Supplements and Health

Do Omega-3s Prevent Age-Related Muscle Loss?

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Does Fish Oil Build Muscle?

Author: Dr. Stephen Chaney

 

omega-3Omega-3-rich fish oil supplements have attracted their share of controversy in recent years, but there appear to be lots of reasons to make sure that you get enough omega-3s from your diet.

There is actually pretty good evidence that omega-3s offer a natural approach for people who wish to lower their blood pressure (https://www.chaneyhealth.com/healthtips/do-omega-3s-lower-blood-pressure/) or heart attack risk (https://www.chaneyhealth.com/healthtips/fish-oil-really-snake-oil/). There is also some evidence that omega-3s may be important for brain development in infants (J Protzko et al, Perspectives on Psychological Science, 8: 25-40, 2013), for mental performance in children (https://www.chaneyhealth.com/healthtips/omega-3s-improve-reading-skills/) and for preventing cognitive decline in the elderly (https://www.chaneyhealth.com/healthtips/omega-3s-slow-cognitive-decline/).

If the latest headlines are to be believed, we can add preventing age-related muscle loss to the benefits of an omega-3-rich diet.

Why Is Age-Related Loss of Muscle Mass a Problem?

The term for age-related muscle loss is sarcopenia, and it is a big problem for older adults. After age 50 we lose 1-2% of our muscle mass each year. As you might expect, our strength declines as well. Each 1% loss of muscle mass translates into about 1.5% loss in strength. That means after age 50 we lose 1.5% of our muscle strength each year, and once we hit 60 the rate of loss increases to around 3% per year.

That may not sound like much on an annual basis, but it adds up over time. With a little bit of higher math you can calculate that you could easily have lost 45% of your muscle strength by the age of 70 and a whopping 75% by the age of 80. At that point even the simplest physical activities – lifting a grandchild or a bag of groceries – can become challenging. That loss of strength also contributes to a loss of balance that can lead to debilitating falls.

The most effective way of preventing age-related muscle loss is regular resistance training, especially when coupled with adequate intake of protein and leucine (https://www.chaneyhealth.com/healthtips/protein-needs-for-older-adults/). However, resistance training is hard work, so many older adults gravitate to quick fixes like testosterone, growth hormone, or DHEA – even though each of those treatment regimens have significant side effects and risks.

That’s why the recent headlines suggesting that a risk-free approach like omega-3 supplementation might increase muscle mass and strength in older adults is so enticing.

Do Omega-3s Prevent Age-Related Muscle Loss?

A previous study had suggested that omega-3 supplementation enhanced the effect of strength training in elderly women (Rodacki et al, AJCN, 95: 428-436, 2012). Although the mechanism of that effect is unclear, the authors of this study decided to go one step further. They asked if omega-3 fatty acids might prevent loss of muscle mass even in the elderly in the absence of a structured exercise program (Smith et al, AJCN, doi: 10.3945/ajcn.114.105833, 2015).

age-related muscle lossThe study consisted of 44 men and women age 60-85 (average age 69) who were not exercising on a regular basis. They were given either 4 gm of fish oil (containing 1.86 gm of EPA and 1.5 gm of DHA) or a placebo containing corn oil each day for 6 months. Muscle mass and four measures of muscle strength were performed at the beginning of the study and again at 6 months. The measures used were thigh muscle volume (a measure of muscle mass), hand grip strength, overall muscle strength (the maximum weight that the subject could lift in a single repetition for leg press, chest press, knee extension, and knee flexion) and isokinetic power (the power attained in knee extension and flexion exercises). The results were pretty impressive for the omega-3 group compared with the control group:

  • Thigh muscle volume (muscle mass) increased by 3.6%
  • Handgrip strength increased by 6%.
  • Overall muscle strength increased by 4%.
  • Isokinetic power increased by 5.6%.
  • Other than complaints about fishy breath, there were no adverse effects in the omega-3 group.
  • The authors calculated that the increase in muscle mass and strength during 6 months of omega-3 supplementation was sufficient to offset 2-3 years of normal age-related muscle loss and strength loss.
  • The increase in muscle mass and strength associated with omega-3 supplementation was less than can be attained from regular resistance exercise coupled with adequate protein intake. However, it was the same or greater than could be obtained from testosterone, growth hormone or DHEA – and didn’t have the risks associated with those treatments.

For example, a recent study has concluded that testosterone injections are associated with a significant risk of stroke, acute coronary syndromes, hospitalization and death (Layton et al, JAMA Internal Medicine, doi: 10.1001/jamainternmed.2015.1573).

The authors concluded ”Fish oil-derived omega-3 therapy slows the normal decline in muscle mass and function in older adults and should be considered a therapeutic approach for preventing sarcopenia and maintaining physical independence in older adults.”

Limitations of the Study

Before you all run out and stock up on fish oil supplements, I should point out that this study has several limitations.

  • It is a very small study. It needs to be replicated by future studies.
  • It used a very high dose of fish oil (4 gm/day). High doses are often used in an initial study like this one just to establish whether there is an effect worth further study. However, this study needs to be repeated at lower doses to see if this benefit of omega-3 supplementation is also seen at more physiological doses (500 – 1,000 mg) of omega-3s.

Because of these limitations, I am not yet ready to agree with the authors that omega-3 supplementation “…should be considered a therapeutic approach for preventing sarcopenia and maintaining physical independence in older adults.” This is an interesting finding that holds the promise of an inexpensive, risk-free, natural approach for maintaining muscle mass in older adults, but it needs to be verified by future studies before it can be widely recommended.

There are many reasons to supplement with omega-3s, but at this point in time I would definitely not recommend fish oil supplementation as an alternative to resistance exercise and adequate protein intake for older adults who wish to prevent age-related loss of muscle mass and strength.

However, the health risks of testosterone, growth hormone, and DHEA supplementation are significant. For someone who is absolutely set on pursuing an exercise-free solution to maintaining muscle mass and strength as they age, I would recommend omega-3 supplementation first rather one of the riskier alternatives.

 

The Bottom Line

  • A recent study has suggested that omega-3 supplementation may prevent age-related loss of muscle mass and strength. The study was performed in both men and women age 60-85 who were not exercising on a regular basis.
  • Omega-3 supplementation was less effective than regular resistance exercise coupled with adequate protein intake, but equal to or greater in effectiveness than testosterone, growth hormone, or DHEA treatment.
  • This was a very small study and it used a very high dose of omega-3s. It is a promising finding because it represents an inexpensive, risk-free, natural approach for maintaining muscle mass in older adults, but it needs to be verified by future studies before it can be widely recommended.
  • There are many good reasons to supplement with omega-3s, but at this point in time I would definitely not recommend fish oil supplementation as an alternative to resistance exercise and adequate protein intake for older adults who wish to prevent age-related loss of muscle mass and strength. Resistance training combined with adequate protein is a proven intervention. Omega-3 supplementation is not.
  • However, the health risks of testosterone, growth hormone, and DHEA supplementation are significant. For someone who is absolutely set on pursuing an exercise-free solution to maintaining muscle mass and strength as they age, I would recommend omega-3 supplementation first rather one of the riskier alternatives. It might just work, and it is a lot less risky.

 

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.

Restaurant Chains Beginning To Serve Healthy Fast Food?

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Would You Like Hydrocolloids In Your “Healthy Fast Food?”

Author: Dr. Stephen Chaney

 

The fast food industry is changing. Some of the changes are good. Some of the changes are bad. Some of the changes are downright ugly. Let’s start with the good.

healthy fast foodIn recent months Panera, MacDonald’s and Subway have all announced that they are switching to ingredients that people can recognize – ingredients that you might actually use in your own kitchen. Chipotle has recently announced that they have removed all genetically modified organisms from their foods.

This week Pizza Hut said that it will remove artificial colors and preservatives from its food. Taco Bell pledged to remove artificial colors, artificial flavors, high-fructose corn syrup and palm oil from its foods.

For example, Taco Bell will start using real pepper instead of “black pepper flavor” in its food (I didn’t even realize that there was an artificial pepper flavor. Come on! Real pepper can’t be that expensive!). They also plan to remove Yellow No. 6 from their nacho cheese, Blue No. 2 from their avocado ranch dressing, and carmine from their red tortilla strips.

Are restaurants making healthy fast food? Or is this all for show?

Will Healthy Fast Food Be Available At  Ordinary Fast Food Chains?

Now let’s look at the bad. Perhaps the first question to ask is: “Why is the fast food industry making these changes? Have they suddenly decided that they want to become part of the health food industry?”

One clue to those questions is the name of the parent company that owns both Pizza Hut and Taco Bell. They call themselves Yum Foods. You will notice that they don’t call themselves Health Foods. Their name alone speaks volumes about their priorities.

When the CEO of Yum Foods was describing these changes, he didn’t speak about any desire to make healthy fast food. He spoke about responding to shifting consumer attitudes and the desire of consumers for “real food” as driving these kinds of changes. The bottom line is that fast food companies are realizing that consumers are becoming more aware of the dangers of artificial ingredients and are making their buying choices accordingly. The companies simply don’t want to lose market share.

The second question to ask is: “Are these foods actually healthier?” The answer is: “Not really”. None of these companies are talking about removing fat, sugar, salt or calories from their foods. They are more concerned with retaining the “yum” factor than they are in actually making healthy fast food.

Do You Want Hydrocolloids With That Pizza?

hydrocolloidsNow let’s talk about the ugly. Perhaps the most important questions you should be asking are: “What is behind the curtain?” “What aren’t they telling us about?” The answer is: “You probably don’t want to know.”

For example, I came across an interesting article in a food industry journal. A Spanish company called Premium Ingredients was announcing that they had developed a new “food” product from hydrocolloids and melting salts that could be used to replace casein in pizza toppings.

But, first a bit of background:

You’ve heard nutritionists claim that pizza is a perfect food because it contains foods from all four food groups. Of course, that’s ignoring the fact that pizza is generally made with white flour and contains lots of fat – mostly saturated, calories and sodium.

But, when you look at many of the frozen and fast food pizzas on the market it gets even worse.

You noticed that Premium Ingredients didn’t say that their hydrocolloids/melting salts mixture could be used to replace cheese. They said that it could be used to replace casein. That’s because many pizza manufacturers haven’t used real cheese in years.

Instead they are using casein (milk protein) and a chemical smorgasbord to manufacture a cheese “food” with the taste and consistency of cheese.

Cheese is a good source of protein and calcium, and it supplies a lot of other essential nutrients as well – such as vitamin D, vitamin A, vitamin B12, riboflavin, folic acid, magnesium & zinc. Some of the artificial cheeses on the market do supply the calcium found in real cheese, but almost none of them provide the other essential micro-nutrients. But, because the artificial cheeses have been made with casein up to now, we could at least count on them to supply the protein found in real cheese.

Now, thanks to Premium Ingredients, the manufacturers of frozen and fast food pizzas won’t even have to use casein-containing artificial cheeses. In their trade journal article Premium Ingredients boasted that their product will help manufacturers cut costs (and cut protein and essential nutrients in the process).  Is this creating healthy fast food?

Lucky us?

 

The Bottom Line

  • A number of fast food chains have recently announced that they are removing some artificial ingredients from their foods.
  • These changes appear to arise from a desire to respond to changes in consumer preferences rather than to actually make healthy fast food.
  • For example, most of the fast food chains that are removing artificial ingredients from their foods are making no effect to reduce fat, sugar, salt and calories. Fast foods are not becoming health foods.
  • Even worse are the hidden ingredients you don’t know about. For example, a fast food supplier recently announced that it had developed a mixture of hydrocolloids and melting salts that could be used in place of casein (milk protein) for the “cheese food” that fast food chains for their pizza topping.
  • That saves the fast food chains money, but it leaves you with a pizza that gives you no milk, no calcium, no vitamin D and less of many other essential nutrients.
  • Pizzas are just the tip of the iceberg. Most of us no longer make complex foods like pizza from scratch. We count on manufacturers to use the same natural ingredients that we would use. But, in fact we have no idea of what they are putting in the foods that we are eating. That is why our food supply is becoming depleted of essential nutrients in ways that we don’t even know about. That’s one reason why I use food supplements and why I recommend food supplements for others.

 

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 Supplements Cause Cancer?

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Danger

The Kernel of Truth Behind the Scary Headlines

Author: Dr. Stephen Chaney

DangerOnce again the sky is falling! Some of the recent headlines have been downright scary. You’ve probably seen headlines saying things like “The American Association for Cancer Research reports that dietary supplements increase cancer risk” and “A recent study shows that taking extra vitamins and minerals may do more harm than good”. You’re probably asking yourself if you should throw away those vitamin and mineral supplements that you have been taking.

Let me start by correcting some of the more misleading statements in the recent headlines:

•    This was not a position statement from the American Association for Cancer Research. It was a talk presented by a single scientist at the American Association for Cancer Research annual meeting.

•    This was not a new study. The talk was based on a paper published in 2012 (Martinez et al., Journal of the National Cancer Institute, 104: 732-739, 2012).

•    This was not even a study. It was a review of previously published studies.

•    When you read the paper you find that the majority of studies found no effect of supplementation on cancer risk, a few suggested that supplementation might decrease cancer risk, and a very few suggested that supplementation might increase cancer risk. However, the scientist giving the talk at the American Association for Cancer Research meeting choose to emphasize the few studies suggesting increased risk.

Should We Worry About A Few Studies Suggesting Increased Cancer Risk?

The important question is whether we should be concerned about even a few studies suggesting that supplementation increases cancer risk. As a mythsresearch scientist I am not particularly concerned. That’s because I realize that there is always some variability in the results of clinical trials.

•    Sometimes that’s because an individual clinical study was poorly designed. Those are studies that are easy to eliminate from consideration.

•    However, many times we do not know why an individual study is an “outlier”. We only know that it is different from all the other studies. Good scientists base their opinions on the weight of the evidence from all available clinical studies, not individual studies – particularly if the individual studies are outliers.

Unfortunately, that’s not the way it works in the “real world”. In the real world individual studies that support a particular viewpoint are often quoted over and over until they become “generally accepted as true” – even if multiple subsequent studies have come to the opposite conclusion. They become what I call “nutrition myths”.

In this issue of “Health Tips From the Professor” I will briefly debunk some of these nutrition myths about the cancer risk of supplementation by exposing the clinical studies that were poorly designed and/or have been contradicted by multiple subsequent studies.

However, there is often a “kernel of truth” buried in all the hype. This kernel of truth is the main focus of this issue because it should guide our decisions about supplementation – not the scary headlines.

Antioxidants & Cancer Risk – A Poorly Designed Study

One of the most widely quoted studies supporting the claim that antioxidant supplements increase the risk of cancer was a meta-analysis of 66 published clinical studies (American Journal of Clinical Nutrition, 297: 842-857, 2007). It came to the conclusion that consumption of extra vitamins A, E, and beta-carotene were associated with up to a 16% increased risk of cancer. However, that study included only those studies in which adverse outcomes were reported. 400 studies with no adverse outcomes were ignored.

More to the point, another group of scientists came back and re-analyzing the same data set a couple of years later (Nutrients, 2: 929-949, 2010). When they looked at same 66 studies included in the original meta-analysis, they reported that 60% of the studies showed no effect of supplementation; 36% of studies showed a benefit of supplementation; and only 4% showed an increased cancer risk.

You might ask yourself, “If only 4% of the studies showed any increase in cancer risk, how could the meta-analysis of all 66 studies report a 16% increase in cancer risk?” That’s because of a statistical quirk. In a meta-analysis the outcome of a single very large study can swamp the conclusions of multiple smaller studies. In this case, the increased cancer risk reported in the original meta-analysis was almost entirely due to a single study in which participants using vitamin E were also on hormone replacement therapy. That’s a concern because we now know that hormone replacement therapy significantly increases cancer risk.

In short, this was a flawed study, but it is cited over and over as “proof” that antioxidant supplementation may increase cancer risk.

Examples of Nutrition Myths Disproved by Subsequent Studies

Antioxidants & Cancer Risk

antioxidant supplementsI have covered this topic in a previous “Health Tips From the Professor” so I’ll just give you a brief summary here. In short, the flawed paper suggesting that antioxidants has been followed by several major studies that have come to the opposite conclusions. For example:

•    One study followed 24,000 adults in Germany for 11 years and found that those consuming antioxidant supplements at the beginning of the study had a 48% decrease in cancer mortality and a 42% decrease in overall mortality (European Journal of Nutrition, 51: 407-413, 2012).

•    A US study followed 15,000 male physicians for 10 years and found that multivitamin supplementation decreased cancer incidence by 8% (JAMA, 308: 1871-1880, 2012).

•    Another study with the same group of 15,000 physicians found that vitamin C and E supplements had no effect on cancer risk over an 8 year period. But, when the study was extended by an additional 3.8 years vitamin C supplementation decreased the risk of colon cancer by 46% (American Journal of Clinical Nutrition, 100: 915-923, 2014).

•    Finally, a study of 7,728 women with invasive breast cancer showed that multivitamin use increased breast cancer survival by 30% (Breast Cancer Research & Treatment, 141: 495-505, 2013).

Folic Acid & Cancer Risk

I have also covered this topic in a previous “Health Tips From the Professor”, so, once again, I will be brief.

•    The study (JAMA, 297: 2351-2359, 2007) that is widely quoted as suggesting that folic acid supplementation might increase the risk of developing colon cancer in people over 50 didn’t actually look at colon cancer. It looked at adenomas in the colon. That is an important distinction because adenomas are benign. They can develop into a cancerous lesion over time, but that is not inevitable.

•    Two major studies since then (American Journal of Clinical Nutrition, 94: 1053-1062, 2011 and Gastroenterology, 141: 98-105, 2011) have reported that folic acid supplementation does not increase the risk of colon cancer.

•    In fact, the second study showed that people with the highest intake of both folic acid from supplementation and folates from food significantly decreased their risk of developing colon cancer.

The Kernel of Truth Behind the Headlines

While the scary headlines about supplements causing cancer are clearly misleading, I would be doing my readers a disservice if I didn’t discuss the Newspaper Headlineskernel of truth behind the headlines.

Let me start by saying that I am not a big fan of high dose, high purity individual supplements. In foods vitamins and minerals tend to occur in a natural balance. When we take individual nutrients in high doses, they often interfere with our body’s ability to absorb and utilize similar nutrients from the foods we eat. We create an imbalance.

That is the “kernel of truth” behind the headlines. High dose, high purity supplements have the potential to create nutritional imbalances. They have the potential to cause harm. Let me give you some examples in the context of cancer risk.

•    Alpha-tocopherol is the most abundant form of vitamin E in foods. However, there are many other forms of vitamin E in foods and high dose, pure alpha-tocopherol suppresses their absorption. This is a potential concern because some of them – gamma-tocopherol and the tocotrienols, for example – are more effective than alpha-tocopherol at reducing the risk of certain cancers in animal studies. This selective anticancer effect has not yet been demonstrated in humans, but it does raise some concern about the use of high dose, high purity alpha-tocopherol supplements.

•    Antioxidants are generally found in combination in foods, not as isolated nutrients. This is important because antioxidants work together. For example, vitamin E reduces free radicals to chemically unstable intermediates that have the potential to damage cells and cause cancer. A selenium-containing enzyme is required to convert these unstable intermediates into completely harmless compounds. This is thought to be the reason why a recent study found that high dose alpha-tocopherol increased prostate cancer risk in men with low selenium status, but not in men with high selenium status (Journal of the National Cancer Institute, doi: 10.1093/jnci/djt456, 2014).

•    Beta-carotene is the most abundant carotenoid in foods, but there are many other naturally occurring carotenoids – some of which appear to have unique anticancer activity in animal studies. This has been suggested as the reason why several studies have shown that diets high in carotenoids decrease the risk of lung cancer in smokers, but high dose beta-carotene alone appears to increase the risk of lung cancer in smokers.

•    B vitamins are best utilized in balance. That is especially true for folic acid, B12 and B6, which probably explains a recent study that suggested high dose B6 and folic acid supplements were associated with an increased risk of mortality, but a B complex supplement containing the same doses of both folic acid and B6 was not associated with increased mortality (Archives of Internal Medicine, 171: 1625-1633, 2011).

Do Supplements Cause Cancer?

Now that you understand the “kernel of truth” behind the headlines you can better understand why some experts recommend getting our vitamins and minerals from foods rather than supplements. While I understand the logic behind that recommendation, I consider it an imperfect solution to the problem for three reasons:

#1: Most of us don’t eat the way that we should. The USDA tells us that only 3-5% of Americans eat a healthy diet on a daily basis.

#2: Most of us don’t eat enough variety of foods. Even if we eat some healthy foods, we won’t get the balance of essential nutrients we need unless we eat a wide variety of healthy foods.

#3: Some of us have increased nutritional needs. Poor diet, genetic predisposition and poor health can all increase our needs for certain essential nutrients – and we may not know about those increased needs until it is too late.

Supplementation to fill nutritional gaps is still a good choice for many Americans, but I recommend avoiding the high dose, high purity individual supplements. For example:

•    Choose a supplement that contains all the naturally occurring forms of vitamin E and selenium in addition to alpha-tocopherol.

•    Choose a supplement that contains a variety of carotenoids, not just pure beta-carotene.

•    Choose a supplement that contains the B vitamins in balance, not just high dose individual B vitamins like folic acid or vitamin B6.

I could go on, but I think you get the idea. If you take individual high purity, high dose supplements you might actually increase your cancer risk. For the most part, the increased cancer risk has not been proven, but it is theoretically possible. A better approach is to choose supplements that are designed to mimic the balance of vitamins and minerals found in the foods we eat.

The Bottom Line

•    Ignore the scary headlines warning that supplement use may increase your risk of cancer. For the most part, those headlines are based on a few flawed studies that have been refuted by multiple subsequent studies which have come to the opposite conclusion.

•    However, there is a kernel of truth behind the idea that certain supplements might have the potential to increase cancer risk. High dose, high purity individual supplements such as alpha-tocopherol, beta-carotene and folic can interfere with our body’s ability to absorb or utilize related nutrients that are important for cancer prevention. In short, high dose, high purity supplements can create nutrient imbalances that have the potential to increase cancer risk.

•    That doesn’t mean that we need to avoid supplements entirely. It does mean that we need to make wise choices about the supplements we use. My recommendations are:

o    Choose a supplement that contains all the naturally occurring forms of vitamin E and selenium in addition to alpha-tocopherol.

o    Choose a supplement that contains a variety of carotenoids, not just pure beta-carotene.

o    Choose a supplement that contains the B vitamins in balance, not just high dose individual B vitamins like folic acid or vitamin B6.

o    I could go on, but you get the idea. You want to choose supplements that are designed to mimic the balance of nutrients we find in nature.

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

Are Sports Supplements Safe?

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Are There Any Sports Supplement Companies You Can Trust?

Author: Dr. Stephen Chaney

 

are sports supplements safe“Pump up your muscles”, “Explode your muscles”, “”Blast your fat”, “Annihilate your fat”, “Ramp up your energy”: The claims leap off the page of the ads for many sports and weight loss supplements.  But, are sports supplements safe?

The easiest way to ramp up your energy and annihilate your fat is to put amphetamines or other illegal stimulants in the supplement. The easiest way to pump up your muscles is to put steroids in the supplement. Unfortunately, there are always a few unscrupulous companies that are only too willing to do just that.

Well, the chickens have come home to roost. It’s been a bad few weeks for the sports supplement industry. It seems like every time you turned around there was another article about a sports supplement making fraudulent claims, containing illegal ingredients, or actually harming people. It makes you wonder whether you should just completely avoid sports supplements all together.

That would be unfortunate because sports supplements can help with hydration, endurance and recovery. They can help you maximize the benefits of your exercise program. Furthermore, there are a lot of reputable sports supplement companies out there. The problem is that there are a few “bad apples” in the industry, and the FDA is not really doing its job to protect the American consumer from their deceptive and dangerous products.

Even worse, when the FDA acts, major retail nutrition stores often drag their feet at actually removing the products from their shelves (https://www.chaneyhealth.com/healthtips/are-dietary-supplements-safe/), and the unscrupulous manufacturers just switch to another equally dangerous stimulant.

It is, therefore, important for those of us who are nutrition educators to warn consumers like you about the dangerous products that are in the marketplace. The FDA will eventually act, but you need to know about those products now!

I have previously warned you about sports nutrition products containing the amphetamine-like stimulants DMAA (https://www.chaneyhealth.com/healthtips/are-dietary-supplements-safe/), DEPEA (https://www.chaneyhealth.com/healthtips/are-fat-burning-sports-supplements-safe/) and DMBA (https://www.chaneyhealth.com/healthtips/supplements-to-avoid/). As you might guess from the names, these are all structurally related compounds. They have several other characteristics in common:

  • They are all synthetic amphetamine analogs.
  • The sports nutrition companies selling products with these ingredients tried to fool the public (and the FDA) by claiming that they were natural components of the herbal ingredients in their product.
  • None of them had ever been tested for safety and efficacy in humans. Some of them actually killed people before the FDA stepped in and banned them.

Amphetamine and amphetamine-like substances are popular in sports nutrition and weight loss products because they increase energy levels and speed up metabolism. Unfortunately, they also cause high blood pressure, arrhythmia, heart attacks and death.

Are Sports Supplements Safe?  Yes and No.

sports supplementsSports Supplements Containing a Form of Amphetamine

Yet another analog of DMAA called beta-methylphenethylamine (BMPEA) has appeared in the sports nutrition marketplace. It is an isomer of amphetamine that was first synthesized in the 1930’s. Because it is an analog of amphetamine, BMPEA is classified as a banned substance by the World Anti-Doping Agency. Unfortunately, its story is all too familiar.

The FDA first reported the presence of pharmacological doses of BMPEA in 43% of sports and weight loss supplements containing the herbal ingredient Acacia rigidula in 2012. The manufacturers claimed that the BMPEA in their products came from the Acacia rigidula even though there was no scientific evidence that it had ever been successfully extracted from Acacia rigidula.

BMPEA causes high blood pressure in animals and has never been tested for safety or efficacy in humans. Its close analog, DMAA, caused scores of deaths before the FDA finally banned it. However, the FDA did not warn consumers that supplements with the ingredient Acacia rigidula might contain BMPEA and might, therefore, be dangerous.

A group led by Dr. Pieter Cohen of Harvard University (Cohen et al, Drug Testing and Analysis, DOI: 10.1002/dta.1793, 2015) recently decided to analyze sports and weight loss supplements containing Acacia rigidula to see whether some companies had voluntarily removed DMPEA from their products over the last two years. One might hope that at least some of those companies might have been more motivated by protecting the health of their customers than by profit.

Not a chance! Dr. Cohen and his colleagues tested 21 products containing Acacia rigidula and found that 11 of them (52%) contained BMPEA – some in amounts as high as 94 mg/serving.

Dr. Cohen was quoted as saying “More than two years after the FDA’s discovery [of BMPEA in sports supplements], the FDA has yet to warn consumers about the presence of an amphetamine isomer in supplements. This is really about the FDA and why the FDA is not enforcing the law. This is a great example of how the FDA could so easily move now and not wait like it did with DMAA, wait until strokes and heart attacks had become front page news.”

After Dr. Cohen’s article became front page news several Senators called on the FDA to ban BMPEA. A week later the FDA finally caved in and announced that BMPEA was not a legal ingredient and that any products listing it on the label must be withdrawn from market. A skeptic might note that this was a full two years after the FDA discovered the existence of products containing BMPEA. The FDA’s announcement also did not cover BMPEA-containing products listing only Acacia rigidula on the label – which made up most of the BMPEA-containing products identified by Dr. Cohen and his colleagues. As the old saying goes, the FDA action was “a day late and a dollar short”.

Sports Supplements Containing Steroids

sports supplements containing steroidsA week later the FDA issued a warning to consumers to stop using a product call Tri-Methyl Extreme because of reports of serious liver damage in people using it. The product contained the anabolic steroids methyl-stenbolone, MAX LMG (a non-methylated prohormone) and epistane.

There are two important take home lessons from this incident.

  • The product actually claimed that it contained anabolic steroids. Anabolic steroids are known to cause liver damage, heart attack and stroke, testicular cancer, infertility and mood disorders. It is hard to imagine why anyone would use a product that claimed to contain anabolic steroids. Unfortunately, some people are willing to do almost anything that will increase muscle mass and strength.
  • The FDA often only acts once a product has either seriously injured or actually killed people. I tend to agree with Dr. Cohen that it would be far preferable for the FDA to be proactive and warn consumers about products that have the potential to do harm.

Sports Supplements That Cause Cancer

As if that weren’t bad enough, at about the same time a paper was published reporting that use of muscle-building supplements by young men may increase their risk of testicular cancer by up to 177% (Li et al, British Journal of Cancer, DOI: 10.1038/bjc.2015.26).

The incidence of testicular germ cell cancer in men 15-39 years old has increased 1.6-fold between 1975 and 2011. The reason for that increase is not known, but the authors of British Journal of Cancer article noted that the use of performance-enhancing supplements in that group has also increased dramatically during the same time period.

A previous study of testicular cancer patients reported that a high percentage of them (~20%) had used performance-enhancing supplements, but no control group was included in that study. Thus, the authors of this study set out to carefully match testicular cancer patients with healthy men of the same age and demographics – something we scientists call a case-control study.

The study compared 356 testicular cancer patients age 18-55 from Connecticut and Massachusetts with 513 controls that were matched by age, race, education, tobacco and alcohol use, exercise level, injury to testes or groin, and family history of testicular cancer. The results were pretty scary.

  • Use of muscle building supplements increased the risk of testicular cancer by 65% compared to men who never used that kind of supplement.
  • For men who started using muscle building supplements before they were 25, the risk of developing testicular cancer increased by 121%.
  • For men who used muscle building supplements for more than 3 years, the risk increased to 156%.
  • For men who used more than 2 types of muscle building supplements, the risk increased to a whopping 177%. That’s almost double.

This study did not identify the actual ingredients that caused the increased testicular cancer risk, but with so many of the muscle-building supplements on the market containing dangerous and/or illegal ingredients it is perhaps not surprising that they might increase cancer risk. After all, this demographic (young males) is the group most likely to choose the “Monster Muscle Builder” products rather the less glamorous, but safer, sports supplements.

Sports Supplements That Mislead

sports supplements companies that misleadAt the same time that we were hearing about sports supplements with dangerous and illegal ingredients and sports supplements that may cause cancer, the Advertising Standards Authority (the British equivalent of the FTC) accused a British sports supplement company of making false and misleading ingredient claims. That’s a polite way of saying they were lying!

In particular, they disallowed claims that:

  • CLA builds lean muscle and attacks fat stores, promotes fat loss, improves mood and focus and boosts energy.
  • Acetyl-L-Carnitine aids weight loss, burns fat, boosts energy, improves mental performance, and improves focus.

There were more claims they disallowed (click here for the complete report) (http://www.asa.org.uk/Rulings/Adjudications/2015/4/Protein-World-Ltd/SHP_ADJ_288571.aspx#.VS2VbJOk9RN), but I included those two because you’ve probably seen similar claims for those ingredients on this side of the Atlantic. Those claims are just as bogus in the United States as they are in England.

How To Choose A Sports Supplement Company You Can Trust

safe sports supplementsBy now you are probably convinced that you should never use a sports supplement product again. However, as I said above good sports supplements properly used can improve hydration, endurance, recovery and the results you obtain from your exercise program. Here are the questions to ask.  Are sports supplements safe?  They can be.   Which sports nutrition products can you trust? Here are some simple guidelines to help you choose a trustworthy sports supplement company.

  • Avoid the hyped claims. If the supplement makes claims like “Get ripped fast”, “Intense Energy”. “Extreme Energy”, “Eviscerate fat”, “Makes fat cells self-destruct” or “boosts testosterone”, you should run the other direction.
  • Ignore testimonials. The placebo effect is close to 50% for things like energy, and if an athlete “thinks” they have more energy every time they work out, they will get stronger.
  • Look for published clinical studies showing that the product is safe and effective. Those clinical studies should be published in peer-reviewed scientific journals. If the company just cites their own “studies” or “white papers”, ignore them. They may look impressive, but they have not been peer reviewed. You have no idea whether they are accurate.
  • I could tell you to look for rigorous quality control standards, but every company claims they have excellent quality controls. Instead I will tell you to look for supplements that are used by medal winning Olympic athletes. Why Olympic athletes? That is because Olympic athletes are more rigorously drug tested than any other athlete. They absolutely cannot afford to have any stimulants, steroids or other banned substances in their body at any time. They need products that are pure, safe and effective.
  • Finally, avoid products with artificial ingredients. While the risks associated with artificial sweeteners, artificial flavors and artificial colors are not as great as the risks associated with stimulants and steroids, they are still ingredients to be avoided. We simply do not know the long term health consequences of artificial ingredients.

 

The Bottom Line

  • There are a few bad apples in every barrel, and the sports supplement industry is no exception. Are sports supplements safe?  Over one two-week period lately we have learned:
  • Over 50% of sports nutrition products labeled as containing an innocuous sounding herbal ingredient were actually found to contain an amphetamine isomer called BMPEA that has been banned by the World Anti-doping Agency. After years of dragging its feet, the FDA finally banned some of the products containing BMPEA, but left many others on the market. As the old saying goes, the FDA was “a day late and a dollar short”.
  • Even though they are extremely dangerous, new sports supplements with anabolic steroids keep popping up online. Once again, the FDA has had to warn consumers not to use a new muscle building supplement containing steroids because several people using that supplement suffered severe liver damage.
  • A study reported that young men who use muscle building supplements may increase their risk of testicular cancer by up to 177%.
  • The British equivalent of our FTC has told a British sports supplement manufacturer that it must stop making false and misleading claims about ingredients like CLA and acetyl-L-carnitine. That is noteworthy because some sports supplement companies in the US make very similar claims for the same ingredients.
  • You shouldn’t necessarily avoid sports supplements because of a few bad apples. Good sports supplements properly used can improve hydration, endurance, recovery and the results you obtain from your exercise program. There are a few simple guidelines that can help you choose the good sports supplement companies and avoid the bad ones:
  • Avoid the hyped claims.
  • Ignore testimonials.
  • Look for published clinical studies showing that the product is safe and effective.
  • Look for supplements that are used by medal winning Olympic athletes. That’s because Olympic athletes absolutely need products that are pure, safe and effective.
  • Avoid products with artificial ingredients.

 

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 Women Get Enough Omega-3 During Pregnancy?

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Should Pregnant Women Take Omega-3 Supplements?

Author: Dr. Stephen Chaney

 

  • omega-3 during pregnancyLong Chain Omega-3 Fatty Acids, Especially DHA, Are Essential For Normal Brain Development

Long chain omega-3 fatty acids, especially DHA, have been shown to be very important during pregnancy, especially during the third trimester when DHA accumulates in the fetal brain at a very high rate. It is during that third trimester that the fetus forms the majority of brain cells that they will have for an entire lifetime.

Inadequate intake of long chain omega-3 during pregnancy and lactation has been shown to be associated with poor neurodevelopmental outcomes. These include poor developmental milestones, problem solving, language development and increased hyperactivity in the children (Coletta et al, Reviews in Obstetrics & Gynecology, 3, 163-171, 2010).

  • The Current Recommendation is 200 mg DHA/day During Pregnancy & Lactation.

In order to support brain development in the fetus, some experts have recommend intake of 300 mg per day of DHA during pregnancy. The best dietary sources of long chain omega-3 fatty acids such as DHA are fish and fish oil supplements. However, because of concerns about seafood contamination with heavy metals and PCBs (both of which are neurotoxins), the FDA recommended in 2004 that pregnant women limit seafood consumption to two servings a week, which amounts to about 200 mg/day of DHA – and this has been subsequently adopted by the American College of Obstetricians and Gynecologists and the European Union as the amount of DHA recommended during pregnancy and lactation (Coletta et al, Reviews in Obstetrics & Gynecology, 3, 163-171, 2010).

Even that recommendation for DHA from seafood could be overly generous. A recent study using the EPA risk assessment protocol concluded that some farmed salmon were so contaminated with PCBs that they should be eaten no more than once a year (Hites et al, Science, 303: 226-229, 2004).

  • Most Pregnant & Lactating Women In The US Are Probably Not Getting The Recommended Amount of DHA In Their Diet

Many pregnant women avoid seafood because of concerns about mercury and PCBs. Unfortunately, the other food sources of omega-3 fatty acids in the American diet, even many omega-3 fortified foods and supplements, are primarily composed of the short chain omega-3 fatty acid linolenic acid (also called alpha-linolenic acid or ALA), and only 1-4% of linolenic acid is converted to DHA in the body (Coletta et al, Reviews in Obstetrics & Gynecology, 3, 163-171, 2010).

Consequently, experts have been concerned for some time that American and Canadian women may not be getting enough DHA during pregnancy and lactation, but it was not clear how serious an issue this was.

Do Women Get Enough Omega-3 During Pregnancy?

women take enough dha omega-3 during pregnancyA group of scientists decided to test the adequacy of DHA intake by comparing DHA intake with the recommended 200 mg/day in a group of 600 pregnant and lactating women enrolled in the Alberta Pregnancy Outcomes and Nutrition study (Jia et al, Applied Physiology, Nutrition & Metabolism, 40: 1-8, 2015). The average age of the women in this study was 31.6. They were primarily Caucasian and married. 92% of them breastfed their infants. Most of them were taking a multivitamin or prenatal supplement on a daily basis. Approximately 1/3 of them were also taking a long chain omega-3 supplement.

The majority of women had completed college and had annual household incomes in excess of $100,000/year. In short, this was a very affluent, well-educated group of women. This is the kind of group one might consider most likely to be getting enough DHA from their diet.

DHA intake was based on 24 hour food recalls and supplement intake questionnaires collected in face-to-face interviews 2-3 times during pregnancy and again 3 months after delivery. The DHA content of the diet was determined from these data using well established methods.

The results were both dramatic and concerning.

  • Only 27% of pregnant women and only 25% of postpartum women who were breastfeeding met the recommendation of 200 mg of DHA/day. In short, nearly three-quarters of the women in the study were not getting enough (DHA) omega-3 during pregnancy and lactation.
  • When the women who were taking DHA-containing supplements were excluded from the data analysis, only 13% of pregnant and lactating women were getting enough DHA from their diet. In short, nearly 90% of the women relying on diet alone were not getting enough DHA.
  • Taking a DHA-containing supplement increased the likelihood of achieving the recommended 200 mg DHA/day by 10.6 fold during pregnancy and 11.1 fold during breastfeeding.
  • Not surprisingly, seafood, fish and seaweed products were the major contributors to the total dietary DHA intake.

The authors concluded “Our results suggest that the majority of participants in the cohort were not meeting the EU recommendations for DHA during pregnancy and lactation, but taking a supplement significantly improved the likelihood that they would meet the recommendations.”

 

The Bottom Line

  • Long chain omega-3 fatty acids, especially DHA, are essential for normal brain development. Inadequate DHA intake during pregnancy and lactation is associated with poor developmental milestones, problem solving, language development and increased hyperactivity in the children.
  • There is no established Daily Value for omega-3 fatty acids. However, the American College of Obstetricians and Gynecologists and the European Union recommend 200 mg DHA/day during pregnancy and lactation.
  • This recommendation is based partly on the amount of DHA needed for brain development and partly on the FDA warning that pregnant women should not consume more than 2 servings of fish/week due to heavy metal and PCB contamination.
  • This recommendation can be met by 1-2 six ounce servings/week of fish or a fish oil supplement containing 550 – 600 mg of omega-3 fatty acids.
  • Many pregnant women avoid fish because of concerns about contamination with heavy metals and PCBs, both of which are neurotoxins. Therefore, the major source of omega-3s in the American and Canadian diets are short chain omega-3 fatty acids that are only inefficiently (1-4%) converted to DHA.
  • Consequently, experts have been concerned for some time that American and Canadian women may not be getting enough DHA during pregnancy and lactation, but it was not clear how serious an issue this was.
  • A recent study done with a group of 600 women enrolled in the Alberta Pregnancy Outcomes and Nutrition study found that:
  • Only 27% of pregnant women and only 25% of postpartum women who were breastfeeding met the recommendation of 200 mg of DHA/day. In short, nearly three-quarters of the women in the study were not getting enough (DHA) omega-3 during pregnancy and lactation.
  • When the women who were taking DHA-containing supplements were excluded from the data analysis, only 13% of pregnant and lactating women were getting enough DHA from their diet. . In short, nearly 90% of the women relying on diet alone were not getting enough DHA.
  • Taking a DHA-containing supplement increased the likelihood of achieving the recommended 200 mg DHA/day by 10.6 fold during pregnancy and 11.1 fold during breastfeeding.
  • This was a very affluent, well-educated group of women. If any women anywhere are getting enough DHA during pregnancy and lactation, this should have been the group that was.
  • The authors concluded “Our results suggest that the majority of participants in the cohort were not meeting the EU recommendations for (DHA) omega-3 during pregnancy and lactation, but taking a supplement significantly improved the likelihood that they would meet the recommendations.”

 

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.

Risk Factors for Diabetes

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Are Statins Dangerous?

Author:  Dr. Stephen Chaney

 

statins side effectsSeveral years ago I recall a cardiologist telling my class of first year medical students that statins were so beneficial that we should just put them in the water supply. He said it in a lighthearted manner, but I think he really believed it. [In actuality, statin drugs are so widely prescribed that they already are in the water supply of some major US cities (http://usatoday30.usatoday.com/news/nation/2008-03-10-drugs-tap-water_N.htm).]

The Pros And Cons of Statins

When taken by people who have already had a heart attack, statins clearly save lives. However, as I documented in my eBook “The Myths of the Naysayers” (scroll down to Check It Out if you would like to learn how you can get that eBook for FREE) the benefits of statins are marginal at best in healthy people who have not yet had a heart attack.  So are statins one of the risk factors for diabetes?

Statin Side Effects

In addition, statins have some significant side effects. For example, up to 5% of people taking statins develop muscle pain. For most people the muscle pain is merely an inconvenience, but in a small percentage of cases it can lead to fatal complications.

More concerning are the required label warnings that statins can lead to memory loss, mental confusion, high blood sugar and type 2 diabetes. In other words, they may not kill you, but they sure can make life miserable.

Because of the marginal benefits in healthy people and the multiple side effects, some experts are starting to step up and say that statins may be overprescribed. For example, Dr. Roger Blumenthal, MD, a professor and director of the Ciccarone Preventive Cardiology Center at Johns Hopkins recently said: “Statin therapy should not be approached like diet and exercise as a broadly based solution for preventing coronary heart disease. These are lifelong medications with potential, although rare, side effects, and physicians should only consider their use for those patients at greatest risk…”

Dr. Blumenthal made that statement a few years ago when we thought that statins only increased diabetes risk by 9-22%. The latest study suggests that statins may increase diabetes risk by as much as 46%. That, in my opinion, is a game changer.

Statins And Diabetes Risk?

statins and diabetes riskThe idea that statins increase the risk of type 2 diabetes is not new. Previous studies have reported that statins increase the risk of diabetes anywhere from 9% to 22%. As a consequence, the FDA required that “increased risk of elevated blood sugar and developing type 2 diabetes” be added to the warning label on statin drugs starting in 2012.

The authors of the current study (Cederberg et al., Diabetologia, DOI 10.1007/s00125-015-3528-5) felt that previous studies may have underestimated the true risk of developing diabetes because:

  • Previous studies were often done with patient populations at very high risk of cardiovascular disease. In today’s world statin drugs are often prescribed for patients at moderate or low risk of cardiovascular disease. The authors felt that the effect of statins on diabetes risk might not be the same in these two populations.
  • Previous studies relied on self-reported diabetes or fasting blood glucose levels as the criteria for classifying the study subjects as diabetic. In today’s world there are a wider array of diagnostic tests that are used to confirm a diagnosis of diabetes.

This study looked at the risk of developing type 2 diabetes associated with statin treatment over a 6-year period in a group of 8,749 Finnish men (aged 45-73 years) who were enrolled in the Metabolic Syndrome in Men (METSIM) study. That means that the men had metabolic syndrome (they were pre-diabetic), but none of them were yet diabetic at the beginning of the study. Other important characteristics of the study were:

  • This was a healthy cross-section of the Finnish population. Only 24.5% of the study participants were using statin drugs.
  • The diagnosis of diabetes was based on multiple criteria: fasting blood glucose levels, an oral glucose tolerance test, and hemoglobin A1c (a measure of blood sugar control over the last 6 weeks).

As you might suspect, the increased risk of developing diabetes during the 6-year trial was greatest for those who were older, more obese, less physically active and had more advanced metabolic syndrome at the beginning of the study. What was surprising, however, were the other conclusions of the study.

  • Statin treatment increased the risk of developing type 2 diabetes by 46%, and the increased risk of developing diabetes directly correlated with the dose of the statin drug.
  • Insulin sensitivity was decreased by 24% and insulin secretion was decreased by 12% in individuals on statin treatment. In layman’s terms that means the pancreas was 12% less able to release insulin and tissues in the body were 24% less able to respond to insulin. That’s a double whammy!

Even though this study is a significant improvement over previous studies, it does have some limitations of its own.

  • The study population was exclusively white, Finnish men. The conclusions may not apply to other population groups.
  • Simvastin (Zocor) and atorvastatin (Lipitor) were the most widely used statin drugs in this study (84% of the study participants taking statins were on one of these two drugs). These two statins clearly increased the risk of developing diabetes in a dose-dependent manner. There were not enough subjects on the other statin drugs to evaluate their effect on diabetes risk, but previous studies have suggested that other statins may be less prone to increase diabetes risk.

Should You Take Statins If you are Diabetic or Pre-Diabetic?

statins and diabetesLet’s start by identifying the symptoms of metabolic syndrome or pre-diabetes. They are:

 

  • Abdominal obesity (waist size of greater than 35” for women & 40” for men)
  • Slightly elevated triglycerides (greater than 150 mg/dl)
  • Low HDL cholesterol (less than 50 mg/dl for women and 40 mg/dl for men)
  • Slightly elevated blood pressure (greater than 130/85
  • Slightly elevated blood sugar (greater than 100 mg/dl fasting blood glucose)

If you have three or more of these symptoms, you likely have metabolic syndrome or pre-diabetes.

The medical profession and the pharmaceutical industry are circling their wagons and assuring us that the benefits of taking statins clearly outweigh the risks – even if you are diabetic or pre-diabetic. I’m not so sure

The problem is that the benefits of statin therapy in healthy individuals who have not had a heart attack are modest at best. This sets up a real “Catch 22” situation. Diabetes and pre-diabetes increase the risk of heart disease, so current guidelines recommend that statin drugs should be prescribed for individuals who are pre-diabetic or diabetic. However, we now know that those very same statin drugs increase the risk of you becoming diabetic if you are already pre-diabetic. Because they decrease insulin production and increase insulin resistance they may also make your diabetes worse if you are already diabetic, but that has not been directly tested.

That is concerning because diabetes can lead to very serious complications such as neuropathy (numbness in the extremities), kidney disease & kidney failure, high blood pressure and stroke, and cataracts & glaucoma. Of course, you can always use diabetes medications to counteract the diabetes-enhancing effect of the statins, but those medications also have serious side effects. The pharmaceutical merry-go-round continues!

Are There Alternatives For Reducing the Risk Of Heart Disease?

alternative is eat healthyIf statins are only modestly effective at reducing the risk of heart disease in otherwise healthy individuals and they significantly increase the risk of developing diabetes, it is perhaps prudent to ask whether there are alternative, non-drug approaches that can significantly reduce your cholesterol levels and allow you to avoid statins altogether?

According to the National Heart Lung & Blood Institute the answer to that question is a resounding yes! They call it Therapeutic Lifestyle Change or TLC (http://www.nhlbi.nih.gov/health/resources/heart/cholesterol-tlc). The TLC recommendations are:

  • Eat less than 7 percent of your daily calories from saturated fat
  • Eat less than 200 mg a day of cholesterol
  • Get only 25–35 percent of daily calories from total fat (this includes saturated fat calories)
  • Other diet options you can use for more LDL lowering are:
    • Add 2 grams per day of plant stanols or sterols
    • Add 10–25 grams per day of soluble fiber
  • Consume only enough calories to reach or maintain a healthy weight
  • In addition, you should get at least 30 minutes of a moderate intensity physical activity, such as brisk walking, on most, and preferably all, days of the week.

The NHLB Institute recommends that the TLC approach always be tried first, and that statins only be used if the lifestyle approach fails – a message that seems to have gotten lost in the translation in many doctor’s offices.

I have also discussed some natural alternatives in my previous articles such as “Does An Apple A Day Keep Statins Away?” (https://www.chaneyhealth.com/healthtips/apple-day-keep-statins-away/) and “Is Fish Oil Really Snake Oil?” (https://www.chaneyhealth.com/healthtips/fish-oil-really-snake-oil/).

What Should You Do?

Perhaps it is time to have a serious discussion with your doctor about following the National, Heart Blood & Ling Institute’s TLC recommendations – either as an alternative to statins or as something that will allow your doctor to reduce the amount of statins that your need to take.

I also recommend that you make lots of fresh fruits and vegetables and either oily fish or fish oil supplements part of your regular diet.

The old professor is just like the rest of you. My cholesterol gets a bit high from time to time and my doctor suggests going on a statin. Instead I ramp up my exercise, watch what I eat a bit more carefully, and use a supplementation program that includes stanols, sterols and omega-3 fatty acids.

My cholesterol gets back to where it is supposed to be. My doctor is happy, and I am happy.

 

The Bottom Line

  • The news about statin drugs keeps getting worse. Not only are they only marginally effective in healthy people who have not yet had a heart attack, but the latest study suggests that they may increase the risk of developing diabetes by up to 46%.
  • That is concerning because the complications of diabetes can be quite serious, and diabetes drugs have side effects of their own.
  • In addition to the TLC program I recommend lots of fresh fruits and vegetables, oily fish or fish oil supplements, and a supplement that provides the TLC-recommended 2,000 mg of plant stanols and sterols.

If you have been prescribed statin drugs, it may be time to make a serious commitment to the TLC lifestyle change and have a discussion with your physician about reducing or eliminating your statins. This is especially true if you are already pre-diabetic or diabetic.

 

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.

Folic Acid and Cancer

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Does Folic Acid Increase Cancer Risk?

Author: Dr. Stephen Chaney

 

folic acid and cancerYou’ve seen the headlines. “Folic Acid Supplements May Increase Colon Cancer Risk in People Over 50” and “Folic Acid Supplements May Increase Prostate Cancer Risk in Men”. And I’ve seen articles telling people over 50 that they should take their multivitamin tablets every other day to avoid getting too much folic acid.

I’ve even heard of doctors telling their patients to avoid any supplements containing folic acid. So what’s the truth?  Is there a cause and effect relationship between folic acid and cancer?

Why Do People Say Folic Acid Increases Colon Cancer Risk?

Perhaps a bit of historical perspective is in order. A number of population studies had suggested that high intakes of folic acid might protect against cancer, especially colon cancer, so several placebo controlled clinical studies were initiated to test that hypothesis. Those studies had mixed results, with some suggesting that folic acid might be protective and others suggesting that it had no effect. None of those studies suggested that folic acid supplementation increased the risk of any kind of cancer.

In 1998 mandatory folic acid fortification of grain products was introduced. In addition, the number of Americans taking supplements with folic has increased dramatically in recent years. As a consequence total intake of folates (folic acid from fortified foods and supplements plus folates naturally found in foods) has increased significantly. By one estimate blood levels of folates have increased 2.5-fold between 1994 (before fortification) and 2000 (after fortification).

So it was just natural to ask if this increase in folate intake might have unintended consequences. And one clinical study seemed to suggest that it might (JAMA, 297: 2351-2359, 2007)

That study looked at colorectal adenomas and reported high folate intake was associated with an increased risk of more advanced adenomas. [It is important to note that adenomas are benign tumors. They are thought to be precursors to colorectal cancer but they are not actually cancerous].

Some experts immediately started warning about getting too much folic acid in the diet – with some going so far as to warn that people over 50 should only take a multivitamin every other day.

And several papers were published speculating on how differences between the way that folic acid and the other folates were utilized by the body could cause folic acid to increase the risk of colorectal cancer while naturally occurring folates decreased the risk.

Let me put this into perspective. Any good scientist knows not to trust a single clinical study. Individual clinical studies can provide misleading results. Sometimes it is possible to pinpoint the cause. For example, the study may have been poorly designed, may have included a non-representative population group, or the statistical analysis may have been incorrect. But, sometimes we never know why an individual clinical study came to the wrong conclusion.

folic acid and colon cancerThat is why good scientists generally say that more studies are needed and base their recommendation on the preponderance of many studies rather than a single study.

The problem was that all of this hype and hypothesizing about folic acid increasing the risk of colon cancer was based on a single study, and that study didn’t actually look at colorectal cancer. A Norwegian study four years later found no evidence for increased colorectal cancer at folic acid intakes of up to 800 ug/day (AJCN, 94: 1053-1062, 2011) – but it was largely ignored.

The background is similar for the claims that folic acid may increase prostate cancer risk. When a small meta-analysis that included some, but not all, published clinical studies suggested an increased risk of prostate cancer, some experts went as far as to suggest that men should completely avoid supplements with folic acid.

The problem is that even meta-analyses can be misleading if they only examine a small sub-set of clinical studies because they can be unduly influenced by a single misleading clinical study.

Does Folic Acid Increase Colon Cancer Risk?

Should We Avoid Supplemental Folate?

The American Cancer Society decided to resolve the uncertainty about folic acid intake and colon cancer risk once and for all (V.L. Stevens et al, Gastroenterology, 141: 98-105, 2011). They designed the study to answer two very important questions:

1) Has the increased folate intake by Americans over the past several years actually increased their risk for colorectal cancer?

2) Does the chemical form (folic acid versus folate) influence its effect on colorectal cancer risk?

And this study had two very important firsts:

1) This was the very first study to investigate the association between folate intake and colorectal cancer entirely in the post-fortification period.

2) This was also the very first study to separate out the effects of folate and folic acid on colorectal cancer risk.

And it was a very large study. They followed 43,512 men and 56,011 women aged 50-74 for 8 years between 1999 and 2007.

Folate intakes from food ranged from 175 ug/day to 354 ug/day while folic acid intakes from food fortification, supplements and multivitamins ranged from 71 ug/day to 660 ug/day. Total folate (both naturally occurring folates and folic acid) intakes ranged from 246 ug/day to over 1014 ug/day.

When they analyzed the data they found that high intakes of neither folic acid nor natural folates were associated with any increased risk of colorectal cancer. In fact, they found high intake of total folates was associated with a significant decreased risk of colorectal cancer.

Does Folic Acid Increase Cancer Risk?

folates help prevent cancerWhat about prostate cancer and other types of cancer? Could folic acid increase the risk of other cancers? To resolve this issue once and for all, a group from Oxford University (Clarke et al, The Lancet, doi: 10.1016/S0140-6736(12)62001-7) did a meta-analysis of every study published through 2010 that compared folic acid supplementation to a placebo, lasted at least 1 year, included at least 500 people and recorded cancer incidence – some 13 studies with over 50,000 participants.

The results were clear cut. As for folic acid and cancer, supplementation did not increase the overall cancer risk, and when the incidence of individual cancers was analyzed, folic acid supplementation did not increase the risk of developing colon cancer, prostate cancer, lung cancer, breast cancer or any other site-specific cancer.

To put this in perspective the average dose of folic acid used in these clinical studies was 2 mg/day, which is 5 times the RDA and 5 times the dose in most supplements. And one of the clinical trials used 40 mg/day, which is 100 times the dose in most supplements.

 

The Bottom Line

Forget the warnings and the hype. You can be confident that folic acid does not increase the risk of colorectal cancer, prostate cancer, or any other kind of cancer.

  • The American Cancer Society recently performed a very large clinical study looking at the effect of folic acid intake from supplements and folate intake from foods on colon cancer risk. That study found that high intakes of neither folic acid nor natural folates were associated with any increased risk of colorectal cancer. And, they found high intake of total folates was associated with a significant decreased risk of colorectal cancer.
  • The authors of that study concluded: “The findings of this study add to the epidemiological evidence that high folate intake reduces colorectal cancer risk.” “More importantly, no increased risk of colorectal cancer was found, suggesting that the high levels of this vitamin consumed by significant numbers of Americans should not lead to higher incidence rates of this cancer in the population.”
  • A second meta-analysis of every clinical study looking at folic acid intake and cancer risk through 2010. The results of that study were clear cut. Folic acid supplementation did not increase the overall cancer risk, and when the incidence of individual cancers was analyzed, folic acid supplementation did not increase the risk of developing colon cancer, prostate cancer, lung cancer, breast cancer or any other site-specific cancer

Like any good scientist I am aware that future studies could change our understanding, but for now I am confident in saying that there is no credible evidence that folic acid supplementation increases your risk of any kind of cancer. If the science changes, I will be the first to let you know.

But it will be really interesting to see how long it takes all those web sites, blogs and so-called “experts” to acknowledge that the science has changed and they should stop issuing false warnings about folic acid supplementation.

 

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.

Vitamin D Deficiency

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What Is The Real Vitamin D Story?

Author: Dr. Stephen Chaney

 

Vitamin DIf you are like most people, you probably don’t know what to believe about vitamin D deficiency. Some experts tout vitamin D as a miracle nutrient that will help you lead a longer, healthier life. They leave you with the impression that everyone should be supplementing with vitamin D.

Other experts tell you that the supposed benefits of vitamin D are all hype. They tell you not to waste your money on vitamin D supplements.

When you pull back the curtain and look at the clinical studies behind the headlines, a pattern begins to emerge.

Most of the studies that support a role for vitamin D in preventing heart disease, preventing cancer and extending life have been population studies. They have compared populations with low vitamin D intake with populations with adequate vitamin D intake. While population studies are good for suggesting associations, they have their limitations:

  • Population studies are good at suggesting associations, but they do not prove cause and effect.
  • With population studies it is also very difficult to eliminate what scientists call “confounding variables”. Let me give you an example. Suppose someone had low 25-hydroxyvitamin D levels in their blood because they sat around all day watching TV and never got out in the sun. If they got sick you wouldn’t really know whether it was due to low 25-hydroxyvitamin D levels or due to inactivity. In this case, inactivity would be a confounding variable.

On the other hand, most of the studies that fail to find any benefit of vitamin D are double blind, placebo-controlled intervention studies in which one group was given supplemental vitamin D and the other group was given a placebo. While these studies are considered the most reliable clinical studies, they have their limitations as well.

  • In the case of vitamin D many of these studies were done with a cross section of the population in which most of the participants already had adequate blood levels of 25-hydroxyvitamin D at the start of the study. Those studies are incapable of telling us whether correcting a vitamin D deficiency would have been beneficial.
  • Even when the intervention studies focus on participants with low vitamin D status at the start of the trial they have another significant limitation. They are all short term studies. Typically, the best of these studies last no more than a couple of years. Longer term studies are far too expensive. In contrast, diseases such as heart disease and cancer take decades to develop. A one or two year intervention with vitamin D simply may not be sufficient to correct the damage caused by decades of vitamin D deficiency

This is the current dilemma that is creating all of the confusion in the vitamin D story. For the most part, population studies and intervention studies are coming to very different conclusions. And both kinds of studies have inherent limitations that are difficult to overcome.

Fortunately, a new kind of clinical study has been developed in recent years that overcomes the limitations of both population studies and intervention studies.

A New Kind of Clinical Study

Bad GenesThe new approach is something called mendelian randomization. I apologize for the scientific jargon, but let me explain. In this case you are separating your population based on genetic variation rather than on the basis of biochemical or behavioral differences.

 

For example, in the clinical study I will describe in a minute the population was separated into groups based on genetic variations in the DHCR7 and CYP2R1 genes. The first gene is involved in the biosynthesis of cholesterol, which is a precursor of vitamin D, and the second gene converts vitamin D to 25-hydroxyvitamin D. Both genes affect blood levels of 25-hydroxyvitamin D.

This kind of study has several unique strengths:

  • Genetic variations are unaffected by confounding variables such as sun exposure, obesity, smoking, inactivity, and poor diet. If the study population is large enough, those confounding variables will be equally distributed among groups that are selected solely on the basis of genetic variations.
  • These studies are long term by definition. If someone has a genetic variant that lowers their 25-hydroxyvitamin D level, it will do so for their entire lifetime. They can increase their vitamin D status by sun exposure, for example, but their blood levels of 25 hydroxyvitamin D will always be less than someone with equal sun exposure who does not have that genetic variant.
  • Because these studies reflect lifelong exposure to 25-hydroxyvitamin D they are ideally suited for measuring the effect of vitamin D status on mortality and diseases that take decades to develop.

Do Vitamin D Genes Affect Mortality?

This study (S. Afzal et al, The British Medical Journal, 2014;p 349:g6330 doi: 10.1136/bmj.g6330) combined the data from three clinical studies conducted in Copenhagen between 1976 and 2013. The age of the participants ranged from 20 to 100 years and the follow-up was 6-19 years. 95,766 participants in these studies were genotyped for variants in the DHCR7 and CYP2R1 genes which were known to affect 25-hydroxyvitamin D levels. 35,334 of those participants also had blood 25-hydroxyvitamin D levels determined. By the end of the study 10,349 of the participants had died.

  • The individual genetic variants included in this study caused a relatively small (1.9 nmol/L) decrease in blood levels of 25-hydroxyvitamin D. However, because this was a very large study and the participants with those genetic variants were exposed to lower 25-hydroxyvitamin D levels for their entire lifespan, the decreased 25-vitamin D levels were associated with significant increases in all cause mortality and cancer mortality, but not with increased cardiovascular mortality.
  • When they extrapolated to a genetically caused 20 nmol/L decrease in 25-hydroxyvitamin D, the decrease in 25-hdroxyvitamin D was associated with a 30% increase in all cause mortality and a 30% increase in cancer mortality.

What Kind Of Studies Are Needed Next?

The authors noted that this is the first study of its kind, so it obviously needs to be confirmed by other large mendelian randomization studies that test the link between vitamin D status and mortality.

Ideally, it should also be verified by double blind, placebo controlled intervention studies, but that may not be possible. If one really wanted to verify this study, the intervention study should start with a population group with 25-hydroxyvitamin D levels at least 20 nmol/L below what is considered adequate and provide them with enough supplemental vitamin D to increase their 25-hydroxyvitamin D to the adequate range. That is difficult, but doable.

However, the intervention study would also need to be long enough (decades perhaps) to prevent cancer from developing. That kind of study will probably never be done.

 

The Bottom Line

  • The relationship between vitamin D status and mortality has been investigated with a new type of clinical study based on what is called mendelian randomization. Population groups were segregated based on genetic variations in two genes that affect blood 25-hydroxyvitamin D levels (a measure of vitamin D status).
  • This study concluded that a genetically determined decrease of 20 nmol/L in blood 25-hydroxyvitamin D was associated with a 30% increase in all cause mortality and a 30% increase in cancer mortality, but had no significant effect on cardiovascular mortality.
  • This kind of study is particularly strong because it measures the affect of lifelong exposure to 25-hydroxyvitamin D. This is important when assessing the effect of vitamin D status on mortality and diseases such as cancer that take decades to develop. In contrast, the double blind, placebo controlled intervention studies that are consider the “Gold Standard” for clinical studies may be too short term to adequately assess the effect of vitamin D status on cancer or all cause mortality.
  • This study supports the benefit of maintaining optimal vitamin D status, but it is the first clinical study of its kind and needs to be confirmed by other studies.
  • In the meantime, there is no harm to in maintaining your blood levels of 25-hydroxyvitamin D in the optimal range through diet, sun exposure and supplementation. This study suggests it just may help you live a longer, healthier life.

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

Can Resveratrol Improve Memory Performance In The Elderly ?

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red wine benefitsWill Red Wine Make You Smarter?

Author: Dr. Stephen Chaney

It seems like every other day a new headline pops up telling us of yet another nutrient that might improve memory and slow cognitive decline. Perhaps it’s because we having a greying population. Lots of Americans are looking for that magic pill that will allow us to remember where we left the car keys.

This week the banner headlines were about resveratrol, a polyphenol from red wine. The headlines suggested that resveratrol could improve memory performance in healthy older adults. Are those headlines true, and what does that information mean for you?

What is Resveratrol?

Resveratrol is a member of a very large class of compounds called polyphenols that are found in red wine, green tea, and a variety of fresh fruits and vegetables. Polyphenols are very diverse structurally, but most of them are excellent antioxidants. They are one of the reasons that we are constantly being told to eat more fresh fruits and vegetables.

However, resvertrol and a few structurally similar polyphenols are unique in that they also bind to proteins called sirtuins which regulate metabolic processes related to the aging process. In fact, resveratrol garnered a lot of attention a few years ago when Dr. David Sinclair at Harvard Medical School published a study showing that obese mice given resveratrol escaped many of the metabolic consequences of obesity and actually lived longer than mice who were not given resveratrol.

In animal studies resveratrol appears to improve insulin sensitivity and mitochondrial function, lower cholesterol levels and blood pressure, and reduce inflammation and oxidative damage. Human studies have been limited to date, but suggest that resveratrol may impart many of these metabolic benefits to humans as well.

A recent study showed that resveratrol improved memory performance in grey mouse lemurs, a non-human primate species. However, no one had previously looked at whether resveratrol might improve memory in humans.

Can Resveratrol Improve Memory In Healthy Older Adults?

improve memoryIn this study (A. V. Witte et al, The Journal of Neuroscience, 34: 7862-7870, 2014) investigators recruited 46 older (average age 64), overweight (BMI 25-30), adults from Berlin, Germany. All of the subjects were healthy and none of them had any sign of cognitive impairment. For a six month period half of them were given 100 mg of resveratrol twice a day, and half of them were given a placebo (sunflower oil).

At the beginning of the test period they were given a memory test which measures how many of 15 listed words they could recall 30 minutes later. They also underwent a MRI scan that measured brain volume and functional connectivity of the hippocampus, a key region implicated in memory function. Finally, hemoglobin A1c, a measure of long term blood sugar control was measured.

Here are the results:

  • There was a significant effect of resveratrol on retention of words over 30 minutes compared to placebo. Memory improved significantly in the resveratrol group, while it declined slightly in the placebo group.
  • There was no effect of resveratrol on brain volume compared to the placebo (most interventions showing significant effects on brain volume required 2-3 years to demonstrate a significant effect).
  • Subjects in the resveratrol group showed significant increases in functional connectivity of the hippocampus to other brain regions involved learning and memory compared to the placebo group.
  • Subjects in the resveratrol group had lower hemoglobin A1c (better long term blood sugar control) compared to the placebo group.
  • When they statistically evaluated individual patients, the degree of improvement in the word memory test correlated with the increase in functional connectivity of the hippocampus and both of those measures correlated with decreased hemoglobin A1c.

What Does This Study Mean?

This study is promising in that it is well done and is consistent with previous animal studies. However, we need to keep in mind that this is the very first study of this kind. Similar to most first studies, it is small (only 46 subjects) and short in duration (6 months). It also only tested one dose of resveratrol (200 mg/day).

Now that this study has shown that resveratrol might improve memory in healthy older adults, it provides a strong rationale for more clinical studies to test this hypothesis. There is a need for larger, longer term studies in other population groups. Future studies should also evaluate different doses of resveratrol so that we know how much is needed to positively impact mental function.

Can resveratrol improve memory?

The Bottom Line:

  • A recent study suggests that resveratrol, a polyphenol from red wine, improves memory (measured by a word recall test) and functional connectivity of the hippocampus, a region of the brain involved in memory function.
  • This is the very first study of its kind. It was small (46 subjects) and short (6 months). However, it was well designed and consistent with previous animal results. Thus, it should be considered preliminary, but promising. More studies are clearly needed to test this hypothesis.
  • If the results of this study are substantiated, it will not necessary mean that other polyphenols will exert similar effects on memory. The action mechanism of resveratrol is different than most other polyphenols.
  • It also does not necessarily mean that red wine will make you smarter. The 100 glasses of red wine a day that you would need to drink to get the amount of resveratrol used in this study would probably kill more brain cells than the resveratrol could help.
  • Finally, as I said in a recent “Health Tips From the Professor” , there are no “magic bullets” when it comes to preventing cognitive decline. Your chances of reducing cognitive decline are best with a holistic approach that includes healthy diet, exercise, socialization, mental exercises, maintaining a healthy weight, B vitamins and omega-3 fatty acids. If this study is confirmed by future studies, you may be able to add resveratrol supplements to the list.

 

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

Can Antioxidant Supplements Cause Cancer?

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The Truth About Vitamins C & E

Author: Dr. Stephen Chaney

mythsI am always amazed at how certain nutrition myths take on a life of their own. A single study gets sensationalized. The study may not be very good, but some nutrition guru publicizes it even though it may be contradicted by other studies that come to the opposite conclusion.

Other blogs and news feeds pick it up. It gets repeated over and over until it becomes generally accepted as true. It becomes what I call an “urban nutrition myth”. Once these myths become well established they are hard to correct. When contrary information is published, it is ignored because everyone already knows the “truth”.

Can Antioxidant Supplements Cause Cancer?

The risks of antioxidant supplements are a perfect example. Most web sites and health experts warn that you should be careful about using antioxidant supplements. You are told that they may just increase your risk of cancer. They may just kill you!

The antioxidant vitamins C and E have generated the most scrutiny in recent years. There were a number of reasons to suspect that they might decrease cancer risk:

1) They destroy free radicals.
2) They decrease cancer risk in animal studies.
3) Increase consumption of vitamins C & E is associated with decreased risk of cancer in human population studies.

Because there was so much circumstantial evidence that vitamins C & E might decrease cancer risk, there have been a number of double-blind, placebo controlled human clinical trials to test that hypothesis.

• 6 clinical studies showed no effect of vitamin C and/or E on cancer incidence.
• 1 study suggested that vitamin E might decrease prostate cancer risk, and another study suggested that vitamin E might decrease colon cancer risk.
• 1 study (Kristal et al, Journal of the National Cancer Institute, doi: 10.1093/jnci/djt456, 2014) suggested that vitamin E alone might increase prostate cancer risk, but when vitamin E was combined with selenium there was no increased risk. I have discussed a likely explanation of those confusing results in a previous “Health Tips From the Professor” (https://www.chaneyhealth.com/healthtips/selenium-vitamin-e-increase-prostate-cancer-risk/).

That’s it. Six clinical studies show no effect of vitamins C & E on cancer risk, two studies suggest that vitamin E decreases cancer risk and one study suggests that vitamin E increases cancer risk. Yet all the “experts” are warning that antioxidant supplements might increase your cancer risk. It has become an urban nutrition myth.

You may remember that I said that the final characteristic of an urban nutrition myth is that when contrary information is published, it is ignored. In fact, an excellent study showing no effect of vitamins C and E on cancer risk has just been published – and it is being ignored because it doesn’t fit the “truth” that most experts have come to believe.

What Does the Latest Study Show?

antioxidant supplementsThe study in question (Wang et al, American Journal of Clinical Nutrition, 2014; doi: 10.3945/ajcn.114.085480) was a post-trial follow-up to the Physicians’ Health Study II. It followed 14,641 US male physicians (average age 64 at the beginning of the trial) for 10.3 years. The subjects were randomly assigned to receive 400 IU of vitamin E every other day, 500 mg of vitamin C daily, or their respective placebos.

The investigators in charge of the study recognized that cancer takes many years to develop and that the effects of supplementation might not be recognized until years later. Because of that, the subjects were followed for an additional 2.8 years after the close of the trial to allow additional time for cancers to develop.

The results were clear cut:

• Vitamin E supplementation had no effect on the incidence of prostate cancer or total cancers.
• Vitamin C supplementation also had no effect on the incidence of prostate cancer or total cancers.
• Vitamin C supplementation decreased the incidence of colon cancer during the post-trial period by 46%, which was marginally significant.

The Bottom Line:

1) Can antioxidant supplements cause cancer?  You can ignore the dire warnings that antioxidant supplements may increase your risk of cancer. The only case where this appears to be true is for high dose beta-carotene supplements in smokers. The weight of evidence for vitamins C and E suggests that they are unlikely to increase your risk of cancer.

2) As I have said previously if there is any risk of antioxidant supplements, it is most likely to arise from using high purity individual antioxidant supplements. I recommend vitamin E supplements containing the full spectrum of tocopherols and tocotrienols, carotenoid supplements containing all the naturally occurring carotenoids, and supplements that combine complementary antioxidant nutrients – vitamin E and selenium, for example.

3) That doesn’t mean that you should run out and stock up on antioxidant supplements in the hope that they will prevent cancer. The same clinical studies that showed no harm from vitamin C and E supplementation also showed no consistent benefit.

4) This is also consistent with my comments in previous “Health Tips from the Professor”. For example:

• It is very difficult to prove, and unreasonable to expect, that supplementation will have a measurable effect on risk of a particular disease like cancer for everyone. People who are healthy and have very low risk of cancer, may experience other benefits from supplementation but are unlikely to experience a measurable decrease in cancer risk.

• Supplementation is most likely to be advantageous in select populations, generally populations with increased need for a particular nutrient or at highest risk of disease. It is clinical studies looking at the effect of supplementation in these select populations that often show the greatest benefit of supplementation.

• Supplementation is just one component of a holistic approach for reducing disease risk. Diet, weight control, exercise, adequate rest and stress reduction all play a major role as well. You can’t weigh 250 pounds and eat all your meals at McDonalds and expect supplementation to save you from disease.

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

Health Tips From The Professor