Can You Improve Your Healthspan?

Can You Live Healthier, Longer?

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”.

Where are we as a nation? Americans ranked 53rd in the world for life expectancy. We have the life expectancy of a third-world country. We are in sore need of a “Fountain Of Youth”.

That is why I decided to share two recent studies from the prestigious Harvard T.H. Chan School of Public Health with you today.

How Were The Studies Done?

Clinical StudyThese 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 You Live Healthier Longer?

Older Couple Running Along BeachThe 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 the purpose of 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 Improve Your Healthspan?

Questioning ManI posed the question at the beginning of this article, “Can you improve your healthspan?” These two studies showed that you can improve both your life expectancy and your disease-free life expectancy. 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.

The clinical trials that these studies drew their data from were very well designed, so these are strong studies. However, like all scientific studies, they have some weaknesses, namely:

  • They looked at the association of a healthy lifestyle with life expectancy and disease-free life expectancy. Like all association studies, they cannot prove cause and effect.
  • The clinical trials they drew their data with included mostly Caucasian health professionals. The results may differ with different ethnic groups.
  • These studies did not look at the effect of a healthy lifestyle on the onset of Alzheimer’s disease and other forms of dementia. However, other studies have shown that people who were low risk for each of the 5 lifestyle factors (diet, exercise, body weight, smoking, and alcohol use) individually have a reduced risk of developing Alzheimer’s and/or dementia.

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, Seeds 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 use (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 whether you are low risk in each of the 5 lifestyle categories, 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.

Does Vitamin D Prevent Type 1 Diabetes?

Does Genetics Influence Supplementation Benefits?

diabetesThe cause of type 1 diabetes is a mystery. If you go to an authoritarian source like the Mayo Clinic, you will discover that:

  • Type 1 diabetes is an autoimmune disease that selectively attacks the insulin-producing islet cells of the pancreas.
  • Certain genetic variants predispose individuals to type 1 diabetes.
  • The autoimmune response may be triggered by a viral infection or other unknown environmental factors in genetically susceptible individuals.
  • The incidence of type 1 diabetes increases as you travel away from the equator, which suggests that vitamin D may be involved.

The idea that vitamin D may be involved is an important concept because it suggests that vitamin D supplementation might reduce the risk of developing type 1 diabetes. This idea was reinforced by a Finnish study (E Hyponnen et al, Lancet, 358: 1500-1503, 2001) published in 2001 showing the vitamin D supplementation of newborn infants reduced the incidence of type 1 diabetes at age 1.

However, subsequent studies in other parts of the world have had mixed results. Some have confirmed the results of the Finnish study. Others have come up empty.

Similarly, some studies have shown a correlation between low 25-hydroxyvitamin D levels in the blood and the development of type 1 diabetes in children, while other studies have found no correlation.

Why the discrepancy between studies? Some of the differences can be explained by differences in the populations studied or differences in study design. But what if there were another variable that none of the previous studies has considered?

The study (JM Norris et al, Diabetes, 67: 146-154, 2018) I review this week describes just such a variable. The authors of the study hypothesized that the association between 25-hydroxyvitamin D levels and the risk of developing type 1 diabetes is influenced by mutations that affect the way vitamin D works in the body. Previous studies have not taken these mutations into account. If the author’s hypothesis is true, it might explain why these studies have produced conflicting results.

In this article, I will answer 3 questions:

  • Does vitamin D prevent type 1 diabetes?
  • If so, is supplementation with vitamin D important?
  • Who will benefit most from vitamin D supplementation?

But, before I answer those questions, I should begin by providing some background. I will start by reviewing the how diet, increased need, disease, and genetics influence the likelihood that we will benefit from supplementation. Then I will review vitamin D metabolism.

Does Genetics Influence Supplementation Benefits?

need for supplementsThe reason so many studies find no benefit from supplementation is that they are asking the wrong question. They are asking “Does supplementation benefit everyone?” That is an unrealistic expectation.

I have proposed a much more realistic model (shown on the left) for when we should expect supplementation to be beneficial. Simply put, we should ask:

  • Is the diet inadequate with respect to the nutrient that is being studied?
  • Is there an increased need for that nutrient because of age, gender, activity level, or environment?
  • Is there a genetic mutation that affects the metabolism or need for that nutrient?
  • Is there an underlying disease state that affects the need for that nutrient?

When clinical studies are designed without taking this paradigm into account, they are doomed to fail. Let me give you some specific examples.

  • The Heart Outcomes Prevention Evaluation study concluded supplementation with folate and other B vitamins did not reduce heart disease risk. The problem was that 70% of the people in the study were getting adequate amounts of folate from their diet at the beginning of the study. For those individuals not getting enough folate in their diet, B vitamin supplementation decreased their risk of heart disease by 15%. This is an example of poor diet influencing the need for supplementation.

The other three examples come from studies on the effect of vitamin E supplementation on heart disease that I summarized in an article in “Health Tips From The Professor” a few years ago. Here is a brief synopsis.

  • The Women’s Health Study concluded that vitamin E did not decrease heart disease risk in the general population. However, the study also found that in women over 65 (who are at high risk of heart disease), vitamin E supplementation decreased major cardiovascular events and cardiovascular deaths by 25%. This is an example of increased need because of age and gender influencing the need for supplementation.
  • The Women’s Antioxidant Cardiovascular Study” concluded that vitamin E did not decrease heart disease risk in the general population. However, when they looked at women who already had cardiovascular disease at the beginning of the study, vitamin E supplementation decreased risk of heart attack, stroke, and cardiovascular death by 23%. This is an example of an underlying disease affecting the need for supplementation.
  • The HOPE study concluded that vitamin E did not decrease heart disease risk in the general population. However, when they looked at individuals with a mutation that increases the risk of heart disease, vitamin E supplementation significantly decreased their risk of developing heart disease. This is an example of genetics affecting the need for supplementation.

These are just a few of many examples. When you ask whether supplementation benefits everyone, the answer is often no. However, when you look at people with inadequate diet, increased need, underlying disease, and/or genetic predisposition, the answer is often yes.

This background sets the stage for the current study. Of course, to understand the author’s hypothesis that mutations in genes involved in vitamin D metabolism might influence the effect of vitamin D on the risk of developing type 1 diabetes, you need to know a little about vitamin D metabolism.

Biochemistry 101: Vitamin D Metabolism

Vitamin D MetabolismWhen sunlight strikes a metabolite of cholesterol in our skin, it is converted to a precursor that spontaneously isomerizes to form vitamin D3. Because this series of reactions is usually not sufficient to provide all the vitamin D3 our bodies require, we also need to get vitamin D3 from diet and supplementation.

However, vitamin D3 is not active by itself. It first needs to be converted to 25-hydroxyvitamin D by our liver and then to the active 1,25-dihydroxyvitamin D. 1,25-dihydroxyvitamin D is an important hormone that regulates many cells in our body.

Some of the 1,25-dihydroxyvitamin D is synthesized by our kidneys and released into the bloodstream. This 1,25-dihyroxyvitamin D binds to vitamin D receptors on the surface of many cells and initiates regulatory pathways that affect metabolism inside the cell.

Other cells take up 25-hydroxyvitamin D and convert it to 1,25-dihydroxyvitamin D themselves. In these cells both the synthesis and regulatory effects of 1,25-dihydroxyvitamin D occur entirely inside the cell.

In both cases, it is 1,25-dihydroxyvitamin D that regulates cellular metabolism. The only difference is the way this regulation is accomplished.

There are two additional points that are relevant to this study.

  • The efficiency of conversion of vitamin D to 25-hydroxyvitamin D varies from person to person.
    • Thus, blood levels of 25-hydroxyvitamin D are considered a more reliable measure of vitamin D status than dietary intake of vitamin D or sun exposure.
    • Blood levels of 25-hydroxyvitamin D levels ≥50 nmol/L are considered optimal, while levels of 30 to <50 nmol/L are considered suboptimal, and levels <30 nmol/L are considered deficient.
  • 1,25-dihydroxyvitamin D binds to the vitamin D receptor on immune cells. This initiates a series of reactions that decrease the risk of autoimmune responses by our immune system.

How Was This Study Done?

Clinical StudyThis study was called TEDDY (The Environmental Determinants Of Type 1 Diabetes in the Young). Between September 2004 and February 2010, 424,788 newborn infants from 6 medical centers in Colorado, Georgia, Washington, Finland, Germany, and Sweden were screened for genes that predispose to type 1 diabetes.

The investigators identified 21,589 high-risk infants, and 8,676 of them were enrolled in this study before age 4 months. Clinic visits for the children occurred every 3 months between 3 and 48 months of age and every 6 months thereafter.

  • A DNA sample was taken at the time they entered the study and analyzed for mutations in genes involved in vitamin D metabolism.
  • 25-hydroxy vitamin D levels were obtained at each office visit. Because some studies have suggested the vitamin D status during the first year of life is important, the data were analyzed in two ways.
    1. An average of all 25-hydroxyvitamin D levels (referred to as “childhood 25-hydroxyvitamin D levels”).
    1. An average of 25-hydroxyvitamin D levels during the first 12 months (referred to as “early infancy 25-hydroxyvitamin D levels”).
  • Serum autoantibodies to pancreatic islet cells were measured at each office visit as a measure of an autoimmune attack on those cells. Persistent autoimmune response was defined as positive autoantibodies on two consecutive office visits.

While this study did not directly measure type 1 diabetes, children with an autoimmune response to their pancreatic islet cells are highly likely to develop type 1 diabetes. Thus, for purposes of simplicity I will refer to “risk of developing type 1 diabetes” rather than “persistent autoimmune response” in describing these results.

    1. 418 children developed persistent autoantibodies to their pancreatic islet cells during the study. The onset of this autoimmune response ranged from 2 months to 72 months with an average of 21 months.
    1. These children were compared to 3 matched controls from their medical center who did not develop an autoimmune response.

This study was remarkable for two reasons:

1) It was much larger than previous studies. This gave it greater power to detect an effect of vitamin D status on the risk of developing type 1 diabetes.

2) This was the first study to ask whether mutations in genes controlling the metabolism of vitamin D influenced the effect of vitamin D on the risk of developing type 1 diabetes.

Does Vitamin D Prevent Type 1 Diabetes?

Vitamin DThe study compared the risk of developing type 1 diabetes in children whose 25-hydroxyvitamin D levels were optimal (≥50 nmol/L) to children whose 25-hydroxyvitamin D levels were suboptimal (30 to <50 nmol/L). The results were:

  • Optimal vitamin D status during childhood was associated with a 31% decrease in the risk of developing type 1 diabetes.
  • Optimal vitamin D status during early infancy (first 12 months) was associated with a 40% decrease in the risk of developing type 1 diabetes.

In other words, having optimal vitamin D status significantly reduces the likelihood of developing of type 1 diabetes in childhood.

  • 25-hydroxyvitamin D levels >75 nmol/L provided no additional benefit.

In other words, you need sufficient vitamin D, but higher levels provide no additional benefit.

  • They tested 5 genes involved in vitamin D metabolism to see if they influenced the effect of vitamin D on the risk of developing type 1 diabetes. Only the VDR (vitamin D receptor) gene had any influence.
    • When the VDR gene was fully functional, optimal vitamin D status had no effect on the risk of developing type 1 diabetes. This means that even suboptimal (30 to <50 nmol/L) levels of 25-hydroxyvitamin D were sufficient to prevent type 1 diabetes when the vitamin D receptor was fully functional.
    • Only 9% of the children in this study were vitamin D deficient (<30 nmol/L 25-hydroxyvitamin D). Presumably, these children would be at high risk of developing type 1 diabetes even with a fully functional VDR gene. However, there were not enough children in that category to test this hypothesis.
  • When they looked at children with mutations in the VDR gene:
    • Optimal vitamin D status during childhood was associated with a 59% decrease in the risk of developing type 1 diabetes.
    • Optimal vitamin D status during early infancy (first 12 months) was associated with a 67% decrease in the risk of developing type 1 diabetes.

In short, the need for optimal vitamin D levels to reduce the risk of developing type 1 diabetes is only seen in children with a mutation in the VDR (vitamin D receptor) gene.

  • This is a clear example of genetics affecting the need for a nutrient.
    • For children with a fully functional VDR gene, even 30-50 nmol/L 25-hydroxyvitamin D was sufficient to reduce the risk of developing type 1 diabetes.
    • However, children with mutations in the VDR gene required ≥50 nmol/L 25-hydroxyvitamin D to reduce their risk of developing type 1 diabetes.
  • This is also an example of genetics affecting the need for supplementation with vitamin D.
    • 42% of the children in this study had suboptimal levels of 25-hydroxyvitamin D. Those who also have a mutation in the VDR gene would require supplementation to bring their 25-hydroxyvitamin D up to the optimal level to reduce their risk of developing type 1 diabetes.
    • Other studies have estimated that up to 61% of children in the US may have suboptimal 25-hydroxyvitamin D levels.

What Does This Study Mean For You?

Questioning WomanLet’s start with the three questions I proposed at the beginning of this article.

1) Does vitamin D prevent type 1 diabetes? Based on this study, the answer appears to be a clear yes. However, this is the first study of this kind. We need more studies that into account the effect of mutations in the VDR gene.

2) If so, is supplementation with vitamin D important? If we think in terms of supplementation with RDA levels of vitamin D or sufficient vitamin D to bring 25-hydroxyvitamin D into the optimal range, the answer is also a clear yes. However, there is no evidence from this study that higher doses of vitamin D provide additional benefits.

3) Who will benefit most from vitamin D supplementation? Based on this study, the children who will benefit the most from vitamin D supplementation are those who have a suboptimal vitamin D status and have a mutation in the VDR (vitamin D receptor) gene. To put this into perspective:

    • Up to 60% of children and adults in this country have suboptimal vitamin D levels.
    • The percentage of suboptimal vitamin D levels is highest for people who are obese, have pigmented skin, are institutionalized (eg, elderly in nursing homes), and/or live far from the equator.
    • Supplementation with a multivitamin containing the RDA for vitamin D reduces the risk of having suboptimal vitamin D status by 2.5 to 5-fold depending on the person’s ethnicity.
    • This study may be just the tip of the iceberg. The vitamin D receptor is also found on many other cells that control important biological functions.

Finally, if you are a parent or parent-to-be, you probably have several questions. Here are the ones I have New Parentsanticipated:

#1: Is my child at risk for developing type 1 diabetes? If you or a close family member has type 1 diabetes, you can assume your child is genetically predisposed to developing type 1 diabetes. Other factors that increase your child’s risk of developing type 1 diabetes are obesity, non-White ethnicity, and geographical location far from the equator.

#2: Should I have my baby tested for genetic predisposition to type 1 diabetes? That is not currently recommended. Just be aware of the risk factors listed above.

#3: Should I have my baby tested for VDR mutations? That is unnecessary. If your child has a VDR mutation, they just need sufficient vitamin D, not mega doses of vitamin D. And there are lots of other reasons for making sure your child gets sufficient vitamin D.

#4: How much vitamin D should my child be getting? The recommendation is 400 IU up to age 1 and 600 IU over age 1.

#5: Should I give my child vitamin D supplements? It is a good idea. For children over age 1, I recommend a multivitamin supplying 600 IU of vitamin D.

For infants, the American Association of Pediatrics recommends 400 IU vitamin D drops, regardless of whether the infants are breast or formula fed. That is because studies during the first year of life show that less than one-fifth of all infants get the recommended 400 IU/d from any source, and fewer than one out of 10 breast-fed infants meet the requirement – even if the mother is getting adequate vitamin D in their diet.

One Caution: I do not recommend exceeding 400 IU for infants or 600 IU for children unless directed by your health care provider. In terms of the risk of developing type 1 diabetes, your child needs sufficient vitamin D, and more is not better.

#6: Should I have my child tested for 25-hydroxyvitamin D levels? That is not done routinely at the present time. However, if your child has one or more of the risk factors listed above, it is a conversation you should have with your health care provider.

The Bottom Line

While it is widely accepted that vitamin D helps reduce the risk of developing type 1 diabetes in childhood, that has been difficult to prove. Clinical studies have provided conflicting results. The authors of a recent study postulated that the discrepancies between studies may have arisen because the studies neglected the effect of mutations in genes controlling vitamin D metabolism which may affect the ability of vitamin D to reduce the risk of developing type 1 diabetes.

This study found that:

1) Infants and children with optimal vitamin D status (25-hydroxyvitamin D levels ≥50 nmol/L) were 31-40% less likely to develop type 1 diabetes than children with suboptimal vitamin D status (25-hydroxyvitamin D = 30 to <50 nmol/L).

2) However, the effect of vitamin D on the risk of developing type 1 diabetes was only seen in children with one or more mutations in the VDR (vitamin D receptor) gene. To interpret this observation, you need to know that:

    • Type 1 diabetes is caused by an autoimmune attack on the pancreatic islet cells that release insulin.
    • 1,25-dihydroxyvitamin D promotes immune tolerance and decreases the risk of autoimmune responses.
    • 1,25-dihydroxyvitamin D exerts this effect by binding to the vitamin D receptor on the surface of immune cells.

3) Thus, mutations in the VDR gene modify the effect of vitamin D on the risk of developing type 1 diabetes. Specifically:

    • When the VDR gene is fully active, even suboptimal levels of vitamin D appear to be sufficient to prevent the development of type 1 diabetes in childhood.
    • However, when the VDR gene has mutations that reduce its activity, suboptimal levels of vitamin D no longer prevent type 1 diabetes. Optimal levels of vitamin D are required to reduce the risk of developing type 1 diabetes.

This is an example of genetics increasing the need for a nutrient (vitamin D) and increasing the need for supplementation to make sure that optimal levels of that nutrient are achieved.

While this study focused on the effect of vitamin D on the development of type 1 diabetes, this may just be the tip of the iceberg. The vitamin D receptor is also found on many other cells that control important biological functions.

For more details, read the article above. You will probably want to read the section “What Does This Mean For You?”, including my recommendations for parents of young children

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

Preparing For The New Normal

Can Supplements Strengthen My Immune System?

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

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

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

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

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

Preparing For The New Normal

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

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

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

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

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

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

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

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

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

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

  • Keep your immune system as strong as possible.

Why Is Keeping Your Immune System Strong Important?

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

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

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

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

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

Can Supplements Strengthen My Immune System?

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

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

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

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

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

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

They then made the following recommendations:

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

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

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

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

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

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

What Else Should I Do To Strengthen My Immune System?

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

1) It starts with a healthy diet.

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

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

3) Maintain a healthy weight.

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

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

The Bottom Line

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

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

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

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

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

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

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

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

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

Does Vitamin D Affect Muscle Strength?

Why Is Vitamin D Research So Controversial?

vitamin dMost people lose muscle strength as they age, something called sarcopenia. This is not a trivial matter. Loss of muscle mass:

  • Leads to loss of mobility. It can also make it difficult to do simple things like lifting your grandchild or carrying a bag of groceries.
  • Increases your risk of falling. This often leads to serious fracture which increases your of dying prematurely. In fact, bone fractures increase your risk of dying by 3-fold or more. Even in those who recover their mobility and quality of life may never be the same.
  • Lowers your metabolic rate. This increases your risk of obesity and all the diseases that are associated with obesity.

Loss of muscle strength as we age is preventable. There are several things we can do to preserve muscle strength as we age, but in today’s article I will focus on the effect of vitamin D on muscle strength.

What if something as simple as preventing vitamin D deficiency could improve muscle strength as we age? That idea has been around for a decade or more. But, for reasons I will detail below, it has proven controversial. Let me start by sharing the latest study on vitamin D and muscle strength (N Aspell et al, Clinical Investigations in Ageing, volume 2019:14, pages 1751-1761).

How Was The Study Done?

Clinical StudyThe data for this study came from 4157 adults who were enrolled in the English Longitudinal Study On Aging. Participants in this study were all over the age of 60 and were still living in their own homes. The general characteristics of the study population were:

  • Their average age was 69.8 with 45% male and 55% female.
  • While 76% of the participants rated their health as “good” or above
    • 73% were overweight or obese.
    • 54% had a longstanding disease that limited mobility.
    • 29% were taking multiple medications.

Serum 25-hydroxy vitamin D levels were determined as a measure of vitamin D status.

  • 22% of the participants were vitamin D deficient (<30 nmol/L 25-hydroxy vitamin D).
  • 34% of the participants were vitamin D insufficient (between 30 and 50 nmol/L 25-hydroxy vitamin D).
  • 46% of the participants had adequate vitamin D status (>50 nmol/L 25-hydroxy vitamin D).

Muscle strength was assessed by a handgrip strength test with the dominant hand. Muscle performance was assessed with something called the short physical performance battery (SPPB), consisting of a walking speed test, a repeated chair raise test, and a balance test.

Does Vitamin D Affect Muscle Strength?

When the data on handgrip strength were analyzed:

  • Only 22% of the participants who had adequate vitamin D status had low handgrip strength.
  • 40% of participants who were vitamin D deficient had low handgrip strength. That’s almost a 2-fold difference.
  • Handgrip strength increased linearly with vitamin D status.
    • The relationship between vitamin D status and handgrip strength was highly significant (p<001).
    • The beneficial effect of vitamin D status on handgrip strength plateaued at around 55-69 nmol/L 25-hydroxy vitamin D. In other words, you need adequate vitamin D status to support muscle strength, but higher levels provide no additional benefit.

When the data on muscle performance (the SPPB test) were analyzed:

  • Only 8% of the participants who had adequate vitamin D status scored low on this test.
  • 25% of participants who were vitamin D deficient scored low on this test. That’s a 3-fold difference.
  • Muscle performance also increased linearly with vitamin D status.
    • The relationship between vitamin D status and muscle performance was also highly significant (p<001).
    • The beneficial effect of vitamin D status on muscle performance also plateaued at around 55-69 nmol/L 25-hydroxy vitamin D.

The authors concluded: “Vitamin D deficiency was associated with impaired muscle strength and performance in a large study of community-dwelling older people. It is generally accepted that vitamin D deficiency should be reversed to prevent bone disease. This strategy may also protect skeletal muscle function in aging.”

Why Is Vitamin D Research So Controversial?

ArgumentYou can be forgiven if you are saying to yourself: “I’ve heard this sort of thing before. I see a blog or headline claiming that vitamin D has a certain benefit, but it’s usually followed by later headlines saying those claims are false. Why can’t the experts agree? Is all vitamin D research bogus?”

The relationship between vitamin D status and muscle strength is no different.

  • Most, but not all, studies looking at the association between vitamin D status and muscle strength find that vitamin D status affects muscle strength.
  • However, many randomized, placebo-controlled clinical trials looking at the effect of vitamin D supplementation on muscle strength have come up empty.

A meta-analysis (L Rejnmark, Therapeutic Advances in Chronic Disease, 2: 25-37, 2011) of randomized, placebo-controlled clinical trials of vitamin D supplementation and muscle strength provides insight as to why so many of them come up empty.

The meta-analysis combined data from 16 clinical trials. The conclusions were similar to what other meta-analyses have found:

  • Seven of the studies showed a benefit of vitamin D supplementation on muscle strength. Nine did not.
  • When the data from all 16 studies were combined, there was only a slight beneficial effect of vitamin D supplementation on muscle strength.

However, it was in the discussion that the reason for these discrepancies became apparent. There were three major deficiencies in study design that were responsible for the discrepancies.

1) There was a huge difference in study design.

    • The subjects were of different ages, genders, and ethnicities.
    • The dose of vitamin D supplementation varied.
    • Different measures of muscle strength and performance were used.

Until the scientific and medical community agree on a standardized study design it will be difficult to obtain consistent results.

While this deficiency explains the variation in outcomes from study to study, there are two other deficiencies in Garbage In Garbage Outstudy design that explain why many of the studies failed to find an effect of vitamin D on muscle strength. I call this “Garbage In, Garbage Out”. Simply put, if the study has design flaws, it may be incapable of detecting a positive effect of vitamin D on muscle strength.

2) Many of the studies did not measure vitamin D status of the participants at the beginning of the study.

    • The results of the study described above show that additional vitamin D will be of little benefit for anyone who starts the study with an adequate vitamin D status.
    • In the study above 46% of the participants had adequate vitamin D status. This is typical for the elderly community. When almost 50% of the participants in a study have adequate vitamin D status at the beginning of a study it becomes almost impossible to demonstrate a beneficial effect of vitamin D supplementation on any outcome.

It is essential that future studies of vitamin D supplementation start with participants who have low vitamin D status. Otherwise, you are almost guaranteeing a negative outcome.

3) Most of the studies ignored the fact that vitamin D status is only one of three factors that are essential for muscle strength.

    • In the case of muscle strength, especially in the elderly, the three essentials are vitamin D, protein, and exercise. All three are needed to maintain or increase muscle strength. Simply put, if one is missing, the other two will have little or no effect on muscle strength. Unfortunately, you cannot assume that exercise and protein intake are adequate in older Americans:
      • Many older adults don’t get enough exercise because of physical limitations.

Unfortunately, many clinical studies on the effect of vitamin D supplementation and muscle strength fail to include exercise and adequate protein intake in the study. Such clinical trials are doomed to failure.

Now you know why vitamin D research is so controversial. Until the scientific and medical community get their act together and perform better designed experiments, vitamin D research will continue to be controversial and confusing.

What Does This Mean For You?

Old Man Lifting WeightsLoss of muscle mass as we age is not a trivial matter. As described above, it:

  • Leads to loss of mobility.
  • Increases your risk of falling. This often leads to serious fracture which increase your risk of disability and death.
  • Lowers your metabolic rate, which increases your risk of obesity and obesity-related diseases.

So, what can you do prevent loss of muscle mass as you age? The answer is simple:

1) Aim for 25-30 grams of high-quality protein in each meal.

    • That protein can come from meat, fish, eggs, or legumes.
    • That doesn’t mean you need to consume an 8-ounce steak or a half chicken. 3-4 ounces is plenty.
    • However, it does mean you can’t subsist on green salads and leafy greens alone. They are healthy, but you need to include a good protein source if you are going to meet your protein needs.

2) Aim for 150 minutes of moderate intensity exercise per week.

    • At least half of that exercise should be resistance exercise (lifting weights, for example).
    • If you have physical limitations, consult your doctor and a physical therapist or personal trainer to design resistance exercises you can do.
    • Aim for a variety of resistance exercises. You will only strengthen the muscles you exercise.

3) Aim for an adequate vitamin D status.

    • Start with a multivitamin containing at least 800 IU of vitamin D3.
    • Because there is large variation in the efficiency with which we convert vitamin D to 25-hydroxy vitamin D, you should get your serum 25-hydroxyvitamin D tested on a yearly basis. Your health professional can tell you if you need to take larger amounts of vitamin D3.
    • This study suggests that a serum 25-hydroxy vitamin D level of 55-69 nmol/L is optimal, and higher levels provide no additional benefit. That means there is no need to take mega-doses of vitamin D3 unless directed by your health professional.

The Bottom Line

A recent study looked at the effect of vitamin D status on muscle strength and performance in a healthy population with an average age of 69.

When they looked at handgrip strength:

  • Only 22% of the participants with an adequate vitamin D status had low handgrip strength.
  • 40% of participants who were vitamin D deficient had low handgrip strength. That’s almost a 2-fold difference.
  • Handgrip strength increased linearly with vitamin D status.

When they looked at muscle performance:

  • Only 8% of the participants with an adequate vitamin D status scored low on this test.
  • 25% of participants who were vitamin D deficient scored low on this test. That’s a 3-fold difference.
  • Muscle performance also increased linearly with vitamin D status.

The authors concluded: “Vitamin D deficiency was associated with impaired muscle strength and performance in a large study of community-dwelling older people. It is generally accepted that vitamin D deficiency should be reversed to prevent bone disease. This strategy may also protect skeletal muscle function in aging.”

If we look at the research more broadly, there are three factors that are essential for maintaining muscle mass as we age: exercise, protein, and vitamin D. Therefore, my recommendations are to:

1)  Aim for 25-30 grams of high-quality protein in each meal.

2) Aim for 150 minutes of moderate intensity exercise per week. At least half of that exercise should be resistance exercise.

3) Aim for an adequate vitamin D status (>50 nmol/L of serum 25-hydroxy vitamin D). A good place to start is with a multivitamin providing at least 800 IU of vitamin D3.

For more details on my recommendations and a discussion of why studies on vitamin D supplementation are often confusing, 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.

 

The Effect Of Vitamin D On Childhood Development

Is Vitamin D Important During Pregnancy?

vitamin dIf you are parents, you want the best for your child. It can be nerve wracking when your child doesn’t meet the expected developmental milestones. When I saw a recent study titled “Association of maternal vitamin D status in pregnancy and neurodevelopmental outcomes in children” ( AL Darling et al, British Journal of Nutrition, 117: 1682-1692, 2017), I knew you would want to hear about it.

But first a bit of background: Based on blood 25-hydroxy vitamin D levels (considered the most accurate marker of vitamin D status):

  • 8-11% of pregnant women in the US are deficient in vitamin D (<30 nmol/L).
  • ~25% of pregnant women have inadequate vitamin D status (30-49 nmol/L).
  • ~65% of pregnant women have adequate vitamin D status (50-125 nmol/L).
  • ~ 1% of pregnant women have high vitamin D levels (>125 nmol/L).

In short, that means around 1/3 of pregnant women in the US have inadequate or deficient levels of vitamin D. The affect of inadequate vitamin D during pregnancy is not just an academic question.

It is a concern because inadequate vitamin D levels during pregnancy has been associated with gestational diabetes (diabetes during pregnancy), low birthweight babies, and a condition called pre-eclampsia (pre-eclampsia is characterized by the development of high blood pressure during pregnancy and can lead to serious, even fatal, complications for mother and baby).

The Cochrane Collaboration (considered the gold standard for evidence-based medicine) has recently reviewed the literature and has reported) that vitamin D during pregnancy “probably reduces the risk of pre-eclampsia, gestational diabetes, and the risk of having a low birthweight baby compared to placebo or no intervention.”

In short, this means the evidence is pretty good that inadequate vitamin D increases the risk of significant complications during pregnancy and that supplementation with vitamin D reduces the risk of those complications.

However, what about the effect of inadequate vitamin D during pregnancy on the development of the newborn child? Here the evidence is less clear. This study was designed to answer that question.

How Was The Study Designed?

clinical studyThis study followed neurodevelopmental milestones of 7065 children born to mothers in the Avon region of southwest England between April 1, 1991 and December 31, 1992. Maternal 25-hydroxy vitamin D levels were measured during pregnancy. The distribution of 25-hydroxy vitamin D levels in this population was very similar to that observed for pregnant mothers in the United States.

The children were followed from 6 months to 9 years of age and the following neurodevelopmental milestones were measured:

  • Gross-motor skills, fine-motor skills, social development, and communication skills were measured at 6, 18, 30, and 42 months.
  • Behavioral development (socialization, hyperactivity, emotional development, and conduct) was measured at 7 years.
  • IQ was measured at 8 years.
  • Reading skill (words/minute, accuracy, and comprehension) was measured at 9 years.

What Is The Effect Of Vitamin D On Childhood Development?

Child raising handThe study compared children of women who had inadequate vitamin D status (<50 nmol/L) during pregnancy to children of women who had adequate vitamin D status (≥50 nmol/L) during pregnancy. Here is what the study found:

The children of mothers with inadequate vitamin D during pregnancy had:

  • Delayed gross-motor skills at 18 and 30 months.
  • Delayed fine-motor skills at 30 and 42 months.
  • Delayed social development at 42 months.

However, when they looked at later years, there was no significant effect of maternal vitamin D status on:

  • Behavioral development at 7 years.
  • IQ at 8 years.
  • Reading skills at 9 years.

This is encouraging because it suggests that the effect of inadequate vitamin D during pregnancy does not have a permanent effect on childhood development. By the time they are 7 or older their nutrition and intellectual stimulation during childhood appears to outweigh the effect of their mother’s nutrition on their development.

In interpreting this information, we need to keep in mind that this study was performed in England, not in a third world country. In particular:

  • England, like the United States, has supplemental food programs for disadvantaged children.
  • England has an excellent educational system. So, we can assume these children also received intellectual stimulation as soon as they reached school age.

Is Vitamin D Important During Pregnancy?

pregnant women taking vitaminIf we focus on a healthy pregnancy, there is good evidence that inadequate vitamin D during pregnancy increases the risk of serious complications and that supplementation with vitamin D can reduce these complications. We also know that vitamin D deficiency during pregnancy can affect bone development in the newborn.

Thus, adequate vitamin D is clearly needed for a healthy pregnancy.

However, if we just consider the effect of maternal vitamin D on childhood development, it would be tempting to downplay the importance of vitamin D during pregnancy. This study focused on vitamin D, but studies focusing on other nutritional deficiencies usually give similar results.

In most of these studies, the effects of inadequate nutrition during pregnancy on childhood developmental milestones appear to be transient. Developmental delays are seen during the first few years of life but disappear as the children get older.

This is incredibly good news. It means that mild nutritional deficiencies during pregnancy do not have to handicap a child for life. If the children are given adequate nutrition and intellectual stimulation as they grow, the poor start they received in life can be erased.

It is also a caution. We already know that poor nutrition during childhood can affect a child’s behavior and intellectual development. If that child also received poor nutrition in the womb, their chances of normal childhood development may be doubly impacted.

In short, if adequate vitamin D during pregnancy improves early developmental milestones in children, that can be viewed as an added benefit.

The only question is how much vitamin D is needed. Fortunately, the present study cast some light on that question.

The study asked whether blood levels of 25-hydroxy vitamin D ≥75 nmol/L were more beneficial than blood levels ≥50 nmol/L. The answer was a clear no. That means an adequate vitamin D status during pregnancy is sufficient to support normal developmental milestones in children.

The current recommendation (DV) of vitamin D3 for pregnant women is 15 mcg (600 IU). Thus, my recommendations are:

  • If you are pregnant, be sure that your prenatal supplement provides at least 600 IU of vitamin D3.
  • If you are a woman of childbearing age, be sure that your multivitamin provides at least 600 IU of vitamin D3.
  • Slightly more is OK but avoid mega doses unless prescribed by a health professional who is monitoring your 25-hydroxy vitamin D status.
  • Because we all utilize vitamin D with different efficiencies, I would recommend asking for a 25-hydroxy vitamin D test and working with your health professional to keep your levels in the adequate range.

The Bottom Line

A recent study looked at the effect of mild vitamin D deficiency during pregnancy on childhood developmental milestones. The study found that children born to vitamin D-deficient mothers had:

  • Delayed gross-motor skills at 18 and 30 months.
  • Delayed fine-motor skills at 30 and 42 months.
  • Delayed social development at 42 months.

This is concerning. However, when they looked at later years, there was no significant effect of maternal vitamin D status on:

  • Behavioral development at 7 years.
  • IQ at 8 years.
  • Reading skills at 9 years.

The is encouraging. The reasons for this are discussed in the article above.

If we summarize this and previous studies, the bottom line is:

  • Adequate vitamin D is clearly needed for a healthy pregnancy.
  • If adequate vitamin D during pregnancy improves early developmental milestones in children, that can be viewed as an added benefit.

For more details and my recommendations on how much vitamin D you need, read the article above.

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

Preventing And Reversing Osteoporosis

A Bone Health Lifestyle

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

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

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

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

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

https://disaster.salvationarmyusa.org

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

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

Preventing And Reversing Osteoporosis

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

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

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

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

A Bone Healthy Lifestyle

A Bone Healthy Lifestyle
A Bone Healthy Lifestyle

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

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

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

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

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

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

Can Supplements Help You Live Longer?

Are Supplements The Fountain Of Youth?

Author: Dr. Stephen Chaney

 

It is buyer beware in the supplement industry. I have discussed the dark side of the supplement industry in the first half of my book “Slaying The Supplement Myths.”

I called that section of my book “The Lies of the Charlatans.”  In it, I detailed many of the false claims that some manufacturers make for their supplements. There are claims that their supplements will…

  • Cure what ails you (Just fill in the disease of your choice. Some company will try to tell you they have the cure).
  • Make the pounds melt away.
  • Make you smarter.
  • Make you stronger.
  • Improve your sex life.

Can supplements help you live longer?

The list seems endless…Except for one! I don’t know of any supplement company claiming their supplements make you live longer. Nobody is claiming their supplements are the “Fountain of Youth.”

However, many of you have been asking me about headlines claiming that a recent study showed that supplements don’t extend lives. Could it be that the study generating the recent headlines was designed to disprove a claim nobody was making?

In this issue of “Health Tips From The Professor” I will analyze the study and answer two questions:

  • Is it true?
  • Is it important?

How Was The Study Done?

Every few years the National Center for Health Statistics (a division of the CDC) conducts a massive survey of factors affecting the health of the American population. This survey is called the National Health and Nutrition Examination Survey (NHANES). The NHANES survey includes interviews and examinations of thousands of people across the country.

The interview includes dietary, health-related, demographic, and socioeconomic questions. The examination component includes laboratory tests plus medical, dental, and physiological measurements. The NHANES database is used for many studies such as this one.

The current study (F Chen et al, Annals of Internal Medicine, doi:10.7326/M18-2478, published April 9, 2019) used data from 30,899 US adults aged 20 years or more who participated in 6 cycles of the NHANES survey from 1999 to 2010. The dietary portion of the survey taken by these participants contained questions on the dietary supplements they had used in the 30 days prior to the survey.

The NHANES data were linked to the National Death Index mortality data so that the effect of nutrient intake and supplement use on mortality could be assessed. The median follow-up for the participants in the study was 6.1 years. During that time, 3613 deaths occurred, 945 from heart disease and 805 from cancer.

Of the participants:

  • 71% were white, 11% were non-Hispanic black, and 13% were Hispanic.
  • 9% were female, 49.1% were male.
  • 2 % of the participants reported supplement use in the 30 days preceding the survey.
  • Among the supplement users, the major supplements reported were:
    • Multivitamin/multimineral (74.8%).
    • Vitamin C (40.3%).
    • Calcium (38.6%).
    • Vitamin D (37.6%).
    • Zinc (34.5%).
    • Magnesium (33.3%).

When they compared supplement users with non-supplement users, the supplement users were:

  • More likely to be female and non-Hispanic white.
  • Have higher levels of family education and income.
  • Eat a healthier diet and be more physically active.
  • Less likely to be current smokers, heavy drinkers, or obese.

These are all factors that favor a longer lifespan.  However, the supplement users were also:

  • Older (average age = 50.7 versus 42.8 for non-supplement users).
  • Sicker (They were more likely to have cancer, heart disease, diabetes, high blood pressure, and high cholesterol levels).

These are factors that favor a shorter lifespan.

These are what statisticians refer to as confounding variables. They can influence the results of a study in unexpected ways.

 

Can Supplements Help You Live Longer?

When they looked at the raw data, supplemental use of most-individual nutrients was associated with a lower risk for all-cause death. In simple terms, supplementation appeared to increase lifespan.

However, when the data were statistically adjusted for all of the confounding variables (age, sex, race/ethnicity, education, physical activity, smoking, alcohol intake, diet quality, BMI [a measure of obesity], and diseases the participants had when they entered the study), the effect of supplementation on lifespan became non-significant.

The authors concluded: “Use of dietary supplements was not associated with mortality benefits among a nationally representative sample of U.S adults.”  Those are the headlines you saw from your favorite news source.

What Does This Study Mean For You?

Let’s go back to the two questions I posed about the study at the beginning of this article.

  • Is it true? Can supplements help you live longer?  The study had many weaknesses, which the authors identified in their discussion. Of course, the people writing the headlines never bothered to read the paper, so they were unaware of its weaknesses. Here are some of the major weaknesses reported by the authors:
  • The NHANES questionnaire only asked about supplement use over the preceding 30 days. We have no idea how long the participants had been using those supplements. It could have been years, or it could have been a month. In the words of the authors: “Dietary supplement use was assessed in the previous 30 days, which may not reflect habitual use or capture changes in use [before or] after the baseline assessment.”
  • The supplement users were more likely to have been diagnosed with health conditions such as cancer, heart disease, diabetes, and high blood pressure. It is well documented that diagnosed health conditions motivate some people to initiate supplement use.
  • Finally, there were multiple confounding variables in this study. The conclusion of the study rested on a statistical adjustment of the data to correct for those confounding variables. In the words of the authors: “Residual confounding may still be present.”

That last point reminds me of the famous Mark Twain quote: “There are lies. There are damn lies. And then there are statistics.” Don’t misunderstand me. I am not accusing the study authors of lying. They are some of the top scientists in the field. What Mark Twain and I are saying is that when you rely on statistics, sometimes bad things happen. You can come to erroneous conclusions.

  • Is it important? Even if the conclusion of this study is true, we should ask if it is important. If there had been widespread claims that supplements make you live longer, this would be an important finding. However, nobody I know is making that claim. This study simply reaffirms what most people assumed anyway. There is no fountain of youth.

By the way, the situation is similar for diets. There have been a few claims in the past that healthy diets will help you live longer. However, when those claims have been rigorously evaluated, there is very little effect of diet on lifespan. There have been some studies that have reported a decrease in premature death due to heart disease or cancer. However, death from all causes usually remains unchanged. Once again, the fountain of youth has eluded us.

You may be asking, if supplements don’t increase lifespan, what good are they? The answer is simple. They increase healthspan. Simply put, that means you spend a greater portion of your lifespan in good health.

Of course, now you are probably really confused. You’ve read all those headlines saying that supplements don’t have any effect on your health. The problem is that the studies generating those headlines are flawed. They aren’t asking the right questions. When you look at populations with poor diets, increased needs, genetic predisposition, and/or pre-existing disease, supplementation is often beneficial. I cover this in the second half of my book, “Slaying the Supplement Myths.”  That section is called “The Myths Of The Naysayers.”

 

The Bottom Line

 

A recent study reported that supplements do not reduce mortality. They won’t make you live longer. In this article I provide a detailed analysis of that article. The two important take-aways are:

  • There are several weaknesses in the study. The conclusion may not be accurate.
  • Even if it is accurate, it may not be important. If there had been widespread claims that supplements make you live longer, this would be an important finding. However, nobody I know is making that claim. This study simply reaffirms what most people assumed anyway. There is no fountain of youth. Could it be that the study generating the recent headlines was designed to disprove a claim nobody was making?

The real benefit of supplementation isn’t in increasing your lifespan. It is increasing your healthspan. I cover that in my book, “Slaying The Supplement Myths.”

For more details read the article above.

 

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

Do You Need Supplements?

Supplements As Part of a Holistic Lifestyle

Author: Dr. Stephen Chaney

 

do you need supplementsDo you need supplements?

The headlines about supplementation are so confusing. Are they useful, or are they a waste of money? Will they cure you, or will they kill you? I feel your pain.

I will answer these questions in depth in my upcoming book, but let me give you a quick overview today. I call it: “Do You Need Supplements?” I created the graphic on the left to illustrate why I feel responsible supplementation is important for most Americans. Let me give you specific examples for each of these categories.

 

Examples of Poor Diet

do you need supplements dietDo you need supplements if you have a poor diet? You have heard the saying that supplementation fills in the nutritional gaps in our diets.  So what are the nutritional gaps? According to the USDA’s 2015-2020 Dietary Guidelines for Americans, many Americans are consuming too much fast and convenience foods. Consequently, we are getting inadequate amounts of calcium, magnesium, and vitamins A, D, E and C. Iron is also considered a nutrient of concern for young children and pregnant women. According to a recent study, regular use of a multivitamin is sufficient to eliminate all these deficiencies except for calcium, magnesium and vitamin D (J.B. Blumberg et al, Nutrients, 9(8): doi: 10.3390/nu9080849, 2017 ). A well-designed calcium, magnesium and vitamin D supplement may be needed to eliminate those deficiencies.

In addition, intake of omega-3 fatty acids from foods appears to be inadequate in this country. Recent studies have found that American’s blood levels of omega-3s are among the lowest in the world and only half of the recommended level for reducing the risk of heart disease (K.D. Stark et al, Progress In Lipid Research, 63: 132-152, 2016 ;S.V. Thuppal et al, Nutrients, 9, 930: doi: 10.3390/nu9090930, 2017 ). Therefore, omega-3 supplementation is often a good idea.

In previous editions of “Health Tips From the Professor” I have talked about our “mighty microbiome”, the bacteria and other microorganisms in our intestine. These intestinal bacteria can affect our tendency to gain weight, our immune system, inflammatory diseases, chronic diseases such as diabetes, cancer, and heart diseases, our mood—the list goes on and on. This is an emerging science. We are learning more every day, but for now it appears our best chances for creating a health-enhancing microbiome are to consume a primarily plant-based diet and take a probiotic supplement.

Finally, diets that eliminate whole food groups create nutritional deficiencies. For example, vegan diets increase the risk of deficiencies in vitamin B12, vitamin D, calcium, iron, zinc and long chain omega-3 fatty acids.  A recent study reported that the Paleo diet increased the risk of calcium, magnesium, iodine, thiamin, riboflavin, folate and vitamin D deficiency (A. Genomi et al, Nutrients, 8, 314; doi: 10.3390/nu8050314, 2016. The Keto diet is even more restrictive and is likely to create additional deficiencies.

 

Examples of Increased Need

do you need supplements increasedDo you need supplements if you have an increased need?  We have known for years that pregnancy and lactation increase nutritional requirements. In addition, seniors have increased needs for protein, calcium, vitamin D and vitamin B12. In previous issues of “Health Tips From the Professor” I have also shared recent studies showing that protein requirements are increased with exercise.

Common medications also increase our need for specific nutrients. For example, seizure medications can increase your need for vitamin D and calcium. Drugs to treat diabetes and acid reflux can increase your need for vitamin B12. Other drugs increase your need for vitamin B6, folic acid, and vitamin K. Excess alcohol consumption increases your need for thiamin, folic acid, and vitamin B6. These are just a few examples.

Vitamin D is a special case. Many people with apparently adequate intake of vitamin D have low blood levels of 25-hydroxy vitamin D. It is a good idea to have your blood 25-hydroxy vitamin D levels measured on an annual basis and supplement with vitamin D if they are low.

More worrisome is the fact that we live in an increasing polluted world and some of these pollutants may increase our needs for certain nutrients. For example, in a recent edition of “Health Tips From the Professor” I shared a study reporting that exposure to pesticides during pregnancy increases the risk of giving birth to children who will develop autism, and that supplementation with folic acid during pregnancy reduces the effect of pesticides on autism risk. I do wish to acknowledge that this is a developing area of research. This and similar studies require confirmation. It is, however, a reminder that there may be factors beyond our control that have the potential to increase our nutritional needs.

 

Examples of Genetics Influencing Nutritional Needs

do you need supplements geneticsDo you need supplements if your genetics call for specific nutritional needs?  The effect of genetic variation on nutritional needs is known as nutrigenomics. One of the best-known examples of nutrigenomics is genetic variation in the methylenetetrahydrofolate reductase (MTHFR) gene.  MTHFR gene mutations increase the risk of certain birth defects, such as neural tube defects. MTHFR mutations also slightly increase the requirement for folic acid. A combination of food fortification and supplementation with folic acid have substantially decreased the prevalence of neural tube defects in the US population. This is one of the great success stories of nutrigenomics. Parenthetically, there is no evidence that methylfolate decreases the risk of neural tube defects.

Let me give you a couple of additional examples:

One of them has to do with vitamin E and heart disease (A.P. Levy et al, Diabetes Care, 27: 2767, 2004 ). Like a lot of other studies, there was no significant effect of vitamin E on cardiovascular risk in the general population. But there is a genetic variation in the haptoglobin gene that influences cardiovascular risk. The haptoglobin 2-2 genotype increases oxidative damage to the arterial wall, which significantly increases the risk of cardiovascular disease. When the authors of this study looked at the effect of vitamin E in people with this genotype, they found that it significantly decreased heart attacks and cardiovascular deaths.

This has been confirmed by a second study specifically designed to look at vitamin E supplementation in that population group (F. Micheletta et al, Arteriosclerosis, Thrombosis and Vascular Biology, 24: 136, 2008 ). This is an example of a high-risk group benefiting from supplementation, but in this case the high risk is based on genetic variation.

Let’s look at soy and heart disease as a final example. There was a study called the ISOHEART study (W.L. Hall et al, American Journal of Clinical Nutrition, 82: 1260-1268, 2005 ; W.L. Hall et al, American Journal of Clinical Nutrition, 83: 592-600, 2006 ) that looked at a genetic variation in the estrogen receptor which increases inflammation and decreases levels of HDL. As you might expect, this genotype significantly increases cardiovascular risk.

Soy isoflavones significantly decrease inflammation and increase HDL levels in this population group. But they have no effect on inflammation or HDL levels in people with other genotypes affecting the estrogen reception. So, it turns out that soy has beneficial effects, but only in the population that’s at greatest risk of cardiovascular disease, and that increased risk is based on genetic variation.

These examples are just the “tip of the iceberg.” Nutrigenomics is an emerging science. New examples of genetic variations that affect the need for specific nutrients are being reported on a regular basis. We are not ready to start genotyping people yet. We don’t yet know enough to design a simple genetic test to predict our unique nutritional needs. That science is 10-20 years in the future, but this is something that’s coming down the road.

What the current studies tell us is that some people are high-risk because of their genetic makeup, and these are people for whom supplementation is going to make a significant difference. However, because genetic testing is not yet routine, most people are completely unaware that they might be at increased risk of disease or have increased nutritional requirements because of their genetic makeup.

 

Examples of Disease Influencing Nutritional Needs

do you need supplements diseaseFinally, let’s consider the effect of disease on our nutritional needs. Do you need supplements because of disease?  If you look at the popular literature, much has been written about the effect of stress on our nutritional needs. In most cases, the authors are referring to psychological stress. In fact, psychological stress has relatively minor effects on our nutritional needs.

Metabolic stress, on the other hand, has major effects on our nutritional needs. Metabolic stress occurs when our body is struggling to overcome disease, recover from surgery, or recover from trauma. When your body is under metabolic stress, it is important to make sure your nutritional status is optimal.

The effects of surgery and trauma on nutritional needs are well documented. In my upcoming book, I will discuss the effects of disease on nutritional needs in some detail. Let me give you a brief overview here. It is very difficult to show beneficial effects of supplementation in a healthy population (primary prevention). However, when you look at populations that already have a disease, or are at high risk for disease, (secondary prevention), the benefits of supplementation are often evident.

For example, studies suggest that vitamin E, B vitamins, and omega-3s each may reduce heart disease risk, but only in high-risk populations. Similarly, B vitamins (folic acid, B6 and B12) appear to reduce breast cancer risk in high risk populations.

 

Do You Need Supplements?

 

With this information in mind, let’s return to the question: Do you need supplements? Here is my perspective.

  • The need for supplementation is greatest when these circles overlap, as they do for most Americans.
  • The problem is that while most of us are aware that our diets are not what they should be, we are unaware of our increased needs and/or genetic predisposition. We are also often unaware that we are at high risk of disease. For too many Americans the first indication they have heart disease is sudden death, the first indication of high blood pressure is a stroke, or the first indication of cancer is a diagnosis of stage 3 or 4 cancer.

So, let’s step back and view the whole picture. The overlapping circles are drawn that way to make a point. A poor diet doesn’t necessarily mean you have to supplement. However, when a poor diet overlaps with increased need, genetic predisposition, disease, or metabolic stress, supplementation is likely to be beneficial. The more overlapping circles you have, the greater the likely benefit you will derive from supplementation.

That is why I feel supplementation should be included along with diet, exercise, and weight control as part of a holistic approach to better health.

So, do you need supplements?

 

The Bottom Line

 

In this article I provide a perspective on who needs supplementation and why. There are four reasons to supplement.

  • Fill nutritional gaps in our diet
  • Meet increased nutritional needs due to pregnancy, lactation, age, exercise, many common medications, and environmental pollutants.
  • Compensate for genetic variations that affect nutritional needs.
  • Overcome needs imposed by metabolic stress due to trauma, surgery, or disease.

With this information in mind, let’s return to the question: “Do you need supplements? Here is my perspective.

  • A poor diet alone doesn’t necessarily mean you have to supplement. However, when a poor diet overlaps with increased need, genetic predisposition, or metabolic stress, supplementation is likely to be beneficial. The more overlap you have, the greater the likely benefit you will derive from supplementation.
  • The problem is that while most of us are aware that our diets are not what they should be, we are unaware of our increased needs and/or genetic predisposition. We are also often unaware that we are at high risk of disease. For too many Americans the first indication they have heart disease is sudden death, the first indication of high blood pressure is a stroke, or the first indication of cancer is a diagnosis of stage 3 or 4 cancer.

For more details, read the article above.

 

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

Is The Jellyfish Memory Supplement A Hoax

Are The Claims Too Good To Be True?

Author: Dr. Stephen Chaney

jellyfish memory supplementDid another phony nutritional supplement, the jellyfish memory supplement, just bite the dust? You’ve seen the TV ads reminding us that our memory starts to fade as we age. You’ve heard the claims about a protein derived from a jellyfish improving your memory. You’ve seen graphs summarizing a clinical study proving the product works. It all sounds so compelling. Are those claims too good to be true? According to the FTC and the New York Attorney General’s Consumer Protection Division, the answer is yes.

Is The Jellyfish Memory Supplement A Hoax?

On January 9th 2017, the FTC and the New York Attorney General’s office sued the makers of the “jellyfish memory supplement,” accusing the company of making false and unsubstantiated claims that the product improves memory, provides cognitive benefits, and is “clinically shown” to work.The FTC complaint alleged that the marketers relied on a study that failed to show that their product works better ftcthan a placebo on any measure of cognitive function. In their joint press release the FTC said “The marketers of [the jellyfish supplement] preyed on the fears of older consumers experiencing age-related memory loss. But one critical thing these marketers forgot is that their claims need to be backed up by real scientific evidence.” The New York Attorney General said “The marketing for [the jellyfish supplement] is a clear-cut fraud, from the label on the bottle to the ads airing across the country. It’s particularly unacceptable that this company has targeted vulnerable citizens like seniors in its advertising for a product that costs more than a week’s groceries, but provides none of the health benefits that it claims.”

Why Were The Clinical Study Results So Misleading?

clinical studyI am a strong supporter for innovation in supplement development. However, innovative products should be backed up by published clinical studies showing significant benefit before being marketed to the public. Unfortunately, the clinical study cited for the “jellyfish memory supplement” does not meet this standard.

  • The study has not been published in a peer-reviewed scientific journal. That means the study has not been independently reviewed by anyone not associated with the manufacturer.
  • When you actually analyze the data, it turns out that the improvement in memory was inconsistent from subject to subject, and the overall results were not statistically significant.
  • The graph shown on TV shows a 20% improvement in memory in just 90 days. In fact, that degree of improvement was only experienced by a very small subset of users. Most users experienced either no improvement or an insignificant 5-10% improvement. The graph the company used to market their product was clearly misleading.

Why Was The Scientific Rationale For The Product So Misleading?

misleading studyApoaequorin, the jellyfish protein in question, is a calcium binding protein. The manufacturer claims that it improves calcium balance in the body, which improves brain function. There are numerous fallacies in that model. For example:

  • Apoaequorin is not found in humans. In fact, the manufacturer does not even use the protein found in jellyfish. They use a synthetic version produced through genetic engineering.
  • Calcium balance is very tightly regulated in the human body. There is no evidence that the addition of apoaequorin, or any other calcium binding protein, improves calcium balance or brain function in humans.
  • Proteins do not enter our bloodstream intact. They have to be degraded to individual amino acids before they can be absorbed. That means when you take a pill containing apoaequorin protein, all you get is a release of amino acids into your bloodstream.
  • Finally, even if you were magically able to get apoaequorin protein into your bloodstream, it couldn’t cross the blood-brain barrier. The only reliable means of getting proteins into the brain is by cranial injection, and I don’t think anyone is going to be doing that for mild cognitive impairment.

The emperor has no clothes! Don’t get me wrong. As someone who is moving into my “golden years,” I would love to see this product succeed. I would love for them to produce clinical evidence that their product makes a statistically significant improvement in memory. I would love for the data to be good enough that it could be published in a peer reviewed journal. I would love for the jellyfish memory supplement to be legitimate. However, I suspect the FTC will win this one. I suspect another bogus product is about to bite the dust.

What Does This Mean For You?

This is just one of many examples of supplements that have first rate marketing, but second rate science. As a consumer, you need to be eternally vigilant. Unfortunately, most of you are not scientists, so it is very difficult for you to evaluate the claims. The FDA does it’s best to shut down products that are dangerous to your health. The FTC does it’s best to shut down products that make unfounded claims. I will do my best to warn you about about bogus products. However, none of us can keep up with all the dangerous and bogus products that flood the marketplace. At the end of the day, your best defense is to remember that famous quote “If it sounds too good to be true…” The jellyfish memory supplement sounds too good to be true.

The Bottom Line

  • The FTC and New York Attorney General have sued the manufacturers of the “jellyfish memory supplement” that has been so widely advertised on TV. The FTC alleges that the claims for that product are “false and unsubstantiated.”
  • The clinical study cited by the manufacturer was flawed because:
    • The results had not been published in a peer reviewed scientific journal. That means the study has not been independently reviewed by anyone not associated with the manufacturer.
    • The results were not statistically significant.
  • The scientific rationale for the product was flawed because:
    • The “jellyfish protein” is not found in humans. In fact, the manufacturer does not even use the protein found in jellyfish. They use a synthetic version produced through genetic engineering.
    • Proteins must be degraded to individual amino acids before they can be absorbed into the bloodstream. That means when you take a pill containing “jellyfish protein”, all you get is a release of amino acids into your bloodstream.
  • Even if you were magically able to get the protein into your bloodstream, it couldn’t cross the blood-brain barrier. The only reliable means of getting proteins into the brain is by cranial injection, and I don’t think anyone is going to be doing that for mild cognitive impairment.
  • I will do my best to alert you about bogus supplements. The FDA and FTC will do their best to protect you. However, none of us can keep up with all the dangerous and bogus products that flood the marketplace. At the end of the day, your best defense is to remember that famous quote “If it sounds too good to be true…”

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.

Deceptive Food Labels

What The Food And Supplement Industries Don’t Want You To Know

Author: Dr. Stephen Chaney

 

deceptive food labelsHealthy Eating Is In. We are told we need more fiber, whole grains, fruits & vegetables, nuts and omega-3s in our diet. We are being told that we should be eating “super foods” we’ve never heard of because of their amazing health benefits. As a consequence, more and more Americans are reading labels to be sure that the foods and supplements they are buying are healthy.  We trust the FDA and others not to allow us to be had by deceptive food labels.

But what if those food labels were deceptive? What if the food labels were more about marketing than about real health benefits? Is it possible that BIG FOOD Inc. and the supplement industry could actually be lying to us? Could it be that the manufacturers care more about their profits than about our health?

Deceptive Food Labels? 

Vegetable & Fruit Follies In The Supermarket

Everyone knows that fruits and vegetables are good for us. They are chock-full of vitamins, minerals, and phytonutrients as well as fiber. But who wants to spend the time peeling an orange or washing the pesticides off that broccoli? It’s much more fun to get our fruits and vegetables from chips, pasta, and breakfast cereals.

companies that use deceptive food labelsFood manufacturers are only too happy to oblige. The chemical companies make a variety of fruit and vegetable powders that food manufacturers can add to their products. For example, Powder Pure tells food manufacturers “Whether you want to add nutrition to your label, infuse full color, or formulate a specific flavor profile for your discerning consumers, Powder Pure has the right powder to enhance your presence in the marketplace.”  You will notice they are talking about adding nutrition to the label, not to the food. They are talking about “enhancing your presence in the marketplace,” not making your food healthier.

The problem is that sprinkling a little fruit and vegetable powder into a processed food will never provide the full range of nutrients that those fruits and vegetables would have provided.

Most manufacturers can’t (or won’t) specify the amounts of nutrients and phytonutrients you get from the fruit & vegetable powders they add to their processed foods, but that doesn’t stop them from making label claims like “We pop a flavorful blend of nine veggies…[in our chips]” or there is “half serving of vegetables in a 2 oz serving…[of our pasta].”  Is this using deceptive food labels?

The Fruits & Vegetables in a Capsule Con

One of my pet peeves is the food supplement manufacturers who try to tell you that they have concentrated a cornucopia of fresh fruits and vegetables in a capsule. For example, one company claims that their capsules contain apple, barley, broccoli, beet, cabbage, carrot, cranberry, date, garlic, kale, oats, orange, parsley, peach, pineapple, prunes, spinach, plant enzymes, fiber, and acidophilus.  All this in one capsule!  Does that sound like the use of deceptive food labels?

While this list sounds impressive, you need to ask whether they are providing meaningful amounts of those fruits and vegetables.  For example, the product claims to have oats.  A serving of oats is equal to 1/3 cup dry oats and weighs about 28 grams.  A capsule typically weighs about 0. 5 grams. Therefore, to get the equivalent of one serving of oats from a capsule, you would have to consume 56 capsules!  And that’s assuming that the entire capsule was filled with oats.

Broccoli is another claimed ingredient.  A serving of fresh broccoli weighs 88 grams, but roughly 80 grams of that is water.  So if you dehydrated the broccoli you would be left with about 8 grams of material. Therefore, to get a single serving of dehydrated broccoli you would have to consume 16 capsules. Again, that’s assuming that the capsules were completely filled with just broccoli.

You can do this kind of calculation with each ingredient they claim is in their capsules.  But when you add up the number of capsules needed to get a reasonable amount of each of these ingredients, the capsule total is staggering.

deceptive food labels marketingAs for essential nutrients, when you read the labels on some of these products you discover that their capsules only contain small amounts of a few essential nutrients. They simply do not provide significant amounts of the vitamins, minerals, and phytonutrients you would have been getting if you ate the real foods.

On the other hand, if the label does list significant amounts of the essential nutrients, that’s usually because purified vitamins and minerals have been added to the final product. Those products are no different from any other multivitamin supplement except that they contain insignificant quantities of fruit and vegetable powders that provide no additional health benefits. Once again, it’s all about using deceptive food labels marketing, not your good health.

Faux Protein Supplements

The same deceptive marketing practices have also entered the lucrative protein supplement marketplace. You are being told about protein products that are full of fruits & vegetables, super foods and herbs. It all sounds wonderful, but once again it is all smoke and mirrors. These companies are just mixing a little fruit and vegetable powders in with their protein powder.

You are being told that these products contain dozens of fruits and vegetables that provide vitamins and antioxidants in their natural form. However, when you read the label it is obvious that many of the vitamins and minerals in that product never saw a fruit or vegetable. They were synthesized in a chemical laboratory and added to the final product along with the fruit and vegetable powders.

You are being told that these products contain super foods that provide important phytonutrients, but none of those phytonutrients is present in sufficient quantities to be featured on the nutrition label. You are told that these products contain herbal ingredients with amazing healing powers, but none of the active ingredients of the claimed herbs are present in high enough quantities to be included on the nutrition label.

fruits and vegetablesOnce again, it is all about marketing. Manufacturers are adding fruit and vegetable powders and a pinch of herbal ingredients to their protein powders so that they can make marketing claims, but those fruit and vegetable powders and herbal ingredients aren’t present in large enough quantities to make any significant impact on your health.

Allowed Label Claims

Many of you have asked me about companies that claim their supplement has the amount of vitamin C found in 7 oranges or the amount of folic acid found in 4 cups of cooked green peas.  Those are allowed claims and are generally accurate. Just don’t assume that the vitamin C actually came from 7 oranges (it didn’t) or that their supplement has all the nutrients found in 7 oranges (it doesn’t).  Again, these companies find ways to use deceptive food labels to make sales.

 

The Bottom Line

  • We are being told that we should read labels to make sure that the foods and supplements we buy are good for us. We are also being told that we should be eating more fruits and vegetables. Food manufacturers know an emerging trend when they see one, so many of them are adding fruit and vegetable powders to the foods and supplements they manufacture. This increases the marketing appeal of their products, but does nothing to make their products healthier. It is label deception, pure and simple.

If you want to avoid being deceived by deceptive food labels, you should:

  • Ignore the label claims of fruits and vegetables added to the processed foods you see in the market. The fruit and vegetable powders added to those foods provide no proven benefit. The best place to get your fruits and vegetables is to [surprise] eat your fruits and vegetables.
  • Leave those supplements claiming to have concentrated lots of fruits and vegetables into a single capsule on the shelf. Those claims are grossly deceptive because the capsules do not contain significant amounts of the fruits and vegetables listed on the label. They do not provide the nutrients you would have gotten if you had eaten the real foods. Once again, the best way to get the fruits and vegetables you need in your diet is to actually eat fresh fruits and vegetables.
  • Forget those protein supplements that make amazing claims based on all the fruits, vegetables, super foods, and herbal ingredients they have. Once again, the fruit and vegetable powders and herbal ingredients in these products are not present in sufficient quantities to provide any significant health benefits. It is the marketing that is amazing, not the health benefits.
  • Finally, many of you have asked me about companies that claim their supplement has the amount of vitamin C found in 7 oranges or the amount of folic acid found in 4 cups of cooked green peas. Those are allowed claims and are generally accurate. Just don’t assume that the vitamin C actually came from 7 oranges (it didn’t) or that their supplement has all the nutrients found in 7 oranges (it doesn’t).

 

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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