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Which Foods Affect Stroke Risk?

March 24, 2020 by Dr. Steve Chaney

Why Is Diet And Stroke Risk So Confusing?

One day we are told vegetarian diets reduce our stroke risk. The next day we are told they increase stroke risk. It’s the same with red meat, dairy, and eggs. We keep getting mixed messages. It’s enough to make your head spin. Why is diet and stroke risk so confusing?

Part of the problem is that there are two distinct types of stroke. The technical names for them are ischemic stroke and hemorrhagic stroke.

An ischemic stroke occurs when an artery in the brain becomes blocked, shutting off blood flow and damaging part of the brain. This is usually caused by the gradual buildup of fatty deposits and cholesterol plaques in the arteries. When a blood clot forms and lodges in one of the narrowed arteries leading to the brain, an ischemic stroke occurs.

Ischemic strokes account for 87% of all strokes.

Ischemic strokes are associated with obesity, elevated cholesterol, diabetes, high blood pressure, and smoking.

A hemorrhagic stroke occurs when a weakened blood vessel bursts and bleeds into the surrounding region of the brain. Because our brains are surrounded by a protective skull, that blood has nowhere to go. Pressure from the buildup of blood damages brain cells in the vicinity of the bleed.

Hemorrhagic strokes account for only for only 15% of strokes but are responsible for 40% of stroke deaths.

The most common cause of a hemorrhagic stroke is the localized enlargement of a blood vessel due to chronic high blood pressure. This weakens the wall of the blood vessel, making it prone to rupturing.

Part of the confusion about diet and stroke risk is because many earlier studies did not distinguish between the two types of stroke.

If the studies just measured the incidence of stroke, the data were dominated by ischemic strokes (87% of strokes are ischemic).

However, if the studies focused on stroke deaths, hemorrhagic stroke made a larger contribution to the data set (40% of stroke deaths are hemorrhagic).

Fortunately, recent studies have started to focus on the effect of diet on ischemic and hemorrhagic strokes separately. However, many of those studies have been too small to accurately assess the effects of diet on hemorrhagic stroke.

The latest study (TYN Tong et al, European Heart Journal, ehaa007, published February 24, 2020) is one of the largest studies to look at the effect of diet on both kinds of stroke. It has enough patients in the hemorrhagic group to get an accurate estimate of the effect of diet on hemorrhagic stroke.

How Was The Study Done?

This study analyzed data on diet and stroke from 418,329 participants in the EPIC (European Prospective Investigation into Cancer and Nutrition). Although the study has cancer in the title, it actually investigated the effect of nutrition on multiple diseases (Presumably, the study title was chosen because EPIC is a more appealing acronym than EPID (European Prospective Investigation into Diseases and Nutrition)).

The participants were recruited from 9 European countries (Denmark, Germany, Greece, Italy, the Netherlands, Norway, Spain, Sweden, and the UK). The average age of participants was 50, and they were followed for an average of 12.7 years.

At the beginning of the study participants completed country-specific dietary and lifestyle questionnaires.

The dietary assessment was a food frequency questionnaire that asked participants about their dietary intake for the year prior to enrollment in the study. The food frequency data were used to estimate daily intake of red meat, processed meat, poultry, fish, dairy products, eggs, grains, fruits, vegetables, legumes, nuts, seeds, and dietary fiber (It measured total fiber and fiber from grains, fruits and vegetables individually).

The outcome measured was the incidence of ischemic and hemorrhagic strokes during the 12.7-year follow-up.

Which Foods Affect Stroke Risk?

For ischemic stroke:

Each 200 gram/day increase in consumption of fruits and vegetables decreased ischemic stroke risk by 13% (200 grams roughly corresponds to one large apple or one large orange without the skin).

Each 10 gram/day increase in consumption of fiber decreased ischemic stroke risk by 23%. Most of this decreased stroke risk was due to fiber from whole grains, fruits, and vegetables.

- Each 4 gram/day increase in fiber from whole grains decreased ischemic stroke risk by 10%.

- Each 4 gram/day increase in fiber from fruits and vegetables decreased ischemic stroke risk by 12%.

Dairy foods decreased ischemic stroke risk with the following breakdown:

- Each cup of milk decreased ischemic stroke risk by 5%.

- Each half cup of yogurt decreased ischemic stroke risk by 9%.

- Each ounce of cheese decreased ischemic stroke risk by 12%.

Each 50 grams/day (2 ounces) of red meat increased ischemic stroke risk by 14%.

- However, red meat was only half as likely to increase risk of ischemic stroke when the diet was also rich in fruits, vegetables, whole grains, and legumes.

For hemorrhagic stroke:

Each 20 gram/day increase in consumption of eggs increased hemorrhagic stroke risk by 25% (20 grams roughly corresponds to about 1/2 of a small egg or 1/3 of a jumbo egg).

This study did not measure the effect of salt intake on hemorrhagic stroke risk.

No other foods measured in this study had a significant effect on hemorrhagic stroke risk.

However, hemorrhagic stroke is highly associated with high blood pressure. When we look at the influence of foods on high blood pressure, here are the Harvard School of Medicine recommendations for keeping blood pressure low:

Eat more fish, nuts and beans in place of high-fat meats.

Choose fruits and vegetables instead of sugary, salty snacks and desserts.

Select whole grains rather than refined grains.Eat fruit instead of drinking fruit juice.

Use unsaturated fats like olive, canola, soybean, peanut, corn or safflower oils instead of butter, coconut oil, or palm-kernel oil.

Use herbs, spices, vinegar, and other low-sodium flavorings instead of salt; Choose low-sodium foods whenever possible.

Why Is Diet And Stroke Risk So Confusing?

As I mentioned at the start of this article, part of the reason that the headlines about diet and stroke risk are so confusing is:

Many studies did not distinguish between the two types of stroke.

Other studies were too small to reliably estimate the effect of food on hemorrhagic stroke risk.

However, there are still some unexplained inconsistencies among recently published studies. It is these inconsistencies I would like to address. For example:

1) In a recent issue of Health Tips From the Professor I reported on a major study (500,000 people followed for 8.9 years) in China. That study came to the opposite conclusion about eggs and risk of hemorrhagic than the EPIC study I discussed above. It found:

People consuming one egg per day had a 26% decrease in hemorrhagic stroke risk and a 28% decrease in hemorrhagic stroke deaths compared to people who never or rarely consumed eggs.

In other words, the two studies came to opposite conclusions. In the China study eggs decreased risk of hemorrhagic stroke. In the European study (EPIC) eggs increased risk of hemorrhagic stroke. The reason for this discrepancy is not clear, but one can speculate it might be explained by differences in the underlying diets of the two countries:

In China the diet is primarily plant-based. The addition of an egg/day may provide needed protein, fat, and cholesterol (Some cholesterol is essential. We just overdo it in this country).

In Europe the diet is already high in protein, saturated fat, and cholesterol. Getting more of them from eggs may not be such a good thing.

In short, if your diet is primarily plant-based, the addition of an egg/day may be a good thing. However, if your diet is already high in meat, saturated fat, and cholesterol, the addition of an egg/day may not be a good thing.

2) In another recent issue of Health Tips From the Professor I reported on the EPIC-Oxford study that claimed vegetarians had 20% increased risk of hemorrhagic stroke compared to meat eaters.

Interestingly, the EPIC-Oxford study represented a very small portion (~10%) of the overall EPIC study and differed from the rest of the EPIC study in two important ways.

It looked at the effect of diets rather than foods on stroke risk.

Oxford was the only one of the 22 research centers involved in the EPIC study to invite people following a vegetarian diet to enroll in the study, so it had a much higher proportion of vegetarians than other centers that participated in the study.

The current study did not find any evidence that fruits, vegetables, nuts, seeds, beans, or whole grains influenced the risk of hemorrhagic stroke. In other words, in this much larger data set there was no evidence that the foods associated with a vegetarian diet increased hemorrhagic stroke risk.

However, most of the participants in larger EPIC study were also eating meats. They were not following a pure vegetarian diet.

As I said previously, “If the data on hemorrhagic stroke risk in the EPIC-Oxford study are true, it suggests it may not be a good idea to completely eliminate meat from our diet. However, you don’t need to add much meat to a vegetarian diet. The fish eaters in this study were consuming 1.4 ounces of fish per day. That was enough to eliminate the increased risk of hemorrhagic stroke.”

What Does This Mean For You?

For ischemic stroke (blockage of blood flow to the brain), which is the most common form of stroke, the data are clear cut:

Fruits, vegetables, whole grains and dairy foods are good for you. (Your mother was right.)

Red meat is not so good for you. However, the bad effect of red meat on ischemic stroke risk can be reduced by including plenty of fruits, vegetables, and whole grains in your diet.

These conclusions are consistent with multiple previous studies, and the mechanisms of these effects are well established.

For hemorrhagic stroke (bleeding from a weakened blood vessel in the brain) the data are not as clear cut.

If you are consuming a primarily plant-based diet, eggs appear to reduce your risk of hemorrhagic stroke.

If you are consuming a diet with lots of meat, saturated fat, and cholesterol, adding eggs may increase your risk of hemorrhagic stroke.

A vegetarian diet may increase your risk of hemorrhagic stroke. But you don’t need to add much meat to a vegetarian diet. Consuming 1.4 ounces of fish per day appears to be enough to eliminate the increased risk of hemorrhagic stroke.

The mechanisms of these effects of food on hemorrhagic stroke are unclear, so these conclusions may be modified by subsequent studies.

In terms of an overall take-home lesson on diet and stroke risk, my advice is: “A primarily plant-based diet is a good idea, but you don’t need to become a vegan purist. Nor do you want to follow fad diets that eliminate whole food groups. We have 5 food groups for a reason. Eliminating any of them may not be a good idea.”

The Bottom Line

A recent study examined the effect of various foods on the risk of the two major forms of stroke.

For ischemic stroke (blockage of blood flow to the brain), which is the most common form of stroke, the data are clear cut:

Fruits, vegetables, whole grains and dairy foods are good for you. (Your mother was right.)

Red meat is not so good for you. However, the bad effect of red meat on ischemic stroke risk can be reduced by including plenty of fruits, vegetables, and whole grains in your diet.

These conclusions are consistent with multiple previous studies, and the mechanisms of these effects are well established.

For hemorrhagic stroke (bleeding from a weakened blood vessel in the brain) the data are not as clear cut.

If you are consuming a primarily plant-based diet, eggs appear to reduce your risk of hemorrhagic stroke.

If you are consuming a diet with lots of meat, saturated fat, and cholesterol, adding eggs may increase your risk of hemorrhagic stroke.

A vegetarian diet may increase your risk of hemorrhagic stroke. But you don’t need to add much meat to a vegetarian diet. Consuming 1.4 ounces of fish per day appears to be enough to eliminate the increased risk of hemorrhagic stroke.

The mechanisms of these effects of food on hemorrhagic stroke are unclear, so these conclusions may be modified by subsequent studies.

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.

Why Do Diet Sodas Make You Fat?

March 10, 2020 by Dr. Steve Chaney

Is Mixing Diet Sodas With Carbs Bad For You?

Many people, and many doctors, believe that diet sodas and artificially sweetened foods are a healthy choice. After all:

Cutting calories by drinking diet sodas and eating artificially sweetened foods should help you lose weight.

If sugar is the problem for diabetics, diet sodas and artificially sweetened foods should be a healthier choice.

On the surface, these ideas appear to be self-evident. They seem to be “no-brainers”. The truth, however, is more complicated.

When studies are tightly controlled by dietitians so that the people consuming diet sodas don’t add any extra calories to their diet, the results are exactly as expected. People consuming diet sodas lose weight compared to people drinking regular sodas.

However, as I have described in an earlier issue of “Health Tips From the Professor”, the results are different in the real world where you don’t have a dietitian looking over your shoulder. In those studies, diet sodas are just as likely to cause weight gain as regular sodas.

As Barry Popkin, a colleague at the University of North Carolina, put it” “The problem is that we [Americans] are using diet sodas to wash down our Big Macs and fries.” In short, people drinking diet sodas tend to increase their caloric intake by adding other foods to their diet. Even worse, the added foods aren’t usually fruits and vegetables. They are highly processed junk foods.

Why is that? The short answer is that nobody knows (more about that later). However, a recent study (JR Dalenberg et al, Cell Metabolism, 31: 493-502, 2020) suggests an unexpected mechanism for the weight gain associated with diet soda consumption. Let’s look at that study.

How Was The Study Done?

The study recruited 45 healthy young adults (ages 20-45) who habitually consumed less than 3 diet sodas a month. They were randomly assigned to three groups. The participants in each group came into the testing facility seven times over a span of 2 weeks. Each time they were given 12 ounces of one of three equally sweet tasting beverages in a randomized, double-blind fashion.

Group 1 received a sucralose-sweetened drink contained 0.06 grams of sucralose (equivalent to two packets of Splenda).

Group 2 received a sugar-sweetened drink contained 7 teaspoons of sucrose (table sugar).

Group 3 received a combo drink contained 0.06 grams of sucralose plus 7 teaspoons of maltodextrin. Maltodextrin is a water-soluble carbohydrate that does not have a sweet taste.

o Maltodextrin was used because Splenda and most other commercial sucralose products contain it along with sucralose. You need something to fill up those little sucralose-containing packets.

o This drink was included as a control. The expectation was that it would give the same results as the sucralose-sweetened drink.

Three measurements were performed prior to and following the 2-week testing period:

An oral glucose tolerance test in which participants drink a beverage containing a fixed amount of glucose. Then their blood sugar and blood insulin levels are measured over the next two hours.

o This is a measure of how well they were able to control their blood sugar levels.

A test in which they were given samples that had either a sweet, sour, salty, or savory taste. Then:

o They were asked to identify each taste and report how strong the taste was.

o MRI scans of their brains were performed to determine how strongly their brains responded to each of the tastes.

Is Mixing Diet Soda With Carbs Bad For You?

The results were surprising. The first surprise came when the investigators unblinded the results of the oral glucose tolerance test:

Blood sugar and blood insulin responses were unaffected by the 2-week exposure to sugar-sweetened drinks.

o This was expected.

Blood sugar and blood insulin were relatively unaffected by the 2-week exposure to sucralose-sweetened drinks. If anything, the control of blood sugar levels was slightly improved at the end of two weeks.

o This was a disappointment for the investigators. One of the prevailing theories is that artificially sweetened beverages alter the blood sugar response. The investigators found no evidence for that idea.

Following the 2-week exposure to the combo drinks (sucralose plus maltodextrin), blood sugar levels were unaffected, but blood insulin levels were increased. This implies that more insulin was required to control blood sugar levels. In other words, these participants had developed insulin resistance.

o This result was unexpected. Remember the investigators had included this drink as a control.

o The investigators pointed out that the insulin resistance associated with the sucralose-maltodextrin combo could increase the risk of type 2 diabetes and obesity.

Because of this unexpected result, the investigators did a follow-up study in which participants were given a maltodextrin-only drink using the same study protocol. The oral glucose tolerance test was unchanged by the 2-week exposure to maltodextrin-only drinks.

When the investigators conducted taste tests, the ability of participants to taste all four flavors was unchanged by a 2-week exposure to any of the drinks.

However, when the investigators did MRI scans to measure the brain’s response to these flavors:

A two-week exposure to the sucralose plus maltodextrin drinks reduced the brain’s response to sweet but not to any of the other flavors.

o In other words, the subjects could still taste sweet flavors, but their brains were not responding to the sweet taste. Since sweetness activates pleasure centers in the brain this could lead to an increased appetite for sweet-tasting foods.

o This might explain the weight gain that has been observed in many previous studies of diet sodas.

Two-week exposures to the other drinks had no effect on the brain’s response to any of the flavors. Once again, this effect was only seen in the sucralose-maltodextrin combination.

The investigators concluded:

“Consumption of sucralose combined with carbohydrates impairs insulin sensitivity…and…neural responses to sugar.

Insulin sensitivity is not altered by sucralose or carbohydrate consumption alone.

The results suggest that consumption of sucralose in the presence of a carbohydrate dysregulates gut-brain regulation of glucose metabolism.”

The investigators pointed out that this could have several adverse consequences. Again, in the words of the authors:

“Similar exposure combinations (artificial sweeteners plus carbohydrates) almost certainly occur in free-living humans, especially if one considers the consumption of a diet drink along with a meal. This raises the possibility that the combination effect may be a major contributor to the rise in incidence of type 2 diabetes and obesity. If so, addition of artificial sweeteners to increase the sweetness of carbohydrate-containing food and beverages should be discouraged and consumption of diet drinks with meals should be counseled against.”

Why Do Diet Sodas Make You Fat?

As I mentioned at the start of this article, there are a lot of hypotheses as to why diet sodas make us fat. These hypotheses break down into two classifications: psychological and physiological.

The psychological hypothesis is easiest to explain. Essentially, it goes like this: We feel virtuous for choosing a zero-calorie sweetener, so we allow ourselves to eat more of our favorite foods. It is unlikely that this hypothesis holds for all diet soda drinkers. However, it is also hard to exclude it as at least part of the explanation for the food overconsumption associated with diet soda use.

There are multiple physiological hypotheses. Most of them are complicated, but here are simplified explanations of the three most popular hypotheses:

The sweet taste of artificial sweeteners tricks the brain into triggering insulin release by the pancreas. This causes blood sugar levels to plummet, which increases appetite.

The sweet taste of artificial sweeteners is not appropriately recognized by the brain. This diminishes release of hormones that suppress appetite.

Artificial sweeteners interfere with insulin signaling pathways, which leads to insulin resistance.

There is some evidence for and against each of these hypotheses.

However, this study introduces a new physiological hypothesis – namely that it is the combination of artificial sweeteners and carbohydrates that results in a dysregulation of the normal mechanisms controlling appetite and blood sugar.

What Does This Study Mean For You?

Let’s start with the obvious. This is just a hypothesis.

This was a very small study. Until it is confirmed by other, larger studies, we don’t know whether it is true.

This study only tested sucralose. We don’t know whether this applies to other artificial sweeteners.

The study only tested maltodextrin in combination with sucralose. We don’t know whether it applies to other carbohydrates.

Therefore, in discussing how this study applies to you, let’s consider two possibilities – if it is true, and if it is false.

If this hypothesis is true, it is concerning because:

We often consume diet sodas with meals. If, for example, we take the earlier example of a diet soda with a Big Mac and fries, both the hamburger bun and the fries are high carbohydrate foods.

Sucralose and other artificial sweeteners are used in low calorie versions of many carbohydrate rich processed foods.

If this hypothesis is false, it does not change the underlying association of diet soda consumption with weight gain and type 2 diabetes. It is merely an attempt to explain that association. We should still try to eliminate diet sodas and reduce our consumption of artificially sweetened, low calorie foods.

My recommendation is to substitute water and other unsweetened beverages for the diet drinks or sugar sweetened beverages you are currently consuming. If you crave the fizz of sodas, drink carbonated water. If you need more taste, try herbal teas or infuse water with slices of lemon, lime, or your favorite fruit. If you buy commercial brands of flavored water, check the labels carefully. They may contain sugars or artificial sweeteners. Those you want to avoid.

The Bottom Line

Many studies have called into question the assumption that diet sodas and diet foods help us lose weight. In fact, most of these studies show that diet soda consumption is associated with weight gain rather than weight loss.

There are many hypotheses to explain this association, but none of them have been proven at present.

This study introduces a new hypothesis – namely that the combination of artificial sweeteners and carbohydrates results in a dysregulation of the normal mechanisms controlling appetite and blood sugar. In particular, this study suggested that combining sucralose with carbohydrates caused insulin resistance and reduce the ability of the brain to respond appropriately to sweet tastes.

The authors concluded: “Similar exposure combinations (artificial sweeteners plus carbohydrates) almost certainly occur in free-living humans, especially if one considers the consumption of a diet drink along with a meal. This raises the possibility that the combination effect may be a major contributor to the rise in incidence of type 2 diabetes and obesity. If so, addition of artificial sweeteners to increase the sweetness of carbohydrate-containing food and beverages should be discouraged and consumption of diet drinks with meals should be counseled against.”

If this hypothesis is true, it is concerning because:

We often consume diet sodas with meals. If, for example, we take the example of a diet soda with a Big Mac and fries, both the hamburger bun and the fries are high carbohydrate foods.

Artificial sweeteners are used in low calorie versions of many carbohydrate rich processed foods.

If this hypothesis is false, it does not change the underlying association of diet soda consumption with weight gain and type 2 diabetes. It is merely an attempt to explain that association. We should still try to eliminate diet sodas and reduce our consumption of artificially sweetened, low calorie foods.

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 Impossible Burger Healthy For You?

February 11, 2020 by Dr. Steve Chaney

Is The Impossible Burger Healthy For the Planet?

Americans love their meat. In 2018 we averaged over 200 pounds of meat per person. If we just focus on beef, we eat about 54 pounds per year. That’s equivalent to four quarter pounders a week!

But we are also getting the message that too much meat, especially red meat, may be bad for us. Nearly 40% of us are trying to eat a more plant-based diet.

The problem is that we love the convenience of fast food restaurants, and we love our burgers. Plus, in the past the meatless burgers on the market were, in a word, disappointing. Their taste and texture left something to be desired. You really needed to be committed to a plant-based diet to eat them in place of a regular burger.

That all changed a few years ago with the introduction of the and new generation of meatless burgers – the Impossible Burger and the Beyond Burger. They had the taste and texture of a real burger, but they were completely plant-based. What wasn’t to like?

Both companies claimed that their meatless burgers were healthier for the planet than regular burgers. For example, Impossible Food’s mission statement is: “Animal agriculture occupies almost half the land on earth, consumes a quarter of our freshwater, and destroys our ecosystems. So, we’re doing something about it: We’re making meat using plants, so that we never have to use animals again”.

Neither company claims their burgers are healthier for you. However, because their burgers are plant-based, the almost universal assumption has been that they are healthier than regular burgers.

Since their introduction they have taken the world by storm. You can find them in almost every supermarket and in many of your favorite fast food restaurants. Now that they are omnipresent, it is perhaps time to step back and take a closer look at this new generation of meatless burgers. In this article, I will ask two questions:

Are they healthier for you than regular burgers?

Are they healthier for the planet than regular burgers?

For the sake of simplicity, I will focus on the Impossible Burger with occasional comparisons with the Beyond Burger. It is beyond the scope of this article to compare these burgers with the many other meatless burgers that are now starting to flood the marketplace.

What’s In The Impossible Burger?

When we think of a burger, the first thing we think of is protein. The Impossible Burger gets its protein from soy, while the Beyond Burger gets its protein from peas.

However, soy and pea protein don’t give you the mouth feel, flavor, red color, and texture of a beef burger.

The mouth feel of a burger comes from its saturated fat. Both the Impossible Burger and Beyond Burger use coconut oil as their source of saturated fat.

- Coconut oil has gained a reputation as a “healthier” saturated fat. However, as I have discussed in my book, “Slaying The Food Myths”, we have no long term studies on the health effects of diets high in coconut oil. We don’t really know whether it is healthier than other saturated fats.

The taste and color of a beef burger come from its heme content. Heme does not occur in the parts of plants we eat. However, heme is involved in nitrogen fixation, so it is found in the roots of some legumes.

- The Impossible Burger has genetically engineered yeast to produce a type of heme called leghemoglobin that is found in soy roots. The Beyond Burger uses beet juice extract and annatto for the color and unspecified “natural flavor” for the flavor.

To get the texture of a beef burger, both the Impossible Burger and the Beyond Burger use maltodextrin, modified food starch, and a variety of other ingredients. They are both highly processed foods.

Iron is another important nutrient you expect to get from a beef burger. The Impossible Burger contains 4.5 mg of iron and the Beyond Burger contains 5.4 mg of iron.

- However, that is only part of the story. When iron is attached to a heme molecule, it is more efficiently absorbed by our bodies. Beef burgers and the Impossible Burger contain heme iron. The Beyond Burger does not.

In addition, the Impossible Burger adds in the vitamins, including B12, that we would expect to get from a beef burger. The Beyond Burger does not.

What Are The Pluses Of The Impossible Burger?

There are some definite pluses for the Impossible Burger and Beyond Burger:

Both the Impossible Burger and Beyond Burger are made from plant-based ingredients rather than from meat.

Both are cholesterol free.

Both contain modest amounts of fiber (3 grams for the Impossible Burger and 2 grams for the Beyond Burger), while a meat burger contains none.

Both are good sources of iron, and the iron in the Impossible Burger is heme-iron, which is efficiently absorbed by our bodies.

What Are The Minuses of the Impossible Burger?

There are, however, some definite minuses as well.

Both the Impossible Burger and Beyond Burger are high in saturated fat. The Impossible Burger is higher in saturated fat and the Beyond Burger contains the same amount of saturated fat as a real burger. That’s important because the latest advisory of the American Heart Association warns that saturated fat increases our risk of heart disease (I have discussed this finding in detail in a previous issue of “Health Tips From the Professor”).

- The saturated fat in both burgers comes from coconut oil. However, as I discussed above, we don’t know whether coconut oil is better or worse for us than other saturated fats. The relevant studies have not been done.

Both the Impossible and Beyond burgers are high in sodium. They have almost 5-times more sodium than a beef burger.

The heme in red meat catalyzes the formation of N-nitroso compounds in our gut which increase the risk of colon cancer. We do not know whether the form of heme added to Impossible Burgers catalyzes the same reaction, but it is likely.

Both plant-based burgers are low in protein compared to a beef burger (~20 grams versus 27 grams). On the other hand, 20 grams of protein is reasonable for a single meal.

The plant proteins used for these burgers (soy for the Impossible Burger and pea for the Beyond Burger) are highly processed. They lack the phytonutrients found in the unprocessed proteins.

- The isoflavones found in soy are thought to decrease the risk of cancer and osteoporosis.

- The phytonutrients found in peas have antioxidant and anti-inflammatory benefits. They are also thought to decrease the risk of certain cancers.

The Impossible Burger is GMO. The leghemoglobin is produced by genetically engineered yeast, and the soy is also GMO.

Neither the Impossible Burger nor Beyond Burger are certified organic. Organic certification refers to how the plant was grown. Both burgers are highly processed. Many of the ingredients in both burgers came from factories, not farms.

Is The Impossible Burger Healthy For You?

Now, it is time to return to the original question: “Is the Impossible Burger healthy for you?” Since it is plant-based, it would be easy to assume that it is healthier than a burger made from beef. However, when you look more closely, it is not clear that it is healthier.

The manufacturers of the Impossible Burger and similar burgers have gone to the laboratory and have been successful at creating meatless burgers with the taste, mouth feel, and texture of real burgers. However, these improvements have come with a price.

The Impossible Burger and similar burgers are higher in saturated fat than a beef burger. This means they may be just as likely to increase the risk of heart disease as a beef burger.

The Impossible Burger contains as much heme as a beef burger, which means it may be just as likely to increase the risk of cancer as a beef burger.

The Impossible Burger and similar burgers are highly processed. That means:

- The plant proteins no longer contain the phytonutrients thought to be responsible for some of their health benefits.

- They also don’t contain the vitamins you would expect to find associated with the plant proteins.

The Impossible Burger and similar burgers are not organic. Even worse, the Impossible Burger is GMO.

On balance, we can’t really assume the Impossible Burger is any healthier than the beef burgers it replaces. Plus, if you include the usual condiments and add fries and a soft drink, any slight health benefits of the Impossible Burger will be lost.

It would be much healthier to choose a bean burger. They don’t taste like beef, but many of them are quite tasty. Plus, if you do some label reading, you can find ones that use only whole, unprocessed ingredients.

For example, I looked up the Organic Sunshine brand South West Black Bean burgers. It only provides half as much protein as an Impossible Burger, but all the ingredients are organic, non-GMO, and minimally processed. Note: I am not recommending a particular brand. However, with a little research I am confident you can find a healthy meatless burger with a taste you will enjoy.

Is The Impossible Burger Healthy For the Planet?

Now, let’s look at the second question: “Is the Impossible Burger healthy for the planet?” The answer to this question seems obvious. As the Impossible Burger company states in their mission statement: “Animal agriculture occupies almost half the land on earth, consumes a quarter of our freshwater, and destroys our ecosystems”. It seems logical that any meatless burger would be an improvement.

If we are talking about a minimally processed black bean burger, like the one I described above, the answer is a clear yes. It is healthier for the planet. However, when you look more closely at the Impossible Burger, the answer isn’t as clear.

As coconut oil has increased in popularity massive areas of untouched, forested land have been cleared for coconut plantations.

- These forested areas provide an essential ecosystem for animals and provide natural storm protection by absorbing rainwater. Therefore, coconut oil, like beef, also destroys our ecosystems.

- In addition, many of the coconut plantations use large amounts of chemical fertilizers which contribute to phosphate pollution and algae overgrowth in lakes, rivers, and coastal ocean areas. This also degrades our environment.

The Impossible Burgers and similar meatless burgers contain many highly processed ingredients. Each of these ingredients imposes its own environmental burden. For example:

- Coconut oil is often processed with hexane, which is categorized as a hazardous air pollutant by the Environmental Protection Agency.

- In addition, coconut oil is primarily grown in the Philippines, Indonesia, and India. Transporting it to this country generates significant greenhouse gas emissions.

- And, of course, coconut oil represents only one of the many highly processed ingredients in the Impossible Burger and similar meatless burgers.

In short, the Impossible Burger may be slightly healthier for the planet than a beef burger, but it is much less environmentally friendly than your typical, minimally processed, bean burger.

The Bottom Line

Two weeks ago, I wrote about recent headlines claiming that the best advice for the American public was to eat as much red meat as they like. I looked at the study behind the headlines and pointed out the many flaws in that study.

Last week I wrote about headlines claiming that red meat was just as heart healthy as white meat. I looked at the study behind the headlines and showed it was an excellent example of how the beef industry influences the design of clinical trials to minimize the health risks of red meat. It is also an example of how the media misleads and confuses the public about the effect of nutrition on their health.

What the studies I reviewed the last two weeks really showed was that very small amounts (2-3 ounces) of very lean red meat is probably OK as part of a healthy diet like the Mediterranean diet. Larger servings of fattier cuts of red meat as part of the typical American diet is problematic.

However, if you love your burgers, what are you to do? Are the meatless burgers like the Impossible Burger and Beyond Burger that are showing up in your favorite fast food restaurants the answer? Specifically, you are probably asking:

Is the Impossible Burger, and similar burgers, healthy for you?

Is the Impossible Burger, and similar burgers, healthy for the planet?

I looked at the composition, pluses, and minuses of this new generation of meatless burgers in this article. The bottom line is:

On balance, the Impossible Burger is only slightly healthier than the beef burgers it replaces. And, if you include the usual condiments and add fries and a soft drink, any slight health benefits of the Impossible Burger will be lost.

It would be much healthier to choose a bean burger. They don’t taste like beef, but many of them are quite tasty. Plus, if you do some label reading, you can find ones that are organic, non-GMO, and use only whole, unprocessed ingredients.

Similarly, the Impossible Burger may be slightly healthier for the planet than a beef burger, but it is much less environmentally friendly than your typical, minimally processed, bean burger.

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.

Diet And Mental Health In Teens

March 6, 2018 by Dr. Steve Chaney

Is Your Teen Crazy Because Of What They Eat?

Author: Dr. Stephen Chaney

If you have teenagers or have had teenagers in the past, you know they can be a little crazy at times. Sometimes they are a lot crazy. It’s easy to dismiss the occasional weird behavior by attributing it to raging hormones. I wouldn’t want to dismiss the difficulty teens experience adjusting to all these new hormones running around inside their body.

However, if you have a teenager, you also know their diet often isn’t the best. Many of them live on sodas, fast foods, snack foods and sweets. Could there be a correlation between what they eat and their mental health? In fact, several recent studies have suggested there is a correlation between poor diet and mental health issues in teens.

What is the connection between diet and mental health in teens?

This study (WH Oddy et al, Brain, Behavior, and Immunity, doi.org/10.1016/j.bbi.2018.01.002) breaks new ground.

The scientists in charge of the study asked whether the effect of diet on mental health was direct or indirect. Specifically, they asked whether diet influenced obesity and inflammation which, in turn, influenced mental health.
They also investigated a reverse hypothesis model. Specifically, they asked whether poor mental health led to poor diet rather than the other way around.

How Was This Study Done?

This study has a very interesting history. It grew out of a major pregnancy study (The Raine study) initiated in Western Australia in 1989. The Raine study was designed to determine how events during pregnancy and childhood influence health later in life. Diet and many other variables were measured during pregnancy, at birth, and at 1, 2, 3, 5, 8, 10, 14, 17, 18, 20, and 22 years of age for the offspring. This particular study followed 843 teenagers who were assessed at ages 14 and 17.

Based on food frequency questionnaires administered at both ages, the participants’ diets were given a score ranging from a “Healthy” at one extreme to “Western” at the other extreme.

The “Western” diet was characterized by fast foods, convenience foods, red and processed meats, full-fat dairy, French fries, refined grains, sweets, soft drinks, chips, sauces, and dressings. (Does that sound like your teen?)
The “Healthy” diet was characterized by whole grains, fruits, vegetables, legumes, and fish. (It’s nice to know that some teens eat that way.)

In addition to diet, the scientists measured BMI (a measure of obesity) and mental health in the 14-year-old group. When those same teens reached 17, the measurements were repeated, and blood markers of inflammation were also measured.

Two assessments of mental health were used.

The first assessment measured depression.
The second assessment measured “Internalizing Behaviors” (withdrawal, depression, and anxiety) and “Externalizing Behaviors” (aggression, delinquency, and attention disorders). High scores on this test indicate a higher level of emotional and behavioral problems.

Diet And Mental Health In Teens

Here are the results of the study:

Adherence to a “Western” diet was associated with greater caloric intake and obesity at age 14.
By the time the teens reached 17, adherence to a “Western” diet was associated with:
- Obesity and inflammation
- Depression and other mental health issues
A “Healthy” diet was protective against obesity, inflammation and mental health issues.
Obesity and inflammation were independently associated with depression and mental health issues in the 17-year-olds.

So what was the correlation between diet and mental health in teens?

On this basis, the investigators speculated that the effect of poor diet on mental health outcomes in teens was mediated by obesity and inflammation. (That is a fancy way of saying poor diet leads to obesity and inflammation, and obesity and inflammation lead to poor mental health.) However, the authors acknowledged they could not exclude a direct effect of diet on mental health.

Depression at age 14 did not correlate with poor dietary patterns at age 14. Simply put, if you started with everyone who had poor dietary habits at age 14, it correlated well with depression. However, if you went in the reverse direction – if you started with everyone who was depressed at age 14, it did not correlate well with poor diet.

On this basis, the investigators concluded that the reverse model hypothesis was unlikely. In short, they concluded that a model in which poor diet leads to depression and other mental health issues in teens is much more likely than a model in which mental health issues lead to a poor diet.

What Does This Mean For You?

When you put this in the context of previous studies, it is clear that what we eat matters. More importantly, what we eat matters at every stage of life. For example:

What a mother eats prior to and during pregnancy determines the likelihood of a successful pregnancy. For example, in previous issues of “Health Tips From the Professor” I have highlighted studies showing the importance of getting adequate folic acid, omega-3s, and iodine during pregnancy.
In another study a child’s diet and risk of obesity at age 6 are highly correlated with what they were fed during the first year of life.
In the study reported in this article, a poor diet at age 14 predicts obesity, inflammation, depression, and other mental health issues at age 17.
In another study poor diet in adults was associated with depression.

These studies are just the tip of the iceberg. There are dozens of recent studies that come to the same conclusion. In short, a good diet can make you happier as well as healthier. Whether you are 9 months or 90 years, a good diet is just as important for your mental health as for your physical health.

As for those crazy teens of yours, you might want to encourage them to eat healthier. It may be a hard sell at first, but once they start feeling happier and calmer they may just be converts to a healthy eating plan.

Remember, there is a connection between diet and mental health in teens.

The Bottom Line:

A recent study followed a group of teens in Western Australia from ages 14 to 17. They compared the effect of a “Western diet” (characterized by fast foods, convenience foods, red and processed meats, full-fat dairy, French fries, refined grains, sweets, soft drinks, chips, sauces, and dressings) with a “Healthy diet” (characterized by whole grains, fruits, vegetables, legumes, and fish) on obesity, inflammation, depression, and mental health. The study found:

Adherence to a “Western” diet was associated with greater caloric intake and obesity at age 14.
By the time the teens reached 17, adherence to a “Western” diet was associated with:
- Obesity and inflammation
- Depression and other mental health issues
A “Healthy” diet was protective against obesity, inflammation and mental health issues.

This study was consistent with dozens of other studies showing that diet affects mental health at every age. These studies show a good diet can make you happier as well as healthier. Whether you are 9 months or 90 years, a good diet is just as important for your mental health as for your physical health.

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.

Should We Take Calcium Supplements?

September 27, 2016 by Dr. Steve Chaney

Clearing Up The Calcium Confusion

Author: Dr. Stephen Chaney

Should 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?

I 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?

As 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? 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.

Personalized Nutrition To Change Your Life?

August 31, 2016August 30, 2016 by Dr. Steve Chaney

Author: Dr. Stephen Chaney

Can a personalize nutrition assessment provide you with information to assist your health strategy? We’ve been told that genetic testing is the wave of the future. We’ve been promised that genetic testing will tell us which diseases we are most likely to develop. Of course, the unspoken assumption is that if we knew which diseases were most likely to kill us, we’d be highly motivated to make the diet and lifestyle changes needed to reduce the risk of that disease.

But what if a personalized nutrition assessment based on a simple online diet survey was just as effective at getting us to make better food choices as all those fancy genetic tests? That is just what a recent study suggests.

How Was The Study Designed?

The study was based on a simple online diet survey called Food4Me developed by University College Dublin and Crème Software Ltd. The Food4Me diet survey asks people how many times per week or per day they eat basic food groups and develops personalized diet recommendations based on what they are actually eating. It is a very simple, user friendly, survey requiring only 5-10 minutes to complete. Consumer satisfaction with this kind of survey is high. For example:

92% of participants said that “the Food4Me website was easy to use.”
76% of participants were “satisfied with the detail of information they received in their personalized nutrition report.”
80% of participants felt that “the dietary advice in the report was relevant to them.”

In spite of its simplicity and ease of use, the Food4Me survey is also quite robust. Previous studies have shown that the reproducibility and validity of the Food4Me diet survey compares very favorably with much more extensive dietary analyses (For example, R. Fallaize, et al., Journal of Medical Internet Research, 16: e190, 2014).

This study (International Journal of Epidemiology, 2016, 1-11, doi:110.093/ije/dyw186) measured the effectiveness of the Food4Me personalized nutrition reports at improving health-related behaviors. It was a 6-month randomized control study of 1269 adults from 7 European countries. It compared 4 different interventions on health-related behavior changes. The 4 interventions were:

standardized dietary advice
personalized nutrition advice based on the Food4Me survey
personalized nutrition advice based on the Food4Me survey plus BMI and blood biomarkers
personalized nutrition advice based on all that plus genetic testing

Is Personalized Nutrition The Wave Of The Future?

The results of the study were quite striking:

Compared to the group who just received standardized diet advice, the groups who received personalized nutrition advice were significantly more successful at improving health related behaviors. In particular, the groups receiving personalized nutrition advice:
- Consumed less red meat.
- Consumed less saturated fat
- Consumed less salt
- Got more folate from their diet
- Had an improved “Healthy Eating Index” (a measure of overall diet quality)

Adding information on blood biomarkers (cholesterol, carotenoids, omega-3s, and vitamin D) and genotype received did not enhance the effectiveness of the personalized nutrition recommendations at changing health behaviors.

What Does This Study Mean For You?

This is a single study, but it does suggest several interesting take-home lessons.

#1: We are much more likely to follow diet advice that is personalized to us than we are to follow standardized diet advice. This should come as no surprise. We’ve had generalized diet advice like the USDA Food Guide Pyramid and, more recently, the USDA My Plate guidelines for decades, and they haven’t moved the needle. Maybe people think of generalized guidelines as applying to other people and personalized guidelines as applying to them. Personalized nutrition seems to be more effective.

#2: This was personalized diet advice, not weird diet advice. The participants were not being told to eat as much fat as they wanted. They weren’t being told that avoiding wheat will make them slimmer and smarter. They weren’t being told to eat like a caveman. They were being given USDA-approved diet recommendations. The only difference was that the dietary recommendations were personalized to them. For example, they were only being told to eat more fruits and vegetables if, in fact, fruits and vegetables were not a regular part of their daily diet.

#3: Blood biomarkers did not provide any additional incentive to increase health related behaviors. I wouldn’t read too much into this observation. With the exception of cholesterol, the blood biomarkers selected for this study merely reinforced the diet analysis. For example, you could ask whether low blood carotenoid levels really provided any additional incentive to change their diet for an individual who was already told their intake of fruits and vegetables was low. If the study had measured disease-related blood biomarkers, it might have found that they provided additional incentive for individuals to make positive diet changes.

#4: Genetic testing did not provide any additional incentive to increase health related behaviors. This probably simply reflects the state of the science. Current genetic tests are only weakly predictive of major diseases like heart disease, diabetes, and cancer so they provide little incentive to make major lifestyle changes. This may change in the future as we improve our understanding of genetic influences on disease risks.

Missed Opportunities

This study clearly showed that a simple online diet survey like the Food4Me personalized diet assessment is very useful for changing health-related dietary behavior. However, this study also missed several opportunities to create an even more valuable tool for improving health-related behaviors. For example, the study collected data on obesity and activity levels, but did not attempt to provide personalized lifestyle recommendations based on that data. In addition, 44% of the participants reported that they had a disease, but no attempt was made to include health goals in the personalized diet and lifestyle recommendations.

The Bottom Line

A recent study showed that personalized nutrition recommendations based on a simple online survey were much more effective than standardized dietary advice at getting people to improve health-related eating habits.

Adding information on blood biomarkers and genetic tests did not enhance the effectiveness of the personalized nutrition recommendations at changing health behaviors.

The study did not evaluate the value of adding activity levels and health goals to the assessment. That perhaps represented a missed opportunity to create an even more powerful tool for positively influencing health-related behaviors.

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.

American Omega-3 Deficiency

July 12, 2016 by Dr. Steve Chaney

Is There an American Omega-3 Deficiency?

Author: Dr. Stephen Chaney

Omega-3s have been controversial in recent years. However, virtually everyone agrees that omega-3 intake in North American is low. But, would you believe that the United States and Canada are dead last with respect to omega-3 status – that we are among the countries with the lowest omega-3 status in the world? Is there an American omega-3 deficiency? That is what a recent study suggests!

Omega-3 Deficiency in Americans

Previous studies have suggested that the American and Canadian diets were deficient in long chain omega-3s like EPA and DHA, but those studies were based on 24-hour diet recalls or food frequency surveys which might underrepresent the true amount of omega-3s in the diet. Therefore, a group of investigators from the United States and Canada decided to look at blood levels of EPA and DHA.

This study (Stark et al, Progress In Lipid Research, 63: 132-152, 2016) was a meta-analysis of 298 studies that recorded blood levels of EPA and DHA. These studies were from 36 counties and distinct regions around the world. They converted all of the measurements to a common unit expressed as percent by weight of EPA + DHA relative to the total weight of fatty acids in the blood.

They combined all studies from a given country or region to give an average value of percent EPA + DHA and then divided the countries and regions into four groupings based on the average weight percentage of EPA + DHA in the blood. If all that seems confusing, the figure on the right (taken from Stark et al, Progress In Lipid Research, 63: 132-152, 2016) should clear things up.

Red = very low (< 4%) EPA + DHA levels
Orange = low (4-6%) EPA + DHA levels
Yellow = moderate (6-8%) EPA + DHA levels
Green = adequate (>8%) EPA + DHA levels
Grey = no valid measurements in those countries

It is clear from this study that most Americans and most Canadians don’t do a very good job of incorporating omega-3 fatty acids into their diet, as several previous dietary surveys have suggested. This could contribute to omega-3 deficiency.

Is The United States Dead Last In Omega-3 Status?

The global map of EPA + DHA blood levels certainly suggests that the United States is among a handful of countries with the very lowest omega-3 status. There are a few caveats, however.

As the large areas of grey indicate, there are a number of countries with no valid omega-3 blood measurements. The United States might have lots of company in the very low omega-3 status category.

There are some very large countries like Russia which have relatively few omega-3 blood measurements, and those measurements are only from a few regions of the country. The average omega-3 status for the entire country might be lower than indicated in this map.

On the other hand, there are lots of omega-3 blood measurements from countries like Japan, so it is clear that there are countries with much better omega-3 status than the United States.

What Does This Study Mean To You?

The important questions are, of course:Does it matter? What do these blood levels of EPA + DHA actually mean? Is < 4% EPA + DHA low enough to matter? What are the health consequences of low omega-3 status? If you have an omega-3 deficiency, what are the risks?

Let’s start with the first question: How do we translate a blood level of EPA + DHA into how much we should be getting in our diet? While there is no established Dietary Reference Intake for EPA + DHA, several expert panels and international organizations have made recommendations for EPA + DHA intake. Those recommendations generally range from 250 mg/day to 500 mg/day for general health and 500 mg/day to 1,000 mg/day for heart health. Unfortunately, most people in the United States and Canada consume less than 200 mg/day of omega-3 fatty acids, and most of those are short chain omega-3s that are inefficiently converted to the long chain EPA and DHA.

More importantly, a recent study (Patterson et al, Nutrition Research, 35: 1040-1051, 2015) has examined how much additional EPA + DHA must be consumed by someone eating a typical North American diet to significantly improve their omega-3 status. It showed that:

200 mg/day of EPA + DHA is required to improve omega-3 status from very low to low.
500 mg/day of EPA + DHA is required to improve omega-3 status from very low to moderate.
1250 mg/day of EPA + DHA is required to improve omega-3 status from very low to adequate.

It is no surprise that these numbers correlate so well. My recommendation would be to consume at least 500 mg/day of EPA + DHA for general health and at least 1,000 mg/day for heart health.

Now let’s look at the last question: What are the health consequences of low omega-3 status? There are multiple health benefits associated with optimal omega-3 status, but the best evidence is for the beneficial effects of omega-3s on fetal and infant neurodevelopment and heart health. For example:

A recent meta-analysis conducted by scientists at Tufts and Harvard (Shulkin et al, The FASEB Journal, 30: supplement 295-6, 2016) concluded that DHA + EPA supplementation during pregnancy and infancy improved motor skills. Other studies have suggested that DHA + EPA supplementation in infancy and childhood improves reading skills and reduces ADHD symptoms in children with low omega-3 status.

Several major clinical studies have shown that oily fish and fish oil supplements improve heart health and reduce the risk of heart attacks in at-risk individuals (Investigators of the GISSI-Prevenzione trial, Lancet, 354: 447-455, 1999 (http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(99)07072-5.pdf); Lamaitre et al, American Journal of Clinical Nutrition, 77: 319-325, 2003 (http://ajcn.nutrition.org/content/77/2/319); Gammelmark et al, British Journal of Nutrition, 116: 167-177, 2016 (http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=10341239&fileId=S000711451600180X).

In case you have been confused by recent studies suggesting that omega-3s have no effect on heart health you should know that most of those studies were looking at the effect of EPA + DHA in patients who were already taking 3 or 4 heart medications. The studies actually concluded omega-3s provided no additional benefits in people already taking multiple heart medications. That is a totally different question.

Where Should You Get Your Omega-3s?

Now that you know how important the long chain omega-3s, EPA and DHA, are for your health, and you know that most of us have a very poor omega-3 status and therefore have an omega-3 deficiency , your next questions are likely to be: “What’s the best way to improve my omega-3 status?” and “Where can I find EPA and DHA in my diet?” The answer is complicated.

Cold water, oily fish like salmon are a great source of EPA and DHA. Unfortunately, our oceans are increasingly polluted and some of those pollutants are concentrated even more in farm raised fish. A few years ago a group of experts published a report in which they analyzed PCB levels in both wild caught and farm-raised fish from locations all around the world (Hites et al, Science 303: 226-229, 2004) . Based on PCB levels alone they recommended that some wild caught salmon be consumed no more than once a month and some farm raised salmon be consumed no more than once every other month!

Unfortunately, when you buy salmon in the grocery store or your favorite restaurant, you can ask whether the salmon is wild or farm-raised, but you have no idea where the salmon came from. You have no idea how safe it is to eat. I love salmon and still eat it on occasion, but not nearly as frequently as I used to.

As an aside, the buzzword nowadays is sustainability. I support sustainability. However, the easiest way to assure that fish are sustainable is to raise them in fish farms. When a waiter tells me how sustainable the “catch of the day” is, I ask them how polluted it is. If they can’t answer, I don’t buy it. My health is more important to me than sustainability.

Nuts, seeds, and canola oil are good sources of ALA, a short chain omega-3 fatty acid. These food sources are less likely to be contaminated, but the efficiency of conversion of ALA to EPA and DHA is only around 5-10%. In other words, you need to eat a lot of ALA-rich foods to enjoy the health benefits associated with EPA and DHA.

That leaves fish oil supplements, but you need to remember that the EPA + DHA supplements you purchase in the health food store come from polluted fish. Unfortunately, many manufacturers have inadequate purification and quality control standards. In other words, neither you nor they know whether their omega-3 products are pure. You need to make sure that the omega-3 supplement you purchase is made by a manufacturer with stringent quality control standards.

The Bottom Line

A recent study has shown that most Americans are deficient in long chain omega-3s like EPA and DHA. In fact, the mainland United States and Canada were tied with half a dozen other countries for the lowest omega-3 status in the world. Omega-3 deficiency in Americans seems to be the worst.

That is unfortunate because recent studies have shown that optimal blood levels of EPA and DHA are associated with a number of health benefits, especially fetal and infant neurodevelopment and heart health.

Other studies suggest that most Americans should consume an extra 500 mg/day of EPA + DHA for general health and at least 1,000 mg/day for heart health.

Unfortunately, it is not easy get those levels of EPA and DHA from our diet:

Oily, cold water fish are a great source of EPA and DHA, but our oceans are increasingly polluted and experts recommend that some fish that are the best sources of EPA and DHA be consumed no more than once a month. The situation is even worse for farm-raised fish.

Of course, nowadays the buzzword for fish is sustainability, but sustainability does not guarantee purity. Sustainable fish can be just as polluted as the worst of the farm raised fish.

seeds and canola oil are great sources for ALA, a short chain omega-3 fatty acid. This source of omega-3s is less likely to be contaminated, but the efficiency of conversion of ALA to EPA and DHA in our bodies is only around 5-10%.

Fish oil supplements can be a convenient source of the EPA and DHA you need, but the fish oil often comes from polluted fish and many manufacturers have inadequate purification methods and quality control standards. If you choose fish oil supplements as your source of omega-3s, be sure to choose a manufacturer with stringent quality control standards. Otherwise, neither you nor the manufacturer will know whether their omega-3 supplement is pure.

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

Omega-3 And Blood Pressure: The Good News

May 24, 2016 by Dr. Steve Chaney

Will Fish Oil Lower Your Blood Pressure?

Author: Dr. Stephen Chaney

Is there a relationship between omega-3 and blood pressure we should understand to for health benefits?

High blood pressure is a killer! It can kill you by causing heart attacks, strokes, congestive heart failure, kidney failure and much more.

High blood pressure is a serial killer. It doesn’t just kill a few people. It kills lots of people. The American Heart Association estimates that high blood pressure directly or indirectly caused 363,000 deaths in 2010. That is almost 1 person every second and represents a 41% increase from 2000. It’s because high blood pressure is not a rare disease.

31% of Americans have high blood pressure, also called hypertension, (defined as a systolic blood pressure of 140 mm Hg or more or a diastolic blood pressure of 90 mm Hg or more).

Another 30% of Americans have prehypertension (systolic blood pressure of 120-139 mm Hg or diastolic blood pressure of 80-89 mm Hg).

That’s over 61% of Americans with abnormal blood pressure!

High blood pressure is a silent killer. That’s because it is a very insidious disease that sneaks up on you when you least expect it. Systolic blood pressure increases 0.6 mm Hg/year for most adults over 50. By age 75 or above 76-80% of American adults will have high blood pressure. Even worse, many people with high blood pressure have no symptoms, so they don’t even know that their blood pressure is elevated. For them the first symptom of high blood pressure is often sudden death.

Blood pressure medications can harm your quality of life. Blood pressure medications save lives. However, like most drugs, blood pressure medications have a plethora of side effects – including weakness, dizziness, fainting, shortness of breath, chest pain, nausea, diarrhea or constipation, heartburn, depression, heart palpitations, and even memory loss . The many side effects associated with blood pressure medications lead to poor compliance, which is probably why only 47% of patients with high blood pressure are adequately controlled.

You do have natural options. By now you are probably wondering whether there are natural approaches for controlling your blood pressure that are both effective and lack side effects. The answer is a resounding YES! I’ll outline a holistic natural approach for keeping your blood pressure under control in a minute, but let me start with the good news about omega-3 fatty acids.

The Good News About Omega-3 and Blood Pressure

What’s the good news about omega-3 and blood pressure? We’ve known for some time that omega-3 fatty acids helped lower blood pressure, but two recent studies have really highlighted just how strong the effect of omega-3s on lowering blood pressure is.

The first study (Miller et al, American Journal of Hypertension, 27: 885-896, 2014) was a meta-analysis of 70 randomized, placebo-controlled clinical trials of long chain omega-3 (EPA + DHA) supplementation and blood pressure.

Here are the results of this study:

In the group with normal blood pressure at the beginning of the study EPA + DHA supplementation decreased systolic blood pressure by 1.25 mm Hg.

Given that systolic blood pressure rises an average of 0.6 mm Hg/year in adults over 50, the authors estimated that omega-3 supplementation alone would delay the onset of age-related high blood pressure by 2 years.

In the group with elevated blood pressure not taking medication at the beginning of the study, EPA + DHA supplementation decreased systolic blood pressure by an impressive 4.51 mm Hg and diastolic blood pressure by 3.05 mm Hg.

The authors noted that this decrease in systolic blood pressure could “prevent an individual from requiring medication [with all its side effects] to control their hypertension” or decrease the amount of medication required.

However, the doses of omega-3s used in these studies ranged from 1 to over 4 grams/day (mean dose = 3.8 grams/day). That sparked a second study (Minihane et al, Journal of Nutrition, 146: 516-523, 2016) to see whether lower levels of omega-3s might be equally effective. This study was an 8 week double-blind, placebo-controlled study comparing the effects of 0.7 or 1.8 grams of EPA + DHA per day (versus an 8:2 ratio of palm and soybean oil as a placebo) on blood pressure.

Here are the results of this study:

In the group with normal blood pressure at the beginning of the study, EPA + DHA supplementation caused no significant decrease in blood pressure. This could be due to the smaller number of subjects or the lower doses of EPA + DHA used in this study.

In the group with elevated blood pressure not taking medication at the beginning of the study, EPA + DHA supplementation decreased systolic blood pressure by 5 mm Hg and, the effect was essentially identical at 0.7 grams/day and 1.8 grams/day.

The authors concluded “Our data suggest that increased EPA + DHA intakes of only 0.7 grams/day may be an effective strategy for blood pressure control.”

A Holistic Approach To Blood Pressure Control

The latest information about omega-3 and blood pressure is good news indeed, but that’s not the only natural approach that lowers blood pressure. You have lots of other arrows in your quiver. For example:

The DASH diet (A diet that has lots of fresh fruits and vegetables; includes whole grains, low fat dairy, poultry, fish, beans, nuts and oils; and is low in sugar and red meats) reduces systolic blood pressure by 5-6 mm Hg. [Low sodium, low sodium/high-potassium, low-sodium/low-calorie, low-calorie and Mediterranean diets also lower blood pressure, but not by as much as the DASH diet].

Reducing sodium by about 1,150 mg/day reduces systolic blood pressure by 3-4 mm Hg.

Reducing excess weight by 5% reduces systolic blood pressure by 3 points.

Doing at least 40 minutes of aerobic exercise 3-4 times/week reduces systolic blood pressure by 2-5 mm Hg.

Nitrates, whether derived from fresh fruits and vegetables or from supplements probably also reduce blood pressure , but we don’t yet know by how much.

If you’ve been keeping track, you’ve probably figured out that a holistic lifestyle that included at least 0.7 grams/day of long chain omega-3s (EPA + DHA) plus everything else in the list above could reduce your systolic blood pressure by a whopping 18-22 mm Hg.

That’s significant because,as the graphic on the right shows, the CDC estimates that reducing high systolic blood pressure by only 12-13 mm Hg could substantially decrease your risk of disease.

A Word Of Caution

While holistic approaches have the potential to keep your blood pressure under control without the side effects of medications, it is important not to blindly rely on holistic approaches alone. There are also genetic and environmental risk factors involved in determining blood pressure. You could be doing everything right and still have high blood pressure. Plus, you need to remember that high blood pressure is a silent killer that often doesn’t have any detectable symptoms prior to that first heart attack or stroke.

My recommendations are:

Monitor your blood pressure on a regular basis.

If your blood pressure starts to become elevated, consult with your doctor about starting with natural approaches to bring your blood pressure back under control. Doctors are fully aware of the side effects of blood pressure medications, and most doctors are happy to encourage you to try natural approaches first.

Continue to monitor blood pressure as directed by your doctor. If natural approaches are insufficient to bring your blood pressure under control, they will prescribe the lowest dose of blood pressure medication possible to get your blood pressure where it needs to be.

Don’t stop making holistic lifestyle choices to reduce blood pressure just because you are on medication. The more you do to keep your blood pressure under control, the less medication your doctor will need to use (That means fewer side effects).

The Bottom Line

Recent studies have shown that supplementation with as little as 0.7 grams of long chain omega-3s (EPA + DHA) per day is sufficient to decrease systolic blood pressure by ~ 5 mm Hg in people with untreated hypertension (high blood pressure). If your blood pressure is currently in the normal range, it is not yet clear how much EPA + DHA you need to keep it there. That may require a higher dose.

When you combine that with other natural approaches such as the DASH diet, reducing sodium, losing weight, and increasing exercise you can decrease blood pressure by 18-22 mm Hg.

The CDC estimates that is enough to substantially decrease your risk of stroke, coronary heart disease, memory loss, kidney disease, erectile dysfunction, death from cardiovascular disease, and death from any cause.

The authors of these recent studies concluded that holistic lifestyle changes including substantially increasing omega-3 intake have the potential to significantly delay the onset of age-related hypertension and may allow people with elevated blood pressure to eliminate or substantially reduce the use of blood pressure medications – with their many side effects.

High blood pressure is a silent killer. It is important to monitor your blood pressure regularly. If it becomes elevated, work with your doctor to find the balance of natural approaches and medication that is right 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.

The Benefits of Resveratrol

April 26, 2016 by Dr. Steve Chaney

Author: Dr. Stephen Chaney

Some athletes, particularly Olympic athletes, are starting to use resveratrol to improve their workouts and their performance in events. Is their belief in the benefits of resveratrol justified, or is resveratrol just another of those “mythical” sports nutrition supplements? There have only been a few small studies on the subject, and those studies have been conflicting.

The study I am featuring this week (Polley et al, Appl. Physiol. Nutr. Metab. 41: 26-32, 2016) asked a more fundamental question. It asked whether resveratrol enhanced the effect of exercise on muscle mitochondrial capacity. For those of you who aren’t scientists that statement may require some interpretation.

What Are Mitochondria and Why Are They Important?

You can think of mitochondria as the power packs of the cell. They are tiny organelles that are found in most cells in our body. The foods that we eat contain a lot of energy (calories), but that energy is not in a form that our cells can use. Our cells metabolize those foods into small molecules that donate electrons to our mitochondria, and the mitochondria use those electrons to create energy in a form that our cells can utilize.

As you might imagine, mitochondria are particularly important for cells with high energy requirements, like our muscle cells. Those muscle cells responsible for endurance and high intensity (think gymnastics or weight lifting) exercise have the highest density of mitochondria and are the most dependent on those mitochondria for optimal performance.

Why Resveratrol Might Increase Muscle Mitochondrial Capacity?

Mitochondria have a finite lifetime in our cells. As our cells age their mitochondria become less efficient and start doing bad things like releasing damaging free radicals into the cell. Exercise stress causes the mitochondria in our muscles to age more rapidly than the mitochondria in other cells. Fortunately, regular exercise also stimulates a pathway that causes production of new mitochondria and enhances their efficiency. Thus, the net effect of any exercise program is to increase both the number and efficiency of mitochondria, something referred to as mitochondrial capacity.

It turns out that resveratrol and a small group of related polyphenols also stimulate the same pathway. Animal and cell culture studies show that resveratrol can increase muscle mitochondrial capacity. However, since resveratrol and exercise increase mitochondrial capacity by the same mechanism, the question is whether resveratrol has any added benefit over exercise alone. That is the question this study was designed to answer.

The Benefits of Resveratrol on Muscle Mitochondrial Capacity?

Previous studies had suggested that one of the benefits of resveratrol might be increasing muscle mitochondrial capacity for people who have engaged in relatively little physical activity in the past. For examples, studies have shown that resveratrol activates the pathway leading to increased mitochondrial capacity in obese and diabetic populations, both groups that may not have been involved in regular exercise. In contrast, other studies found no enhancement of those same pathways compared to exercise alone in more highly trained populations involved in high intensity training.

Based on those results, the present study (Polley et al, Appl. Physiol. Nutr. Metab. 41: 26-32, 2016) was specifically designed to assess the effect of resveratrol supplementation along with low-intensity exercise in an untrained muscle group. The authors recruited healthy young adults with approximately equal numbers of men and women. To assure that the muscle group was relatively untrained, they asked the subjects to perform wrist flexor exercises in their non-dominant arm. They excluded from the study anyone whose exercise regimen involved regular use of the non-dominant forearm such as rowing, rock climbing or CrossFit.

This was a double-blind, placebo-controlled study. Half of the group received 500 mg of resveratrol and the other half received the placebo. The placebo group served as a control for the effect of exercise alone. The dominant arm was not exercised, so it served as a control for the effect of resveratrol alone. The participants took resveratrol or placebo upon wakening each morning. The wrist flexor exercises were performed 3 times per week for 4 weeks. Mitochondrial capacity measurements were made using near infrared spectroscopy on a weekly basis.

The results were pretty straight-forward.

Low-intensity training alone (placebo group) for 4 weeks resulted in a 10% increase in mitochondrial capacity.

Low-intensity training plus resveratrol for 4 weeks resulted in a 40% increase in mitochondrial capacity. This represented a highly significant difference between the resveratrol and placebo groups.

Neither the resveratrol group or the placebo group exhibited changes in the untrained arm, which suggests that resveratrol without exercise has little or no effect on mitochondrial capacity in young, healthy subjects.

The authors concluded: “Taken together, these findings indicate that [the] combination of exercise and resveratrol is needed for eliciting maximal muscle mitochondrial adaptations to low-intensity training programs.”

What Are the Strengths and Weaknesses of This Study?

Strengths:Because previous studies had suggested that the effects of resveratrol might be masked in highly trained individuals or by high intensity exercise, this study was specifically designed to look at the effects of resveratrol on mitochondrial capacity when administered along with low-intensity exercise in untrained muscles. In that sense this study breaks new ground and suggests that, under the right conditions, resveratrol can enhance exercise training.

Weaknesses:The weaknesses of this study were many:

It was a very small study. That is not unusual in this area of research, but clearly much more research is needed.

It used a higher dose of resveratrol than previous studies. However, plasma levels of resveratrol were not determined and the effect of lower doses was also not determined, so we have no idea how much resveratrol is actually needed to elicit this response.

While increased mitochondrial capacity is a probable predictor of improved exercise efficiency, no performance outcomes were actually measured. Most people probably don’t care how well their mitochondria work. They care about how well their muscles perform.

What Does This Mean For You?

We are in the very early stages of research into the benefits of resveratrol on exercise. Many more studies are needed before we will be in a position to fully understand the effects of resveratrol on exercise efficiency and performance outcomes. This and previous studies suggest that resveratrol is likely to be most effective at enhancing exercise efficiency with low intensity exercise in relatively untrained muscles.

If true, that would mean resveratrol might be helpful for the millions of Americans who are “weekend warriors” or exercise sporadically. It may even be beneficial for those of us who exercise regularly at a low to moderate intensity level.

However, because resveratrol and exercise improve mitochondrial capacity by the same mechanism, previous studies suggest that resveratrol might be a less effective addition for highly trained athletes engaged in high-intensity exercise.If true, this would put resveratrol in the same category as several other popular exercise supplements such as arginine and citrulline that also appear to be more effective for untrained individuals than they are for highly trained athletes.

However, I am aware of many Olympic athletes who use and swear by a resveratrol polyphenol blend. It could be placebo, but it could also suggest that resveratrol does enhance performance for highly trained athletes engaged in high-intensity exercise. As I said at the beginning of this section, there is much more research to do. That’s what makes science so much fun. There are always new things to learn.

The Bottom Line

We are in the very early stages of research into the benefits of resveratrol on exercise. Many studies will be needed before we will be in a position to fully understand the effects of resveratrol on exercise efficiency and performance outcomes. However, a recent study is of interest because it introduces a new perspective to our understanding of the possible effects of resveratrol on exercise efficiency.

Thisstudy reports that resveratrol significantly enhances the increase in mitochondrial capacity caused by low-intensity exercise in untrained muscles

If true, that would mean resveratrol might increase exercise efficiency for the millions of Americans who are “weekend warriors” or exercise sporadically. It may even be beneficial for those of us who exercise regularly at a low to moderate intensity level.

However, because resveratrol and exercise improve mitochondrial capacity by the same mechanism, previous studies suggest that resveratrol might be a less effective addition for highly trained athletes engaged in high-intensity exercise.

If true, this would put resveratrol in the same category as several other popular exercise supplements such as arginine and citrulline that also appear to be more effective for untrained individuals than they are for highly trained athletes.

However, I am aware of many Olympic athletes who use and swear by a resveratrol polyphenol blend. It could be placebo, but it could also suggest that resveratrol does enhance performance for highly trained athletes engaged in high-intensity exercise.

As I said before, there is much more research to do. That’s what makes science so much fun. There are always new things to learn.

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.

PAHs Contaminate Supplements?

April 12, 2016 by Dr. Steve Chaney

Do Your Supplements Contain Carcinogens?

Author: Dr. Stephen Chaney

Most of us take supplements to improve our health. We count on those supplements being pure and effective. We don’t expect the supplements we take to contain carcinogenic (cancer causing) contaminants. However, that expectation appears to be unfounded. A recent study found that 72% of supplements tested were contaminated with a particularly dangerous class of cancer causing chemicals called polycyclic aromatic hydrocarbons (PAHs)

Where Do PAHs Come From andWhy Are TheyDeadly?

Polycyclic aromatic hydrocarbons (PAHs) are produced by incomplete combustion of organic materials. Major environmental sources of PAHs are incomplete burning of gasoline, coal and other fuels. Unfortunately, automobile exhaust, coal burning power plants, and exhaust from factories are almost ubiquitous in today’s world, resulting in significant PAH contamination of our air, water, and soil. The unfortunate truth is that we all live in an increasingly dirty and toxic environment.

As you might imagine, cigarette smoke is the #1 source of PAHs in humans. However, foods are a major route for PAH exposure in humans as well. There are many food sources of PAHs. For example,

Grilling, roasting and frying foods, especially meats, at high temperatures creates PAHs.
Smoking fish or meats creates PAHs.
Barbecuing meats creates PAHs.
Even plant-based foods can contain PAHs if the soil, air or water they were grown in was contaminated.
PAHs can be introduced into supplements if any of their ingredients are dried at high temperatures as part of the processing procedure.

By now you are probably realizing that it is not just our environment that is increasingly being contaminated with PAHs. We are all becoming contaminated with PAHs as well. Our bodies are becoming toxic waste dumps.

Unfortunately, PAHs are not innocuous chemicals. Perhaps the best studied and deadliest of the PAHs is a compound called benzo[a]pyrene. It is classified as a class 1 carcinogen and mutagen by the IARC (International Agency for Research on Cancer). Perhaps some explanation is in order:

The IARC is an international organization that is charged with evaluating the scientific evidence for the carcinogenicity of various chemicals. It also sets upper limits for safe exposure to those chemicals.

Class 1 carcinogens are compounds that the IARC has classified as definitely carcinogenic to humans. Simply put, the IARC considers the scientific evidence to be overwhelming that those compounds are carcinogens.

To date only 118 compounds have been blacklisted by the IARC as class 1 carcinogens and benzo[a]pyrene is one of them. However, many of the other, less studied, PAHs are classified as probable carcinogens by the IARC.

Unfortunately, in most countries of the world (including the United States), PAH limits in food and supplements are unregulated. Because they are unregulated, many supplement companies don’t even test for them. That is unfortunate because a recent study shows that many supplements are contaminated with high levels of PAHs, and their manufacturers didn’t even know it.

Do Your Supplements Contain PAHs or Other Carcinogens?

The European Union has taken the lead in regulating PAH levels. They have used the IARC guidelines to create upper allowable limits for PAHs in food and supplements. Separate standards were set for benzo[a]pyrene and the total of the four most common PAH contaminants (benzo[a]anthracene, benzo[a]pyrene, benzo[b]fluoranthrene, and chrysene). Those new regulations just went into effect April 1^st 2016.

To gauge the impact of these new regulations on the supplement industry, the EU asked the European Union Reference Laboratory to measure the levels of PAH contamination in supplements sold in the EU prior to the implementation of the new regulations. Because vitamin and mineral supplements are seldom contaminated with PAHs, they were excluded from the study.

The EU Reference Laboratory started collecting a wide range of herbal and botanical supplements, fish and edible oil food supplements, and propolis and other bee supplements sold in the EU in 2013. The Reference Laboratory analyzed 94 different supplements for PAH contamination, and the results of these analyses were published in October 2015 (Z. Zelinkova and T. Wenzyl, Food Additives & Contaminants: Part A, 32: 1914-1926, 2015).

[In case you, like me, were wondering what propolis is, it is a resin like substance that bees use as a glue to hold their hives together. WebMD states that it may have some use as a topical agent for cold sores, genital herpes, and after mouth surgery, but that any other uses are unproven. However, if you visit websites for propolis products you find it in capsules and liquids for internal consumption. You are told that it cures bacterial and fungal infections, cures viral infections like AIDs, cures cancer, and removes warts.]

The results of their analysis were pretty scary:

72% of the supplements tested exceeded EU limits for the four most common PAH contaminants, and 52% exceeded EU limits for benzo[a]pyrene.

Propolis and spirulina were the most heavily contaminated supplements. Valerian and St. John’s Wort had moderately high levels of contamination, and some samples of bee pollen, sea buckthorn oil, barley greens, Echinacea, and Ginko far exceeded EU standards.

If consumers took the recommended dosage of the two most contaminated products (Premium Spirulina and Propolis Intense) they would more than double their daily intake of PAHs and far exceed what the IARC considers safe.

Fish oils generally had low levels of PAH contamination. The authors speculated this may be because fish have the ability to metabolize PAHs. However, other edible oils, particularly sea buckthorn oil and a mixture of garlic oil with soybean and sunflower oils did exhibit significant PAH contamination. The authors speculated that this PAH contamination may have been introduced during the processing of these oils.

Why The PAH and Contamination Problem Is Worse Than You Thought

You might be thinking what could be worse than 72% of supplements being contaminated with cancer causing PAHs? Here is some food for thought.

PAHs are just the tip of the iceberg. Many supplements are also contaminated with PCBs and heavy metals. For example:

Fish oil is often contaminated PCBs.

Rice protein and other rice-derived ingredients are often contaminated with lead and/or mercury.

The US regulates PAHs in our water supply, but does not currently regulate PAHs in our supplements. That means that manufacturers that make products primarily for consumption in the US have no incentive to test their products for PAH contamination. Most of them have no idea whether their products are safe or not.

There is no guarantee that even products labeled Certified Organic and Non-GMO are free of PAH contamination. For example:

Organic certification just means that the crop was raised using organic methods. No analysis of purity is required to assure that the crop had not been inadvertently contaminated. The same is true of non-GMO certification. No analysis of purity is required.

Organically grown, non-GMOcrops that are used as ingredients for supplements can still be contaminated if the air, soil or water is contaminated from any nearby pollution source. For example, ground water pollution is the major source of the heavy metal contamination often seen in rice-derived ingredients.

Organically grown, non-GMO crops can even become contaminated by PAHs if they are grown next to a busy highway.

Even if the ingredients are pure to begin with, PAH contamination can be introduced during processing.

What does all of this mean to us? It means that it is absolutely imperative that we do our due diligence and only choose supplement manufacturers whose quality control standards far exceed what is required of the industry. Our health just may depend on it.

The Bottom Line

A recent study has reported that 72% of herbal and botanical supplements, fish and edible oil food supplements, and supplements derived from bees sold in the EU were contaminated with high levels of cancer causing polycyclic aromatic hydrocarbons (PAHs).

The levels of PAHs in many of these products far exceeded standards recently enacted by the EU. If those supplements were taken as recommended, the daily intake of PAHs by people consuming them would also far exceed the safe limits of exposure to these toxic chemicals set in place by the International Agency for Research on Cancer.

While all of this sounds bad enough, the news is even worse for most of us living in the US.

PAHs are just the tip of the iceberg. Many supplements are also contaminated with PCBs and heavy metals.

The US regulates PAHs in our water supply, but does not currently regulate PAHs in our supplements. That means that manufacturers that make products primarily for consumption in the US have no incentive to test their products for PAH contamination. Most of them have no idea whether their products are safe or not.

There is no guarantee that even products labeled Certified Organic and Non-GMO are free of PAH contamination.

What does all of this mean to us? It means that it is absolutely imperative that we do our due diligence and only choose supplements manufacturers whose quality control standards far exceed what is required of the industry. Our health just may depend on it. Remember, PAHs are not the only potential problem.

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.