Food and Health

Can Supplementation Improve Teen Behavior?

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Author: Dr. Stephen Chaney

 

can supplementation improve teen behaviorAll teenagers can be a handful at times. Experts tell us that their raging hormones are to blame, but could their junk food diets play a role as well? If so, would something as simple as supplementation improve teen behavior?

This has been a controversial issue, with some studies saying yes and other studies saying no. With that in mind I thought I would share a recent study that concludes supplementation may improve behavior in teens. While this one study will not resolve the controversy, it does provide some insight into why the results of previous studies have been so contradictory.

Can Supplementation Improve Teen Behavior?

This study (Tammam et al, British Journal of Nutrition, 115: 361-373, 2016) enrolled 196 healthy teens aged 13-16 from a large public school in London. The school was located in an economically depressed area of London where a large proportion of the adults were out of work and had no formal education. Many of the children attending that school had adverse home environments and poor nutrition.

This is an important point. The scientists running the study had specifically chosen a teenage school population that was likely to have poor nutritional status. This poor nutritional status was confirmed by blood samples taken at the beginning of the study which showed the teens were low in iron, folate, vitamin D, vitamin C and omega-3 fatty acids – all of which are important for brain health.

teen behvaviorThe students were given either a comprehensive multivitamin plus 541 mg of omega-3 fatty acids (containing 165 mg EPA and 116 mg DHA) or matched placebos for one school term (12 weeks). The study was fully blinded in that neither the students nor their teachers knew who had received the supplements and who had received the placebo.

Blood test taken at the end of the study showed that students taking the supplements had significantly higher blood levels of folate, vitamin C, vitamin D, and omega-3 fatty acids (iron levels remained unchanged) while those nutrient levels were unchanged in the placebo group.

Teachers rated the student’s behavior using the Connors Clinical Index Teacher Rating Scale before the study began and again during the last week of the study. The results were clear cut. Behavior improved in the group receiving the supplements and worsened in the group receiving the placebo.

The researchers also looked at disciplinary infringement logs (you can think of those as disciplinary problems severe enough to send the kids to the principal’s office), but the number of disciplinary incidents per child were too low to draw any statistically significant conclusions.

Why Are Supplementation and Teen Behavior Studies So Contradictory?

diet and behaviorAs I said at the beginning of this article, previous nutritional intervention trials looking at teen behavior problems have been conflicting. Some, like this study, have shown a clear benefit of supplementation on teenage behavior. Others have shown no benefit at all.

Most experts tend to treat all studies on a particular topic as equal. They throw all of the studies into a statistical pot and look at the average effect. When studies are contradictory, as is the case for studies looking at the effect of supplementation on teenage behavior, the positive and negative studies cancel each other out and the net effect is often close to zero. When that happens experts generally consider the intervention as “unproven”.

That is a valid approach, but I also like to look for patterns. I like to ask why the studies have come to such contradictory conclusions.

When you evaluate the studies on supplementation and teenage behavior carefully, a pattern starts to emerge. If most of the teenagers in the study have poor nutritional status or have severe behavior problems (such as teenagers in prison), the studies generally show a benefit of supplementation. If most of the teens in the study have good nutritional status at the beginning of the study, the results of supplementation are very difficult to detect. Similarly, if most of the teens in the study are well behaved to begin with, supplementation appears to have little effect.

What Does This Mean For Your Teenager(s)?

The causes of teenage behavior problems are many. Poor nutrition may play a significant role, but genetics, hormones, home environment and school environment are important as well. However, teen eating habits are often less than ideal. If you have a teenager with behavior problems and poor eating habits, supplementation is an inexpensive intervention that may just contribute to better behavior.   So, can supplementation improve teen behavior?  Maybe.

 

The Bottom Line

  • The study was performed in an economically depressed school district where many children suffered from poor nutritional status. Blood test taken at the beginning of the study showed that the students were low in iron, folate, vitamin C, vitamin D, and omega-3 fatty acids. Blood tests taken at the end of the study showed improved nutritional status for every nutrient except iron in the group taking supplements.
  • When you combine this study with previous studies, a pattern emerges.  If most of the teenagers in the study have poor nutritional status or have severe behavior problems (such as teenagers in prison), the studies generally show a benefit of supplementation. If most of the teens in the study have good nutritional status at the beginning of the study, the results of supplementation are difficult to detect. Similarly, if most of the teens in the study are well behaved to begin with, supplementation appears to have little effect.
  • What does all of this mean to the general public? Nutritional status is just one component of teenage behavior. Hormones, genetics, home environment and school environment are important as well. However, teen eating habits are often less than ideal. If you have a teenager with behavior problems and poor eating habits, supplementation is an inexpensive intervention that may just contribute to better behavior.

 

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

8 Weight Loss Myths

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Why Your Weight Is Increasing Rather Than Decreasing

Author: Dr. Stephen Chaney

 

weight lossUsually I review scholarly publications of clinical studies, but occasionally I find an article in the popular press that’s so good I just have to share it with you. The lead article about weight loss by Bonnie Liebman in the April 2015 issue of Nutrition Action is just such an article. She called it “8 Weight Mistakes”, but I think “8 Weight Loss Myths” would be a better title.

There are certain weight loss myths that are repeated so often that most people believe they are true. Unfortunately, each one of these myths is a “fat trap” that can sabotage your efforts to achieve a healthy weight. If your New Year’s weight loss resolution isn’t going as well as you would like, it may be because you are still holding on to one or more of these myths.

Weight Loss Myth #1: I Can Lose It Later

It’s easy to tell yourself that you don’t need to watch your weight during the holidays or while you are on vacation. After all you can cut back a bit when those special occasions are over and lose that extra weight. What makes that belief particularly insidious is that it actually worked for you when you were in your teens or early twenties. Why doesn’t it work anymore? There are 4 reasons:

  • dietOn most diets you lose muscle as well as fat. I have talked about this in a previous article, High Protein Diets and Weight Loss , but muscle is important because it burns off calories much faster than fat.
  • Your organs become smaller. For example, as you lose weight your heart doesn’t have to service as many miles of blood vessels, so it can become smaller as well. That’s important because your heart works so hard pumping blood that it burns off calories much faster than resting muscle.
  • Once you have lost a significant amount of weight exercise burns fewer calories. If you don’t believe that, try lugging an extra 10 or 20-pound weight up a flight of stairs.
  • Your metabolism slows down. This is particular true if you try to lose weight too fast as I have explained in my “3 Things Every Successful Diet Must Do” eBook, which is available at Health Tips From the Professor.

Just in case you are still a doubter, Ms. Liebman shared a study in her article that showed most people never lose all of the weight they gained during the holidays before the next holiday season starts. Does that sound familiar?

Weight Loss Myth #2: Once It’s Off, It’ll Stay Off

weight loss dietYou’ve heard this one before. However, even on the most successful diets, weight loss is temporary. Most people eventually regain all the weight they’ve lost and more. Again I’ve also covered the reason for this in my “3 Things Every Successful Diet Must Do” eBook, which is available at Health Tips From the Professor. To spare you the trouble of reading the book I will share the secret with you. Simply put: “Diets never work long term. Only true lifestyle change can lead to long term weight loss.”

However, that doesn’t stop people from believing that the next “magic” diet will be their ticket to permanent weight loss. It always amazes me that people fall for this same myth time after time.

Weight Loss Myth #3: Fat Is Fat, No Matter Where It Is

Most of you probably already knew that belly fat (the so-called apple shape) is metabolically more dangerous to our health than thigh & leg fat (the so-called pear shape). However, some of the other information Ms. Liebman shared was a surprise to me.

  • It turns out that belly fat is actually easier to lose than thigh & leg fat. As you add fat to your lower body you create lots of new fat cells fat is fat(2.6 billion new fat cells for every 3.5 pounds of fat). Once you add that extra fat to your lower body you’re pretty much stuck with it.
  • Of course, you can’t add new fat to your belly forever without creating new fat cells, and once you’ve created those new fat cells you may be stuck with your belly fat as well.

Weight Loss Myth #4: You Have To Go Out Of Your Way To Overeat

It’s really difficult to understand how anyone could believe in this myth. The fact is that we live in a “fat world”. There are fast food restaurants on virtually every street corner in every city and in virtually every mall in this country. Restaurant portion sizes are through the roof. Every social interaction seems to be centered around food or drink.

You don’t need to go out of your way to overeat. Overeating has become the American way. You actually need to go out of your way to avoid overeating.

Weight Loss Myth #5: All Extra Calories Are Equal

Research has confirmed what many of you probably suspected already. All calories are NOT equal. Calories from alcohol, saturated fats, trans fats and sugars make a beeline for your belly where they are converted into the most dangerous form of fat.

Weight Loss Myth #6: I Can Just Boost My Metabolism

boost metabolismMany Americans cling to the false hope that they can eat whatever they want as long as they take some sort of magic herb or pill to boost their metabolism. The fact is that natural metabolic boosters like green tea have a very modest effect on metabolism. They can play a role in a well-designed diet program, but they will never allow you to eat whatever you want and lose weight.

As for those magic herbs and drugs that promise to burn off fat calories without you lifting a finger, my advice is to avoid them like the plague. I’ve talked about many of them in my previous “Health Tips From the Professor” articles. For example, you might be interested in my articles “Are Dietary Supplements Safe?” or “Are Diet Pills Safe?”. The bottom line is that these metabolic boosters are dangerous – and they just might kill you.

Weight Loss Myth #7: There’s A Magic Bullet Diet

Hope springs eternal. Perhaps that’s why so many new diets appear each year. Some diets are low fat, some are low carbohydrate, some hearken back to cave man times, and others are just plain weird. Some of them actually do give better weight loss than others short term. However, when you follow people on those diets for two years or more, none of them work very well (see myth #2), and there isn’t a dimes worth of difference between them.

Weight Loss Myth #8: I Can Work Off The Extra Calories

exerciseThis is perhaps the most pervasive myth of all. This is the one that sells millions of gym memberships every January.

Don’t get me wrong. Diet plus exercise can be very beneficial because it helps you retain muscle mass as you are losing weight, especially if you are consuming enough protein to support the exercise.

However, exercise alone isn’t going to help you nearly as much as you think.

  • You’d have to ride your bicycle for an hour and 25 minutes to offset the 500 calorie dessert you just consumed at your favorite restaurant.
  • Exercise helps some people more than others. Studies show that some people get hungrier when they exercise. As a result, they eat more calories and actually gain weight rather than losing it.
  • Finally, don’t rely on your fitness trackers. Most of them grossly overestimate the calories you burn through exercise. If you use a fitness tracker you should cut their estimates for calories burned by 50% or more.

 

The Bottom Line

 

A recent article shared the 8 most common weight loss myths. If you actually believe any of these myths, you will have a very difficult time getting your weight under control.

  • I can lose it later.
  • Once it’s off, it’ll stay off.
  • Fat is fat, no matter where it is.
  • You have to go out of your way to overeat.
  • All extra calories are equal (A calorie is a calorie).
  • I can just boost my metabolism.
  • There is a magic bullet diet.
  • I can work off the extra calories.

 

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

 

Do Calcium Supplements Prevent Bone Fractures? – Part2: Preventing Osteoporosis

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Creating A “Bone Healthy” Lifestyle

Author: Dr. Stephen Chaney

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

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

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

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

What Is A “Bone Healthy” Lifestyle?

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

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

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

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

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

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

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

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

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

Exercise Is A Critical Part of  Preventing Osteoporosis

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

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

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

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

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

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

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

Putting It All Together –  A “Bone Healthy” Lifestyle

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

  • Consume a “bone healthy” diet that emphasizes fresh fruits and vegetables, minimizes meats, and eliminates sodas and other acidic beverages. For more details on whether your favorite foods are acid-forming or alkaline-forming, you can find plenty of charts on the internet.
  • Minimize the use of medications that adversely affect bone density. You’ll need to work with your doctor on this one.
  • Get plenty of weight bearing exercise. This is an absolutely essential part of a bone healthy lifestyle. Your local Y can probably give you guidance if you can’t afford a personal trainer. Of course, if you have physical limitations or have a disease, you should consult with your health professional before beginning any exercise program.
  • Get your blood 25-hydroxy vitamin D level tested. If it is low, take enough supplemental vitamin D to get your 25-hydroxy vitamin D level into the sufficient range – optimal is even better. Sufficient blood levels of 25-hydroxy vitamin D are also absolutely essential for you to be able to utilize calcium efficiently.
  • Consider a calcium supplement. Even when you are doing everything else correctly, you still need adequate calcium in your diet to form strong bones. “I’m not necessarily recommending a “one-size fits all” 1,000 to 1,200 mg/day. Supplementation is always most effective when you actually need it. For example:
  • If you are not including dairy products in your diet (either because they are acid-forming or for other health reasons), it will be difficult for you to get adequate amounts of calcium in your diet. You can get calcium from other food sources such as green leafy vegetables. However, unless you plan your diet very carefully you will probably not get enough.
  • If you are taking medications that decrease bone density, that may increase your need for supplemental calcium. Unfortunately, we don’t yet have guidelines on how much is needed.
  • If you do use a calcium supplement, make sure it is complete. Don’t just settle for calcium and vitamin D. At the very least you will want your supplement to contain magnesium and vitamin K. I personally recommend that it also contain zinc, copper, and manganese.
  • Unfortunately, we don’t really have good guidelines for how much calcium you need. Studies like the one described above are challenging the old RDAs, but we don’t yet have enough studies to know how much calcium we need to build strong bones when we are following a “bone healthy” lifestyle that includes proper diet, sufficient 25-hydroxy vitamin D blood levels and plenty of exercise.

What About Medications For Preventing Bone Loss?

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

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

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

 

The Bottom Line

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

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

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

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

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

  • Start with a “bone healthy” diet. Avoid acid-forming foods like sodas, meats, eggs, dairy, and grains. Instead choose alkaline-forming foods like most fruits & vegetables, peas, beans, lentils, seeds and nuts.
  • Check on the medicines you are using. If they are ones that adversely affect bone density, ask your health professional if there are bone-healthier options.
  • Check your blood level of 25-hydroxy vitamin D on a regular basis. If it is low, consult with your health professional on the amount of vitamin D you need to take to bring your 25-hydroxy vitamin D into the optimal range.
  • Get plenty of weight bearing exercise. This means pumping iron. It is an absolutely essential part of a bone healthy lifestyle. Of course, if you have physical limitations or have a disease, you should consult with your health professional before beginning any exercise program.
  • If you are not getting sufficient calcium from your diet, consider a complete calcium supplement. In addition to calcium and vitamin D, a bone-healthy calcium supplement should at the very least contain magnesium and vitamin K. I also recommend it contain zinc, copper, and manganese.

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

 

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

Skinny Fat

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Overweight Vs. Obesity

Author: Dr. Stephen Chaney

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

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

How Can You Be Obese Without Being Overweight?

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

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

  • Normal body weight is defined as a BMI of 18.5-24.9 kg/m2.
  • Overweight is defined as a BMI of 25-29.9 kg/m2.
  • Obesity is defined as a BMI of ≥30 kg/m2.

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

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

In general BMI and WHR correlate. However:

  • 11% of men and 3.3% of women are normal weight according to BMI measurements, but have excess belly fat according to WHR measurements.These are the individualswho are obese according to their WHR measurements without being overweight according to their BMI measurements. These are the individuals often referred to as “skinny fat”.
  • There are similar percentages of men and women who are overweight or obese according to BMI measurements, but have low WHR measurements. These are often referred to as “pear shaped” obese individuals to distinguish them from the “apple shaped” obese individuals with a lot of belly fat.

Being Skinny Fat Can Kill You

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

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

  • Normal weight individuals with excess belly fat (“skinny fat” individuals) were 1.5 – 2.0 fold more likely to die during the 14.3 year follow up period than individuals who were normal weight and had little belly fat (“skinny lean” individuals). This was expected because this had been shown in several previous studies.
  • However, the surprising finding was that normal weight individuals with excess belly fat were also more likely to die than individuals who were overweight or obese. Specifically:
  • Men who were “skinny fat” were 2.2 – 2.4 fold more likely to die prematurely than men who were either overweight or obese, but did not have excess belly fat (men with a “pear shaped” fat distribution). “Skinny fat” women were 1.3 – 1.4 fold more likely to die prematurely than overweight or obese women with “pear shaped” fat distribution.
  • Men who were “skinny fat” were even slightly more likely to die prematurely than overweight or obese men with excess belly fat (men with “apple shaped” fat distribution). “Skinny fat” women were just as likely to die as overweight or obese women with “apple shaped” fat distribution.
  • When they looked at deaths due to cardiovascular disease the results were essentially the same.
  • These results were novel and should, perhaps serve as a wake-up call for normal weight individuals with excess belly fat.

The authors concluded:

  • “Our analysis of data…show that normal-weight U.S. adults with central obesity [excess belly fat] have the worst long-term survival compared with participants with normal fat distribution, regardless of BMI category.”
  • “To our knowledge, our study is the first to show that normal-weight central obesity, measured by WHR, is associated with an increased risk of cardiovascular mortality.”
  • “Our findings suggest that persons with normal-weight central obesity may represent an important target population for lifestyle modification and other preventative strategies.”

Why Is Being Skinny Fat So Dangerous?

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

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

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

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

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

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

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

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

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

  • Alcohol: The term “beer belly” says it all. Excess alcohol consumption is associated with an increase in belly fat. Once you understand the metabolism of alcohol the explanation is pretty simple. Alcohol causes blood sugar to drop, which increases appetite. Alcohol also interferes with our judgement, which can cause us to make poor food choices.
  • Excess saturated fat tends to be stored preferentially as belly fat.
  • Excess sugars and simple carbohydrates are rapidly converted to fat stores and stored as belly fat.

What Can You Do If You Are Already Skinny Fat?

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

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

  • Get really serious about exercise. I’m talking about 30 minute workouts at least 3-5 times per week. These workouts need to include strength training as well as aerobics and flexibility exercises. I would suggest you ask your health professional what kind of exercise program is best for you and start your exercise program under the guidance of a personal trainer or physical therapist.
  • Make sure that your diet contains enough protein and enough of the essential amino acid leucine to maximize the gain of lean muscle mass following your workouts. I have covered the latest age-appropriate recommendations in, leucine and muscle gain, a previous “Health Tips From The Professor.”

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

  • Drink alcohol in moderation.
  • Make food choices that allow you to replace saturated fat with monounsaturated fat and polyunsaturated fats, especially the omega-3 polyunsaturated fats.
  • Replace excess sugars and simple carbohydrates with complex carbohydrates from fresh fruits and vegetables along with modest amounts of whole grain foods.

The Bottom Line

  • A recent study has shown that being “skinny fat” (having normal body weight, but excess belly fat) is more likely to result in premature death than if you were overweight, or even obese.
  • The most likely explanation for this alarming statistic is that someone who is “skinny fat” has excess belly fat, which predisposes to a number of diseases, and a loss of muscle mass, which protects against those same diseases.
  • If you are overweight or obese, you need to reduce your caloric intake to lose weight. However, if you are “skinny fat”, you don’t want to reduce your caloric intake. You need to change your exercise and diet habits.
  • Loss of muscle mass and gain of fat mass is a normal part of aging. However, you can slow or reverse the age-related loss of muscle mass with an exercise program and enough protein and leucine in your diet to maximize the effects of that workout program (details above).
  • You can prevent or get rid of excess belly fat by:
  • Following the exercise program and nutritional support of that exercise program described above.
  • Making food choices that replace saturated fats with monounsaturated fats and polyunsaturated fats, especially omega-3 polyunsaturated fats.
  • Replacing foods high in sugar and simple carbohydrates with fresh fruits and vegetables and whole grains in moderation.

 

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

8 Tips on How to Eat Less

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Avoid Mindless Eating

Author: Dr. Stephen Chaney

 

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

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

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

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

8 Tips on How to Eat Less 

Tip #1: The Size Of The Container Matters

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

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

Tip #2:Don’t Fall For Marketing Hype

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

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

Tip #3: Make Junk Food Inconvenient

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

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

Tip #4: Watch The Refills.

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

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

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

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

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

Tip #6: Health Foods Are Not Necessarily Healthy

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

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

Tip #7: Don’t Call It Exercise

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

The take home lesson is two-fold.

  • Reframe our virtuous behavior. If we call it exercise or a work-out, it implies that we have done something virtuous and deserve a reward. If we call it a nature walk or think of it as a sport, it becomes its own reward. If we think of substituting a salad for a dinner of fried chicken and mashed potatoes with gravy as virtuous behavior, we may think we deserve a dessert as a reward. If we think of the salad as a gourmet experience, it can become a reward in its own right.
  • Rethink our rewards. The reward doesn’t need to be food related. It could involve reading a book, watching a show, or whatever you favorite activity might be.

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

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

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

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

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

How Can You Avoid Mindless Eating?

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

Dr. Wansink recommends planning ahead. For example:

  • Serve your food on small plates and don’t leave food lying around where you can see it or get to it easily.
  • If you bring home a box or bag of snack food (hopefully healthy snack food), divide it up into healthy portion sizes as soon as you bring it home.
  • Put the healthy food choices in the front of your refrigerator or cupboard where you will see them easily and hide the unhealthy foods in the back (or don’t bring them home to begin with).

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

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

 

The Bottom Line

 

  • Brian Wansink’s research has shown that overeating, to a large extent, is mindlessly dependent on external eating cues, and that you can’t necessarily avoid being influenced by those external clues even if you are intelligent and motivated!
  • I have distilled his research into 8 simple tips to help you eat less and attain a healthier weight next year than you did this year.

 

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

Healthy Thanksgiving

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The Holidays Don’t Have To Be Unhealthy

Author: Dr. Stephen Chaney

 

healthy thanksgivingIt’s time for my annual “Healthy Thanksgiving” blog. While “Healthy Thanksgiving” doesn’t quite have the appeal of the more familiar “Happy Thanksgiving” greeting, I used it here to make the point that Thanksgiving dinner (and many other holiday meals) doesn’t have to be an unhealthy affair.

After all, there is a lot to like about the ingredients in Thanksgiving dinner.  Turkey can be a healthy, low- fat meat, if prepared correctly.  Sweet potatoes, yams, winter squash and pumpkin are all loaded with vitamin A and other important nutrients.  And cranberries are a nutrition powerhouse.

Healthy Thanksgiving

Here are some tips to make your Thanksgiving meal one that contributes to your health:

1) Skip the basting.  Choose a plain bird and cook in a bag to seal in the moisture.  Remove the skin before serving.

2) Refrigerate the turkey juices and skim off the hardened fat before making gravy and use a gravy cup that pours from the bottom to minimize fat.

3) Use ingredients like whole wheat bread, vegetables, fruits (cranberries, raisins, dates or apples), nuts and your favorite spices for the stuffing and bake it in the oven rather than in the turkey.

4) Serve your sweet potatoes or yams baked rather than candied and let your guests add butter to taste.

5) Use skim milk or buttermilk rather than whole milk and skip the butter for your mashed potatoes.

6) Give your meal gourmet appeal by cooking your green vegetables with garlic, nuts and herbs rather than creamy or fat-laden sauces.

7) Don’t serve the meal on your largest plates. By using smaller plates you ensure smaller portion size and even that second helping isn’t quite so damaging.

8) Use the Shaklee 180 meal replacement products for one or more meals the day before and/or after Thanksgiving so that your total caloric intake over the three day period is not excessive.

By now you have the idea.  There are lots of little things that you can do to make your Thanksgiving dinner one that your waist and your heart will thank you for. Bon Appetit and have a Happy, Healthy Thanksgiving!

The Bottom Line

  • If you make healthy food choices and choose your portion sizes wisely, you can make this a Healthy Thanksgiving as well as a Happy Thanksgiving.

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.

Magnesium Supplements Benefits | Reduce Diabetes Risk?

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Author: Dr. Stephen Chaney

 

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

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

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

 

Do Magnesium Supplements Improve Blood Sugar Control?

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

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

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

At the end of 16 weeks:

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

The authors concluded:

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

Magnesium and Blood Sugar Control

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

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

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

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

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

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

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

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

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

 

The Bottom Line

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

 

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

ADHD Diet VS Medication for ADHD

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Author: Dr. Stephen Chaney

 

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

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

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

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

 

Is an ADHD Diet Better Than Medication For ADHD?

 

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

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

I will summarize their key findings below:

Do Omega-3 Fatty Acids Reduce ADHD Symptoms?

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

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

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

Does the Elimination of Food Additives Reduce ADHD Symptoms?

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

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

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

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

Food Sensitivities

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

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

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

Sugar

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

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

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

Does Eliminating Iron and Zinc Deficiencies Reduce ADHD Symptoms?

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

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

Does Eating A Healthy Diet Reduce ADHD Symptoms?

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

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

 

The Bottom Line

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

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

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

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

 

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

Artificial Sweeteners And Diabetes

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Another Myth Bites The Dust

Author: Dr. Stephen Chaney

 

artificial sweeteners and diabetesArtificial sweeteners and diabetes; is there a relationship?

Once again, artificial sweeteners have come up empty. They were supposed to help you lose weight, but several recent clinical studies have suggested that artificially sweetened beverages are just as likely to lead to weight gain as sugar sweetened beverages, see  Do Diet Sodas Make You Fat.

What about type 2 diabetes? There have been several clinical trials that have suggested that excess consumption of sugar sweetened beverages may increase your risk of developing type 2 diabetes (For example, Basu et al, Am J Pub Health, 103: 2071-2077, 2013; Malik et al, Diabetes Care, 33: 2477-2483, 2010).

As a consequence if you are at risk of developing type 2 diabetes, you’ve probably been advised by your doctor or dietitian to switch from sugar sweetened beverages to artificially sweetened beverages or natural fruit juices. But, does that really work? Maybe not.

In fact, some studies have suggested that excess consumption of artificially sweetened beverages or fruit juice may be just as likely to lead to type 2 diabetes as consuming sugar sweetened beverages (For example, Greenwood et al, Br J Nutr, 112: 725-734, 2014; Xi et al, PloS One, 9:e93471, 2014).

A Systematic Study Of Beverage Consumption And Diabetes Risk

However, this has been a very controversial topic. The problem is that it is devilishly difficult to design studies that provide definitive answers to these important questions.

To start with there are problems with confounding factors. For example,

  • It is pretty well established that consumption of sugar sweetened beverages leads to obesity and obesity leads to type 2 diabetes, but many of the studies did not adjust the data for obesity.
  • In addition, many people who are overweight often switch to artificially sweetened beverages in the mistaken belief that they will help them lose weight. Once again, many of the published studies did not correct for that.

There are also problems with study design. For example, many of the studies did not directly compare sugar sweetened and artificially sweetened beverages in the same population group. If the population groups are different enough between studies, it can be a little like trying to compare apples to oranges.

Because of these limitations an international team of experts designed a major systematic review and meta-analysis (Imamura et al, Br J Med, doi: 101136/bmj.h3576, 2015) of all reasonably well designed prospective studies that measured the effect of beverage consumption on the development of type 2 diabetes over time.

They evaluated the data from 17 studies that represented 38,253 people who developed type 2 diabetes over a period of at least two years. They used the most rigorous statistical analysis methods available, and they interpreted their results very cautiously.

In short, this was a major study. So, what did the study show?

Is There a Relationship Between Artificial Sweeteners And  Diabetes?

On face value, the data appeared to be fairly clear:

  • prevent diabetesAn additional one serving per day of a sugar-sweetened beverage increases your risk of developing type 2 diabetes by 18%. When you correct for obesity, the increased risk is 13%. (Note: we are talking about an 8 ounce serving here, not a 32 ounce Big Gulp or 64 ounce Double Gulp).
  • An additional one serving per day of an artificially-sweetened beverage increases your risk of developing type 2 diabetes by 25%. When you correct for obesity, the increased risk is 8%.
  • An additional one serving per day of fruit juice increases your risk of developing type 2 diabetes by 5%. When you correct for obesity, the risk actually increases to 7%.

In short, if you want to decrease your risk of developing type 2 diabetes, none of these options is a particularly good choice.

How Were These Data Interpreted

Of course, the strength of any meta-analysis is limited by the quality of the studies that were included in the meta-analysis. It is the old GIGO (garbage in, garbage out) principle. The authors acknowledged that limitation and analyzed in great detail the quality of the individual studies included in their meta-analysis. Their conclusions were as follows:

  • garbage in garbage outThe quality of the data on sugar sweetened beverages was strong enough that they could conclude that “habitual consumption of sugar sweetened beverages is associated with a greater incidence of type 2 diabetes, independent of obesity”. In short, you want to stay away from sugar sweetened beverages. They can cause obesity AND they can cause type 2 diabetes.
  • They also said that “…artificially sweetened beverages and fruit juice also showed positive associations with incidence of type 2 diabetes”, but did not feel the existing data were strong enough to make a definitive conclusion. They felt that more studies are needed.
  • However, they did feel that the existing data were strong enough to conclude that “neither artificially sweetened beverages nor fruit juice are suitable alternatives to sugar sweetened beverages for the preventing of type 2 diabetes.” In short, consumption of artificially sweetened beverages and fruit juice may not cause type 2 diabetes, but they clearly don’t prevent it.

 

The Bottom Line

If you are overweight or otherwise at risk of developing type 2 diabetes, you have probably been advised to switch from sugar-sweetened beverages to either artificially sweetened beverages or fruit juices. A major study has just turned that advice on its head!

This study (Imamura et al, Br J Med, doi: 101136/bmj.h3576, 2015) was a systematic review and meta-analysis of 17 previously published clinical studies that measured the effect of beverage consumption on the development of type 2 diabetes over time. Based on a very careful analysis of the data from this meta-analysis the authors concluded:

  • The quality of the data on sugar sweetened beverages was strong enough that they could unequivocally state that “habitual consumption of sugar sweetened beverages is associated with a greater incidence of type 2 diabetes, independent of obesity”. In short, you want to stay away from sugar sweetened beverages. They can cause obesity AND they can cause type 2 diabetes.
  • They also said that “…artificially sweetened beverages and fruit juice also showed positive associations with incidence of type 2 diabetes”, but did not feel the existing data were strong enough to make a definitive conclusion. They felt that more studies are needed.
  • However, they did feel that the existing data were strong enough to conclude that “neither artificially sweetened beverages nor fruit juice are suitable alternatives to sugar sweetened beverages for the preventing of type 2 diabetes.” In short, consumption of artificially sweetened beverages and fruit juice may not cause type 2 diabetes, but they clearly don’t prevent it.

So what kind of beverages should you consume if you don’t want your beverage intake to contribute to type 2 diabetes?

  • Water is always the first choice.
  • Milk, protein shakes and similar beverages can also be an excellent choice as long as you take the calories into account. The protein content of those beverages generally slows the rate of sugar uptake. Look for products with a low glycemic index.
  • High intensity or long endurance exercise requires a lot of carbohydrate, so sugars in rehydration or recovery sports supplements are well tolerated. However, those same sports drinks would be a concern if used as part of a sedentary lifestyle.
  • Finally, tea, coffee, and non-caffeinated herbal teas are excellent choices as long as you learn to enjoy them without adding sugar or artificial sweeteners.

 

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

Leucine And Muscle Gain

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Should Your Post-Workout Protein Shake Contain Added Leucine?

Author: Dr. Stephen Chaney

 

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

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

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

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

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

How Much Protein Do You Need and What Kind?

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

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

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

Unanswered Questions About Optimizing Muscle Gain Post-Workout

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

Does Leucine Enhancement Improve Low Protein Shakes?

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

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

The results were clear cut:

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

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

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

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

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

 

The Bottom Line

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

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

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

 

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

Health Tips From The Professor