than the high carbohydrate diet. Another study suggested the keto diet decreased peak power.

The authors concluded: “When compared to a high carbohydrate diet, there are mixed findings for the effect of the keto diet on endurance performance…The limited number of published studies point to a need for more research in this field.” I would add that we need larger, better designed studies, with common measures of exercise performance.

What Does This Mean For You?

confusionYou may be wondering why I even bothered to talk about such poor-quality studies and a review that could not provide a definitive answer. In fact, that is exactly my point.

This is characteristic of the kind of “evidence” that Dr. Strangelove and his buddies present to support whatever food myth they are featuring on their website. They don’t know how to distinguish good studies from bad studies, and they “cherry pick” only the studies that support their food myth.

So, if you believe that the keto diet is best for endurance exercise, you can “cherry pick” the one published clinical study that supports your belief. You just need to ignore the other 6 published studies.

And, if you believe that a high carbohydrate diet is better for endurance exercise than the keto diet, you can “cherry pick” two clinical studies that support your belief. You just need to ignore the other 5 published clinical studies.

None of the studies are high-quality studies, and the effect of either diet on endurance exercise in these studies is miniscule.

In short, there is no convincing evidence that the keto diet is best for endurance exercise. Or, put another way, we do not have enough evidence to elevate that belief from a food myth to a recommendation we can confidently make for an endurance athlete.

The Bottom Line

A recent publication conducted an impartial review of the evidence for and against the popular belief that a keto diet is the best diet for endurance exercise. The review found only 7 poor-quality studies on this topic in the scientific literature, and the results of those studies were all over the map.

  • One study reported the keto diet was better than a high carbohydrate diet for endurance exercise.
  • Two studies reported that the high carbohydrate diet was better.
  • The other 4 studies were inconclusive.
  • None of the studies found a significant effect on endurance performance by either diet.

So, if you believe that the keto diet is best for endurance exercise, you can “cherry pick” the one published clinical study that supports your belief. You just need to ignore the other 6 published studies.

And, if you believe that a high carbohydrate diet is better for endurance exercise than the keto diet, you can “cherry pick” two clinical studies that support your belief. You just need to ignore the other 5 published clinical studies.

In short, there is no convincing evidence that the keto diet is best for endurance exercise. Or, put another way, we do not have enough evidence to elevate that belief from a food myth to a recommendation we can confidently make for an endurance athlete.

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.

Preparing For The New Normal

Can Supplements Strengthen My Immune System?

COVID-19The United States and the rest of the world are facing the biggest challenge of our lifetimes. COVID-19 has killed hundreds of thousands of people and decimated economies around the world.

As of the publication date of this article we have no vaccine and only one treatment option that appears to be about 30% effective in a preliminary clinical trial. People are scared.

The question I get asked most often is: “Can supplements protect me from COVID-19”. That’s not a question I can answer with confidence. The few studies we have are small and preliminary. Plus, there is too much we still do not know about COVID-19.

However, there are studies about how diet and supplements affect the immune system. I can answer the question, “Can Supplements Strengthen My Immune System”, with confidence. That will be the focus of this article.

However, before covering that, let me take an objective look at what our “New Normal” will be like and how we can prepare for it.

Preparing For The New Normal

ProfessorAs a scientist I am appalled by the divisive and hyper-partisan arguments about how we should be handling the COVID-19 pandemic. This is a time when our country should be united against a common enemy. Instead I see myths and lies propagated on both sides of this important issue.

The press only magnifies the problem by repeating the myths without fact checking. Whether they are on the left or the right, the media only repeats myths that fit their narrative. As a result, people like you are confused and scared.

Let me try to give you a more objective and scientific view of what the “New Normal” will look like, and how we can prepare for it.

Let’s start with one of the biggest arguments over the past few weeks – when should we reopen our country. This argument is based on the myth that if we wait long enough, the virus will be gone, and life can return to normal.

Nothing could be further from the truth. In reality viruses don’t work that way. They continue to circulate through the population at low levels. Whenever we emerge from our homes and resume our daily lives, the virus will be lurking. There will be flare-ups. There will be hot spots. There will be deaths. And the press will report every one.

So, the question should not be when we emerge. It should be how we emerge. We should emerge cautiously. We should continue to take appropriate precautions. These precautions will become our “New Normal” until we have an effective vaccine. By now, you probably have the CDC precautions memorized, but let me repeat them here:

  • If you are sick, stay home until you recover. If your symptoms worsen, contact your doctor right away.
  • If you are exposed, get tested right away and self-quarantine for 14 days if you test positive.
  • When you go out, wear a face mask and practice social distancing. When you get home, wash your hands in soap and water for 20”.
  • For now, we will need to avoid the customary handshake (and if you are from the South like me, the customary hug).
  • If you are very old or very sick, you should stay home as much as possible. If you have a loved one in this category, you should do everything in your power to protect them from exposure.
  • The guideline that is hardest to project into the future is the one on crowd size. It is hard to predict what the CDC will recommend about crowd size as part of our “New Normal” a few months from now. However, because this virus is extremely contagious, it may be risky to attend any gatherings where there are large, tightly packed crowds for the foreseeable future. This could include some of our favorite things – like movies, live theater, night clubs, and sporting events.Myth Versus Facts

Finally, there is another big myth, namely that the virus will simply disappear once we have a vaccine. Vaccines reduce your risk of exposure because fewer people are carriers of the virus. However, coronaviruses never disappear. They continue to circulate in the population for decades.

Even after we have a vaccine, people will still get sick from COVID-19. People will still die from COVID-19. The difference is that we will no longer hear about COVID-19 cases and deaths on the nightly news. Those cases and deaths will just become part of the statistics that the CDC collects on flu-like illnesses each year – and everyone ignores.

Now that I have discussed what the “New Normal” will look like and summarized the CDC guidelines for reducing your exposure to COVID-19 as the lockdown eases, let me add another guideline of my own:

  • Keep your immune system as strong as possible.

Why Is Keeping Your Immune System Strong Important?

strong immune systemIt is no secret that the media likes to focus on bad news. It is the bad news that draws people in and keeps them coming back for more.

Pandemics are no different. It doesn’t matter whether we are talking about the Spanish flu, SARS, MERS, or COVID-19. We focus on cases and deaths – the bad news. We ignore the good news – there are millions of people who were infected and had no symptoms.

However, if you have been listening closely to what the experts have been saying rather than relying on the media for your information, the good news is obvious.

  • 80-85% of people who have tested positive for COVID-19 have mild or moderate symptoms. Their symptoms are no worse than they experience with the seasonal flu.
  • Preliminary antibody tests suggest that the number of people infected with COVID-19 who experience no symptoms may be 10 to 40 times higher than reported cases.
  • The experts say that the difference is a strong immune system. They tell us that it is people with weakened immune systems that suffer and die from COVID-19.

So, how do you keep your immune system strong? Let’s start by looking at the role of supplementation.

Can Supplements Strengthen My Immune System?

MultivitaminsThose of you who follow me know that I consider supplementation as just one aspect of a holistic approach to health. However, I am starting with supplements because the question I am often asked these days is: “Can supplements protect me from COVID-19”.

As I said at the beginning of this article, that is not a question I can answer with confidence. Instead, the question you should be asking is, “Can Supplements Strengthen My Immune System?”

As I mentioned above, the experts are telling us that it is people with weakened immune systems who suffer and die from COVID-19. That means it is important to keep our immune system as strong as possible.

How do we do that? Here is what an international group of experts said in a recent review (PC Calder et al, Nutrients, 12, 1181-1200, 2020).

1) “A wealth of mechanistic and clinical data show that vitamins A, B6, B12, C, D, E, and folate; trace elements zinc, iron, selenium, magnesium, and copper; and omega-3 fatty acids EPA and DHA play important and complementary roles in supporting the immune system.”

2) “Inadequate intake and status of these nutrients are widespread, leading to a decrease in resistance to infections, and an increase in disease burden.”

They then made the following recommendations:

1) Supplementation with the above micronutrients and omega-3 fatty acids is a safe, effective, and low-cost strategy to help support optimal immune function.

    • They recommended 100% of the RDA for vitamins A, B6, B12, C, D, E, and folate and minerals zinc, iron, selenium, magnesium, and copper in addition to the consumption of a well-balanced diet.
    • They recommended 250 mg/day of EPA + DHA.

2) Supplementation above the RDA for vitamins C and D is warranted.

    • They recommend 200 mg/day of vitamin C for healthy individuals and 1-2 g/day for individuals who are sick.
    • They recommend 2000 IU/day (50 ug/day) for vitamin D.

3) Public health officials are encouraged to include nutritional strategies in their recommendations to improve public health.

Their recommendations could be met by a multivitamin that provides all the micronutrients they recommend, an omega-3 supplement, and extra vitamins C and D.

What Else Should I Do To Strengthen My Immune System?

healthy foodsAs I said above, supplementation is only one part of a holistic approach to a strong immune system. Here are the other components of a holistic approach:

1) It starts with a healthy diet.

    • Eat foods from all 5 food groups.
    • Eat plenty of fruits and vegetables. They provide antioxidants and phytonutrients that are important for our immune system.
    • Eat plenty of high fiber foods. Include whole grains and beans in addition to fruits and vegetables. That’s because the friendly gut bacteria that strengthen our immune system need a variety of fibers from different food sources to feed on.
    • Eat oily fish on a regular basis.
    • Avoid sodas, sugary foods, and highly processed foods.
    • Avoid high fat diets

2) Get adequate sleep. For most of us, that means 7-8 hours of sleep a night.

3) Maintain a healthy weight.

4) Get adequate exercise. Aim for a minimum of 150 minutes of moderate intensity exercise each week.

5) Manage stress and anxiety in healthy ways. Yes, that means if you let the news about COVID-19 cause anxiety, you are weakening your immune system. You may want to turn off the news and try prayer, meditation, yoga, or whatever relieves stress for you.

The Bottom Line

In this article, I summarized the “New Normal” we face as we emerge from lockdown and how to navigate the new normal as safely as possible. If I were to summarize this article in a few short sentences, this is what I would say:

Until we have an effective vaccine the “New Normal” is a world in which a dangerous virus is lurking in the community, waiting to strike the unprepared.

Forget all the angry rhetoric about when we should emerge from lockdown. The important question is not when we emerge. It is how we emerge.

We don’t need to stay huddled in our homes, fearful to leave, unless we are very old or very sick.

We do need to take appropriate precautions when we leave home based on the recommendations of the CDC. None of us are invincible as far as this virus is concerned. More importantly, if we bring the virus home, we may kill the very people we love the most. We need to follow the guidelines.

We should also make sure that our immune system is as strong as possible through a holistic combination of diet, supplementation, adequate sleep, exercise, weight management, and stress reduction.

For more information on CDC COVID-19 Guidelines, click here.

For more details about preparing for the new normal and diet & supplementation recommendations, 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.

Preventing And Reversing Osteoporosis

A Bone Health Lifestyle

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

Woman Enjoying Autumn LeavesFall is glorious in my book.  I was up in New York a few weeks ago, and the trees were just changing – I was about a week too early for the best colors, but it was still beautiful. Then I flew out to Lake Tahoe, and it was really beautiful there.  The air was crisp and clean, and I loved all the fall decorations.

In Florida we are entering our most wonderful time of year. It’s starting to get cooler, the humidity is going down, and hurricane season is over. Hooray!  It’s great to be outdoors again!

Please remember all the people who are still going through very difficult times in the Bahamas.  Many people have lost their homes, their workplaces and the income that supports them, and some have lost loved ones. A devastating loss.

We here in the USA were blessed that Dorian didn’t come any further west and do the same thing to Florida, Georgia, and the Carolinas. I wanted to share what I have with the people who now have nothing. That made me search for places I trust that will send all the money I donate. In case you want to help, and you don’t have a favorite charity, I want to share those places with you:

https://disaster.salvationarmyusa.org

http://secure.americares.org/help/now‎

https://www.mercycorps.org/articles/hurricane-dorian-bahamas#mercy-corps-helping

Preventing And Reversing Osteoporosis

Exercise And NutritionWeight-bearing exercise builds strong bones. That statement is so common that just about everyone knows they need to exercise for strong muscles and bones, and for all the good it does for just about every system in the body.  And, we are what we eat, so nutrition is vital.

Do you like to exercise? Some people are almost addicted to exercise, but I’m not one of them.  I go to the gym and I have a fitness trainer to help me stay on track, but it fits right in with my eagerness of going to the dentist.  I must say, I’d like that to change, and maybe if I can find a workout partner, it will.

Meanwhile I need to do something because I’ve been told I have osteoporosis. Yikes! One thing for sure, I’m not taking any type of medication. I truly believe there is another solution.

While I’m not an exercise nut, I do love nutrition and I know that the body is so adaptable that if it’s given the proper nutrition, it can do miracles. I believe nutrition and exercise can reverse this osteoporosis diagnosis.

A Bone Healthy Lifestyle

A Bone Healthy Lifestyle
A Bone Healthy Lifestyle

The first thing I did was contact my friend, Steve Chaney, PhD, author of the weekly blog “Health Tips From The Professor.  He pointed me to an article he had written on a “Bone Healthy Lifestyle”. Here is a brief summary:

  • Exercise, calcium, and vitamin D are all essential for bone formation. If any of them are missing, you can’t form healthy bone. The reason so many clinical studies on calcium supplementation and bone density have come up empty is that exercise, or vitamin D, or both were not included in the study.
  • Get plenty of weight bearing exercise. This is an essential part of a bone healthy lifestyle. Your local Y can probably give you guidance if you can’t afford a personal trainer. Of course, if you have physical limitations or have a disease, you should consult with your health professional before beginning any exercise program.
  • Get your blood 25-hydroxy vitamin D level tested. If it is low, take enough supplemental vitamin D to get your 25-hydroxy vitamin D level into the adequate range – optimal is even better. Adequate blood levels of 25-hydroxy vitamin D are also essential for you to be able to utilize calcium efficiently.
  • Consume a “bone healthy” diet that emphasizes fresh fruits and vegetables, minimizes meats, and eliminates sodas and other acidic beverages. For more details on whether your favorite foods are acid-forming or alkaline-forming, you can find plenty of charts on the internet.
  • Minimize the use of medications that adversely affect bone density. You’ll need to work with your doctor on this one.
  • Consider a calcium supplement. Even when you are doing everything else correctly, you still need adequate calcium in your diet to form strong bones. Dr. Chaney wasn’t advocating a “one-size fits all” 1,000 to 1,200 mg/day for everyone. Supplementation is always most effective when you actually need it. For example:

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

o   If you are taking medications that decrease bone density, that may increase your need for supplemental calcium. Ask your pharmacist about the effect of any medications you are taking on your calcium requirements.

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

Between increasing my exercise and ramping up all the nutrients that build bone, I just know that by this time next year I’m going to be surprising the doctor with my great health

Is Our Microbiome Affected By Exercise?

Microbiome Mysteries

Author: Dr. Stephen Chaney

is our microbiome affected by exerciseIn a recent post,  What is Your Microbiome and Why is it Important,  of “Health Tips From The Professor” I outlined how our microbiome, especially the bacteria that reside in our intestine, influences our health. That influence can be either good or bad depending on which species of bacteria populate our gut. I also discussed how the species of bacteria that populate our gut are influenced by what we eat and, in turn, influence how the foods we eat are metabolized.

I shared that there is an association between obesity and the species of bacteria that inhabit our gut. At present, this is a “chicken and egg” conundrum. We don’t know whether obesity influences the species of bacteria that inhabit our gut, or whether certain species of gut bacteria cause us to become obese.

Previous studies have shown that there is also an association between exercise and the species of bacteria that inhabit our gut. In particular, exercise is associated with an increase in bacteria that metabolize fiber in our diets to short chain fatty acids such as butyrate. That is potentially important because butyrate is a primary food source for intestinal mucosal cells (the cells that line the intestine). Butyrate helps those cells maintain the integrity of the gut barrier (which helps prevent things like leaky gut syndrome). It also has an anti-inflammatory effect on the immune cells that reside in the gut.

However, associations don’t prove cause and effect. We don’t know whether the differences in gut bacteria were caused by differences in diet or leanness in populations who exercised regularly and those who did not. This is what the present study (JM Allen et al, Medicine & Science In Sports & Exercise, 50: 747-757, 2018 ) was designed to clarify.  Is our microbiome affected by exercise?

 

How Was The Study Designed?

is our microbiome affected by exercise studyThis study was performed at the University of Illinois. Thirty-two previously sedentary subjects (average age = 28) were recruited for the study. Twenty of them were women and 12 were men. Prior to starting the study, the participants filled out a 7-day dietary record. They were asked to follow the same diet throughout the 12-week study. In addition, a dietitian designed a 3-day food menu based on their 7-day recall for the participants to follow prior to each fecal collection to determine species of gut bacteria.

The study included a two-week baseline when their baseline gut bacteria population was measured, and participants were tested for fitness. This was followed by a 6-week exercise intervention consisting of three supervised 30 to 60-minute moderate to vigorous exercise sessions per week. The exercise was adapted to the participant’s initial fitness level, and both the intensity and duration of exercise increased over the 6-week exercise intervention. Following the exercise intervention, all participants were instructed to maintain their diet and refrain from exercise for another 6 weeks. This was referred to as the “washout period.”

VO2max (a measure of fitness) was determined at baseline and at the end of the exercise intervention. Stool samples for determination of gut bacteria and concentrations of short-chain fatty acids were taken at baseline, at the end of the exercise intervention, and again after the washout period.

In short, this study divided participants into lean and obese categories and held diet constant. The only variable was the exercise component.

 

Is Our Microbiome Affected By Exercise?

is our microbiome affected by exercise fitnessThe results of the study were as follows:

  • Fitness, as assessed by VO2max, increased for all the participants, and the increase in fitness was comparable for both lean and obese subjects.
  • Exercise induced a change in the population of gut bacteria, and the change was comparable in lean and obese subjects.
  • Exercise increased fecal concentrations of butyrate and other short-chain fatty acids in the lean subjects, but not in obese subjects.
  • The exercise-induced changes in gut bacteria and short-chain fatty acid production were largely reversed once exercise training ceased.

The authors concluded: “These findings suggest that exercise training induces compositional and functional changes in the human gut microbiota that are dependent on obesity status, independent of diet, and contingent on the sustainment of exercise.” [Note: To be clear, the exercise-induced changes in both gut bacteria and short-chain fatty acid production were independent of diet and contingent on the sustainment of exercise. However, only the production of short-chain fatty acids was dependent on obesity status.]

 

What Does This Study Mean For You?

is our microbiome affected by exercise gut bacteriaThere are two important take home lessons from this study.

  • With respect to our gut bacteria, I have consistently told you that microbiome research is an emerging science. This is a small study, so you should regard it as the beginning of our understanding of the effect of exercise on our microbiome rather than conclusive by itself. It is consistent with previous studies showing an association between exercise and a potentially beneficial shift in the population of gut bacteria.

The strength of the study is that it shows that exercise-induced changes in beneficial gut bacteria are probably independent of diet. However, it is the first study to look at the interaction between obesity, exercise and gut bacteria, so I would interpret those results with caution until they have been replicated in subsequent studies.

  • With respect to exercise, this may be yet another reason to add regular physical activity to your healthy lifestyle program. We already know that exercise is important for cardiovascular health. We also know that exercise increases lean muscle mass which increases metabolic rate and helps prevent obesity. There is also excellent evidence that exercise improves mood and helps prevent cognitive decline as we age.

Exercise is also associated with decreased risk of colon cancer and irritable bowel disease. This effect of exercise has not received much attention because the mechanism of this effect is unclear. This study shows that exercise increases the fecal concentrations of butyrate and other short-chain fatty acids. Perhaps, this provides the mechanism for the interaction between exercise and intestinal health.

 

The Bottom Line

A recent study has reported that:

  • Exercise induces a change in the population of gut bacteria, and the change was comparable in lean and obese subjects.
  • Exercise causes an increase in the number of gut bacteria that produce butyrate and other short-chain fatty acids that are beneficial for gut health.
  • These effects are independent of diet, but do not appear to be independent of obesity because they were seen in lean subjects but not in obese subjects.
  • The exercise-induced changes in gut bacteria and short-chain fatty acid production are largely reversed once exercise training ceases.

The authors concluded: “These findings suggest that exercise training induces compositional and functional changes in the human gut microbiota that are dependent on obesity status, independent on diet, and contingent on the sustainment of exercise.”

For more details and my interpretation of the data, 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.

Can You Eat Spinach For Muscle Growth

Was Popeye Right?

Author: Dr. Stephen Chaney

can eat spinach for muscle growthYou may have seen the recent headlines proclaiming that eating spinach will make you stronger. The more “mature” adults among my readers may remember the Popeye cartoons of our youth. Every time Popeye was on the brink of disaster he would down a can of spinach and become superhuman. Was Popeye right? Can spinach actually improve strength and endurance?  Can you eat spinach for muscle growth?  To answer those questions, I analyzed the study behind the headlines.

The short answer is that there may be some truth to the headlines, but you would never be able to prove it from the study they quoted.

Even worse, this study and the headlines it generated are typical of the sports nutrition marketplace. There are far too many headlines and sports nutrition products based on weak and inconclusive studies.

Spinach for Muscle Growth?

spinachLet’s start at the beginning. In the first place the study behind the headlines (De Smet et al., Frontiers In Physiology, 7: 233-244, 2016) did not actually use spinach. In fact, participants were advised to avoid nitrate-rich foods like spinach and beets during the study.

The study enrolled moderately-trained male students from the University of Leuven in Belgium. All the participants completed 5 weeks of sprint interval training (SIT) consisting of 30 second sprints followed by 4.5-minute recovery intervals on an exercise cycle. This was repeated 4-6 times per session 3 times per week.

One group took a sodium nitrate supplement containing 400 mg of nitrate 30 minutes before each workout. The other group received a placebo. There were only 9 students in each group. [I have simplified the study design for the purposes of this discussion. There were other aspects of the study, but they are not relevant to our discussion.]

The investigators measured maximum oxygen consumption (a measure of exercise efficiency and endurance), maximum power output during a 30-second sprint, and composition of quadriceps muscle fibers both before the 5-week training started and again when it was completed.

The results were disappointing:

  • thumbs downNitrate supplementation caused a modest increase in fast twitch (type IIa) muscle fibers compared to placebo. That is a physiological response that may (or may not, depending on who you believe) allow high intensity exercise to be sustained for longer without fatigue.
  • Nitrate supplementation failed to show any significant benefit for any other measure of exercise capacity. In particular, no effect of nitrate supplementation was observed on:
    • Maximum oxygen consumption
    • Maximum power output
    • Peak heart rate
    • Time to exhaustion.
    • Various metabolic markers of exercise efficiency

In spite of these largely negative results, the authors concluded: “The current experiment demonstrated that oral nitrate supplementation during short-term sprint-interval training increased the proportion of type IIa muscle fibers, which may contribute to enhanced performance in short maximal exercise events…”

“May” is the operative word here. Their data did not provide any evidence that nitrate supplementation actually improved performance.

Online headlines (the kind of nutrition information most people read) took it a step further. For example, one headline claimed “Spinach Can Boost Your Physical Fitness and Muscle Strength.” That headline came out of thin air.

Sports Nutrition Myths

mythsUnfortunately, this study is typical of many of the sports nutrition studies I have reviewed over the years. Most of them are very small studies. In many of them only one or two measure exercise performance change, while other measures show no effect of supplementation.

That doesn’t stop bloggers from hyping the studies and creating sports nutrition myths. It also doesn’t stop companies from offering sports products with those ingredients and making outrageous claims about how their product will make you bigger, faster, and stronger.  For example, a claim that you can eat spinach for muscle growth.

It is only when dozens of studies have been published, and a meta-analysis combines the data from all the studies that we are in a position to see whether any particular nutrient has a statistically significant effect on performance.

Must You Eat Spinach for Muscle Growth or Could Nitrates Provide Exercise Benefits?

nitrates and exerciseDespite the weakness of this particular study, there is reason to believe that nitrates might improve exercise performance.

  • There is a plausible mechanism. In the body nitrates are converted to nitric oxide, which improves arterial health, lowers blood pressure, and enhances blood flow. Increased blood flow to the muscles could enhance exercise efficiency.
  • Other studies have come to a similar conclusion. There are several other exercise studies Health Benefits of Beetroot Juice involving supplements containing either nitrates or beetroot juice (which is rich in nitrates) that have suggested that supplementation improves exercise efficiency. Each of the studies are small and inconclusive by themselves, but in the aggregate they suggest that nitrate may have some benefits.
  • Arginine, which also enhances nitric oxide production, is well established in the sports nutrition world. There are dozens of published exercise studies involving arginine and meta-analyses of these studies suggest that arginine provides modest benefits. However, there is an important caveat, which I shall explain below.

In short, the idea that nitrate supplementation might improve exercise performance is plausible. However, plausible is a long way from proven.

The Ultimate Irony

When you analyze the meta-analyses of arginine supplementation and exercise performance studies, the ultimate irony is that arginine supplementation is most effective for untrained individuals who are just beginning an exercise program. It provides little benefit for trained athletes (R. Bescos et al, Sports Medicine, 42: 99‐117,2012).

There is a logical explanation for this observation. Intense exercise also enhances nitric oxide production and blood flow to the muscle. Most highly trained athletes have already maxed their nitric oxide levels and have excellent blood flow to their muscles. Arginine (or nitrate) supplementation provides little additional benefit for them.

Why do I call this the ultimate irony? Think about it for a minute.

The people most likely to use sports supplements with arginine or nitrate are gym rats and highly trained athletes – the people who get the least benefit from those supplements.

The people least likely to use special sports supplements with arginine or nitrate are the weekend warriors and the busy professionals who are just trying to stay fit – the people who are most likely to benefit from those supplements.

 

The Bottom Line

 

  • Recent headlines have suggested that you can eat spinach for muscle growth and exercise performance.
  • When you look at the study behind the headlines, the study was done with nitrate, not with spinach. Spinach is a nitrate-rich food (as are beet roots), but the headlines were clearly misleading.
  • The study was also inconclusive. It was a small study, and most parameters of exercise performance were not affected by nitrate supplementation.
  • Unfortunately, this kind of small, inconclusive study is all too common in the sports nutrition literature. That doesn’t stop bloggers from hyping the studies and creating sports nutrition myths. It also doesn’t stop companies from offering sports nutrition products with those ingredients and making outrageous claims about how their product will make you bigger, faster, and stronger.
  • However, other studies suggest the idea that nitrate in food or supplements could improve exercise performance is plausible.
  • In our bodies, nitrate is converted to nitric oxide, which enhances blood flow to the muscles.
  • Other studies with nitrate and with beetroot juice (an excellent source of nitrate) have shown some exercise benefits.
  • Arginine, which is also converted to nitric oxide, is a fairly well established sports supplement.

Of course, plausible is a long way from proven.

  • The ultimate irony is that the people most likely to use sports supplements with arginine or nitrates are gym rats and highly trained athletes. They already have excellent blood flow to their muscles. They are the people who get the least benefit from those supplements.
  • In contrast, the people least likely to use special sports supplements with arginine or nitrates are the weekend warriors and the busy professionals who are just trying to stay fit. Those are the people who are most likely to benefit from those supplements.

 

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 We Take Calcium Supplements?

Clearing Up The Calcium Confusion

Author: Dr. Stephen Chaney

should we take calcium supplementsShould we take calcium supplements?  You have every right to be confused about calcium supplementation. There have been a lot of conflicting headlines in recent months.

It has seemed like a no-brainer for years that calcium supplementation could help post-menopausal women and men over 50 avoid the debilitating effects of osteoporosis.

After all:

  • >99% of adults fail to get the USDA recommended 2.5-3 servings/day of dairy products.
  • 67% of women ages 19-50 and 90% of women over 50 fail to meet the RDA recommendations for calcium intake from diet alone.
  • Men do a little better (but only because we consume more food). 40% of men ages 19-50 and 80% of men over 50 fail to meet the RDA recommendations for calcium intake from diet alone.
  • Inadequate calcium intake over a lifetime is considered a major risk factor for osteoporosis.
  • Osteoporosis is serious business. It doesn’t just cause bone fractures. It can result in chronic pain, disability, long term nursing home care, and even death.

It’s no wonder that some experts have predicted that supplementation with calcium and vitamin D could save over $1 billion per year in health care cost savings. It is also why health professionals have recommended calcium supplementation for years, especially for postmenopausal women and men over 50.

However, recent headlines have claimed that calcium supplementation doesn’t really increase bone density or prevent osteoporosis (more about that later). Other headlines have suggested that calcium supplementation is actually bad for you. It may increase your risk of heart disease.

That’s why the general public, and even many doctors, are confused.  Should we take calcium supplements?  Everyone wants to know the answer to two questions:

  • Do calcium supplements work?
  • Are calcium supplements safe?

I will start with the second question first.

Are Calcium Supplements Safe?

are calcium supplements safeI have discussed the issue of calcium supplements and heart disease risk in a previous issue of Health Tips From the Professor. Briefly, the initial studies suggesting that calcium supplementation might increase the risk of heart attacks and cardiovascular disease were good studies, but they were small, short-term studies.

The initial studies raised an important question, so the scientific community stepped up to the plate and conducted larger, longer term studies to test the hypothesis. Both of those studies concluded that calcium supplementation posed no heart health risks.

Now a third major study on the subject has just been published (Raffield et al, Nutrition, Metabolism & Cardiovascular Disease, doi: 10.1016/j.numecd.2016.07.007). The study followed 6236 men and women ages 45-84 for an average of 10.3 years. The subjects were from four different race/ethnicity groups and came from 6 different locations in the United States. More importantly, there were 208 heart attacks and 641 diagnoses of cardiovascular disease during the study, so the sample size was large enough to accurately determine the relationship between calcium supplementation and heart disease.

The results were pretty straight forward:

  • The authors concluded: “[This study] does not support a substantial association of calcium supplement use with negative cardiovascular outcomes.” If you would like the plain-speak version of their conclusion, they were saying that they saw no increase in either heart attacks or overall cardiovascular disease in people taking calcium supplements.
  • If anything, they saw a slight decrease in heart attack risk in those taking calcium supplements, but this was not statistically significant.

In summary, the weight of evidence is pretty clear. Three major studies have now come to the same conclusion: Calcium supplementation does not increase the risk of either heart attacks or cardiovascular disease.

Of course, once information has been placed on the internet, it tends to stay there for a very long time – even if subsequent studies have proven it to be wrong. So the myth that calcium supplementation increases heart attack risk will probably be with us for a while.

So, should we take calcium supplements?  Let’s first investigate a little further.

 

Do Calcium Supplements Work?

do calcium supplements workAs I mention above, recent headlines have also suggested that calcium supplementation does not increase bone density, so it is unlikely to protect against osteoporosis. I analyzed the study behind those headlines in great detail in two previous issues of Health Tips From the Professor.

In Part 1 Calcium Supplements Prevent Bone Fractures  I pointed out the multiple weaknesses in the study that make it impossible to draw a meaningful conclusion from the data.

 

In Part 2 Preventing Osteoporosis  I discussed the conclusion that the study should have come to, namely: Adequate calcium intake is absolutely essential for strong bones, but calcium intake is only one component of a bone healthy lifestyle.

The bottom line is that calcium supplementation will be of little use if:

  • You aren’t getting adequate amounts of vitamin D and all of the other nutrients needed for bone formation from diet and supplementation.
  • You aren’t getting enough exercise to stimulate bone formation.
  • You are consuming bone dissolving foods or taking bone dissolving drugs.

Conversely, none of the other aspects of a bone healthy lifestyle matter if you aren’t getting enough calcium from diet and supplementation.

The bottom line is that you need to get adequate calcium and have a bone healthy lifestyle to build strong bones and prevent osteoporosis, and calcium supplementation is often essential to make sure you are getting adequate calcium.

 

Should We Take Calcium Supplements?

should we take calcium supplements nowShould we take calcium supplements?  If you are one of the millions of Americans who aren’t meeting the RDA guidelines for calcium from diet alone, the answer is an unqualified yes.  Calcium supplementation is safe, and it is cheap.  Osteoporosis is preventable, and it is not a disease to be trifled with.

However, you also need to be aware that calcium supplementation alone is unlikely to be effective unless you follow a bone healthy lifestyle of diet, exercise and appropriate supplementation to make sure you are getting all of the nutrients needed for bone formation.

Of course, it is always possible to get too much of a good thing. The RDA for calcium is 1,000 – 1,200 mg/day. The suggested upper limit (UL) for calcium is 2,000 – 3,000 mg/day.  I would aim closer to the RDA than the UL unless higher intakes are recommended by your health care professional.

 

The Bottom Line

 

  • 80% of men and 90% percent of women over 50 do not get enough calcium from their diet.
  • Consequently, doctors have consistently recommended calcium supplementation to prevent osteoporosis, and 50% of men and 60% of women over 60 currently consume calcium supplements on a regular basis.
  • Some small, short term studies suggested that calcium supplementation might increase the risk of heart disease, and warnings about calcium supplementation have been widely circulated on the internet. This hypothesis has been evaluated by three larger, longer term studies that have all concluded that calcium supplementation does not increase heart disease risk.
  • A recent study claimed that calcium supplementation was ineffective at increasing bone density, and that report has also been widely circulated. However, there are multiple weaknesses in the study that make it impossible to draw a meaningful conclusion from the data.
  • If you are one of the millions of Americans who aren’t meeting the RDA guidelines for calcium from diet alone, you should consider calcium supplementation.  It is safe.  It is effective when combined with a bone healthy lifestyle of diet, exercise, and appropriate supplementation.  Finally, it is cheap. Osteoporosis is preventable, and it is not a disease to be trifled with.
  • Of course, it is always possible to get too much of a good thing. The RDA for calcium is 1,000 – 1,200 mg/day. The suggested upper limit (UL) for calcium is 2,000 – 3,000 mg/day. I would aim closer to the RDA than the UL unless higher intakes are recommended by your health care professional.

 

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.

Stretching Exercises For Flexibility And Pain Relief

The Pluses And Minuses Of Stretching

Author: Julie Donnelly, LMT –The Pain Relief Expert

Editor: Dr. Steve Chaney

 

muscle knotsWhen using stretching exercises for flexibility and pain relief, you should be careful to release the knots first.

Minuses!  Are there any minuses to stretching?  Yes, there are…let me explain.

All muscles originate on one bone, we’ll call the bone that is at the beginning of the muscle the “stationary bone,” then the muscle tendons cross over a joint and insert into another bone we’ll call the “moveable bone.”

When the muscle contracts (shortens) it pulls on the tendons, and they pull on the moveable bone where they are inserting.  This is how all joints move.

Let me demonstrate with the biceps muscle in your upper arm.  Your biceps originate in two different places:

The “long head” is deep inside your shoulder joint, and the “short head” is on a bone at the top of your shoulder called the coracoid process of your shoulder blade.

muscle painYour biceps tendon crosses over the inside of your elbow joint and inserts into the bone in your forearm.

When your biceps contract, you bend your elbow so you can touch your shoulder.

Notice that your triceps, on the back of your arm, are having to totally stretch to allow this movement.

Imagine what will happen if your triceps won’t stretch.

You won’t be able to bend your arm and your elbow will hurt.  You may decide that you need to stretch your triceps – but this is where the “minus” comes in!

The “Minus” of Stretching Exercises for Flexibility When Your Muscle is Tight

stretching exercisesWhen you repetitively use a muscle, in this case the triceps, the muscle fibers spasm and become painful, tying them into knots that are shortening the muscle fibers.  The fibers are now short, but they are still originating and inserting in the same place.  This causes a strain on the bone, usually at the insertion point.

If you had a 12″ length of rope and tied enough knots in it to make it 11″ and then consider what would happen to the rope if you tried to stretch it back to 12″ without first untying the knots.  The knots would get tighter and the fibers outside of the knots would be overstretched. This is what happens to your muscles when you stretch without first releasing the spasms.  It is the main reason you may feel worse after stretching than you did before you stretched.

Also, since the fibers are now short, they can’t lengthen enough to allow the joint to bend.  In this example, the triceps have shortened which prevents them from lengthening. You either think you need to strengthen your biceps, or you think you need to stretch your triceps.

Rarely does anyone think about first releasing the spasms, and then stretching the muscle fibers.  Yet,  this is exactly what needs to be done if you plan on using stretching exercises for flexibility and pain relief.

Release the Spasms  Preventing You From Using Stretching  Exercises Safely.

release spasmsAs I mentioned, when you try to stretch you are now causing the knots in the muscles to become more complicated, and you are overstretching the fibers on either side of the knot.

However, if you release the spasm by putting direct pressure on it, you will feel a burning sensation, but as you press and release, the burn will lessen until it totally disappears.  Now you can safely stretch for flexibility without injuring any of the muscle fibers.

The Perfect Stretching For Flexibility Packages:

Two products that will demonstrate how you can safely release the spasms and then start stretching for flexibility

The 15 Minute Back Pain Solution

 

Specifically written to focus on each muscle that causes back pain. THE 15 MINUTE BACK PAIN SOLUTION explains in detail why the muscles from the middle of your back to your knees will cause low back and hip pain, including sciatica and what to do to relieve the pain.  An easy-to-read eBook that has a step-by-step program you can do in 7 Days.

This is the perfect way to prepare your muscles so you can use stretching exercises for flexibility!

And

Focused Flexibility Training

back pain solutionThe comprehensive stretching program covers all aspects of releasing the spasms that have shortened the muscle fibers, and then guides you through a safe stretching routine using proven yoga-style postures.

Focused Flexibility Training has three DVDs that:

  1. Demonstrates how to do every Julstro self-applied treatment taught in Treat Yourself to Pain-Free Living.
  2. Two 30-minute yoga-style stretching programs for the upper body
  3. Two 30-minute yoga-style stretching programs for the lower body.

Both stretching programs featured in the DVDs start with a 15-minute routine of Julstro self-applied treatments to release spasms in the muscles being stretched and then continue on to the 30-minute guided stretching programs.

Focused Flexibility Training also comes with a Julstro Perfect Ball and a Bamboo Stick Massager to provide all the tools you’ll need to be safely stretching for flexibility.

With just a bit of time and focused attention on safely stretching, you will be able to get back to living your life without joint pain and with more flexibility than ever before – it’s easy and it feels great!

Wishing you well,

Julie Donnelly

 

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.

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 Obesity Cause Cancer?

Is The Obesity Epidemic Killing Us?

Author: Dr. Stephen Chaney

Does obesity cause cancer?

does obesity cause cancerYou probably already know that we are in the midst of a world-wide obesity epidemic. If not, here are some of the alarming statistics that characterize that epidemic:

  • The global prevalence of obesity has increased by 27.5% between 1980 and 2013.
  • 35% of the adult population worldwide is now overweight (BMI ≥ 25), including 12% who are classified as obese (BMI ≥30).
  • According to the NIH the situation is even worse in developed countries like the US where 75.1% of adults are now overweight, including 35.7% who are obese, and 6.3% who are very obese (BMI ≥40).

Unfortunately, overweight and obesity are not benign. You probably already knew that those excess pounds increase your risk of diabetes, heart disease, kidney failure and much more. You probably also knew that those excess pounds increase your risks of certain types of cancer such as colon, rectal, kidney, pancreatic, postmenopausal breast, ovarian and uterine cancer.

It’s been a little more difficult to determine just how much obesity increases cancer risk. However, a recent study suggests that the increased risk could be quite significant. In fact, if this study is correct, obesity may only be second to smoking as a preventable cause of cancer. The truth might just scare you skinny!

Does Obesity Cause Cancer?

cancer epidemicThe International Agency For Research On Cancer did a worldwide study, (Arnold et al, The Lancet Oncology 16: 36-45, 2015),  in which they looked at the effect of BMI on cancer incidence in adults aged 20 years or older. The BMI data was collected in 2002 and was segregated by sex and age groups. Recognizing that cancer takes decades to develop, they then collected data on newly diagnosed cancers in adults 30 and older in the same countries in 2012.  They were determined to get closer to answering the question, does obesity cause cancer?

By comparing BMIs in 2002 with the incidence of newly diagnosed cancers 10 years later they were able to calculate the effect of excess body weight (BMI ≥25) on cancer incidence. The results were startling:

  • They estimated that 481,000 new cases of cancer in 2012 in adults over 30 were attributable to excess weight.
  • That represents 3.6% of all new cancer cases, which makes overweight second only to smoking as a preventable cause of cancer.
  • Uterine cancer, postmenopausal breast cancer, and colon cancer accounted for 63.6% of all cancers caused by overweight. Other cancers affected by excess weight were rectal cancer, pancreatic cancer, kidney cancer, gallbladder cancer, and ovarian cancer.
  • The effect of excess weight on cancer risk was almost 3-fold greater for women (5.4% of new cancer cases) than for men (1.9% of new cancer cases).
  • In North America 111,000 new cases of cancer in 2012 for adults over 30 were attributable to excess weight. That represents 3.5% of all new cancers in men and 9.4% of all new cancers in women.
  • A quarter (about 118,000) of the worldwide cancer cases related to high BMI in 2012 could be attributed to the increase in BMI that has occurred since 1982.

The authors concluded “These findings emphasize the need for a global effort to abate the increasing numbers of people with high BMI. Assuming that the association between the high BMI and cancer is causal, the continuation of current patterns of population weight gain will lead to continuing increases in the future burden of cancer.”

What Does This Study Mean For You?

We have to stop kidding ourselves. That excess flab isn’t harmless. It is killing us, and cancer is a particularly gruesome way to go. It’s time to get serious about weight loss. Here are my top 5 tips for lasting weight loss.

  • fad dietsEat healthy low calorie meals and snacks with plenty of protein so that you maintain muscle mass while you are losing fat.
  • Avoid the fad diets. You don’t need to restrict carbohydrates or fats. You just need to focus on fresh fruits and vegetables, healthy proteins and modest amounts of healthy fats and healthy carbohydrates.
  • Find an exercise program you like and stick with it every day.
  • Focus on true lifestyle change rather than short term diets. A good strategy is to make one healthy change at a time rather than trying to do everything at once.
  • Change how you think about food, think about exercise, and think about your ability to make the kinds of changes that will lead to permanent weight loss. Don’t think of yourself as a fat person who is trying to lose weight. Think of yourself as a skinny person who happens to have a few extra pounds that are on their way out.

Of course, getting to a healthier weight isn’t the only change you want to make if you are trying to reduce your risk of cancer. Here are my top 7 lifestyle change suggestions (besides weight loss) for reducing cancer risk.

  • healthy eatingIf you smoke, stop. No ifs, ands, or buts. Smoking is still the #1 cause of cancer.
  • Eat a healthy diet (including supplements to fill the gaps).
  • Eat plenty of fresh fruits and vegetables, especially those that are good sources of cancer-fighting antioxidants, carotenoids, flavonoids, and polyphenols.
  • Eat fish and fish oil supplements to make sure that you get plenty of omega-3 fatty acids.
  • Minimize saturated fats and avoid trans fats. Substitute olive oil for vegetable oils whenever possible.
  • If you drink alcohol, drink it in moderation.
  • Avoid sun exposure as much as possible, and use sunscreen when outdoors.
  • Eat healthy proteins.
  • Minimize consumption of red meats and processed meats.
  • Use chicken, fish and vegetable proteins whenever possible.
  • Soy protein is particularly helpful for reducing the risk of breast cancer. (Yes, those scary blogs about soy and breast cancer are wrong. For accurate information, just go to https://chaneyhealth.com/healthtips and type soy in the search box).
  • Get plenty of exercise.
  • Get regular check-ups.

So, does obesity cause cancer?  I think you now know the answer.

 

The Bottom Line

 

  • A recent study has shown:
  • 481,000 new cases of cancer worldwide each year are attributable to excess weight.
  • That represents 3.6% of all new cancer cases, which makes overweight second only to smoking as a preventable cause of cancer.
  • Uterine cancer, postmenopausal breast cancer, and colon cancer accounted for 63.6% of all cancers caused by overweight.
  • The effect of excess weight on cancer risk was almost 3-fold greater for women (5.4% of new cancer cases) than for men (1.9% of new cancer cases).
  • In North America 111,000 new cases of cancer for adults over 30 are attributable to excess weight. That represents 3.5% of all new cancers in men and 9.4% of all new cancers in women.
  • That excess flab isn’t harmless. It is killing us, and cancer is a particularly gruesome way to go. For my top 5 tips for lasting weight loss and my top 7 tips for reducing your risk of cancer, read the article above.

 

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

Health Tips From The Professor