Healthy Diet Archives - Health Tips From The Professor

600th Issue Celebration

November 5, 2024 by Dr. Steve Chaney

Nutrition Advances Over The Last Two Years

Author: Dr. Stephen Chaney

In the nearly twelve years that I have been publishing “Health Tips From The Professor”, I have tried to go behind the headlines to provide you with accurate, unbiased health information that you can trust and apply to your everyday life.

The 600^th issue of any publication is a major cause for celebration and reflection – and “Health Tips From The Professor” is no different.

I am dedicating this issue to reviewing some of the major stories I have covered in the past 100 issues. There are lots of topics I could have covered, but I have chosen to focus on three types of articles:

Articles that have debunked long-standing myths about nutrition and health.

Articles that have corrected some of the misinformation that seems to show up on the internet on an almost daily basis.

Articles about the issues that most directly affect your health.

Here are my picks from the last two years:

Weight Loss Diets

Since it is almost January, let’s start with a couple of articles about diet and weight loss (or weight gain). I have covered the effectiveness of the Paleo, Keto, Mediterranean, DASH, vegetarian, and Vegan diets for both short and long-term weight loss in my book “Slaying The Food Myths”, so I won’t repeat that information here. Instead, I will share a few updates from the past 100 issues.

Is Time-Restricted Eating Better Than Other Diets? Time-restricted eating is one of the latest fads. But is it really better than other diets for weight loss and improved health? In this article I reviewed two studies that compare time-restricted eating with diets that do not restrict time of eating but cut calories to the same extent. You may be surprised at the results.

Can You Lose Weight Without Dieting? In this article I share 8 tips for losing weight without going on a diet. The article is based on research by Dr. Brian Wansink, a behavioral psychologist who specializes in studying how external clues influence our eating patterns. As you might suspect his 8 tips for losing weight have nothing to do with counting calories or going on restrictive diets.

Healthy Diets

Is Whole Fat Dairy Healthy? For years dietary guidelines have been telling us to select low fat dairy foods. But some health gurus are telling you that isn’t true. They claim whole fat dairy is healthy. So, you are probably wondering, “What is the scoop (as in ice cream) on whole fat dairy?” In this article I look at the study behind the headlines and answer that question. But the answer is not a simple “Yes” or “No”. The answer is more nuanced. It turns out that whole fat dairy is healthier in some diets than in others.

Are Low Carb Diets Healthy? Are low carb diets good for you or bad for you? It depends on which study you quote. Two major studies in recent years have come to opposite conclusions. In this article I help you sort through the conflicting studies and rephrase the question. Instead of, “Are low carb diets healthy”, the question should be, “Which low carb diets are healthy?”

Are All Plant-Based Diets Healthy? Plant-based diets have acquired a “health halo” in recent years. Your mama told you to eat your fruits and vegetables. And many health gurus have been telling you not to neglect your grains, legumes, nuts, and seeds as well. But some of these foods require a lot of food preparation.

Never fear! The food industry has come to your rescue with a wide variety of processed plant-based foods. No need for food prep. But are they as good for you as the unprocessed plant foods they replace? In this article I review a study that answers that question.

You probably know what that answer is, but the article is worth a read anyway. That is because the study also asks whether vegan and vegetarian diets are healthier than other primarily plant-based diets. And you may not know the answer to that question.

Diet And Heart Disease

Are Eggs Bad For You? For years we were told that eggs are bad for us because they contain cholesterol. Then we were told that eggs in moderation may not increase our risk of heart disease. And recently studies have appeared claiming eggs may be good for our hearts. What is the truth about eggs and heart disease? In this article I review a recent study claiming eggs are bad for our heart and put that study into the context of other recent studies to clear up the “eggfusion”.

Which Diets Are Heart Healthy? Every popular diet claims to help you lose weight, reduce your risk of diabetes, and reduce your risk of heart disease. All these claims can’t be true. Which diets deliver on their promises, and which are just pretenders? In this article I review a recent study that answered that question for heart disease.

This study was a very large metanalysis of over 40 studies with 35,548 participants that looked at the effect of different diets on heart disease outcomes. The study identified two diets that significantly reduced the risk of heart disease. There are other diets that might reduce the risk of heart disease, but their benefits have not been proven by high quality clinical studies. They are merely pretenders.

The Dangers Of Processed Foods

In previous issues of “Health Tips From the Professor” I have shared articles showing that diets high in processed foods are associated with an increased risk of obesity, diabetes, and heart disease. But the story keeps getting worse. Here are two articles on recent studies about processed foods that appeared in “Health Tips From The Professor” in the last two years.

Why Does Processed Food Make You Fat? We already know that eating a lot of highly processed food is likely to make us fat. But what is it about processed food that makes us fat? In this article I review a recent study that answers that question.

This study is interesting for two reasons.

It identifies the characteristics of processed foods that make us want to eat more.

It identifies some minimally processed foods that have the same characteristics and suggests we should choose minimally processed foods wisely. Simply put, knowledge is power. We may want to avoid minimally processed foods that have the same obesity-inducing characteristics as processed foods.

Do Processed Foods Cause Cancer? Previous studies have shown that processed food consumption is associated with a higher risk of obesity, diabetes, and heart disease. Can it get any worse? In this article I review a recent study that shows processed food consumption is associated with an increased risk of several kinds of cancer.

Maintaining Muscle Mass As We Age

As we age, we begin to lose muscle mass, a process called sarcopenia. Unless we actively resist loss of muscle mass it will eventually impact our quality of life and our health.

We can prevent this loss of muscle mass with resistance exercise, adequate protein intake, and adequate intake of the amino acid leucine. Previous studies have shown people over 50 need more of each of these to maintain muscle mass, but the amount they need has been uncertain until now. Three recent studies have given seniors better guidelines for maintaining muscle mass.

Can You Build Muscle In Your 80s? In this article I review a recent study that enrolled a group of octogenarians in a high-intensity exercise program to see if they could gain muscle mass. They were able to increase their muscle mass, but the intensity of the exercise required may surprise you.

Optimizing Protein Intake For Seniors. In this article I review two recent studies that looked at the amount, timing, and kind of protein needed for seniors in their 60s and 70s to maximize gain in muscle mass.

How Much Leucine Do Seniors Need? In this article I review a recent study that determined the amount of leucine seniors in their 70s need to optimize gains in muscle mass and strength.

The Benefits And Risks Of Supplementation

If you listen to Big Pharma or the medical profession, you hear a lot about the “risks” of supplementation and very little about the benefits. In “Health Tips From the Professor” I try to present a more balanced view of supplementation by sharing high-quality studies showing benefit from supplementation and studies that put the supposed risks into perspective.

The Good News About Omega-3s and Stroke. Multiple studies have shown that omega-3 supplementation reduces the risk of ischemic strokes (strokes caused by a blood clot). But it has been widely assumed they might increase the risk of hemorrhagic strokes (strokes caused by bleeding). In this article I review a meta-analysis of 29 clinical studies with 183,000 participants that tested that assumption.

How Much Omega-3s Are Best For Blood Pressure? Multiple studies have shown that omega-3 supplementation can reduce high blood pressure. But the doses used vary widely from one study to the next. In this article I review a meta-analysis of 71 double-blind, placebo-controlled clinical studies that determined the optimal dose of omega-3s for controlling blood pressure.

Omega-3 Supplements Are Safe. As I said above, it has been widely assumed that omega-3 supplementation increases the risk of bleeding and hemorrhagic stroke. In this article I review the definitive study on this topic. More importantly, it reveals which omega-3 supplements might increase bleeding risk and which do not.

Are Calcium Supplements Safe? Big Pharma and the medical profession have been warning us that calcium supplements may increase heart disease risk. In this article I review the definitive study on this topic.

Prenatal Supplements

If you are pregnant or thinking of becoming pregnant, your health professional has likely recommended a prenatal supplement. You probably assume that prenatal supplements provide everything you need for a healthy pregnancy. Unfortunately, recent research has shown that assumption is not correct.

Is Your Prenatal Supplement Adequate? In this article I review a study that should serve as a wakeup call for every expectant mother. It showed that most prenatal supplements were woefully inadequate for a healthy pregnancy.

What Nutrients Are Missing In Prenatal Supplements? In this article I review a study that identified additional nutrients that are missing in most prenatal supplements.

Prenatal Supplements Strike Out Again. In this article I review a study that looked at the diet of pregnant women to determine their needs and compared that to the nutrients found in prenatal supplements. Once again, most prenatal supplements were woefully inadequate. Is it, “Three strikes and you are out”?

Exercise

Walking Your Way To Health. We have been told that walking is good for our health. But how many steps should you take, how fast should you walk, and does it matter whether these steps are part of your daily routine or on long hikes? In this article I review a study that answers all these questions.

Which Exercise Is Best For Reducing Blood Pressure? If you have high blood pressure, you have probably been told to exercise more. But which exercise is best? In this article I review a study that answers that question. And the answer may surprise you.

Did You Know?

If you have been reading “Health Tips From the Professor” for a while, you probably know that I enjoy poking holes in popular myths. Here are two new ones I deflated in past two years.

Is Low Alcohol Consumption Healthy? You have probably heard that low alcohol intake (that proverbial glass of red wine) is good for you. But is that true? In this article I review a recent study that shows that myth was based on faulty interpretation of the data and provides a more nuanced interpretation of the data.

Is HDL Good For Your Heart? You have been told that increasing your HDL levels reduces your risk of heart disease so many times it must be true. But is it? In this article I review HDL metabolism and a recent study to provide a more nuanced interpretation of the relationship between HDL and heart disease risk.

How To Talk With Your Doctor About Cancer

Because of my years in cancer research, I am often asked whether someone should follow their oncologist’s advice and go on a recommended chemotherapy or radiation regimen. Of course, it would be unethical for me to provide that kind of advice.

In this article I tell you the questions to ask your oncologist about the prescribed treatment regimen, so you can make an informed decision. However, I also recommend you only ask these questions if you can handle the answers.

The Bottom Line

I have just touched on a few of my most popular articles above. You may want to scroll through these articles to find ones of interest to you that you might have missed over the last two years. If you don’t see topics that you are looking for, just go to https://chaneyhealth.com/healthtips/ and type the appropriate term in the search box.

In the coming years, you can look for more articles debunking myths, exposing lies and providing balance to the debate about the health topics that affect you directly. As always, I pledge to provide you with scientifically accurate, balanced information that you can trust. I will continue to do my best to present this information in a clear and concise manner so that you can understand it and apply it to your life.

Final Comment: You may wish to share the valuable resources in this article with others. If you do, then copy the link at the top and bottom of this page into your email. If you just forward this email and the recipient unsubscribes, it will unsubscribe you as well.

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

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My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

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About The Author

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years. Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”. Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com/lifestylechange/.

For the past 45 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

Do Bad Genes Doom You To Bad Health?

October 1, 2024 by Dr. Steve Chaney

The Influence Of Genetics And Diet On Type 2 Diabetes

Author: Dr. Stephen Chaney

Does it ever feel like you have drawn the short straw?

Everyone in your family has succumbed to heart disease, diabetes, or cancer at a young age. Are you doomed to the same fate?

You ordered a DNA test. It sounded like fun. But when the gene report came back it said you had a “bad” genetic profile. You were told you are at high risk of diabetes, heart attack, stroke, cancer, or dementia. Are you doomed to a short and sickly life?

In both cases, you are probably wondering, “Is there anything I can do to improve my odds of a healthy life? What if I lost some of those extra pounds, exercised more, and ate a healthier diet? Would that make a difference?”

The study (J Merino et al, PLoS Medicine 19(4): e1003972, April 26, 2022) I will describe today was designed to answer these questions.

But before I describe the study, I should probably cover what I call Genetics 101: “How Genes Affect Your Health”.

Genetics 101: How Genes Affect Your Health

If you studied genetics in school, you probably learned about diseases like sickle cell anemia, which is caused by a single mutation in a single gene. If you get two copies of the “bad” gene, you will have sickle cell anemia. If you get one copy of the “bad” gene and one copy of the normal gene, you have sickle cell trait, which is much less severe.

Simply put, you either have the disease or you don’t. It’s dependent on your genetics, and you can’t do much about it.

If you know someone who has been treated for breast cancer, you are probably familiar with a more complex relationship between genetics and health. There are several “bad” genes that increase the risk of breast cancer. And knowing which gene is involved is important for selecting the best treatment regimen.

But most of the diseases that shorten our lives (like diabetes, heart disease, most cancers, and dementia) are what we call polygenetic diseases. Simply put, that means that there are dozens of genes that increase the risk of these diseases. Each gene makes a small contribution to the increased risk. So, we can only measure the genetic contribution to these diseases by measuring hundreds of mutations in dozens of genes, something called a polygenetic risk score.

The study I will be describing today looked at the relative effect of genetics (measured as the type 2 diabetes polygenic risk score) and diet quality (measured as the Alternative Healthy Eating Index (AHEI)) on the risk of developing type 2 diabetes.

How Was This Study Done?

The data for this study were obtained from 3 long-term clinical studies conducted in the United States – the Nurses’ Health Study (121,700 participants), the Nurses’ Health Study II (116,340 participants), and the Health Professionals Follow-Up Study (51,529 participants).

These studies measured lifestyle factors (including diet) every 4 years and correlated them with disease outcomes over 20+ years.

The study I will be discussing today was performed with 35,759 participants in these 3 studies for whom DNA sequencing data was available.

The DNA sequence data were used to generate a type 2 diabetes polygenic risk score for each participant in this study.

Food frequency questionnaires obtained every 4 years in these studies were used to calculate the Alternative Healthy Eating Index (AHEI) score for each participant.

- The AHEI is based on higher intake of fruits, whole grains, vegetables, nuts and legumes, polyunsaturated fatty acids, long-chain omega-3 fatty acids, moderate intake of alcohol, and lower intake of red and processed meats, sugar sweetened drinks and fruit juice, sodium, and trans-fat).

The investigators used these measurements to estimate the relative effect of genetics and diet quality on the risk of developing type 2 diabetes.

The Influence Of Genetics And Diet On Type 2 Diabetes

The participants were divided into low, intermediate, and high genetic risk based on their type 2 diabetes polygenic risk score.

Compared with low genetic risk:

Intermediate genetic risk increased the risk of developing type 2 diabetes by 26%.

High genetic risk increased the risk of developing type 2 diabetes by 75%.

Put another way, each 1 standard deviation increase in the polygenetic risk score:

Increased the risk of developing type 2 diabetes by 42%.

Simply put, bad genes can significantly increase your risk of developing type 2 diabetes. That’s the bad news. But that doesn’t mean you should think, “Diabetes is in my genes. There is nothing I can do.”

The investigators also divided the participants into those who had a high-quality diet, those who had an intermediate quality diet, and those who had a low-quality diet based on their AHEI (Alternative Healthy Eating Index) score.

Finally, they divided the participants into groups depending on their BMI, a measure of obesity.

Compared to an obese person consuming a low-quality diet, a lean person consuming a high-quality diet:

Reduced their risk of developing type 2 diabetes by around 43% for each category of genetic risk.

More specifically, a lean person consuming a high-quality diet reduced their risk of developing type 2 diabetes:

- By 41% if they were at low genetic risk.

- By 50% if they were at intermediate genetic risk.

- By 38% if they were at high genetic risk.

The investigators then made a statistical adjustment to remove BMI from their calculations, so they could focus on the effect of diet alone on the risk of developing type 2 diabetes.

Compared to a low-quality diet, a high-quality diet:

Reduced the risk of developing type 2 diabetes by around 33% for each category of genetic risk.

More specifically, a high-quality diet reduced the risk of developing type 2 diabetes:

- By 31% for those at low genetic risk.

- By 39% for those at intermediate genetic risk.

- By 29% for those at high genetic risk.

Looking at it another way:

When people at high genetic risk consumed a high-quality diet, their risk of developing type 2 diabetes was only 13% higher than people at intermediate genetic risk who consumed a low-quality diet (such as the typical American diet).

When people at intermediate genetic risk consumed a high-quality diet, their risk of developing type 2 diabetes was 5% less than people at low genetic risk who consumed a low-quality diet.

Simply put:

If you are at intermediate genetic risk, a high-quality diet may completely reverse your risk of developing type 2 diabetes.

If you are at high genetic risk, a high-quality diet can partially reverse your risk of developing type 2 diabetes.

In short, the good news is that bad genes do not doom you to type 2 diabetes.

The investigators did not provide similar information for the effect of an ideal weight on the risk of developing type 2 diabetes, but it is likely that the combination of diet plus weight management would result in an even more significant reduction in risk of developing type 2 diabetes for individuals in the even the highest risk category.

The authors concluded, “These data provide evidence for the independent associations of genetic risk and diet quality with incident type 2 diabetes and suggest that a healthy diet is associated with lower diabetes risk across all levels of genetic risk.”

Do Bad Genes Doom You To Bad Health?

At the beginning of this article I posed the question, “Do bad genes doom you to bad health?”

Based on this study, the good news is that bad genes don’t doom you type 2 diabetes. And just because most of your relatives are diabetic doesn’t mean that must be your fate.

This study shows that a healthy diet significantly reduces your risk of developing type 2 diabetes at every genetic risk level.

And the study suggests that a healthy diet plus a healthy weight is even more beneficial at reducing your risk of type 2 diabetes.

While not included in this study, other studies have shown that exercise also plays a role in reducing type 2 diabetes risk.

None of this information is new. What is new is that a healthy diet is equally beneficial at reducing type 2 diabetes risk even in individuals with a high genetic risk of developing the disease. Simply put, you can reverse the effects of bad genes.

“And what is this magic diet?”, you might ask. In this study, it was based on AHEI score. Someone with a high AHEI score consumes:

Lots of fruits, whole grains, vegetables, nuts and legumes, polyunsaturated fatty acids, and long-chain omega-3 fatty acids.

Moderate or no amounts of alcohol.

Little or no red and processed meats, sugar sweetened drinks, fruit juices, sodium, and foods with trans-fat.

Any whole food, primarily plant-based diet from vegan to Mediterranean or DASH fits the bill.

Finally, while this study focused just on type 2 diabetes, other studies have come to similar conclusions for other diseases.

Should You Get Your DNA Tested?

If you are looking for guidance on how to reduce your risks, the answer is, “No”. In this study, the same diet and lifestyle changes lowered the risk of type diabetes at every genetic risk level. Despite what some charlatans may tell you, there is no special diet or magic potion for people with a high genetic risk for developing type 2 diabetes.

If you are looking for motivation, the answer may be, “Yes”. If knowing you are at high risk makes it more likely that you will make the diet and lifestyle changes needed to lower your risk of type 2 diabetes, a DNA test may be just what you need

The Bottom Line

If a serious disease runs in your family or if you have had your DNA tested and found out you are at high risk for some disease, you are probably wondering whether there is anything you can do or whether your bad genes have doomed you to a short and sickly life.

A recent study answered that question for type 2 diabetes. It showed a healthy diet significantly reduces the risk of type 2 diabetes even in people at high genetic risk of developing the disease.

Other studies have come to similar conclusions for other diseases. In short, bad genes don’t doom you to bad health.

For more details about the study and what it means for you, 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.

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For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

_______________________________________________________________________

About The Author

Do Optimists Live Longer?

June 25, 2024 by Dr. Steve Chaney

What Does This Study Mean For You?

Author: Dr. Stephen Chaney

You have probably heard the statement that optimists live longer before. In fact, you have probably heard so many times you assume it must be true. But is it a myth or is it the truth?

This question is important because it can affect how people feel about themselves. If you are a natural optimist, statements like this support your feeling of self-worth. But if you are naturally pessimistic, statements like this provide one more reason to feel bad about yourself.

For example, a recent article on the topic in WebMD starts with the statement, “Want to live longer? You might want to try improving your outlook on life.” I am mostly optimistic, so I find this statement to be positive and encouraging.

But I am not sure I would feel about this statement if I were pessimistic or depressed and had tried for years to be more optimistic.

Because of this it is important to ask, “How good is the evidence supporting this claim?”

There are several published studies supporting this claim (For example). However,

Most of these studies have been performed with white, high-income participants. It is not clear whether these same results would apply to other racial and ethnic groups.

There is also the “chicken versus egg” conundrum. The studies claiming that optimists live longer are all association studies. Simply put, that means optimism is associated with longevity, but does not prove cause and effect. That is important because:

- Some studies show that both a healthy diet and exercise improve mood.

- Other studies show that optimists tend to take better care of themselves, and that includes both diet and exercise.

- So, it’s hard to know which comes first – a healthy lifestyle, which creates optimism, or optimism, which creates a healthy lifestyle.

Because of this “chicken versus egg” conundrum, it is not clear whether it is a healthy lifestyle or optimism that is the primary cause of greater longevity.

The study (HK Koga et al, Journal of the American Geriatrics Society, 70: 2793-2804, 2022)) I will review today was designed to answer both questions. Specifically, this study was designed to ask:

Is higher optimism associated with a longer lifespan and exceptional longevity across diverse racial and ethnic groups?

To what extent do lifestyle factors influence this association?

How Was The Study Done?

The data for this study was obtained from the Women’s Health Initiative which enrolled 161,808 postmenopausal women of diverse racial and ethnic groups from 40 medical centers within the United States between 1993 and 1998. The women were aged 50-79 (average = 63.5) at enrollment and were followed for an average of 26 years.

Optimism was assessed at enrollment into the program using the 6-item Life Orientation Test Revised. For each item on the questionnaire, participants were asked to report the degree they agreed with each statement on a scale of 1 = “strongly agree” to 5 = “strongly disagree”. Their responses were summed to create scores ranging from 6 to 30, with 30 being the highest optimism rating.

Lifestyle was assessed on a questionnaire measuring diet quality, physical activity, BMI (a measure of obesity), smoking status, and alcohol consumption. If participants met predefined “healthy standards in each of these categories, they were given a score of 1. Otherwise, their score was 0. Scores from each category were summed to create a composite lifestyle score ranging from 0 (least healthy) to 5 (most healthy).

Longevity was based on survival compared to national averages using the National Death Index (Yes, “Big Brother” is watching you even when you die) to identify and confirm deaths. Deaths of participants were monitored through March 1, 2019. Exceptional longevity was defined as survival to age 90 or older. Overall, 64,301 women (40.3%) died over the 26 years of follow-up.

Finally, women who died within the first 2 years of follow-up were excluded from the data analysis “to mitigate concerns that health status might affect the reporting or experience of optimism levels.” In plain English, people who are within 2 years of dying are often very sick and feel lousy. Even the most optimistic individuals find it hard to maintain an optimistic outlook in those circumstances. This left 159,255 women in the database.

Do Optimists Live Longer?

When comparing women in the highest to women in the lowest quartile of optimism:

Longevity was increased by 5.4%, which corresponds to an additional 4.4 years. When this was broken down by race and ethnicity, longevity was increased by:

- 1% for Non-Hispanic White women.

- 6% for Black women.

- 4% for Hispanic women.

- 5% for Asian women. However, this may have been an underestimate because of the small sample size of this population in the Women’s Health Initiative database.

Exceptional longevity (survival ≥ 90 years) was increased 10%.

When the authors used a complex statistical method to assess the contribution of lifestyle to the increase in longevity, they found:

Lifestyle contributed to 24% of the increased longevity. When this was broken down by race and ethnicity, lifestyle contributed:

- 25% for Non-Hispanic White women.

- 10% for Black women.

- 24% for Hispanic women.

- 43% for Asian women.

The authors concluded, “We found that higher levels of optimism were associated with longer lifespan and greater likelihood of achieving exceptional longevity across racial and ethnic groups, suggesting the health benefits of optimism may hold across these groups.”

“The contribution of lifestyle to these associations was evident but modest.”

“As prior work has demonstrated that optimism is modifiable, it may be a novel target for interventions that aim to extend lifespan across diverse racial and ethnic groups.”

What Are The Strengths And Weaknesses Of This Study?

This is not the first study to suggest that optimists live longer. But it is the best study to date because:

It was larger (159,255 participants) than most previous studies.

It followed the participants far longer (26 years) than previous studies.

It included a more racially and ethnically diverse group of participants than previous studies.

It addressed the “elephant in the room” for studies of this type, namely that optimists tend to actively seek a healthier lifestyle, so the “benefits” of optimism could be due to a healthy lifestyle rather than a state of mind. The study employed statistics to estimate that a healthy lifestyle contributed around 25% to the longevity experienced by optimists.

However, the study did have some weaknesses. In my opinion, the most important weaknesses were:

Optimism and lifestyle were only assessed at the beginning of the study. No effort was made to determine whether either of these important variables changed during the 26-year study.

The relative influence of lifestyle and optimism on longevity was based on a complex statistical analysis. As Mark Twain said, “There are lies, damn lies, and statistics.” Simply put, statistics can sometimes give misleading answers. I would like to see this very important part of the study confirmed using a different method of analysis.

What Does This Study Mean For You?

As I shared above, I have some misgivings about this and other studies claiming that optimists live longer. But let’s assume this claim is true. What does that mean for you?

A 5.4% increase in lifespan might not sound like much, but it added 4.4 years to the lives of the women in the study. What would you do with an extra 4.4 years?

And, as the authors of the study pointed out, that’s equivalent to the gain in lifespan for adults engaged in a regular exercise program. Are those benefits addible? We don’t know, but it is possible that an optimist who exercised regularly and had a healthy diet might experience more than a 4-year gain in lifespan.

The authors said, “Although optimism is partly heritable (23-32%), experimental research has demonstrated that optimism is modifiable…”

Let me share a few things that have helped me maintain a more optimistic outlook:

Affirmations and visualizations of a positive future.

I start my daily prayers by listing the things I am grateful for. For others, a gratitude journal works equally well.

Accept positive input. You can accept compliments with humility by simply thanking the person for the compliment. But in your mind, use the compliment to overcome your inner doubts of self-worth.

Question negative input. Ask if each critic is the kind of person you want to become. If so, ask if what they said is really true.

Create a support network. These are family and friends who will support you when you need it and will give you a gentle kick in the …. when you need that.

Trust in a higher power. I know from experience that it is only God who can give me the “peace that passes all understanding” in my most difficult circumstances. And while I am Christian, I think this is a cornerstone of most religions.

Finally, I know that many people are predisposed to depression and pessimism, so I don’t want to be like the author of the WebMD article and tell you, “Want to live longer? You might want to try improving your outlook on life.”

We know that a healthy lifestyle is associated with longevity. And you don’t have to be an optimist to choose a healthy diet, exercise regularly, avoid smoking and excess alcohol intake, and get regular health check-ups.

We also know these things are associated with a longer healthspan which, simply put, is the number of years you live in good health.

So, whether you are a pessimist or an optimist you can live healthier longer.

The Bottom Line

You have probably heard that optimists live longer, but is it true? In the article above I describe the latest study on this topic. It is better than most previous studies on this topic because:

It was larger (159,255 participants) than most previous studies.

It followed the participants far longer (26 years) than previous studies.

It included a more racially and ethnically diverse group of participants than previous studies.

It addressed the “elephant in the room” for studies of this type, namely that optimists tend to actively seek a healthier lifestyle, so the “benefits” of optimism could be due to a healthy lifestyle rather than a state of mind. The study employed statistics to estimate that a healthy lifestyle contributed around 25% to the longevity experienced by optimists.

When the study compared women in the highest to women in the lowest quartile of optimism:

Longevity was increased by 5.4%, which corresponds to an additional 4.4 years.

Exceptional longevity (survival ≥ 90 years) was increased by 10%.

Lifestyle contributed to 24% of the increased longevity.

“As prior work has demonstrated that optimism is modifiable, it may be a novel target for interventions that aim to extend lifespan across diverse racial and ethnic groups.”

For more details on this study and what it means for you, 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.

______________________________________________________________________________

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

______________________________________________________________________

About The Author

Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”.

Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

What Can Twins Tell Us About Diet?

January 30, 2024 by Dr. Steve Chaney

What Are The Pros And Cons Of Twin Studies?

Author: Dr. Stephen Chaney

Why is the advice on healthy diets so confusing? One blog claims the vegan diet is best. Another says it is the keto diet is best. The Mediterranean diet is popular, but other experts claim the DASH or MIND diet might be better. Blogs champion diets ranging from the familiar to downright weird.

If you try to keep up with the science, it seems like the science is constantly changing. Each week you see headlines saying the latest study shows diet “X” is best – and “X” keeps changing. Why is that? Why do studies on healthy diets keep coming up with conflicting conclusions?

I have discussed the strengths and weaknesses of clinical studies and why they provide conflicting results in detail in previous issues of “Health Tips From the Professor”. However, one factor I have not discussed in detail is the effect of genetics on how we utilize foods, something called nutrigenomics.

Simply put, we are all genetically different. The way we utilize foods is different. The effect that foods have on our bodies is different. I have touched on that briefly in a previous article discussing individual difference in blood sugar response to various foods. But that is just one of many examples.

We do not yet know enough about gene-nutrient interactions to use genomic data to accurately predict which diets are best. Again, I have covered that topic in a previous issue of “Health Tips From the Professor”. However, we do know that genetic differences have a big influence on which diet is best for us. And most clinical studies on diets do not even attempt to take genetic differences into account.

That is where twin studies come in. Identical twins (monozygotic twins) have an identical genetic makeup and usually have an identical environment until they become adults. So, when I saw an identical twin study (MJ Landry et al, JAMA Network Open, 6(11):e2344457, 2023) comparing a vegan diet (only plant foods) with an omnivorous diet (both animal and plant foods), I wanted to review it and share it with you.

How Was The Study Done?

Identical twins were recruited from the Stanford Twin Registry. Twenty-two identical twin pairs were chosen for this study. Their characteristics were average age = 40, BMI = 26% (moderately overweight), sex = 77% female, ethnicity = 73% white, followed by an approximately equal representation of Asian, black, multiracial, and Pacific Islander.

One unanticipated characteristic of this group of twins was that 70% of them still lived together and cooked together, so their environment was also very similar.

One twin of each pair was put on a healthy vegan diet and the other on a healthy omnivorous diet for 8 weeks. Both diets were designed by dietitians. The diets emphasized fruits, vegetables, and whole grains while limiting added sugars and refined grains.

Both diets were healthier than the diets the twins were eating prior to the study. Finally, the participants were not told how much to eat, and were not instructed to lose weight.

For the first four weeks the participants were provided with all their meals by a nationwide food delivery company. The participants were also provided with training on purchasing and preparing healthy foods for their diet. This prepared them for the last 4 weeks of the study in which they purchased and prepared their own meals.

Participants visited the Stanford Clinical and Translational Science Research Unit at the beginning of the study and at the end of weeks 4 and 8 for weight measurement and a fasting blood draw.

Adherence to the diets was measured by a series of unannounced interviews to administer a 24-hour dietary recall questionnaire. These were scheduled for the weeks they visited the clinic.

What Can Twins Tell Us About Diet?

Even though the sample size was small, there were three statistically significant results.

LDL-cholesterol was reduced by 12% for the twin on the vegan diet, while it remained unchanged for the twin on the omnivorous diet.

The fasting insulin level was reduced by 21% for the twin on the vegan diet, while it remained unchanged for the twin on the omnivorous diet. This suggests the twin on the vegan diet was experiencing improved blood sugar control after just 8 weeks.

The twin on the vegan diet lost 4 pounds in 8 weeks, while weight remained the same for the twin on the omnivorous diet. This occurred even though neither twin was instructed to eat less nor to lose weight. It is most likely a consequence of the lower caloric density of the vegan diet (See my discussion of caloric density in last week’s issue of “Health Tips From the Professor”.

The changes in LDL-cholesterol and fasting insulin were remarkable because none of the twins in this study had elevated LDL-cholesterol or problems with blood sugar control at the beginning of the study.

The authors of this study concluded, “In this randomized clinical trial of the cardiometabolic effects of omnivorous vs vegan diets in identical twins, the healthy vegan diet led to improved cardiometabolic outcomes compared with a healthy omnivorous diet. Clinicians can consider this dietary approach as a healthy alternative for their patients.”

[Let me decipher the term cardiometabolic for you. The decrease in LDL-cholesterol is associated with heart health – the cardio portion of the term. The decrease in fasting insulin is associated with decreased risk of diabetes. Since diabetes is considered a metabolic disease, this is the metabolic portion of the term.]

Were There Any Downsides To The Vegan Diet?

This study also highlighted two well-known limitations of vegan diets.

Although the differences were not statistically significant, the authors expressed concern that vitamin B12 intake was less for twins on the vegan diet than twins on the omnivorous diet even though the vegan diet was designed by dietitians.

The authors noted that B12 deficiency among vegans is well known, and said, “Long-term vegans are typically encouraged to take a cyanocobalamin (vitamin B12) supplement.

Although both groups had excellent adherence to their assigned diets, those assigned to the vegan diet expressed a lower satisfaction with the diet, which suggests long-term adherence to the diet after the study ended was unlikely.

The authors said, “Although our findings suggest that vegan diets offer a protective cardiometabolic advantage compared with a healthy omnivorous diet, excluding all meats and/or dairy products may not be necessary because research suggests that cardiometabolic benefits can be achieved with modest reduction in animal foods and increases in healthy plant-based foods compared with typical diets.”

“We believe that lower dietary satisfaction in the vegan group may have been attributable to the strictness of the vegan diet…Some people may find a less restrictive diet preferable for LDL-cholesterol-lowering effects.”

I concur.

What Are The Pros And Cons Of Twin Studies?

The Pros are obvious. Most dietary studies cannot take genetic differences into account and have difficulty accounting for environmental differences. In this study genetics was identical for each twin pair and their environment was very similar. It offers a unique advantage over other studies.

But the strength of this study is also its greatest weakness. Because the general population is genetically and environmentally diverse, it is difficult to extrapolate the results to the general population.

If this were the only study to show cardiometabolic benefits of a plant-based diet, it would simply be an interesting observation.

But there are several studies showing that the vegan diet is associated with lower weight and reduced risk of heart disease and diabetes.

And there are dozens of studies showing that primarily plant-based omnivorous diets reduce the risk of heart disease and diabetes.

This study is fully consistent with those studies.

The Bottom Line

A recent study put identical twins on either a healthy vegan diet (only plant foods) or a healthy omnivorous diet (both animal and plant foods) for 8 weeks. At the end of 8 weeks:

LDL-cholesterol was reduced by 12% for the twin on the vegan diet, while it remained unchanged for the twin on the omnivorous diet.

The fasting insulin level was reduced by 21% for the twin on the vegan diet, while it remained unchanged for the twin on the omnivorous diet. This suggests the twin on the vegan diet was experiencing improved blood sugar control after just 8 weeks.

The twin on the vegan diet lost 4 pounds in 8 weeks, while weight remained the same for the twin on the omnivorous diet. This occurred even though neither twin was instructed to eat less or to lose weight. It is most likely a consequence of the lower caloric density of the vegan diet.

The changes in LDL-cholesterol and fasting insulin were remarkable because none of the twins in this study had elevated LDL-cholesterol or problems with blood sugar control at the beginning of the study.

For more information on the pros and cons of this study and what it means for you, 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.

_____________________________________________________________________________

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

_______________________________________________________________________

About The Author

For the past 35 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

Do Produce Prescriptions Improve Health?

October 3, 2023 by Dr. Steve Chaney

What Are The Pros And Cons Of Produce Prescriptions?

Author: Dr. Stephen Chaney

Can you imagine a world in which doctors asked their patients how many fruits and vegetables they were eating rather than how many drugs they were taking? Can you imagine a world in which doctors advised their patients to try a healthier diet before they put them on drugs?

Unfortunately, that world doesn’t exist currently and is unlikely to exist in the foreseeable future.

But what if there were another approach to encourage healthier eating? And what if it made a meaningful impact on people’s health?

There is such an approach, and it’s called a “produce prescription”.

“What are produce prescriptions?”, you might ask. Simply put, produce prescriptions are government programs that provide lower-income Americans with food insecurity extra income that can only be spent on fresh fruits and vegetables.

And it isn’t a lot of extra income. Previous studies have shown that lower-income Americans only need an extra $63 to $78/month to afford the recommended 3-5 servings of fresh fruits and vegetables a day.

But do produce prescriptions work? Do they significantly improve the diet and health of lower-income Americans who participate in programs offering produce prescriptions?

These are the questions that the authors of the current study (K Hager et al, Circulation: Cardiovascular Quality And Outcomes; 16:e009520, 2023) set out to answer.

How Was The Study Done?

The authors evaluated the results from 9 pilot produce prescription studies that were administered at 22 sites in 12 states between 2014 and 2020. These pilot studies were generally funded as experimental programs through Medicare and SNAP.

The pilot programs enrolled:

Adults at risk for poor cardiometabolic health (at risk for both heart disease and diabetes). The enrollment criteria included being overweight or obese and having either diabetes or elevated blood pressure.

Children who were overweight or obese.

People recruited from health centers serving predominantly low-income neighborhoods who were food insecure.

The authors of the study only included pilot studies that collected data on food intake and measured at least 1 biomarker of improved health (BMI (a measure of obesity), HbA1c (a measure of blood sugar control) and blood pressure).

The income incentive to purchase more fruits and vegetables varied from state to state but averaged $63/month.

With these criteria the study included 1817 children and 2064 adults.

The adults:

Averaged 54.4 years old.
Were 70.7% female, 29.8% non-Hispanic White, 45.1% non-Hispanic Black, 21.4% Hispanic, 3.6% other.

The children:

Averaged 9.2 years old.
Were 51.4% female, 9.2% non-Hispanic White, 13.1% non-Hispanic Black, 75.5% Hispanic, 2.3% other.

Overall:

3% of families enrolled in the program experienced food insecurity.
7% of families enrolled in the program were involved in SNAP.

Finally, the programs lasted an average of 6 months.

Do Produce Prescriptions Improve Health?

The results were encouraging:

At the beginning of the study fruit and vegetable intake was 2.7 cups/day for adults and 3.4 cups/day for children.

By the end of the study fruit and vegetable intake increased by 0.85 cups/day for adults and 0.26 cups/day for children.

Note: It is unfortunate that the authors chose to report fruit and vegetable consumption as cups/day because most of us think in terms of servings per day and the relationship between servings and cups varies with each fruit and vegetable. For example, one cup represents:

One serving of raw spinach.
Two servings of cooked spinach.
Two servings of most fruits.
One serving of bananas.

I could go on, but you get the point.

So, perhaps a better way to think about these results would be to say both adults and children in these low-income households were eating around 3.6 cups/day of fruit and vegetable intake – a 31% increase for adults and a 7.6% increase for children.

Another way of thinking about it would be to say that produce prescription programs got both adults and children in food-insecure households up to a healthier 3.6 cups/day of fruits and vegetables.

As for other outcomes:

Food insecurity dropped by one third for families participating in these programs.

The families reported that they felt healthier.

BMI (a measure of overweight and obesity) decreased for both adults and children.

HbA1c (a measure of blood sugar control) and blood pressure decreased in adults with cardiometabolic disease (heart disease and diabetes) at the beginning of the programs.

In the words of the authors, “In this large, multisite evaluation, produce prescriptions were associated with significant improvements in fruit and vegetable intake, food security, and health status for adults and children, and clinically relevant improvements in glycated hemoglobin (HbA1c), blood pressure, and BMI for adults with poor cardiometabolic health.”

What Are The Pros And Cons Of Produce Prescriptions?

The pros are obvious.

Food insecurity in low-income neighborhoods is a major problem. In the words of the authors:

“Food insecurity is strongly associated with poor health outcomes and higher health care costs.

Food-insecure individuals under use medications and choose cheaper, unhealthful foods due to costs.

[There are] stark disparities in household food insecurity…by race/ethnicity, with 7.1% of White, non-Hispanic households experiencing food insecurity compared with 21.7% of Black, non-Hispanic households, and 17.2% of Hispanic households.”

The authors do not claim that food insecurity is the only cause of health disparities in this country, but a simple program that reduces food insecurity and improves health outcomes is an obvious plus.

But there are cons as well.

While the results of these programs were statistically and clinically significant, they were relatively modest. In the words of the authors, “Produce prescriptions may need to be of longer duration or combined with additional components…”

Most Americans have the income to buy more fruits and vegetables but chose not to. Programs like this can reduce health disparities but are unlikely to improve the health of the American population as a whole.

There was no mention of the cost of implementing this program nationwide in the article, but that is likely to be a major stumbling block.

Unfortunately, government agencies never think of replacing old programs that don’t work with new programs that do work. They only think of adding the cost of the new program to their current budget.

Unfortunately, once you start talking about programs that increase government spending, they become political footballs. Because of this many beneficial programs end up in the dustbin of history.

The Bottom Line

Food insecurity among low-income households is a major cause of health disparities in this country. Several states across the country have piloted an idea called produce prescription programs. Simply put, these programs provide high-risk families who have food insecurity and poor health with a monthly stipend that can only be used to purchase fresh fruits and vegetables from grocery stores and farmers markets.

A recent study evaluated the effectiveness of these pilot programs and found the produce prescription programs:

Improved fruit and vegetable intake for the families who participated in the programs.

In addition:

Food insecurity dropped by one third for families participating in these programs.

The families reported that they felt healthier.

BMI (a measure of overweight and obesity) decreased for both adults and children.

HbA1c (a measure of blood sugar control) and blood pressure decreased in adults with cardiometabolic disease (heart disease and diabetes) at the beginning of the programs.

For more information on this study and a summary of the pros and cons of produce prescription programs, 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.

____________________________________________________________________________

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

Which Diets Are Heart Healthy?

September 26, 2023 by Dr. Steve Chaney

What Does A Heart Healthy Diet Look Like?

Author: Dr. Stephen Chaney

Heart disease is a big deal. According to the CDC, “Heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups in the United States. One person dies every 33 seconds in the United States from cardiovascular disease. About 695,000 people in the United States died from heart disease in 2021 – that’s 1 in every 5 deaths”.

This doesn’t have to happen. According to the Cleveland Clinic, “90 percent of heart disease is preventable through healthier diet, regular exercise, and not smoking”. For this issue of “Health Tips From the Professor”, I will focus on the role of diet on heart health.

The problem is many Americans are confused. They don’t know what a heart-healthy diet is. There is so much conflicting information on the internet.

Fortunately, the American Heart Association has stepped in to clear up the confusion.

In 2021 they reviewed hundreds of clinical studies and published “Evidence-Based Dietary Guidance to Promote Cardiovascular Health”.

And recently they have published a comprehensive review (CD Gardner et al, Circulation, 147: 1715-1730, 2023) of how well popular diets align with their 2021 dietary guidelines.

I will cover both publications below. But first I want to address why Americans are so confused about which diets reduce heart disease risk.

Why Are Americans Confused About Diet And Heart Disease Risk?

I should start by addressing the “elephant in the room”.

As I discussed in last week’s “Health Tips From the Professor” article, Big Food Inc has seduced us. They have developed an unending supply of highly processed foods that are cheap, convenient, easy to prepare, and fulfill all our cravings. These foods are not heart-healthy, but they make up 73% of our food supply.

The Institute of Medicine, the scientific body that sets dietary standards, states that a wide range of macronutrient intakes are consistent with healthy diets. Specifically, they recommend carbohydrate intake at 45% to 65%, fat intake at 20% to 35%, and protein intake at 10% to 35% of total calories. (Of course, they are referring to healthy carbohydrates, fats, and proteins.)

The authors of this article pointed to several reasons why Americans have been misled about heart-healthy diets.

Many of the most popular diets fall outside of the “Acceptable Macronutrient Range”.

Many popular diets exclude heart-healthy food groups.

And, the words of the authors,

“Further contributing to consumer misunderstanding is the proliferation of diet books, [and] blogs [by] clinicians with limited understanding of what the dietary patterns entail and the evidence base for promoting cardiometabolic health.” I call these the Dr. Strangeloves of our world.

What Does A Heart Healthy Diet Look Like?

Let me start by sharing the American Heart Association’s 10 “Evidence-Based Dietary Guidelines to Promote Cardiovascular Health.

#1: Adjust energy intake and expenditure to achieve and maintain a healthy body weight
#2: Eat plenty of vegetables and fruits; choose a wide variety
#3: Choose foods made mostly with whole grains rather than refined grains
#4: Choose healthy sources of protein
	Mostly from plants (beans, other legumes, and nuts)
	Fish and seafood
	Low-fat or fat-free dairy products instead of full-fat dairy products
	If meat or poultry are desired, choose lean cuts and avoid processed forms
#5. Use liquid plant oils (olive, safflower, corn) rather than animal fats (butter and lard) and tropical oils (coconut and palm kernel)
#6. Use minimally processed foods instead of highly processed foods
#7: Minimize intake of beverages and foods with added sugars
#8: Choose and prepare foods with little or no salt
#9: If you do not drink alcohol, do not start; if you choose to drink alcohol, limit intake
#10: Adhere to this guidance regardless of where food is prepared or consumed

Here are my comments on these guidelines:

If you have been reading my “Health Tips From the Professor” blog for a while, you probably realize that these aren’t just guidelines to promote heart health. These guidelines also reduce the risk of diabetes, cancer, inflammatory diseases, and much more.

If you have read my post on coconut oil, you will know that I have a minor disagreement with the AHA recommendation to avoid it. There is no long-term evidence that coconut oil is bad for the heart. But there is also no long-term evidence that it is good for the heart. My recommendation is to use it sparingly.

And you probably know there has been considerable discussion recently about whether full fat dairy is actually bad for the heart. In my most recent review of the topic, I concluded that if full fat dairy is heart healthy, it is only in the context of a primarily plant-based diet and may only be true for fermented dairy foods like unpasteurized yogurt and kefir.

Finally, guideline 10 may need some translation. Basically, this guideline is just asking how easy it is to follow the diet when you are away from home.

Which Diets Are Heart Healthy?

In evaluating how well diets adhered to the American Heart Association guidelines the authors ignored item 1 (energy intake) because most of the diets they evaluated did not provide any guidelines on how many calories should be consumed.

Each diet was given a score between 0 (Fail) and 1 (A+) for each of the other 9 guidelines by a panel of experts. The points for all 9 guidelines were added up, giving each diet a rating of 0 (worst) to 9 (best). Finally, a score of 9 was assigned 100%, so each diet could be given a percentage score for adherence to heart-healthy guidelines.

Here are the results:

Tier 1 diets (the most heart healthy diets) received scores of 86% to 100%. Going from highest (100%) to lowest (86%), these diets were:

DASH, Nordic, Mediterranean, Pescetarian (vegetarian diets that allow fish), and Ovo-Lacto Vegetarian (vegetarian diets that allow dairy, eggs, or both).

You will notice that these are all primarily plant-based diets.

Tier 2 diets were Vegan and other low-fat diets (TLC, Volumetrics). They both received scores of 78%.

The Vegan diet received 0 points for category 10 (ease of following the diet when eating out). It was also downgraded in category 7 for not having clear guidance for the use of salt when preparing foods.

The other low-fat diets were downgraded in categories 7, 10, and 5 (use of tropical oils).

Tier 3 diets received scores of 64% to 72%. They included very-low fat diets (<10% fat, very strict vegan diets) and low-carb diets (Zone, South Beach, Low-Glycemic Index).

They received 0 points for category 10 and were downgraded for eliminating heart-healthy food groups (liquid plant oils for the very low-fat diets, and fruits, vegetables, whole grains, and plant proteins for the low-carb diets).

Tier 4 diets (the least heart healthy diets) were the Paleo diet with a score of 53% and very low-carb diets (Atkins and Ketogenic) with a score of 31%.

The Paleo diet received 0 points for categories 10, 3 (choose whole grains), and 5 (using liquid plant oils rather than animal fats or tropical oils). It was also downgraded for lack of healthy plant-based protein sources.

The very low-carb diets were the least heart healthy. They received 0 points for categories 2 (eat plenty of fruits and vegetables), 3 (choose whole grains), 3 (healthy protein sources), 5 (use liquid plant oils instead of animal fats), 7 (minimize salt consumption), and 10 (ease of following the diet away from home).

The authors concluded, “Numerous [dietary] patterns [are] strongly aligned with 2021 American Heart Association Dietary Guidance (ie, Mediterranean, DASH, pescetarian, vegetarian) [and] can be adopted to reflect personal and cultural preferences and budgetary constraints.

Thus, optimal cardiovascular health would be best supported by developing a food environment that supports adherence to these patterns wherever food is prepared or consumed.”

Given our current food environment that last statement is wildly optimistic. But at least you have the information needed to make the best food choices for you and your family

The Bottom Line

In 2021 the American Heart Association published 10 guidelines for evaluating heart-healthy diets. A recent study looked at how well popular diets adhered to those guidelines. The authors separated the diets into four categories (tiers) based on how heart-healthy they were. The results were not surprising:

Tier 1 diets (the most heart healthy diets) were DASH, Nordic, Mediterranean, Pescetarian (vegetarian diets that allow fish), and Ovo-Lacto Vegetarian (vegetarian diets that allow dairy, eggs, or both).

Tier 2 diets were Vegan and other low-fat diets (TLC, Volumetrics).

Tier 3 diets included very-low fat diets (<10% fat, very strict vegan diets) and low-carb diets (Zone, South Beach, Low-Glycemic Index).

Tier 4 diets (the least heart healthy diets) were the Paleo diet and very low-carb diets (Atkins and Ketogenic).

Thus, optimal cardiovascular health would be best supported by developing a food environment that supports adherence to these patterns wherever food is prepared or consumed.”

Given our current food environment that last statement is wildly optimistic. But at least you have the information needed to make the best food choices for you and your family.

For more information on this study, 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.

____________________________________________________________________________

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

Is Whole Fat Dairy Healthy?

August 29, 2023 by Dr. Steve Chaney

Is It Dairy Or Diet?

Author: Dr. Stephen Chaney

For years we have been told to select low fat dairy foods. But recent headlines claim, “That’s nonsense. Whole fat dairy foods are healthy.” Are those headlines true?

In previous issues of “Health Tips From the Professor” I have kept you abreast of recent studies suggesting that whole fat dairy foods may not be as bad for us as we thought. I also cautioned you that the headlines may not have accurately represented the studies they described.

Headlines have to be simple. But truth is often more nuanced. If we believed the current headlines, we might be asking ourselves questions like, “Should we ditch the current health guidelines recommending low-fat dairy foods? Are foods like ice cream, sour cream, and cheddar cheese actually be good for us?

To answer these questions, I will look at the study (A Mente et al, European Heart Journal, 44, 2560-2579, 2023) behind the current headlines and put the study into perspective.

Spoiler alert: If I could summarize the study findings in two sentences, they would be, “Whole fat dairy can be part of a healthy diet. But can it be part of an unhealthy diet?”

Stay tuned. I will discuss the science behind that statement below.

How Was This Study Done?

This study started with data collected from the Prospective Urban Rural Epidemiology (PURE) study. The PURE study is an ongoing study correlating diet, lifestyle, and environmental effects on health outcomes. It has enrolled 166,762 individuals, age 35-70, from 21 low-, middle-, and high-income countries on 5 continents.

Habitual food intake was determined using country-specific food frequency questionnaires at the time participants joined the study. Participants (166,762) from the PURE study who had complete dietary information were included in this study and were followed for an average of 9.3 years.

Based on preliminary analysis of data from the PURE study, the authors developed their version of a healthy diet, which they call the PURE diet. Like most other healthy diets, the PURE diet emphasizes fruits, vegetables, legumes, nuts, and fish. However:

Based on studies suggesting that whole fat dairy foods can be part of a healthy diet, the PURE diet includes whole fat dairy foods.

This is different from most other healthy diet recommendations.

They went on to develop what they referred to as the PURE healthy diet score by:

Determining the median intake for each of the 6 food groups included in their PURE diet (fruits, vegetables, legumes, nuts, fish, and whole fat dairy).

Assigning each participant in the study a score of 0 or 1 depending on whether their intake for that food group was below or above the median intake.

Adding up the points. Since 6 food groups were included in the PURE diet, this means that each participant in the study was assigned a PURE diet score ranging from 0-6.

Once they had developed a PURE diet score, they expanded their data by including five additional large independent studies that included people from 70 countries. The combined data from all six studies amounted to 245,597 people from 80 countries. Of the people included in the data analysis:

21% came from high income countries.
60% came from middle income countries.
19% came from low-income countries.

This is very similar to the global population distribution. This is a strength of this study because it allowed them to ask whether the PURE diet score worked as well in low-income countries as in high-income countries.

Finally, they correlated the PURE diet score with outcomes like all-cause mortality, heart attack, and stroke.

Is Whole Fat Dairy Healthy?

The authors of this study divided the participants of all 6 studies into quintiles based on their PURE diet score and compared those in the highest quintile (PURE score of ≥ 5) with those in the lowest quintile (PURE score of ≤ 1).

The people in the highest quintile were eating on average 5 servings/day of fruits and vegetables, 0.5 servings/day of legumes, 1.2 servings/day of nuts, 0.3 servings/day of fish, 2 servings/day of dairy (of which 1.4 servings/day was whole fat dairy), 0.5 servings/day of unprocessed red meat, and 0.3 servings/day of poultry.

The people in the lowest quintile ate significantly less fruits, vegetables, nuts, fish, and dairy; and slightly less legumes, unprocessed red meat, and poultry than those in the highest quintile.

However, they consumed significantly more refined wheat foods and white rice. This study did not track consumption of highly processed foods, but the high consumption of white flour leads me to suspect they ate a lot more highly processed food.

With that in mind, when the authors compared people with the highest PURE diet scores to those with the lowest PURE diet scores:

All-cause mortality was reduced by 30%.

Cardiovascular disease was reduced by 18%.

Heart attacks were reduced by 14%.

Strokes were reduced by 19%.

The PURE healthy eating score was slightly better at predicting health outcomes than the Mediterranean, DASH, and HEI (Healthy Eating Index) scores. But the differences were small. So, I still recommend choosing the healthy diet that best fits your preferred foods and your lifestyle.

The PURE healthy eating score was significantly better at predicting health outcomes than the Planetary diet score. I will discuss the nutritional inadequacy of “sustainable diets” like the Planetary diet in next week’s “Health Tips From the Professor” article.

Because of the size and design of this study, they were able to make three interesting observations.

The PURE, Mediterranean, DASH, and HEI diet scores were predictive of health outcomes in every country across the globe. You no longer have to wonder if what works in the United States will work in low-income countries and in countries with very different food preferences. Previous studies have not been able to make that claim.

2) You don’t have to be perfect.

- A 20% increase (one quintile) in PURE score was associated with a 6% lower risk of major cardiovascular events and an 8% lower risk of mortality. In other words, even small improvements in your diet may improve your health outcomes.

- The health benefits of the PURE diet started to plateau at a score of 3 (with 6 being the highest score). The authors concluded that most of the health benefits were associated with a modestly higher consumption of healthy foods compared to little or no consumption of healthy foods.

Simply put, that means the health benefits gained by going from a moderately healthy diet to a very healthy diet are not as great as the health benefits gained by going from a poor diet to a moderately healthy diet.

[Note: There are still improvements in health outcomes when you go from a moderately healthy diet to a very healthy diet. My recommendation: “You don’t need to achieve perfection, but you shouldn’t accept mediocrity”.]

3) The PURE diet score was more predictive of health outcomes in some countries than in others.

- The PURE diet score was more predictive of health outcomes in low-income countries. The authors felt that was because low-income countries started with average PURE scores of 2.1, whereas higher-income countries started with average PURE scores of 3.5.

The authors felt this was another example getting more “bang for the buck” by going from a poor diet to a moderately healthy diet than from a moderately healthy diet to a very healthy diet. (Remember, the health benefits associated with improving PURE diet scores start to plateau at a PURE score of 3.

- The difference in benefits for low-income countries compared to high-income countries was observed for the Mediterranean, DASH, and HEI diet scores. So, it is probably safe to say for any healthy diet you don’t need to be perfect. You just need to be better.

The authors concluded, “A diet composed of higher amounts of fruit, vegetables, nuts, legumes, fish, and whole fat dairy is associated with a lower risk of cardiovascular disease and mortality in all world regions, especially in countries with lower income where consumption of these foods is low.”

Is It Dairy Or Diet?

The headlines are telling us that recommendations to choose low-fat dairy products are out of date. They say there is no reason to fear whole fat dairy foods. They are good for you. Bring on the ice cream, sour cream, cream cheese, and high fat hard cheeses!

As usual, there is a kernel of truth in the headlines, but headlines have to be simple. And the latest headlines are an oversimplification of what the studies actually show. Let me provide perspective to the headlines by asking two questions.

#1: Is it dairy or diet? A major weakness of this and similar studies is that they fail to consider diet context. What do I mean by that? Let’s dig a little deeper into this study.

Let’s start with a description of the PURE diet. It is a diet that emphasizes fruits, vegetables, legumes, nuts, and fish. In other words, it is a primarily plant-based diet.

Although the authors keep referring to the diet as one that includes whole fat dairy. It would be more accurate to say that it includes dairy, which was 30% low-fat and 70% whole fat.

The authors said that removal of any one food group from this combination reduced the predictive power of the PURE diet. In other words, the beneficial effect of 70% whole fat dairy is best seen in the context of a primarily plant-based diet.

The PURE diet was most effective at predicting health outcomes in low-income countries where a significant percent of the population consumes a primarily plant-based diet because meats are expensive.

So, a more accurate description of this study would be it shows that a mixture of low-fat and whole-fat dairy foods are a healthy addition to a primarily plant-based diet. But that is too complicated for a headline.

#2: If whole fat dairy can be part of a healthy diet, can it also be part of an unhealthy diet?

To answer that question let’s compare the potential effects of whole fat dairy on a primarily plant-based diet compared to the typical American or European diet.

Milk and other dairy foods are excellent sources of calcium, vitamin B12, and iodine and good sources of protein, vitamin D, choline, zinc, and selenium – nutrients that are often low or missing in plant-based diet. And this is true whether the dairy foods are low-fat or whole fat.

Primarily plant-based diets tend to be low in saturated fat, so the potential negative effects of adding a small amount of saturated fat to the diet may be outweighed by the beneficial effects of the nutrients dairy foods provide.

On the other hand,

The typical American or European diet provides plenty of protein and vitamin B12 and significantly more choline, vitamin D, iodine, and zinc than a plant-based diet. The added nutrients from adding dairy foods to this kind of diet is still beneficial, but the benefits are not as great as adding dairy foods to a primarily plant-based diet.

If you read the American Heart Association statement on saturated fats, it does not say that any amount of saturated fat is bad for you. In fact, small amounts of saturated fats play some beneficial roles in our bodies. The American Heart Association says, “Eating too much saturated fat can raise the level of LDL cholesterol in your blood…[which] increases your risk of heart disease and stroke.”

Here is where the problem lies. The typical American or European diet already contains too much saturated fat. Whole fat dairy just adds to that excess.

So, the most accurate description of this study would be it shows that a mixture of low-fat and whole-fat dairy foods are a healthy addition to a primarily plant-based diet but may not be a healthy addition to the typical American diet. But that is way too complicated for a headline.

You are probably wondering what this means for you. Here are my recommendations.

If you eat like most Americans, you should continue to follow the current health guidelines to choose low-fat dairy foods.

If you happen to be among the few Americans who eat a primarily plant-based diet, you will probably benefit by adding a mixture of low-fat and whole fat dairy foods to your diet.

The Bottom Line

Once again, the headlines are telling us that recommendations to choose low-fat dairy products are out of date. The articles say there is no reason to fear whole fat dairy foods. They are good for you. Bring on the ice cream, sour cream, cream cheese, and high fat hard cheeses!

As usual, there is a kernel of truth in the headlines, but headlines have to be simple. And the latest headlines are an oversimplification of what the studies actually show. In this post I looked at the study behind the most recent headlines and provided perspective to the headlines by asking two questions.

#1: Is it dairy or diet? A major weakness of this and similar studies is that they fail to consider diet context.

When you consider diet context a more accurate description of this study would be it shows that a mixture of low-fat and whole-fat dairy foods are a healthy addition to a primarily plant-based diet. But that is too complicated for a headline.

#2: If whole fat dairy can be part of a healthy diet, can it also be part of an unhealthy diet?

When you consider that question the most accurate description of this study would be it shows that a mixture of low-fat and whole-fat dairy foods are a healthy addition to a primarily plant-based diet but may not be a healthy addition to the typical American diet. But that is way too complicated for a headline.

You are probably wondering what this means for you. Here are my recommendations.

If you eat like most Americans, you should continue to follow the current health guidelines to choose low-fat dairy foods.

If you happen to be among the few Americans who eat a primarily plant-based diet, you will probably benefit by adding a mixture of low-fat and whole fat dairy foods to your diet.

For more information on this study, and the science behind my summary of the study, 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.

_________________________________________________________________________

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

Does The Mediterranean Diet Improve Pregnancy Outcomes?

May 23, 2023 by Dr. Steve Chaney

Is The Mediterranean Diet Overrated?

Author: Dr. Stephen Chaney

You may have noticed that certain celebrities are singled out for fame and acclaim, while others of equal talent and accomplishment are virtually ignored.

The same thing occurs in the scientific realm. At present, the Mediterranean diet is the darling of the diet world. Study after study is designed to test the benefits of the Mediterranean diet while other excellent diets are ignored. I will discuss this phenomenon and ask whether the Mediterranean diet is overrated at the end of this article. But let’s start at the beginning.

Multiple studies have shown that the Mediterranean diet is associated with lower risk of heart disease, diabetes, and high blood pressure. Some studies suggest it is associated with lower risk of kidney disease and Alzheimer’s disease.

Studies also suggest that the Mediterranean diet is associated with an increase in lifespan (how long you live) and healthspan (how long you enjoy good health). In other words, these studies suggest that following a Mediterranean diet adds years to your life and life to your years.

Most of these studies have been done with men. However, there are enough studies with women to be confident that the beneficial effects of the Mediterranean diet on disease risk and lifespan apply to women as well as to men.

But what about pregnancy? Does the Mediterranean diet support a healthy pregnancy? Here the data are less clear. Three studies have been published showing that pregnant women who follow the Mediterranean diet are less likely to experience gestational diabetes (diabetes during pregnancy).

But what about other adverse pregnancy outcomes that can affect the health of both the mother and her baby such as:

Gestational hypertension (high blood pressure during pregnancy).
Preeclampsia (high blood pressure and protein in the urine that occurs late in pregnancy. It may be associated with liver and/or kidney damage).
Eclampsia (a severe form of preeclampsia where the mother also has seizures).
Preterm birth (birth prior to 37 weeks).
Low birth weight infant.

This study (N Makarem et al, JAMA Network Open. 5(12): e2248165, 2022) was designed to look at the effect of the Mediterranean diet on all seven of these adverse pregnancy outcomes.

How Was This Study Done?

The data for this analysis came from a large clinical trial called the Nulliparous Pregnancy (first time pregnancy) Outcomes Study. The study enrolled 7798 women in their first trimester of pregnancy from 8 medical centers across the country. The women were racially, ethnically, and geographically diverse.

Diet around the time of conception was assessed with a food frequency questionnaire administered at the mother’s first visit to the clinic (usually around 6-13 weeks after conception). The participants were asked to indicate their usual intake of 120 foods and beverages during the past 3 months. In other words, the participants were asked to indicate their diet prior to conception through early pregnancy.

Adherence to the Mediterranean diet was assessed using something called the aMed or Alternative Mediterranean Diet Score (a version of the Mediterranean diet that considers US food preferences). Each participant was assigned one point for:

Above average intake of vegetables, fruits, nuts, whole grains, legumes, fish, and the ratio of monounsaturated fat to saturated fat.

Below average intake of red meat and processed meats.

Alcohol intake was a bit more complicated:

Participants were given 1 point for one 12-ounce can of beer, 5 ounces of wine, or 1.5 ounces of liquor and 0 points for consumption above or below that amount.

The points for all these dietary components were added up to give an aMed score of 0-9, with 9 representing the best adherence to the Americanized version of the Mediterranean diet.

Does The Mediterranean Diet Improve Pregnancy Outcomes?

The authors started out by dividing the pregnant moms into thirds according to adherence to an Americanized Mediterranean diet based their aMed score. When they compared those in the top third (aMed scores of 6-9) with those in the lowest third (aMed scores of 0-3) the risk of developing:

Any adverse pregnancy outcome was reduced by 21%.

Preeclampsia or eclampsia were reduced by 28%.

Gestational diabetes was reduced by 37%.

Other adverse pregnancy outcomes were not statistically different.

Next, they asked whether stricter adherence to the Mediterranean diet would be even more beneficial. To do this they divided the pregnant moms into fifths. When they compared those in the top fifth (aMed scores of 7-9) with those in the lowest fifth (aMed scores of 0-2) the risk of developing:

Any adverse pregnancy outcome was still reduced by 20%, but…

- Preeclampsia and eclampsia were reduced by 35%.

- Gestational diabetes was reduced by 54%.

- Other adverse pregnancy outcomes were not statistically different.

When they broke the results down into participant subgroups:

The effect of the Mediterranean diet on any adverse pregnancy outcomes was not affected by prepregnancy BMI (a measure of obesity), race, or ethnicity.

However, it was significantly affected by age. Any adverse pregnancy outcome was reduced by:

- 48% in women over 35.

- 15% in women younger than 35.

The authors concluded, “We demonstrate that a Mediterranean diet pattern is associated with lower risk of developing any APO [adverse pregnancy outcome] and multiple individual APOs in US women…Our findings add to the growing body of evidence that the Mediterranean diet pattern may play an important role in preserving the health of women across the lifespan, including during pregnancy.”

Is The Mediterranean Diet Overrated?

At the beginning of this article, I posed the question, “Is the Mediterranean diet overrated?” When the authors broke the results down by food group, it suggested the answer may be, “Yes”.

The reduction in any adverse pregnancy outcome was associated with:

Above average consumption of vegetables, fruits, legumes, and fish.

The reduction in preeclampsia and eclampsia was associated with:

Above average consumption of vegetables, fruits, and fish.

The reduction in gestational diabetes was associated with:

Above average consumption of vegetables, and…

Below average consumption of red meat and processed meats.

If you are saying to yourself, “Wait a minute. Doesn’t this pattern of food consumption describe almost any whole food, primarily plant-based diet”, you would be correct. In theory, this pattern of food consumption is also consistent with the DASH diet, Mind diet, Scandinavian diet, flexitarian diet, pesco-vegetarian diet, and semi vegetarian diet, just to name a few.

In my opinion there is nothing about this study that restricts beneficial pregnancy outcomes to the Mediterranean diet. However, I do have a few caveats about that statement.

A good prenatal supplement is a good idea to make sure you are getting the vitamins and minerals required for a successful pregnancy. However, as I have described in a previous article finding a good prenatal supplement may not be as easy as it should be.

Choline is important for a healthy pregnancy, and it is missing in many prenatal supplements. While choline is found in many plant foods, the best sources of choline are fish, poultry, eggs, and dairy. You want to be sure to include some of these in your diet and/or look for a prenatal supplement containing at least 200 mg of choline.

The long chain omega-3s DHA and EPA are important for a healthy pregnancy and are also missing or present in inadequate amounts in many prenatal supplements.

The best dietary sources of DHA and EPA are cold water fish like salmon, tuna, sardines, and herring. That means:

- If you are following the DASH diet or something similar, you will want to substitute fish for red meat.

- A pesco-vegetarian diet is probably a better choice for you than a semi-vegetarian because it focuses on fish as the main protein source in place of poultry and red meat.

- If you are not a big fish lover, you should consider an omega-3 supplement supplying at least 250 mg of long chain omega-3s with most of it as DHA.

What Does This Study Mean For You?

Let me close by putting a few things into perspective.

1) When I said that the Mediterranean diet may be overrated, I did not mean it wasn’t an excellent diet. I simply mean it is probably not any better than other whole food, primarily plant-based diets (with the caveats I listed above).

2) The pregnancy benefits of the Mediterranean diet (and other healthy diets) are related to the overall health of the mother. A good prenatal supplement is still important to assure adequate amounts of all the nutrients essential for a healthy pregnancy.

For example, the authors pointed out that most women do not change their dietary habits when they become pregnant, and that their pregnancy is more likely to be successful if they are in good health at the time of conception.

3) Most diets of women of childbearing age do not provide adequate amounts of choline and omega-3s, so it is important to choose a prenatal supplement program that provides adequate amounts of choline and omega-3s.

4) Adequate calories and protein are also important for a healthy pregnancy.

Pregnancy is not the time to lose weight, even if you are overweight.

A vegan diet may not provide enough protein unless it has been designed by a dietitian.

You should discuss your current diet with your health care provider, and they may refer you to a dietitian if necessary.

The Bottom Line

The Mediterranean Diet is currently the darling of the nutrition world. Yes, numerous studies have shown that people consuming the Mediterranean diet are healthier and live longer. But we find ourselves in a situation where study after study is being designed to look for other benefits of the Mediterranean diet while equally healthy diets are being ignored.

The study discussed in this article is a perfect example. It was designed to determine whether adherence to the Mediterranean diet prior to and during pregnancy reduced the risk of experiencing adverse outcomes during pregnancy – outcomes that could affect the health of the mother and her baby.

The answer to that question was, “Yes”. Adherence to the Mediterranean diet reduced the risk of:

Any adverse outcome during pregnancy by 20%.

Preeclampsia and eclampsia by 35%.

Gestational diabetes by 54%.

And the risk reduction was even greater for women over 35.

However, when the investigators looked at the foods responsible for the reduction in adverse pregnancy outcomes, it appears likely that any whole food, primarily plant-based diet would provide the same results.

In short, this study showed that adherence to the Mediterranean diet improves pregnancy outcomes. The authors chose to focus on the Mediterranean diet because of its popularity. But their data show it is likely that other whole food, primarily plant-based diets would be equally beneficial.

For more information on this study and what it means for you, 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.

___________________________________________________________________________

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

Are Easter Eggs Bad For You?

April 4, 2023 by Dr. Steve Chaney

Clearing Up The Eggfusion

Author: Dr. Stephen Chaney

The Easter Bunny will be here soon bringing beautifully decorated eggs for all the children. But wait. Aren’t eggs bad for us? Should we really be encouraging our kids to eat Easter eggs? Maybe we should encourage them to eat Easter candy instead (just kidding).

What is the truth about eggs on our health? Perhaps it’s time for the professor to clear up the “eggfusion” (That’s short for egg confusion). Let me start with a brief historical summary:

First there were the warnings that eggs were bad for your heart because egg yolks contained cholesterol, and cholesterol was to be avoided at all costs.

Then experts decided that dietary cholesterol wasn’t all that bad for you. It was saturated fats, obesity, and lack of exercise that raised “bad” (LDL) cholesterol levels in your bloodstream.

That was followed by several US studies suggesting that eggs in moderation (one per day) did not affect your risk of heart disease.

Then a major study claimed that an egg a day actually lowered your risk of heart disease.

Now, the most recent headlines claim that eggs increase your risk of heart disease, and you should avoid them. No wonder you are experiencing eggfusion. Let me review the latest study and put it into perspective by comparing it to previous studies. Let me clear up the eggfusion.

But let me warn you. This is a bit complex, as the truth often is. When I try to explain the contradictions between major studies on egg consumption and heart health, I think the best analogy might be the tale of the blind men trying to tell what an elephant was like by touching different parts of the elephant. None of them could provide an accurate description because none of them could see the whole elephant.

We need to look at the “whole elephant” to see what these studies missed.

How Was The Study Done?

This study (WW Zhong et al, JAMA, 321: djw322, 2017) combined the data from 6 clinical trials in the United States that assessed dietary intake and measured cardiovascular health outcomes. In all, these studies included 29,615 adults who were followed for an average of 17.5 years.

The diet of the participants was assessed upon entry into each of the clinical trials. The primary variables derived from the dietary information were cholesterol and egg consumption. Diet was not assessed at later times in these studies.

The primary outcomes measured were heart disease and all-cause mortality. In this study heart disease was an umbrella term that included fatal and non-fatal heart attacks, stroke, heart failure, and death from other heart-related causes.

Do Eggs Increase Heart Disease Risk?

Here are the main findings from this study.

Each additional half an egg consumed per day (which is equivalent to 3-4 eggs per week) was associated with a:

- 6% increased risk of heart disease. While that doesn’t sound like much, the increased risk was over 13% for one egg per day and almost 27% for two eggs per day.

The increased heart disease risk associated with one half egg per day was greater for:

- Women (13% increase) than men (3% increase).

- People who already had high blood cholesterol (7% increase), not people who already had low cholesterol levels (0% increase). This suggests that the effect of eggs on heart disease risk primarily affects people who are already having trouble controlling their blood cholesterol levels – either due to genetics or due to diet & lifestyle.

Of course, the question is whether it was the eggs that increased the risk of heart disease or was it something else in the diet. This study attempted to answer that question by systematically subtracting out other variables that affect heart disease risk to see whether that correction eliminated the association between egg consumption and heart disease risk. When this was done:

The association between egg consumption and heart disease risk disappeared after correcting for dietary cholesterol intake.

The association between egg consumption and heart disease risk remained significant after correcting for other components of the diet, such as fats, animal protein, fiber, sodium, or overall “diet quality”. There were 3 main measures of diet quality.

- The Med diet score measures how closely the diet resembles the Mediterranean diet.

- The DASH diet score measures how closely the diet resembles the DASH diet.

- The Healthy Eating Index (HEI) measures how closely the diet aligns with the USDA Dietary Guidelines For Americans. Basically, the HEI recommends a whole food diet containing foods from all 5 food groups with a heavy emphasis on fruits, vegetables, whole grains, and legumes. It also recommends limiting saturated and trans fats, added sugars, and sodium.

In simple terms the authors concluded that the effect of eggs on heart disease risk was primarily due to their cholesterol content and was not influenced by other components of the overall diet. [I will revisit this conclusion latter.]

What Are The Strengths And Weaknesses Of The Study?

The strengths are obvious. This was a very large study (29,615 participants) and the people enrolled in the study were followed for a long time (an average of 17.5 years). The primary variables in the study (cholesterol consumption, egg consumption, heart disease, and all-cause mortality) were accurately measured in each of the clinical trials included in the study.

However, there were some significant weaknesses as well:

Cholesterol and egg consumption were only measured by a single dietary survey when people entered the study. This study assumes they did not change over the course of the study. That is very unlikely. Both cholesterol intake and egg consumption in the US population have waxed and waned over the years, in part due to variations in dietary guidelines.

The measurements of diet quality used were based on US and European food preferences. That is significant because the only studies showing that egg consumption lowers heart disease risk were performed in China and Japan, where the diet is closer to semi-vegetarian than to US or European diets.

Are Easter Eggs Bad For You?

This is very large, well designed study that combines the data from 6 clinical trials spanning the years 1974 to 2013.

The strongest conclusions from the study are:

In the context of a Western diet (the US diet) egg consumption slightly increases your risk developing heart disease. The increased risk is ~6% for 3-4 eggs/week, ~13% for 1 egg per day, and ~27% for two eggs per day.

The increased risk of heart disease appears to be almost entirely due to the cholesterol content of eggs.

The significance of this study needs to be weighed in the context of:

Recent studies in the US and Europe showing eggs do not increase heart disease risk.

Studies in China and Japan (where the diets can best be described as semi-vegetarian) showing that eggs decrease heart disease risk.

The significance of this study also needs to be weighed in the context of:

Studies showing that obesity, saturated fat, and physical inactivity have bigger effects on serum cholesterol levels and heart disease risk than dietary cholesterol from foods like eggs.

What Did This Study Miss?

If, as this study suggests, the effect of eggs on heart disease risk is due to their cholesterol content, this study (and most previous studies) missed a very important point. The effect of dietary cholesterol on blood cholesterol levels is not strongly affected by the overall composition of the diet. It is affected by the composition of the diet at the time foods containing dietary cholesterol are eaten.

The kind of fiber found in certain fruits, vegetables, whole grains, and legumes bind to dietary cholesterol, preventing it from being absorbed as it passes through the intestine.

Certain phytonutrients in plant foods affect how dietary cholesterol is utilized by the body.

However, to blunt the effect of dietary cholesterol on blood cholesterol levels the fiber and phytonutrient-containing foods must be consumed at the same meal.

Simply put, if your breakfast consists of eggs, sausage, biscuits, and hash browns, the cholesterol in the eggs will likely increase your blood cholesterol level, which in turn increases your risk of heart disease. This will occur even if you eat lots of fruits, vegetables, whole grains, and legumes with your other meals.

If, on the other hand, your breakfast consists of eggs and fiber-rich plant foods like oatmeal and beans, the cholesterol in the eggs will likely have a much smaller effect on your blood cholesterol levels and your heart disease risk.

The fact that previous studies have not looked at what foods were consumed along with the eggs may explain some of the variation in their conclusions about the effect of egg consumption on heart disease risk.

The Professor’s Story

Let me share my story with you. About 25 years ago, my doctor told me that my cholesterol levels were getting high and wanted to put me on statins. I didn’t take a stain, and I didn’t stop eating eggs for breakfast. I changed breakfast.

Now I soft boil my eggs or fry them in olive oil. I eat them along with oatmeal, which contains a fiber that binds cholesterol, and walnuts, which contain omega-3s and phytonutrients that lower blood cholesterol. I also include whatever fruit is in season. Finally, I take a supplement providing 2 grams of plant stanols and sterols, which blocks cholesterol absorption from the intestine.

My blood cholesterol levels have been low ever since. I have not had to take statins, and I get to enjoy the taste and health benefits of an egg any time I want to. Of course, what worked for me may not work for you. The effect of dietary cholesterol on blood cholesterol levels is also affected by genetics, weight, and fitness, just to name the top three.

Are Easter Eggs Good For You?

Once you get past the cholesterol problem, eggs are a very healthy food.

Studies have shown that egg protein results in improved blood sugar control, better satiety (feeling of fullness), and reduced subsequent food intake in healthy and overweight individuals. In layman’s terms that means egg protein can help you achieve and maintain a healthy weight.

2) Egg yolks are a good source of lutein and zeaxanthin. We think of lutein and zeaxanthin as good for eye health. They also play an important role in protecting against oxidation, inflammation, and atherosclerosis.

3) Egg yolks also contain choline. We think of choline as good for brain and nerves. But, choline and other phospholipids in the yolk also raise HDL levels and enhance HDL function.

4) Eggs are a good source of vitamin A, vitamin D, vitamin B12, riboflavin, selenium and iron.

5) Eggs contain almost twice as much monounsaturated and polyunsaturated fats as saturated fats.

Clearing Up The “Eggfusion”

The latest study suggests that eggs may increase your risk of heart disease, and this is due to their cholesterol content.

2) This study needs to be considered in the context of recent studies in the US showing that egg consumption did not increase heart disease risk and studies in China and Japan showing that egg consumption lowered heart disease risk.

3) It is also important to consider that egg consumption in China and Japan is in the context of a semi-vegetarian diet. This suggests that diet plays a role in determining the effect of egg consumption on heart disease risk.

4) However, if you take this study at face value, there are two things you can do to reduce your risk of heart disease:

Reduce dietary cholesterol by avoiding eggs or using egg whites.

- Eat eggs in moderation along with fiber- and phytonutrient-rich plant foods that negate the effect of dietary cholesterol on blood cholesterol levels. I recommend oatmeal or beans, nuts or seeds, and fiber rich fruits and vegetables. These should be consumed at the same meal to minimize the effect of the cholesterol in the eggs on blood cholesterol levels. As for Easter eggs, they are a perfect addition to a green salad.

- Eggs are a very healthy food, so I recommend the second option if possible. Get your blood cholesterol levels measured to determine which approach works best for you.

5) Finally, we need to recognize that egg consumption plays a relatively minor role in determining heart disease risk. Other factors play a much larger role in influencing heart disease risk. For example:

- Smoking, obesity, inactivity, saturated and trans fats significantly increase your risk of heart disease.

- Omega-3s, antioxidants, and a primarily plant-based diet like the Mediterranean diet significantly decrease your risk of heart disease.

If we wish to reduce our risk of heart disease, this is where we should focus most of our attention. We can minimize the effect of egg consumption on heart disease risk by changing the foods we eat with the eggs. For more information on how to reduce your risk of heart disease, read my books, “Slaying The Food Myths” and “Slaying The Supplement Myths”.

The Bottom Line

1) The latest study suggests that eggs increase your risk of heart disease because of their cholesterol content.

2) This was a very large study. It combined the data from 6 clinical trials spanning the years 1974 to 2013. It followed 29,615 people for an average of 17.5 years. However, it has two significant weaknesses:

It only determined cholesterol intake and egg consumption at the time people entered the clinical trials. Both cholesterol intake and egg consumption have waxed and waned considerably over the years covered by these clinical trials.

It did not measure what foods were consumed along with the eggs. Foods consumed along with eggs have a strong influence on how much the cholesterol in the eggs influences blood cholesterol levels, which, in turn, influences the effect eggs have on heart disease risk.

3) This study also needs to be considered in the context of recent studies in the US showing that egg consumption did not increase heart disease risk and studies in China and Japan showing that egg consumption lowered heart disease risk.

4) However, if you take this study at face value, there are two things you can do to reduce your risk of heart disease:

Reduce dietary cholesterol by avoiding eggs or using egg whites.

Eat eggs in moderation along with fiber- and phytonutrient-rich plant foods that negate the effect of dietary cholesterol on blood cholesterol levels. I recommend oatmeal or beans, nuts or seeds, and fiber rich fruits and vegetables. These should be consumed at the same meal to minimize the effect of the cholesterol in the eggs on blood cholesterol levels. As for Easter eggs, they are a perfect addition to a green salad.

Eggs are a very healthy food, so I recommend the second option if possible. Get your blood cholesterol levels measured to determine which approach works best for you.

Smoking, obesity, inactivity, saturated and trans fats significantly increase your risk of heart disease.

Omega-3s, antioxidants, and a primarily plant-based diet like the Mediterranean diet significantly decrease your risk of heart disease.

For more information on how to reduce your risk of heart disease, read my books, “Slaying The Food Myths” and “Slaying The Supplement Myths”.

For more details and to learn what the professor does about egg consumption, read the article above.

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

Can You Create Your Personal Fountain Of Youth?

March 7, 2023 by Dr. Steve Chaney

Can A Healthy Lifestyle Improve Your Healthspan?

Author: Dr. Stephen Chaney

Ever since Ponce de Leon led an expedition to the Florida coast in 1513, we have been searching for the mythical “Fountain Of Youth”. What does that myth mean?

Supposedly, just by immersing yourself in that fountain you would be made younger. You would experience all the exuberance and health you enjoyed when you were young. There have been many snake oil remedies over the years that have promised that. They were all frauds.

But what if you had it in your power to live longer and to retain your youthful health for most of those extra years. The ability to live healthier longer is something that scientists call “healthspan”. But you can think of it as your personal “Fountain Of Youth”.

Now comes the important question, “Can a healthy lifestyle improve your healthspan?” We know a healthy lifestyle is good for us. Most of us know what a healthy lifestyle is. But it’s so hard. Is it worth it? Will it actually increase our lifespan? Will it increase our healthspan?

Today I am sharing two studies from the prestigious Harvard T.H. Chan School of Public Health that answer those questions.

The first study (Y Li et al, Circulation, 138: 345-355, 2018) looks at the effect of a healthy lifestyle on lifespan (how many years you can live).

The second study (Y Li et al, British Medical Journal, 368: 16669, 2020) looks at the effect of a healthy lifestyle on healthspan (how many disease-free years you can live).

How Were The Studies Done?

These studies started by combining the data from two major clinical trials:

The Nurse’s Health Study, which ran from 1980 to 2014.

The Health Professional’s Follow-Up Study, which ran from 1986-2014.

These two clinical trials enrolled 78,865 women and 42,354 men and followed them for an average of 34 years. During this time there were 42,167 deaths. All the participants were free of heart disease, type 2 diabetes, and cancer at the time they were enrolled. Furthermore, the design of these clinical trials was extraordinary.

A detailed food frequency questionnaire was administered every 2-4 years. This allowed the investigators to calculate cumulative averages of all dietary variables.

Participants also filled out questionnaires that captured information on disease diagnosis every 2 years with follow-up rates >90%. This allowed the investigators to measure the onset of disease for each participant during the study. More importantly, 34 years is long enough to measure the onset of diseases like heart disease, diabetes, and cancer – diseases that require decades to develop.

- The questionnaires also captured information on medicines taken and lifestyle characteristics such as body weight, exercise, smoking and alcohol use.

For analysis of diet quality, the investigators use something called the “Alternative Healthy Eating Index”. [The original Healthy Eating Index was developed about 10 years ago based on the 2010 “Dietary Guidelines for Americans”. Those guidelines have since been updated, and the “Alternative Healthy Eating Index” is based on the updated guidelines.] You can calculate your own Alternative Healthy Eating Index below, so you can see what is involved.

Finally, the investigators included five lifestyle-related factors – diet, smoking, physical activity, alcohol consumption, and BMI (a measure of obesity) – in their estimation of a healthy lifestyle. Based on the best available evidence, they defined “low-risk” in each of these categories. Study participants were assigned 1 point for each low-risk category they achieved. Simply put, if they were low risk in all 5 categories, they received a score of 5. If they were low risk in none of the categories, they received a score of 0.

Low risk for each of these categories was defined as follows:

- Low risk for a healthy diet was defined as those who scored in the top 40% in the Alternative Healthy Eating Index.

- Low risk for smoking was defined as never smoking.

- Low risk for physical activity was defined as 30 minutes/day of moderate or vigorous activities.

- Low risk for alcohol was defined as 0.5-1 drinks/day for women and 0.5-2 drinks/day for men.

- Low risk for weight was defined as a BMI in the healthy range (18.5-24.9 kg/m²).

Can A Healthy Lifestyle Improve Your Healthspan?

The investigators compared participants who scored as low risk in all 5 categories with participants who scored as low risk in 0 categories (which would be typical for many Americans). For simplicity, I will refer to people who scored as low risk in 5 categories as having a “healthy lifestyle” and those who scored as low risk in 0 categories as having an “unhealthy lifestyle”.

The results of the first study were:

Women who had had a healthy lifestyle lived 14 years longer than women with an unhealthy lifestyle (estimated life expectancy of 93 versus 79).

Men who had a healthy lifestyle lived 12 years longer than men with an unhealthy lifestyle (estimated life expectancy was 87 versus 75).

It was not necessary to achieve a perfect lifestyle. Life expectancy increased in a linear fashion for each low-risk lifestyle behavior achieved.

The authors of the study concluded: “Adopting a healthy lifestyle could substantially reduce premature mortality and prolong life expectancy in US adults. Our findings suggest that the gap in life expectancy between the US and other developed countries could be narrowed by improving lifestyle factors.”

The results of the second study were:

Women who had a healthy lifestyle lived 11 years longer free of diabetes, heart disease, and cancer than women who had an unhealthy lifestyle (estimated disease-free life expectancy of 85 years versus 74 years).

Men who had a healthy lifestyle lived 8 years longer free of diabetes, heart disease, and cancer than men who had an unhealthy lifestyle (estimated disease-free life expectancy of 81 years versus 73 years).

Again, disease-free life expectancy increased in a linear fashion for each low-risk lifestyle behavior achieved.

The authors concluded: “Adherence to a healthy lifestyle at mid-life [They started their analysis at age 50] is associated with a longer life expectancy free of major chronic diseases. Our findings suggest that promotion of a healthy lifestyle would help reduce healthcare burdens through lowering the risk of developing multiple chronic diseases, including cancer, cardiovascular disease, and diabetes, and extending disease-free life expectancy.”

Can You Create Your Personal Fountain Of Youth?

I posed the question at the beginning of this article, “Can you create your personal Fountain Of Youth”?” These two studies showed that you can improve both your life expectancy and your disease-free life expectancy by simply changing your lifestyle. So, the answer to the original question appears to be, “Yes, you can improve your healthspan. You can create your personal “Fountain of Youth.”

However, as a nation we appear to be moving in the wrong direction. The percentage of US adults adhering to a healthy lifestyle has decreased from 15% in 1988-1992 to 8% in 2001-2006.

Finally, I know you have some questions, and I have answers.

Question: What about supplementation? Will it also improve my healthspan?

Answer: When the investigators analyzed the data, they found that those with the healthiest lifestyles were also more likely to be taking a multivitamin. So, they attempted to statistically eliminate any effect of supplement use on the outcomes. That means these studies cannot answer that question.

However, if you calculate your Alternate Healthy Eating Index below, you will see that most of us fall short of perfection. Supplementation can fill in the gaps.

Question: I cannot imagine myself reaching perfection in all 5 lifestyle categories? Should I even try to achieve low risk in one or two categories?

Answer: The good news is that there was a linear increase in both life expectancy and disease-free life expectancy as people went from low-risk in one category to low-risk in all 5 categories. I would encourage you to try and achieve low risk status in as many categories as possible, but very few of us, including me, achieve perfection in all 5 categories.

Question: I am past 50 already. Is it too late for me to improve my healthspan?

Answer: Diet and some of the other lifestyle behaviors were remarkably constant over 34 years in both the Nurse’s Health Study and the Health Professional’s Follow-Up Study. That means that the lifespan and healthspan benefits reported in these studies probably resulted from adhering to a healthy lifestyle for most of their adult years.

However, it is never too late to start improving your lifestyle. You may not achieve the full benefits described in these studies, but you still can add years and disease-free years to your life.

How To Calculate Your Alternative Healthy Eating Index

You can calculate your own Alternative Healthy Eating Index score by simply adding up the points you score for each food category below.

Vegetables

Count 2 points for each serving you eat per day (up to 5 servings).

One serving = 1 cup green leafy vegetables or ½ cup for all other vegetables.

Do not count white potatoes or processed vegetables like French fries or kale chips.

Fruits

Count 2½ points for each serving you eat per day (up to 4 servings).

One serving = 1 piece of fruit or ½ cup of berries.

(do not count fruit juice or fruit incorporated into desserts or pastries).

Whole Grains

Count 2 points for each serving you eat per day (up to 5 servings).

One serving = ½ cup whole-grain rice, bulgur and other whole grains, cereal, and pasta or 1 slice of bread.

(For processed foods like pasta and bread, the label must say 100% whole grain).

Sugary Drinks and Fruit Juice

Count 10 points if you drink 0 servings per week.

Count 5 points for 3-4 servings per week (½ serving per day).

Count 0 points for 7 or more servings per week (≥1 serving per day).

One serving = 8 oz. fruit juice, sugary soda, sweetened tea, coffee drink, energy drink, or sports drink.

Nuts and Beans

Count 10 points if you eat 7 or more servings per week (≥1 serving per day).

Count 5 points for 3-4 servings per week (½ serving per day).

Count 0 points for 0 servings per week.

One serving = 1 oz. nuts or seeds, 1 Tbs. peanut butter, ½ cup beans, 3½ oz. tofu.

Red and Processed Meat

Count 10 points if you eat 0 servings per week.

Count 7 points for 3-4 servings per week (½ serving per day).

Count 3 points for 3 servings per week (1 serving per day).

Count 0 points for ≥1½ servings per day.

One serving = 1½ oz. processed meats (bacon, ham, sausage, hot dogs, deli meat)

Or 4 oz. red meat (steak, hamburger, pork chops, lamb chops, etc.)

Seafood

Count 10 points if you eat 2 servings per week.

Count 5 points for 1 serving per week.

Count 0 points for 0 servings per week.

1 serving = 4 oz.

Now that you have your total, the scoring system is:

41 or higher is excellent
37-40 is good
33-36 is average (remember that it is average to be sick in this country)
28-32 is below average
Below 28 is poor

Finally, for the purposes of these two studies, a score of 37 or higher was considered low risk.

The Bottom Line

Two recent studies have developed a healthy lifestyle score based on diet, exercise, body weight, smoking, and alcohol use. When they compared the effect of lifestyle on both lifespan (life expectancy) and healthspan (disease-free life expectancy), they reported:

Women who had had a healthy lifestyle lived 14 years longer than women with an unhealthy lifestyle.

Men who had a healthy lifestyle lived 12 years longer than men with an unhealthy lifestyle.

Women who had a healthy lifestyle lived 11 years longer free of diabetes, heart disease, and cancer than women had an unhealthy lifestyle.

Men who had a healthy lifestyle lived 8 years longer free of diabetes, heart disease, and cancer than men who had an unhealthy lifestyle.

It is not necessary to achieve a perfect lifestyle. Lifespan and healthspan increased in a linear fashion for each low-risk lifestyle behavior (diet, exercise, body weight, smoking, and alcohol use) achieved.

These studies did not evaluate whether supplement use also affects healthspan.

- However, if you calculate your diet with the Alternate Healthy Eating Index they used (see above), you will see that most of us fall short of perfection. Supplementation can fill in the gaps.

The authors concluded: “Our findings suggest that promotion of a healthy lifestyle would help reduce healthcare burdens through lowering the risk of developing multiple chronic diseases, including cancer, cardiovascular disease, and diabetes, and extending disease-free life expectancy.”

For more details, including how to calculate your Alternative Healthy Eating Index, 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.