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Maternal Mortality In The United States

by

Leading Causes Of Maternal Deaths

Author: Carolyn Curtis, MSN, CNM, RN, FACNM, FAAN

Editor: Dr. Steve Chaney

Maternal Mortality In The United States

Between 2018 and 2021, the maternal mortality (death) rate in the United States nearly doubled, placing the country last among developed nations in maternal health outcomes.  The maternal mortality ratio (MMR) is a key indicator of a nation’s overall health, making this rapid increase a cause for serious concern.

Understanding Maternal Mortality

Maternal mortality refers to the number of women who die during pregnancy or within 42 days (six weeks) after childbirth for every 100,000 live births. As per the Government Accounting Office, 25% of the increase in maternal mortality from 2020 to 2021 was due to Covid-19, which contributed to the doubling of the maternal mortality ratioi.

The maternal mortality ratio is used globally to assess the state of a country’s health. A rising MMR signals the need for urgent action.

In 2022, the U.S. recorded an overall maternal mortality ratio 22.3 deaths per 100,000 live birthsii. This decreased by about 10 deaths per 100,000 from 2021 (32 deaths per 100,000 live births in 2021). However, stark racial disparities continued to exist as demonstrated through 2018 to 2021.

  • Black women: 49.5 deaths per 100,000 live births (more than 2.5 times the rate for white women)
  • White women: 19.0 deaths per 100,000 live births
  • Hispanic women: 16.9 deaths per 100,000 live births
  • Asian women: 13.2 deaths per 100,000 live births

Maternal Mortality versus Pregnancy Related Deaths

What Is The Difference?

While maternal mortality measures deaths that occur from the onset of pregnancy to six weeks post-delivery, pregnancy-related deaths extend further.  Pregnancy-related deaths are the number of deaths per 100,000 live births up to 12 months (one year) after birth or the first birthday.

Does The Age Of The Mother Make A Difference?

The age of the mother significantly affects the risk of dying during pregnancy. The ratio of deaths among women younger than 25 years of age is 14.4 deaths per 100,000 live births. Women aged 25 to 39 have a rate of 21.1/100,000 live births, while those aged 40 and older face a staggering 87.1 deaths per 100,000 live birthsiii. This means that women over 40 are dying at six times the rate of those under 25 and four times the rate of women aged 25 to 29iv.

When Are The Deaths Occurring?

Surprisingly, a little under half (47%) of maternal deaths occur during pregnancy or within the first week postpartum (Maternal Mortality).  And a little over half (53%) happen between one week and one year after childbirth or the baby’s first birthday (Pregnancy-Related Deaths).

Leading Causes Of Maternal Deaths

The primary causes of maternal mortality in the U.S. are largely preventablev. The six main causes of maternal death include:

  • Mental Health Conditions (23%) – Suicide, overdose, and substance-related poisoning are the leading causes, this affects White and Hispanic women more than Black or Asian women.
  • Hemorrhage (14%) – Severe postpartum bleeding remains one of the top causes of maternal deaths not only in the Unites States but throughout the world with Asian women being more susceptible. Hemorrhage is defined as bleeding about one half quart of blood.
  • Cardiac Conditions (13%) – Heart disease disproportionately affects Black women.
  • Blood Clots (9%) – A major contributor to maternal deaths.
  • Cardiomyopathy (9%) – A condition affecting the heart muscle, making it harder to pump blood efficiently.
  • Hypertensive Disorders of Pregnancy (7%) – relating to high blood pressure

Contributors to maternal death include familial, societal, health care system issues and one’s personal health. it is possible to reduce the risks of maternal death by understanding one’s personal health history and your family’s health history.

This information informs nutritional, behavioral and lifestyle changes that can be made prior to and during pregnancy to reduce health risks, enabling a healthier pregnancy outcome.

The Bottom Line

  • The United States has the highest maternal mortality rate amongst all developed countries in the world.
  • The maternal mortality rate in the U.S. has nearly doubled between 2018 and 2021; Covid-19 caused a 25% increase of maternal deaths from 2020 to 2021 which contributed to the doubling of maternal deaths. Black women have been disproportionately affected, with mortality rates 2.5x that of White women.
  • Women aged 40 and over die at four times the rate of women ages 25 to 39 and six times more than women under 25 years of age.
  • The leading causes of maternal deaths include mental health conditions, hemorrhage, cardiac conditions, blood clots, and cardiomyopathy— most of which are preventable.
  • Almost half of maternal deaths occur throughout pregnancy and the first week after childbirth. A little more than half of maternal deaths occur from the first week following birth up to the first year after birth.  It’s important to continue monitoring mothers with home visits once they return home from the hospital and up until one year after birth.

References

i General Accounting Office, Maternal Health: Outcomes Worsened and Disparities Persisted During the Pandemic.  Oct, 2022.

ii Hoyert DL.  Maternal mortality rates in the United States, 2022.  NCHS Health E-Stats.  2024.  DOI:https://dx.doi.org/10.15620/cdc/152992.

iii Ibid

iv Ibid.

vFour in five pregnancy related deaths in the US are preventable – https://www.cdc.gov/media/releases/2022/p0919-pregnancy-related-deaths.html.

For More Information

Feel free to visit my website, subscribe to my YouTube channel and learn more about my online coaching program, “Mastering Pregnancy and Birth”.

You-Tube Channel – Over 80 videos exploring pregnancy, labor, birth, postpartum and contraception

www.thecarabcompany.com – Website with free downloadable pregnancy and birth information

Mastering Pregnancy and Birth Coaching Program –  A program that prepares Dads and Mom’s-to-be for a healthier pregnancy and safer birth.  This course also provides information for Doulas to provide enhanced support to families.

Carolyn Curtis

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.

About The Author

Carolyn Curtis, MSN, CNM, RN, FACNM, FAAN, has:

 

  • More than 40 years’ experience in the oversight of domestic and international programs and the provision of nursing and midwifery integrated service delivery in maternal child health, family planning, reproductive and women’s health care.

 

  • Twenty years’ experience in teaching, mentoring, and providing clinical oversight to undergraduate and graduate public health, medical, nursing and midwifery students.

 

About The Editor

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.

Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”. Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

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

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

How Much Should You Walk?

by

Walking Your Way To Health 

Author: Dr. Stephen Chaney 

Overweight People ExercisingYou’ve made your New Year’s resolutions. And if you are like millions of Americans, you may already be making plans to join a gym, get a personal trainer, or join a spin class.

The problem is these are all expensive options. And a good portion of that money is wasted. To put it into perspective, let’s look at some statistics

  • Around 6 million Americans buy gym memberships every January.
    • 67% of those memberships are never used.
    • For those memberships used in January, another 50% are not in use 6 months later.
  • Americans spend about 1.6 billion dollars on unused gym memberships every year.
    • And that doesn’t include those gym memberships that are only occasionally used.

If you want to get fit and healthy in the new year, perhaps you should consider a less expensive option – like walking. Your only investments are a good pair of walking shoes and a device that keeps track of the number of steps you take (eg, Fitbit, smart watch, or smart phone).

You still may give up on your New Year’s goal of getting fitter at some point. But you won’t have wasted so much money.

Of course, you probably have some questions about the benefits of walking, such as:

1) Is walking enough to significantly improve my fitness and health?

2) How far (how many steps) should I walk?

3) How fast should I walk?

Fortunately, two recent studies (B del Pozo-Cruz et al, JAMA Internal Medicine, 182: 1139-1148, 2022) and (J del Pozo-Cruz et al, Diabetes Care, 45: 2156-2158, 2022) have answered all three questions.

How Were These Studies Done?

clinical studyThe first study (B del Pozo-Cruz et al, JAMA Internal Medicine, 182: 1139-1148, 2022) followed 78,500 participants (average age 61, 55% female, 97% white) enrolled in the UK Biobank study for an average of 7 years.

At the time of enrollment, each participant was given an accelerometer (a device that measures the number and frequency of steps) to wear on their dominant wrist for 24 hours/day for 7 days. The investigators used the accelerometer data to categorize several types of physical activity.

  • Daily step counts (the average number of steps per day for 7 days). These step counts were further subdivided into two categories:
    • Incidental steps (It was assumed that ˂40 steps/min represented steps taken that were incidental to normal daily activities).
    • Purposeful steps (It was assumed that ≥40 steps/min represented steps taken as part of planned exercise).
  • Stepping intensity (the highest frequency of steps/min averaged over 30 min intervals for all 7 days).

At the end of the study, each of these variables was correlated with the risk of premature deaths due to all causes, cancer, and heart disease.

The second study (J del Pozo-Cruz et al, Diabetes Care, 45: 2156-2158, 2022) was similar except that it:

  • Used data from 1687 adults (average age = 55, 56% male, with diabetes or prediabetes when the study began) in the 2005-2006 National Health and Nutrition Examination Survey in the US.
  • Followed participants for 9 years instead of 7.
  • Only measured total steps/day.
  • Correlated total steps per day with premature death for participants who already had prediabetes or diabetes when they entered the study.

Walking Your Way To Health

woman walking dogStudy 1 looked at the effect of walking on health outcomes in multiple ways.

#1: Increase in number of steps/day:

  • On average study participants took an average of 7200 steps per day, but this ranged from a low of 3,200 steps/day to a high of 12,200 steps/day.
  • Each increase of 2,000 steps/day was associated with a:
    • 8% decrease in all-cause mortality.
    • 11% decrease in cancer mortality.
    • 10% decrease in heart disease mortality.
  • Overall, increasing from 3,200 steps/day to 10,000 steps/day decreased all-cause, cancer, and heart disease mortality by around 36%.
  • There was no minimum threshold to this beneficial effect of walking on the risk of premature death.
  • The benefits of walking appeared to plateau at 10,000 steps/day.

#2: Increase in number of incidental steps/day (steps taken that are incidental to normal daily activities):

  • On average study participants took 3240 incidental steps/day, but this ranged from a low of 2,100 steps/day to a high of 4,400 steps/day.
  • Each 10% increase in incremental steps/day was associated with a:
    • 6% decrease in all-cause mortality.
    • 6% decrease in cancer mortality.
    • 10% decrease in heart disease mortality.

#3: Increase in number of purposeful steps/day (steps taken as part of planned exercise):

  • On average study participants took 4,600 purposeful steps/day, but this ranged from a low of 1,600 steps/day to a high of 8,600 steps/day.
  • Each 10% increase in purposeful steps/day was associated with a:
    • 7% decrease in all-cause mortality.
    • 8% decrease in cancer mortality.
    • 10% decrease in heart disease mortality.

#4: Increase in speed of walking or cadence. The measurement they used was “peak-30 cadence” – the Walking Fasthighest average steps/min during a 30-minute interval within a day:

  • On average study participants had a “peak-30 cadence” of 76 steps/min, but this ranged from a low of 47 steps/min to a high of 109 steps/min.
  • Each 10% increase in “peak-30 cadence” was associated with a:
    • 8% decrease in all-cause mortality.
    • 9% decrease in cancer mortality.
    • 14% decrease in heart disease mortality.
  • The benefits of walking rapidly (increase in “peak-30 cadence”) were in addition to the benefits seen by increasing the number of steps per day.
  • Overall, increasing from a “peak-30 cadence” of 47 steps/min to 109 steps/min decreased all-cause, cancer, and heart disease mortality by an additional 34%.
  • There was no minimum threshold to this beneficial effect of increasing “peak-30 cadence” (the speed of walking) on the risk of premature death.
  • The benefits of increasing “peak-30 cadence” appeared to plateau at 100 steps/min.

strong heart#5 Effect of walking on the prevention of heart disease and cancer: The investigators measured this by looking at the effect of walking on the “incidence” of heart disease and cancer (defined as new diagnoses of heart disease and cancer) during the study. They found.

  • Each 2,000-step increase in the total number of steps/day decreased the risk of developing heart disease and cancer by 4% during this 7-year study.
  • Each 10% increase in the number of purposeful steps/day decreased the risk of developing heart disease and cancer by 4% during this study.
  • Each 10% increase in “peak-30 cadence” decreased the risk of developing heart disease and cancer by 7% during this study.

The authors concluded, “The findings of this population-based…study of 78,500 individuals suggest that up to 10,000 steps/day may be associated with a lower risk of mortality and cancer and CVD incidence. Steps performed at a higher cadence may be associated with additional risk reduction, particularly for incident disease.”

Study 2 extended these findings to diabetes. They started with participants that had either prediabetes or diabetes diabetesand followed them for 9 years. They found that:

  • Study participants with prediabetes ranged from a low of 3,800 steps/day to a high of 10,700 steps/day.
    • Prediabetic participants walking 10,700 steps/day were 25% less likely to die during the study than participants walking only 3,800 steps/day.
  • Study participants with diabetes ranged from a low of 2,500 steps/day to a high of 10,200 steps/day.
    • Diabetic participants walking 10,200 steps/day were also 25% less likely to die during the study than participants walking only 2,500 steps/day.
  • Even small increases in the number of steps per day decreased the risk of premature death for both prediabetic and diabetic participants.
  • Once again, 10,000 steps/day appeared to be the optimal dose to lower the risk of premature death for both diabetic and prediabetic patients.

The authors of this study concluded, “Accumulating more steps/day up to ~10,000 steps/day may lower the risk of all-cause mortality of adults with prediabetes and diabetes.”

How Much Should You Walk?

Walking CoupleThat was a lot of information. You are probably wondering what it means for you. Let’s start with the big picture:

  • Going from couch potato to 10,000 steps per day may reduce your risk of premature death due to all causes, cancer, and heart disease by 36% (24% if you are already prediabetic or diabetic).
  • Increasing the speed with which you walk from 47 steps/min to 109 steps/min sustained for 30 minutes may reduce your risk of premature death by an additional 34%.

In other words, simply walking more and walking faster can have a significant effect on your health. I am not recommending walking as your only form of exercise. I’m just saying not to consider it inferior to other forms of exercise.

  • There is no lower limit to the benefits of walking. Even small increases in the number of steps/day you take and the speed with which you walk may have a beneficial effect on your health.

In other words, you don’t need to speed walk 10,000 steps/day to reap a benefit from walking. Even small increases are beneficial. That’s good news for those of you who may not be able to speed-walk long distances. It also means that if you are a couch potato, you don’t need to attempt 10,000 steps at high speed from day 1. You can work up to it gradually.

  • Incidental walking (walking that is incidental to your daily activities) is almost as beneficial as purposeful walking (walking as part of a planned exercise).

That’s good news for those of you who may not have time for long walks. It also means that advice like “park your car at the far end of the parking lot and walk” or “take the stairs rather than the elevator” can have a meaningful impact on your health.

  • The benefits of walking appear to max out at around 10,000 steps per day and a cadence of 100 steps/min sustained for 30 minutes.

That means once you get to those levels, it’s time to consider adding other kinds of exercise to your regimen. More and faster walking may offer little additional benefit.

Finally, in the words of the authors, “This information could be used to motivate the least active individuals to increase their steps and the more-active individuals to reach the 10,000-step target.”

The Bottom Line 

You’ve made your New Year’s resolutions. And if you are like millions of Americans, you may already be making plans to join a gym, get a personal trainer, or join a spin class.

If you want to get fit and healthy in the new year, perhaps you should also consider a less expensive option – like walking.

Of course, you probably have some questions about the benefits of walking, such as:

  1. Is walking enough to significantly improve my fitness and health?

2) How far (how many steps) should I walk?

3) How fast should I walk?

Fortunately, two recent studies have answered all three questions. They found:

  • Going from couch potato to 10,000 steps per day may reduce your risk of premature death due to all causes, cancer, and heart disease by 36% (24% if you are already prediabetic or diabetic).
  • Increasing the speed with which you walk from 47 steps/min to 109 steps/min sustained for 30 minutes may reduce your risk of premature death by an additional 34%.
  • There is no lower limit to the benefits of walking. Even small increases in the number of steps/day you take and the speed with which you walk may have a beneficial effect on your health.
  • Incidental walking (walking that is incidental to your daily activities) is almost as beneficial as purposeful walking (walking as part of a planned exercise).
  • The benefits of walking appear to max out at around 10,000 steps per day and a cadence of 100 steps/min sustained for 30 minutes.

In the words of the authors of these studies, “This information could be used to motivate the least active individuals to increase their steps and the more-active individuals to reach the 10,000-step target.”

For more details on these studies and what they mean for you, read the article above.

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

 _____________________________________________________________________________

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

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

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

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

 ______________________________________________________________________

About The Author 

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.

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

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

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

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

Relief From Tension Headache Pain

by

Which Muscles Cause Tension Headaches?

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

Topic Of The Month – Tension Headaches

headacheLately a lot of people have been coming to my office complaining of headaches that have plagued them for a long time…in one case for years!

This woman had been everywhere and had every test that the medical world could offer.  Nothing showed why she had these terrible headaches.  At one point she told me the pain was a 10 on a scale of 1-10.  Imagine how terrible it was for her to suffer every day from such a crippling condition.  My heart went out to her!

Fortunately, her problem was caused by muscles, the one thing that most of the medical world doesn’t consider when looking for a solution to pain.

In fact, if you watched my TED talk: The Pain Question No One is Asking, you may have already heard me talk about this missing link. (If you haven’t heard my TED talk, go to YouTube and enter: Julie Donnelly, Pain and I’ll pop up.)

Let’s talk about muscles and why they will cause headaches (and a whole lot more!).

Which Muscles Cause Tension Headaches?

While there are many causes for headaches, such as stress, anxiety, depression, head injury, or anxiety, and life-threatening causes we won’t go into here, one type of headache that is caused by muscular tension is known as a muscle contraction tension headache.

As shown in the graphics above, muscle spasms (colored circles) will refer pain to your head, even when you don’t feel any discomfort where the spasm is actually occurring.

(In this article I will focus on treatments for pain caused by the levator scapulae and trapezius muscles).

Muscles in the neck and scalp can become tense or contract in response to stress, depression, or anxiety, leading to tension headaches.  Fortunately, in many cases, simply pressing on the trigger points (the colored circles) will release the tension being felt in your head.

To prevent tension headaches, it is important to maintain good posture, practice relaxation techniques, and use a pillow that keeps your head, neck, and spine in a horizontal plane while you sleep.

Relief From Tension Headache Pain

There are too many treatments for headaches to include all of them in this newsletter.  If you want to know them, I suggest you get one of my books, especially Treat Yourself to Pain-Free Living or The Pain-Free Athlete.

Meanwhile, I want to share an important Julstro self-treatment that you may find works well for tension headaches:

 

Place a ball such as the Perfect Ball (shown in picture) or a tennis ball, on the top of your shoulder.

 

 

 

Lean into the corner of a wall, as shown.

 

headache relief shoulder muscle pressure using wall

Keep your head close to the wall to prevent the ball from slipping and landing on the floor.

 

Bend at your hips so your upper body goes up and down, causing the ball to roll along the top of your shoulder. This will treat both the levator scapulae and trapezius muscles – both are key muscles for tension headaches.

 

 

Be gentle with this treatment as it will cause pain to be felt in your head as you are doing the treatment.  Only use enough pressure that it “hurts so good.”

Do 5-6 passes on each side.  It can be repeated often during the day but give a little time between each session to allow the muscle to relax.

Drink a LOT of water so the acid that you’re pressing out of the muscle will get flushed out of your body.

This may look a bit confusing, but it’s simple when you follow the directions.  And the best part is, IT WORKS!

How to Learn the Other Treatments for Headaches

If you go to www.FlexibleAthlete.com you can read a lot more about muscles and pain.  You will also find my books and other self-treatment tools by pressing on Shop.

Wishing you well,

Julie Donnelly

www.FlexibleAthlete.com

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.

 ______________________________________________________________________________

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

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

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

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

 ______________________________________________________________________

About The Author

Julie DonnellyJulie Donnelly has been a licensed massage therapist since 1989, specializing in the treatment of chronic pain and sports injuries. The author of several books including Treat Yourself to Pain-Free Living, The Pain-Free Athlete, and The 15 Minute Back Pain Solution.

Julie has also developed a proven self-treatment program for the symptoms of carpal tunnel syndrome.

She has a therapy practice in Sarasota, Florida, and she travels around the USA to teach massage and physical therapists how to do the Julstro Method, and she also teaches self-treatment clinics to anyone interested in taking charge of their own health and flexibility.

She may be reached at her office: 919-886-1861, or through her website: www.FlexibleAthlete.com

About The Editor

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.

Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”. Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

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

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

Are Our Teens Getting Sicker?

by

What Does This Mean For Us?

Author: Dr. Stephen Chaney

High Blood SugarThe increase of prediabetes and type 2 diabetes in the US adult population has been well documented. And these conditions have severe health consequences.

  • Nearly 70% of people with prediabetes will go on to develop type 2 diabetes.
    • Without a change in lifestyle and/or medical intervention, many people with prediabetes develop type 2 diabetes within 5 years.
  • Type 2 diabetes is highly correlated with increased risk for heart disease and stroke, vision loss, kidney disease, nerve damage, and cognitive decline.
  • And as we learned during COVID, diabetes suppresses the immune system, making us much more likely to die from viral infections ranging from flu to RSV and coronaviruses like SARS-CoV-2.

Because both prediabetes and type-2 diabetes are highly correlated with obesity, the US Preventative Services Task Force has recently recommended regular screening of adults aged 35-70 who are overweight or obese for prediabetes and type-2 diabetes.

But what about our teenagers? Are they at risk? Should they be screened also? Recent reports have documented an alarming increase in overweight and obesity in this population group.

The prevalence of type-2 diabetes is low in this group, but previous studies have reported that approximately 1 in 5 US teenagers have prediabetes. Is this a ticking time bomb that will affect their health as adults? More importantly, is the prevalence of prediabetes getting worse, just as it is for the adult population?

The expectation is that the prevalence of prediabetes in US teens is increasing, just as it is for US adults. But scientists and health organizations like the Preventive Services task force require hard data, not just expectations.

So, the study (J Liu et al, JAMA Prediabetes, 176: 608-610, 2022) I will describe today was designed to determine the prevalence trend over the past 20 years for prediabetes in US teenagers.

How Was The Study Done?

clinical studyThe study used data from the NHANES database from 1999 to 2018. NHANES (National Health and Nutritional Examination Survey) is a program administered by the CDC that collects health and nutrition information from adults and children in the United States on a biennial basis.

Among the data collected are demographic information (sex, age, race, economic status, etc.), physical exam information (BMI, blood chemistry, etc.), and health information (prediabetes, diabetes, etc.).

To have enough participants in each time period for statistically significant results, the data were combined for each two consecutive 2-year surveys. (For example, the 2000-2001 and 2001-2002 NHANES surveys were combined into a single dataset from 1999 to 2002.)

The time periods included in this study were 1999-2002, 2003-2006, 2007-2010, 2011-2014, and 2015-2018. A total of 6598 teenagers were included in this study, for an average of around 1,300 per time-period.

The main comparison was prediabetes prevalence among US teens in each time period. The study also looked at the effect of obesity and various sociodemographic classifications on prediabetes prevalence in teens.

Are Our Teens Getting Sicker?

diabetesWhen the 2015-2018 time period was compared to the 1999-2002 time period, the prevalence of prediabetes:

  • Increased from 11.6% to 28.2% – a 2.43-fold increase.

When broken down by age groups, the increase was:

  • 2.35-fold for ages 12-15.
  • 2.56-fold for ages 16-19.

When broken down by gender, the increase was:

  • 2.76-fold for females.
  • 2.30-fold for males.

When broken down by race and ethnicity, the increase was:

  • 2.10-fold for Hispanics.
  • 2.76-fold for Blacks.
  • 2.33-fold for Whites.

None of these differences were statistically significant, but they might have been had the sample size been larger.

In short, there has been more than a 2-fold increase in the prevalence of prediabetes in US teenagers over the last 20 years. And this increase was seen in young teenagers, older teenagers, male and female teenagers, and in every racial and ethnic category surveyed.

Why Is Prediabetes Increasing In Our Teens?

QuestionsKnowing the trend is important. But if you want to reverse the trend, it’s much more important to know what is causing it.

Of course, obesity is an obvious villain. Obesity is highly associated with prediabetes and type 2 diabetes, and we know that obesity is increasing in our teens. The data from this study suggests that obesity may contribute to the increase in prediabetes prevalence. But it’s not likely to be the sole cause.

For example:

  • Obesity in our teens has only increased 1.3-fold over the last 20 years.
  • More importantly, the difference in prediabetes prevalence between normal weight and overweight teens was not significant in this study.

The authors of this study also found no significant effect of educational level of the parents, family income level, or food security on the increased prevalence of prediabetes prevalence in teens.

So, what else might be contributing to the increased prevalence of prediabetes in our teens? I have two suggestions:

  • Decreased physical activity. Teens today are spending more hours staring at screens and less time exercising. Lack of exercise contributes to obesity, but there is also emerging evidence that it may independently contribute to diseases like prediabetes and diabetes.
  • Increased junk food consumption. Teenager’s diets have never been great, but multiple studies have shown that consumption of highly processed food has skyrocketed over the past 20 years.

Obviously, more work needs to be done on proving the causes of increased prediabetes prevalence in our teens, but we know enough already to start making some needed changes.

What Does This Study Mean For Us?

If you are a parent or grandparent, this study is a wake-up call. It’s not that we didn’t already suspect it was happening. After all, the increasing prevalence of type 2 diabetes in young US adults had to come from somewhere.

But this study makes it clear that prediabetes is increasing at an alarming rate in our teenage children (and grandchildren). This is a ticking time bomb.

As I said above, prediabetes leads to diabetes. And diabetes leads to heart disease and other debilitating diseases. Unless we reverse this trend, we may be dooming our teens to poor health and a shortened lifespan as adults.

So, the important questions become, “What can we do about it?” and “What can we do to reverse this trend?”

The top three things we can do are clear. We need to encourage our teens to:

  • Exercise more. Only 1 in 4 high school students get the recommended amount of daily activity.
  • Eat a healthier diet. Today more than 2/3 of the calories our teens consume come from ultraprocessed foods.

And we know the changes they need to make. Previous studies have shown that whole food, primarily plant-based diets reduce the risk of developing prediabetes and type 2 diabetes and can even reverse both conditions as effectively as medications.

  • Maintain a healthier weight. The prevalence of obesity in our teens has increased dramatically in the last 40 years. Of course, the secret is that if they get the diet and exercise part right, weight control is much easier.

But none of these changes are easy. This can’t be a, “Do as I say, not as I do” change. This needs to be a whole family change. We need to set the example.

Of course, I know some teens like to rebel against anything their parents do or recommend. We had a teenager once.

Setting the example doesn’t necessarily mean they will accept it right away. But with time they may come around. They are listening to what you say and watching what you do even when they are doing the opposite.

And I can guarantee if you aren’t willing to make these changes, they won’t be either.

The Bottom Line

A recent study looked at the prevalence of prediabetes in US teenagers over the past 20 years. The results were alarming.

  • The prevalence of prediabetes in US teens has more than doubled over the past 20 years.
  • In 2018, the last year in this study, the prevalence of prediabetes was in the 25-30% range.
  • The increased prevalence of diabetes was independent of gender, income, food security, ethnicity, and education level of the parents.

If you are a parent or grandparent, this is a ticking time bomb because 70% of people with prediabetes go on to develop type 2 diabetes within the next 5 years. And type 2 diabetes dramatically increases the risk of heart disease, stroke, kidney disease, vision loss, and cognitive decline. We may be dooming our teens to poor health and a shortened life span as adults.

For more details about this study, the causes of the increased prevalence of prediabetes in teens, and what you can do to reverse this trend for your teens, read the article above.

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

 _____________________________________________________________________________

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

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

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

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

 _____________________________________________________________________

About The Author 

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

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

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

Are Weekend Warriors As Healthy As Regular Exercisers?

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What Does This Study Mean For You? 

Author: Dr. Stephen Chaney 

It’s a new year and once again you have set New Year’s goals. If you are like millions of Americans your top 3 goals are probably to eat healthier, exercise more, and lose weight – not necessarily in that order. Now comes the hard part:

  • Setting realistic weight loss goals and developing strategies for achieving those goals.
  • Deciding on food choices and eating behaviors you will change.
  • Deciding on what kind of exercises you will do and how often you will do them.

With respect to exercise, the consensus is clear. We should be aiming for ≥150 minutes of moderate-to-vigorous physical activity per week. But how often should we be exercising? Here the answer is a bit murkier.

Most experts recommend we exercise 3-5 times a week. But that advice doesn’t work for everyone. For some people, their work schedule and family responsibilities make it difficult to find time during the week to exercise.

However, many of these individuals are very active during the weekend with things like yard work, organized sports, long hikes, and/or cycling excursions. We refer to these people as Weekend Warriors.

If you are one of these individuals, you are probably wondering if that’s enough. Are weekend warriors as healthy as people who exercise every day, or must you squeeze some exercise into your busy week?

Some recent studies have suggested that frequency of exercise is not important as long as you exceed the magical 150 minutes per week. However, each of these studies had limitations. For example:

  • They only looked at a few kinds of exercise and a few diseases.
  • Some studies depended on self-assessments of exercise frequency and intensity, which are notoriously unreliable.

The study (Circulation, 150: 1236-1247, 2024) I am reviewing today compares the health outcomes of weekend warriors and people who exercise throughout the week and was designed to eliminate the limitations of previous studies.

How Was This Study Done?

clinical studyThe authors used data obtained from the UK Biobank Study, which is an ongoing study following the health outcomes of individuals from all corners of the United Kingdom who enrolled in the study between 2006 and 2010. Each participant underwent a health assessment when they enrolled.

This study used data from a subset of 89,573 participants (average age 62, percent women 56%) who wore a wrist accelerometer to measure activity levels for one week between June 8, 2013, and December 30, 2015. The accelerometer measured activity levels every 5 seconds, so it was able to record the intensity, frequency, and duration of exercise during the week.

Participants were divided into three groups based on their accelerometer measurements:

  • Inactive: <150 minutes per week of moderate-to vigorous physical activity (34% 0f participants).
  • Weekend Warriors: ≥150 minutes per week of moderate-to vigorous physical activity with the bulk of the activity spread over 1-2 days (42% of participants).
  • Regular Exercisers: ≥150 minutes per week of moderate-to vigorous physical activity with the activity spread over multiple days (24% of participants).

The participants were followed for an average of 6.3 years with 94% of participants having >5 years of follow up. The outcome was frequency of incident diseases (diseases that were not present during the accelerometer measurements but were diagnosed during the follow-up period).

Because the United Kingdom is one of the countries with a “Big Brother knows all” health care system, the investigators were able to correlate the exercise levels of each participant with 678 diseases and health conditions. The study compared the disease incidence of weekend warriors with the inactive group, regular exercisers with the inactive group and weekend warriors with the regular exercisers.

Are Weekend Warriors As Healthy As Regular Exercisers?

Let me start with the big picture and then I will give some specific statistics.

  • Both the weekend warrior and regular exercise patterns were associated with lower risk for >200 diseases compared to the inactive group.
    • For both exercise patterns there were a small number of associations with higher disease risks – primarily musculoskeletal disorders and dermatological conditions (think sports injuries and excessive sun exposure).
    • However, both exercise patterns were associated with a lower risk of over a dozen musculoskeletal conditions such as osteoarthritis and spinal degenerative spinal conditions.
  • While both exercise patterns were associated with the risk of >200 diseases, the risk reduction was greatest for cardiometabolic diseases associated with obesity. For example, the risk reduction for:
    • Hypertension was reduced by 23% and 28%, respectively, for weekend warriors and regular exercisers.
    • Diabetes was reduced by 43% and 46%, respectively, for weekend warriors and regular exercisers.
    • Obesity was reduced by 45% and 56%, respectively, for weekend warriors and regular exercisers.
    • Sleep apnea (which is associated with obesity) was reduced by 43% and 51%, respectively, for weekend warriors and regular exercisers.
    • Chronic renal failure (Chronic renal failure can be caused by a fatty liver, which is associated with obesity) was reduced by 36% and 35%, respectively, for weekend warriors and regular exercisers.
    • Gallstones (which are associated with obesity) were reduced by 36% and 43%, respectively, for weekend warriors and regular exercisers.
  • You will notice that risk reduction was generally greater for regular exercisers than for weekend warriors. That is because the regular exercisers averaged higher weekly totals for moderate-to-vigorous activity levels than weekend warriors. When the two groups were compared at the same weekly activity level, there was no significant difference between the two groups.

What Did The Authors Say About This Study?

The authors discussed the limitations of the study in detail in the discussion section of their paper. The three biggest limitations are:

  • This study measured associations. It does not prove cause and effect.
  • The study only measured exercise patterns and intensities for one week. Some participants may have changed their exercise patterns during the follow-up period.
  • The wrist accelerometer used in this study has been validated for a variety of aerobic activities. It may be less accurate at measuring some strength training exercises. And it will be unable to measure isometric exercises, which have been shown to have some cardiometabolic health benefits.

However, this is a very large, well-designed study which is consistent with several earlier studies.

The authors also expanded on the significance of their findings with these comments:

1) “Efforts to optimize physical activity may be expected to have wide-ranging health benefits that extend beyond previously published associations with cardiovascular disease…We observed strong associations between physical activity and lower risk of up to 264 diseases.”

2) “Our results suggest that the achievement of guideline-adherent physical activity volumes [≥150 minutes per week of moderate-to-vigorous activity] is the key factor relevant to incident disease risk, as opposed to the pattern by which physical activity may be accrued…We did not identify a single condition for which risk appeared substantially different for one pattern versus the other.”

3) “Although we noted beneficial associations across a wide variety of diseases, our findings suggest that physical activity may be particularly effective for modifying risk of cardiometabolic conditions, including hypertension, obesity, diabetes, and sleep apnea.”

The authors concluded, “Achievement of measured physical activity volumes consistent with guideline recommendations [≥150 minutes per week of moderate-to-vigorous activity] is associated with lower risk of >200 diseases, with prominent effects on cardiometabolic conditions. Associations appear to be similar whether the physical activity follows a weekend warrior pattern or is spread more evenly throughout the week.”

What Does This Study Mean For You?

QuestionsThis study has three major take-home messages:

1) If you weren’t already motivated to increase your exercise levels in 2025, this study is a wake-up call. You already know that exercise improves your mood, makes weight control easier, and reduces the risk of major diseases like diabetes, hypertension, and heart disease.

This study just added another 200 reasons to increase your exercise levels. (If you want to know the 200+ diseases that are positively impacted by exercise, read the study.

2) If you are someone whose schedule makes it difficult to find time during the week, this study is good news. This study suggests that weekend warriors can be as fit and healthy as people who exercise daily. However, there are a couple of important caveats:

    • This study used a wrist accelerometer, so it was able to select only those weekend warriors whose total activity exceeded 150 minutes of moderate-to-vigorous activity. Unfortunately, many weekend warriors overestimate how much exercise they get during the weekend. For example:
      • Mowing the lawn is exercise, but the amount of exercise you get is vastly different if you use a riding mower instead of a push mower.
      • Weekend sports are a fun way to exercise, but the amount of exercise you get from an hour of soccer is probably different from an hour of softball.
    • I could go on, but you get the idea. If you choose the weekend warrior route, be realistic about the amount of exercise you are getting.

3) This study found that people who exercised often during the week were likely to accumulate higher weekly totals of activity than weekend warriors. Simply put, it is easier to accumulate higher exercise totals when you exercise more frequently.

So, even if your schedule is busy, it’s worthwhile to try and find some time to exercise during the week rather than limiting all your exercise to the weekend.

The Bottom Line

A recent study asked whether weekend warriors got the same benefits from exercise as people who exercised on multiple days during the week (regular exercisers). The key findings from the study were:

  • Weekly exercise levels of ≥150 minutes of moderate-to-vigorous activity were associated with reduced risk of over 200 diseases.
  • The reduction in risk was greatest for obesity and cardiometabolic diseases like diabetes and hypertension.
  • Once the ≥150 minutes of moderate-to-vigorous activity was reached, there was no significant difference in risk reduction between the weekend warrior and regular exercise patterns of activity.

For more details on this study and what this means for you read the article above.

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

 ______________________________________________________________________________

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

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

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

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

___________________________________________________________________________

About The Author 

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.

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

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

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

 

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

Does Diet Matter For Weight Loss?

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Who Benefits Most From A Healthy Diet?

Author: Dr. Stephen Chaney 

fad dietsFad diets abound. High protein, low carb, low fat, vegan, keto, paleo – the list is endless. They all claim to be backed by scientific studies showing that you lose weight, lower your cholesterol and triglycerides, lower your blood pressure, and smooth out your blood sugar swings.

They all claim to be the best. But any reasonable person knows they can’t all be the best. Someone must be lying.

My take on this is that fad diet proponents are relying on “smoke and mirrors” to make their diet look like the best. I have written about this before, but here is a brief synopsis:

  • They compare their diet with the typical American diet.
    • Anything looks good compared to the typical American diet.
    • Instead, they should be comparing their diet with other weight loss diets. That is the only way we can learn which diet is best.
  • They are all restrictive diets.
    • Any restrictive diet will cause you to eat fewer calories and to lose weight.
    • And as little as 5% weight loss results in lower cholesterol & triglycerides, lower blood pressure, and better control of blood sugar levels.

Simply put, any restrictive diet will give you short-term weight loss and improvement in blood parameters linked to heart disease, stroke, and diabetes. But are these diets healthy long term? For some of them, the answer is a clear no. Others are unlikely to be healthy but have not been studied long term. So, we don’t know whether they are healthy or not.

What if you started from the opposite perspective? Instead of asking, “Is a diet that helps you lose weight healthy long term?”, what if you asked, “Does the diet you choose matter for weight loss? Can healthy eating help you lose weight?” The study (S Schutte et al, American Journal of Clinical Nutrition, 115: 1-18, 2022)) I will review this week asked these question.

This was an excellent study. It compared a healthy diet to an unhealthy diet with the same degree of caloric restriction. And it compared both diets to the habitual diet of people in that area. This study was performed in the Netherlands, so both weight loss diets were compared to the habitual Dutch diet.

How Was The Study Done?

clinical studyThis was a randomized controlled trial, the gold standard of clinical studies. The investigators recruited 100 healthy, abdominally obese men and women aged 40-70. At the time of entry into the study none of the participants:

  • Had diabetes.
  • Smoked.
  • Had a diagnosed medical condition.
  • Were on a medication that interfered with blood sugar control.
  • Were on a vegetarian diet.

The participants were randomly assigned to:

  • A high-nutrient quality diet that restricted calories by 25%.
  • A low-nutrient-quality diet that restricted calories by 25%.
  • A continuation of their habitual diet.

The study lasted 12 weeks. The participants met with a dietitian on a weekly basis. The dietitian gave them all the foods they needed for the next week and monitored their adherence to their assigned diet. They were advised not to change their exercise regimen during the study.

At the beginning and end of the study the participants were weighed, and cholesterol, triglycerides, and blood pressure were measured.

Does Diet Matter For Weight Loss?

Vegetarian DietThis study compared a healthy diet to an unhealthy diet with the same degree of caloric restriction. And it compared both diets to the habitual diet of people in that area. This study was performed in the Netherlands, so both weight loss diets were compared to the habitual Dutch diet.

To put this study into context, these were not healthy and unhealthy diets in the traditional sense.

  • Both were whole food diets.
  • Both included fruits, vegetables, low-fat dairy, and lean meats.
  • Both restricted calories by 25%.

The diets were designed so that the “high-nutrient quality” diet had significantly more plant protein (in the form of soy protein), fiber, healthy fats (monounsaturated and omega-3 fats), and significantly less fructose and other added sugars than the “low-nutrient-quality” diet.

When the investigators measured weight loss at the end of 12 weeks:

  • Participants lost significant weight on both calorie-restricted diets compared to the group that continued to eat their habitual diet.
    • That is not surprising. Any diet that successfully restricts calories will result in weight loss.
  • Participants on the high-nutrient quality diet lost 33% more weight than participants on the low-nutrient-quality diet (18.5 pounds compared to 13.9 pounds).
  • Participants on the high-nutrient quality diet lost 50% more inches in waist circumference than participants on the low-nutrient-quality diet (1.8 inches compared to 1.2 inches).
    • Waist circumference is a direct measure of abdominal obesity.

When the investigators measured blood pressure, fasting total cholesterol levels, and triglyceride Heart Healthy Dietlevels at 12 weeks:

  • These cardiovascular risk factors were significantly improved on both diets.
    • Again, this would be expected. Any diet that causes weight loss results in an improvement in these parameters.
  • However, the reduction in total serum cholesterol was 2.5-fold greater and the reduction in triglycerides was 2-fold greater in the high-nutrient quality diet group than in the low-nutrient-quality diet group.
  • And the reduction in systolic blood pressure was 2-fold greater and the reduction in diastolic blood pressure was 1.67-fold greater in the high-nutrient quality diet group than in the low-nutrient-quality diet group.

The authors concluded, “Our results demonstrate that the nutrient composition of an energy-restricted diet is of great importance for improvements of metabolic health in an overweight, middle-aged population. A high-nutrient quality energy-restricted diet enriched with soy protein, fiber, monounsaturated fats, omega-3 fats, and reduced in fructose and other added sugars provided additional health benefits over a low-nutrient quality energy-restricted diet, resulting in greater weight loss…and promoting an antiatherogenic blood lipid profile.”

In short, participants in this study lost more weight and had a better improvement in risk factors for heart disease on a high-nutrient-quality diet than on a low-nutrient-quality diet. Put another way, diet does matter for weight loss. Healthy eating helped them lose more weight and gave them greater improvement in their health.

Who Benefits Most From A Healthy Diet?

obesity vs. overweightNone of the participants in this study had been diagnosed with diabetes when the study began. However, all of them were middle-aged, overweight, and had abdominal obesity. That means many of them likely had some degree of insulin resistance.

Because of some complex metabolic studies that I did not describe, the investigators suspected that insulin resistance might influence the relative effectiveness of the two energy-restricted diets.

To test this hypothesis, they used an assay called HOMA-IR (homeostatic model assessment of insulin resistance). Simply put, this assay measures how much insulin is required to keep your blood sugar under control.

They used a HOMA-IR score of 2.5 to categorize insulin resistance among the participants.

  • Participants with a HOMA-IR score >2.5 were categorized as insulin-resistant. This was 55% of the participants.
  • Participants with a HOMA-IR score ≤2.5 were categorized as insulin-sensitive. This was 45% of the participants.

When they used this method to categorize participants they found:

  • Insulin-resistant individuals lost about the same amount of weight on both diets.
  • Insulin-sensitive individuals lost 66% more weight on the high-nutrient-quality diet than the low-nutrient-quality diet (21.6 pounds compared to 13.0 pounds).

The investigators concluded, “Overweight, insulin-sensitive subjects may benefit more from a high- than a low-nutrient-quality energy-restricted diet with respect to weight loss…”

What Does This Study Mean For You?

Questioning WomanSimply put this study confirms that:

  • Caloric restriction leads to weight loss, and…
  • Weight loss leads to improvement in cardiovascular risk factors like total cholesterol, triglycerides, and blood pressure.
    • This is not new.
    • This is true for any diet that results in caloric restriction.

However, this study breaks new ground in that it shows a high-nutrient quality diet results in significantly better…

  • Weight loss and…
  • Reduction in cardiovascular risk factors….

…compared to a low-nutrient quality diet with the same degree of caloric restriction.

As I said above, the distinction between a “high-nutrient-quality” diet and a “low-nutrient-quality” diet may not be what you might have expected.

  • Both diets were whole food diets. Neither diet allowed sodas, sweets, and highly processed foods.
  • Both included fruits, vegetables, grains, and lean meats.
  • Both reduced caloric intake by 25%.
    • If you want to get the most out of your weight loss diet, this is a good place to start.

However, in this study the investigators designed their “high-nutrient-quality” diet so that it contained:

  • More plant protein in the form of soy protein.
    • In this study they did not reduce the amount of animal protein in the “high-nutrient-quality” diet. They simply added soy protein foods to the diet. I would recommend substituting soy protein for some of the animal protein in the diet.
  • More fiber.
    • The additional fiber came from substituting whole grain breads and brown rice for refined grain breads and white rice, adding soy protein foods, and adding an additional serving of fruit.
  • More healthy fats (monounsaturated and omega-3 fats).
    • The additional omega-3s came from adding a fish oil capsule providing 700mg of EPA and DHA.
  • Less added sugar.
    • While this study focused on fructose, their high-nutrient-quality diet was lower in all added sugars.

All these changes make great sense if you are trying to lose weight.

ProfessorI would group these changes into 7 recommendation

1) Follow a whole food diet. Avoid sodas, sweets, and highly processed foods.

2) Include all 5 food groups in your weight loss diet. Fruits, vegetables, whole grains, dairy, and lean proteins all play an important role in your long-term health.

3) Eat a primarily plant-based diet. My recommendation is to substitute plant proteins for at least half of your high-fat animal proteins. And this study reminds us that soy protein foods are a convenient and effective way to achieve this goal.

4) Eat a diet high in natural fiber. Including fruits, vegetables, whole grains, beans, nuts, seeds, and soy foods in your diet is the best way to achieve this goal.

5) Substitute healthy fats (monounsaturated and omega-3 fats) for unhealthy fats (saturated and trans fats) in your diet. And this study reminds us that it is hard to get enough omega-3s in your diet without an omega-3 supplement.

6) Reduce the amount of added sugar, especially fructose, from your diet. That is best achieved by eliminating sodas, sweets, and highly processed foods from the diet. I should add that fructose in fruits and some healthy foods is not a problem. For more information on that topic, I refer you to a previous “Health Tips” article.

7) Finally, I would like to remind you of the obvious. No diet, no matter how healthy, will help you lose weight unless you cut back on calories. Fad diets achieve that by restricting the foods you can eat. In the case of a healthy diet, the best way to do it is to cut back on portion sizes and choose foods with low caloric density.

Finally, I should touch briefly on the third major conclusion of this study, namely that the “high-nutrient quality diet” was not more effective than the “low-nutrient-quality” diet for people who were insulin resistant. In one sense, this was not news. Previous studies have suggested that insulin-resistant individuals have more difficulty losing weight. That’s the bad news.

However, there was a silver lining to this finding as well:

  • Only around half of the overweight, abdominally obese adults in this study were highly insulin resistant.
    • That means there is a ~50% chance that you will lose more weight on a healthy diet.
  • More importantly, because both diets restricted calories by 25%, insulin-resistant individuals lost weight on both diets.
    • That means you can lose weight on any diet that successfully reduces your caloric intake even if you are insulin resistant. That’s the good news.
  • However, my recommendation would still be to choose a high-nutrient quality diet that is designed to reduce caloric intake, because that diet is more likely to be healthy long term.

The Bottom Line 

A recent study asked, “Can healthy eating help you lose weight?” This study was a randomized controlled study, the gold standard of clinical studies. The participants were randomly assigned to:

  • A high-nutrient quality diet that restricted calories by 25%.
  • A low-nutrient-quality diet that restricted calories by 25%.
  • Continue with their habitual diet.

These were not healthy and unhealthy diets in the traditional sense.

  • Both were whole food diets.
  • Both included fruits, vegetables, low-fat dairy, and lean meats.
  • Both restricted calories by 25%.

The diets were designed so that the “high-nutrient quality” diet had significantly more plant protein (in the form of soy protein), fiber, healthy fats (monounsaturated and omega-3 fats), and significantly less fructose and other added sugars than the “low-nutrient-quality” diet.

At the end of 12 weeks:

  • Participants on the high-nutrient quality diet lost 33% more weight and had better cardiovascular markers than participants on the low-nutrient-quality diet.

The authors concluded, “Our results demonstrate that the nutrient composition of an energy-restricted diet is of great importance for improvements of metabolic health in an overweight, middle-aged population. A high-nutrient quality energy-restricted diet enriched with soy protein, fiber, monounsaturated fats, omega-3 fats, and reduced in fructose and other added sugars provided additional health benefits over a low-nutrient quality energy-restricted diet, resulting in greater weight loss…and promoting an antiatherogenic blood lipid profile.”

In short, participants in this study lost more weight and had a better improvement in risk factors for heart disease on a high-nutrient-quality diet than on a low-nutrient-quality diet. Put another way, diet does matter for weight loss. Healthy eating helped them lose more weight and gave them greater improvement in their heart health.

For more details on this study, what this study means for you, and my 7 recommendations for a healthy weight loss diet, read the article above.

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

 ______________________________________________________________________________

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

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

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

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

 _______________________________________________________________________

About The Author 

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.

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

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

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

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

 

 

Relieve Carpal Tunnel Pain Naturally

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Why I Developed Natural Treatments For Carpal Tunnel Pain 

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

carpal tunnel syndromeIn 1997 I had wrist pain that was so incredibly severe that I couldn’t take my left hand from flat on a table and bring my thumb up to two o’clock.  I couldn’t pick up a pen, never mind write with it, and the pain was like someone was cutting my wrists with a hot knife.  It closed down my massage therapy business and was forcing me to think what I could do to support myself for the rest of my life!

I was told I had carpal tunnel syndrome (CTS) and that I needed surgery, but I knew that scar tissue was going to fill the space, so that’s not something I was willing to do. Also, I knew that cutting the bridge to the carpal tunnel would weaken the thumb muscle, so another reason I didn’t want surgery.

It took a LOT of thinking, but I finally figured out how to solve the problem by treating muscles from my neck to my thumb, each of which was putting a strain/pressure onto the median nerve.  The median nerve is the nerve that causes the symptoms of carpal tunnel syndrome (numbness, tingling, pain).

And it worked!  I was completely out of pain and back to work again!  I was thrilled!!!

Muscles Affecting The Carpal Tunnel

best treatment for carpal tunnel syndromeThe muscles on the top of your arm (B) are called the Extensors.

Your extensors originate at your elbow and insert into the carpal bones (back of your hand) and into your fingertips.

Your Flexor muscles (A) are on the underside of your forearm.

The flexors also originate at your elbow, they come down your forearm and merge into the tendon at your wrist. The tendons then go through your carpal tunnel and then insert into your hand and fingers.

When your hand is flat on a table and your extensors start to contract, you lift up your hand (B). But you can see that the flexors (A) on the underside of your forearm will need to lengthen to allow this movement.

When your flexors are tight (commonly from repetitive movements) they won’t lengthen to allow your extensors to pick up your hand, and the taut flexor tendons may trap your median nerve in your carpal tunnel. This is a major cause of carpal tunnel syndrome because the nerve is being trapped right in the carpal tunnel. It was one of the primary keys to my symptoms, and an important part of the carpal tunnel treatment protocol.

Why I Developed Natural Treatments For Carpal Tunnel Pain

As you look at this graphic, you’ll see the flexor tendons surrounding the median nerve as they all pass through the carpal tunnel.  Also, notice the carpal bones, which are where the extensor muscles attach.  Finally look at the thumb muscle called Opponens Pollicis. This muscle originates on the bridge to the carpal tunnel (called the Flexor Retinaculum), and when the muscle contracts you bring your thumb into the center of your palm.

The flexor retinaculum is the ligament that is severed during carpal tunnel release surgery.  As you look at how close the median nerve is to the flexor retinaculum you can see where a potential surgical mistake could sever the nerve. This accident disables the hand and isn’t reversible. Also, severing the flexor retinaculum means your thumb loses its base, and you lose strength

This is the reason I refused surgery and sought a different carpal tunnel treatment.

As I studied each muscle and saw how they each impacted the median nerve, I realized that if I released the spasms in each muscle that it would take the pressure off the nerve.  And, sure enough, that’s exactly what happened!

It took me about 90 minutes to figure this out (it will only take you 15 minutes to do all of the carpal tunnel treatments to yourself), but in just that short amount of time I released ALL of the pain and numbness in my hand and wrist.  I was beyond being thrilled — I saved my career!

Relieve Carpal Tunnel Pain Naturally

The reason you feel pain at a location that is different from the area of a muscle spasm is pretty simple to explain:

If you pull your hair at the end, it will hurt where it inserts at your scalp.  But you don’t need to massage your scalp, you don’t need pain pills, and you definitely don’t need brain surgery to stop the pain.

You just need to let go of your hair! 

If The Extensors Are The Problem

This same principle applies with muscles. The pain will refer to the insertion point in the wrist or hand. 

If the extensor muscles are the problem, the solution is to until the knot in the muscle by applying direct pressure onto the spasm and holding it for about 30 seconds.

For example, if the knot is in the extensor muscles in your arm, you can apply pressure on your extensor muscles by following the picture on the left and pressing deeply into the muscle fibers.

It will hurt, and you’ll probably feel it refer all the way to your wrist and hand.

Hold the pressure for at least 30 seconds, longer if you want, and then move your fingers 1-2” in either direction.  You’ll keep feeling tender points. Each of them is a spasm that is causing pain in your wrist.

Then turn your arm over and use your fingers to press into the muscles on the underside of

If Your Flexors Are The Problem

Step 1:

 

 

To release the spasms in your thumb muscle, place your opposite elbow into the thick portion of your thumb as shown in the picture to the left.

 

Step 2:

Use your fingertips to guide your elbow along the muscle.  Move your elbow in a line from the center of your wrist to the base of your thumb.

Use sufficient pressure to really feel the muscle and the tender points which are spasms in the muscle fibers.

When you find a spasm, hold the pressure for 30 seconds and then deeply move back and forth a little bit.

If you are experiencing hand/wrist pain or numbness, before you make the decision to go for surgery it is worthwhile to check out my Julstro System For Hand/Wrist Pain and Numbness. You can’t undo surgery!

Wishing you well,

Julie Donnelly

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.

______________________________________________________________________________

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

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

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

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

_______________________________________________________________________

About The Author

Julie DonnellyJulie Donnelly has been a licensed massage therapist since 1989, specializing in the treatment of chronic pain and sports injuries. The author of several books including Treat Yourself to Pain-Free Living, The Pain-Free Athlete, and The 15 Minute Back Pain Solution.

Julie has also developed a proven self-treatment program for the symptoms of carpal tunnel syndrome.

She has a therapy practice in Sarasota, Florida, and she travels around the USA to teach massage and physical therapists how to do the Julstro Method, and she also teaches self-treatment clinics to anyone interested in taking charge of their own health and flexibility.

She may be reached at her office: 919-886-1861, or through her website: www.FlexibleAthlete.com

About The Editor

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.

Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”. Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

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

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

A Global Perspective Of Dietary Inadequacies

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Nutritional Inadequacies Of The American Diet 

Author: Dr. Stephen Chaney 

confusionIf you are like most Americans, you are probably confused by the conflicting information about the nutritional adequacy of the American diet.

  • On the on hand, many bloggers, websites, and the Dr. Strangeloves of the world are telling you the American diet is woefully inadequate, and you need supplements.
  • On the other hand, the pharmaceutical and medical industry are telling you that you get all the nutrients you need from your diet. They tell you supplements are a waste of money.

As usual, the truth lies somewhere in between.

  • There are certain nutrients that are often present in inadequate amounts in our diets, and these should be targeted for correction.

The nutritional inadequacies of the American diet have been well documented, and I will discuss those below.

But nutritional inadequacies on a global perspective are less well documented. That was the purpose of the study (S Passarelli et al, Lancet Global Health, 12: e1590-e1599, 2024) that I will review today.

But first, I should discuss how nutritional inadequacies are defined and their implications for our health.

What Are Nutrient Inadequacies And How Are They Defined?

ProfessorNutrient Deficiencies are defined as nutrient intakes that are below the level needed to maintain normal metabolic and physiological functions. Nutrient deficiencies can lead to health consequences such as anemia (iron or B12 deficiency), scurvy (vitamin C deficiency), or pellagra (B6 deficiency). 

Nutrient Inadequacies are defined as nutrient intakes that are below dietary intake recommendations but above the levels associated with nutrient deficiency.

While nutrient inadequacies do not lead to clearly defined deficiency symptoms such as scurvy, they are not benign.

  • They lead to symptoms that are difficult to diagnose because they could have many causes such as:
    • Fatigue
    • Increased susceptibility to viral and bacterial diseases like flu and COVID.
    • Impaired cognitive functions like attention, focus, and memory.
    • Mood disorders like anxiety and depression.
  • And if they persist long enough, they can increase the risk of chronic diseases.

When estimating nutrient inadequacies, it is also important to consider the standard for dietary intake recommendations they are being compared to.

The Recommended Daily Intake (DRI) is defined as the level of a nutrient that is likely to meet the needs of 97-98% of individuals based on age, gender, and other factors such as pregnancy and lactation.

The Estimated Average Requirement (EAR) is defined as the level of a nutrient that is likely to meet the needs of 50% of individuals based on age, gender, and other factors such as pregnancy and lactation.

This distinction is important because the standard chosen has a large impact on the percentage of people within a population group who are deemed to have an inadequate diet.

  • The data I will discuss in this article refer to the percentage of individuals in a particular group who do meet the EAR standard.
  • Obviously, the percentage of people with nutrient inadequacies would have been much higher if the DRI standard had been used.

How Was This Study Done?

The authors obtained their data from the WHO Global Dietary Database (GDD). They compared nutrient intake for 15 micronutrients with a standard that was based on the needs of 50% of healthy people. Each country sets their own standards for nutrient intakes, so they used “harmonized average requirements” from all the countries in the GDD database as the standard for comparisons.

They then segmented the data into estimates for 34 age-sex groups from 185 countries in the database.

A Global Perspective Of Dietary Inadequacies

The data are alarming. Let’s start with nutrient intakes that were inadequate for more than 50% of the world’s population:

  • Iodine, 68%.
  • Vitamin E, 67%.
  • Calcium, 66%.
  • Iron, 65%.
  • Riboflavin, 55%.
  • Folate, 54%.
  • Vitamin C, 53%.
  • Vitamin B6, 51%.

Nutrient intakes that were inadequate for between 20% and 50% of the world’s population were:

  • Vitamin A, 48%.
  • Zinc, 46%
  • Vitamin B12, 39%.
  • Selenium, 38%.
  • Magnesium, 31%.
  • Thiamin, 30%.
  • Niacin, 22%.

[Note: some micronutrients like vitamin D were not included in this study.]

Within the same country and age group, nutrient inadequacies were:

  • Higher for women than men for iodine, vitamin B12, iron, and selenium.
  • Higher for men than women for magnesium, vitamin B6, zinc, vitamin C, vitamin A, thiamin, and niacin.

Other important observations were:

  • Two thirds of women aged 15-49 had inadequate intakes of iron, zinc, and/or folate. These are the childbearing years, and adequate intake of iron and folate are important for a healthy pregnancy.
  • Over half of children under age 5 had inadequate intakes of iron, zinc, and vitamin A. Deficiencies of iron and vitamin A can have devastating health consequences during this important developmental period.

The authors concluded, “These findings show empirically that most of the global population has inadequate intake of at least one nutrient…Estimates of inadequate global micronutrient intakes [like this one] can help public health researchers and practitioners to identify which age and sex groups in which countries might be in greatest need of intervention for [which] micronutrients.”

Nutrient Inadequacies Of The American Diet

Fast Food DangersThe global distribution of nutritional inadequacies was presented as a color-coded map of the world, so I can’t give you exact percentages of nutrient inadequacies in the United States from this study. However, based on the color coding, nutrient inadequacies in the United States are:

  • ≥75% for iodine and vitamin E.
  • ≥50% for vitamin C.
  • ≥30% for iron and magnesium.
  • ≥25% for calcium and vitamin A.

These percentages of nutrient inadequacies may seem a little lower than estimates you have seen elsewhere. That’s because:

  • These numbers represent the percentage of the US population that is getting less than the EAR, the amount that meets the needs of 50% of healthy adults. If the percentages were based on the DRI, the amount that meets the needs of 97-98% of healthy adults, the percentages would be higher.
  • These numbers are the average of men and women in all age groups in the United States. When you break the numbers down further:
    • Women of childbearing age are much more likely to have low intakes of iron, and iodine than other groups. And these are nutrients that are important for a healthy pregnancy.
    • Teens of both sexes are much more likely to have inadequate intakes of iron and calcium than other age groups.

Do Nutrient Inadequacies Matter?

Question MarkStatistics like these are provocative. They are alarming. But there are two important questions we need to ask:

  • Do these nutrient inadequacies matter?
  • Who do they matter for?

The answer to these questions depends on two things – the percentage of people with inadequate nutrient intake and the likelihood that it has significant health consequences.

Simply put:

  • If 80% of the population has an inadequate intake of a particular nutrient, but inadequate intake of that nutrient has no known health consequences, it is not particularly worrying.
  • On the other hand, if 40% of the population has an inadequate intake of a particular nutrient, but inadequate intake of that nutrient has significant health consequences, it is a cause for concern.

The USDA’s 2020-2025 US Dietary Guidelines list nutrients that are of “public health concern” for each age group. Nutrients of public health concern are nutrients that:

  • Are consumed in inadequate amounts in the American diet.
  • Are associated with health concerns when their intake is low.

Here is their list of nutrients of public health concern for each age group:

  1. General population.
  • Nutrients of public health concern are calcium, dietary fiber, and vitamin D.

2) Breast Fed Infants.

    • Vitamin D3. And supplementation with 400 IU/day of vitamin D is recommended shortly after birth.

3) Vegetarian Toddlers.

    • Iron and vitamin B12 are nutrients of concern.

4) Children & Adolescents.

    • Calcium and vitamin D are nutrients of concern.
    • Iron, folate, vitamin B6, vitamin B12, and magnesium are also nutrients of concern for adolescent females.

5) Adults (Ages 19-59).

    • 30% of men and 60% of women do not consume enough calcium and 90% of both men and women do not get enough vitamin D. These are nutrients of concern for this age group.

6) Pregnant & Lactating Women:

    • Calcium, vitamin D, and fiber are nutrients of concern for all women in this age group.
    • In addition, women who are pregnant have special needs for folate/folic acid, iron, iodine, and vitamin D.

7) Older Adults (≥ 60).

    • Nutrients of concern for this age group include calcium, vitamin D, fiber, vitamin B12, and protein.
      • In fact, about 50% of women and 30% of men in this age group do not get enough protein in their diet.

What Does This Study Mean For You?

Nutrient inadequacies are a serious concern, both here in the United States and across the world.

There are 3 possible solutions to this problem.

1) Governments can provide dietary guidelines for the general population and food assistance for the needy.

In our country dietary guidelines have been an abysmal failure. Only 3% of the US population paid any attention to the food guide pyramid. It was deemed too complicated and was replaced by MyPlate which engaged a whopping 5% of the US population.

2) The food industry can fortify popular foods with “nutrients of concern”.

The most recent food fortification in the United States occurred in 1998 with the addition of folic acid to refined grains. The only other food fortifications in the United States are iodine in salt, vitamin D in milk, and some B vitamins in refined grains. There are no plans for further food fortification currently.

3) Supplementation.

Supplementation is the best option for most of us. It is an inexpensive way to eliminate nutrient inadequacies and their accompanying health concerns. It is something that each of us can control.

We don’t need to wait for the government or the food industry to get their act together. We can take our nutrition and our health into our own hands.

The Bottom Line

A recent study looked at nutrient inadequacies across the globe. It reported the following nutrient intakes were inadequate for more than 50% of the world’s population:

  • Iodine, 68%.
  • Vitamin E, 67%.
  • Calcium, 66%.
  • Iron, 65%.
  • Riboflavin, 55%.
  • Folate, 54%.
  • Vitamin C, 53%.
  • Vitamin B6, 51%.

The authors concluded, “These findings show empirically that most of the global population has inadequate intake of at least one nutrient…Estimates of inadequate global micronutrient intakes [like this one] can help public health researchers and practitioners to identify which age and sex groups in which countries might be in greatest need of intervention for which micronutrients.”

For more details on this study, nutrient inadequacies in the United States, and what this means for you read the article above.

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

_____________________________________________________________________________

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

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

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

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

______________________________________________________________________

About The Author 

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.

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

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

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

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

Can You Trust Your Herbal Supplements?

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It’s A Jungle Out There

Author: Dr. Stephen Chaney

JungleIn 2020 the annual retail sales of herbal supplements in the United States exceeded $12 billion, and the sales of herbal supplements continues to grow at almost 10% per year.

Each of those herbal supplements are marketed to help with a particular health issue. The promise is that they are “natural”. They don’t have the side effects associated with most medications.

But what if it were all a hoax? What if the supplement was adulterated – it contained an inactive powder rather than the active herbal ingredient claimed on the label?

Would you be outraged? You should be.

Unfortunately, it is a jungle out there! Popular botanical ingredients are expensive. It is a lot cheaper to substitute cheaper inactive ingredients for the botanical ingredients listed on the label. This is a shady practice called intentional adulteration.

And equally unfortunately, many manufacturers don’t perform the kind of quality controls that would allow them to identify adulterated herbal ingredients before they end up in their products.

So, you might be wondering:

  1. “Are the herbal supplements I am using adulterated? Am I wasting my money?”
  1. “How can I protect myself from this unethical practice?” “How can I become an informed consumer?”

The study (N Orhan et al, Natural Product Reports, DOI: 10.1039/d4np00014e, March 27, 2024) I am reviewing today answers the first question. It estimates the prevalence of adulteration in the top 5 most popular herbal supplements in the United States; black cohosh, echinacea, elderberry, ginkgo, and turmeric.

I answer the second question below.

What Is Adulteration And How Does It Occur?

questionsTo understand how adulteration occurs it’s best to start from the beginning.

How Do Herbal Ingredients Get Into The Product You Buy?

  • It starts with individual farmers who sell raw ingredients to a supplier.
  • The supplier combines the raw ingredients from multiple farmers into bulk botanical ingredients which they sell to a manufacturer.
  • The manufacturer combines ingredients from several suppliers and creates the herbal supplements you buy.

How Is Adulteration Defined? Adulteration can be accidental, but it is most often intentional. The authors of this paper defined intentional adulteration as “the fraudulent addition of non-authentic substances or the removal and replacement of authentic substances without the purchaser’s knowledge [usually] for the economic gain of the seller.”

How Does Adulteration Occur? Two things are required for the adulteration of herbal supplements – adulteration by the seller and either lack of quality controls or quality controls that are unable to detect the adulteration by the buyer. For example:

  • A farmer sells adulterated raw ingredients to the supplier, and the supplier does not employ adequate quality controls to detect the adulteration.
  • A supplier sells adulterated bulk botanical ingredients to a manufacturer, and the manufacturer does not employ adequate quality controls to detect the adulteration.
  • Of course, when it comes to adulteration of ingredients by the manufacturer, you are the buyer. You have no way to do quality controls on the herbal supplements you buy. But you can become an informed consumer. I tell you how below.

How Was The Study Done?

clinical studyThe investigators focused on five of the top-selling herbal ingredients in the United States for which there were a substantial number of published studies on adulteration. The five herbal ingredients they chose were black cohosh, echinacea, elderberry, ginkgo, and turmeric.

They then searched public databases for all papers on adulteration of these ingredients between January 2000 and July 2023. They identified 78 publications with 2,995 samples of herbal ingredients analyzed.

The samples analyzed included raw ingredients sold by farmers, bulk botanical ingredients sold by suppliers, and herbal supplements sold online or at retail outlets.

The extent of adulteration of each of the five herbal ingredients was calculated as the total number of adulterated samples in relation to the total number of samples analyzed. Overall, 818 of the 2,995 samples analyzed (27%) were adulterated.

Can You Trust Your Herbal Supplements?

AvoidThe results of this study were astonishing and depressing. The extent of adulteration was:

  • 56.7% for ginkgo.
  • 42.2% for black cohosh.
  • 28.5% for echinacea.
  • 17.1% for elderberry.
  • 16.5% for turmeric.

And this is just the tip of the iceberg.

  • The Botanical Adulterants Prevention Program has identified almost 30 botanicals (herbal ingredients) that are subject to adulteration. And this program is just getting started. Many more herbal ingredients remain to be tested for adulteration.
  • This study just reported on adulteration of herbal ingredients. It did not assess contaminants such as pesticides, herbicides, fungicides, and heavy metals. Any manufacturer with quality controls unable to detect adulteration would likely miss many of these contaminants as well.

 

The authors concluded,

  • “The data show that a substantial portion of botanical dietary supplements do not contain what is on their labels.”
  • “Quality control methods used by suppliers, manufacturers, researchers, and regulators need to be sufficiently specific to detect possible adulterants in botanical ingredients and produce high-quality authentic products.”
  • “There are numerous examples where analytical methods used in industry quality control…have been shown to be inadequate to detect adulteration and properly authenticate botanical materials.”

How To Become An Informed Consumer

SkepticThis study just confirms what many of you have already suspected. For many herbal supplements on the market, you can’t trust that what’s on the label is in the product. You can’t trust the products will deliver on their claims. It’s all “smoke and mirrors”.

So, how can the consumer protect themselves from herbal supplements that are worthless – supplements that are just a waste of money? I have two recommendations for you.

#1: Become a skeptic. Don’t believe what sales representatives tell you, ads show you, and websites tell you about the quality of a company’s herbal supplements. Over the years I have seen many company websites that raved about their quality controls and claimed their products were as pure as “the driven snow” – until the day the FDA shut them down because none of that was true.

#2: Become an investigator. If you are thinking about using a company’s herbal supplements, ask:

  • How many quality controls they do on the botanical ingredients used in their products and whether those quality controls can detect both contaminants and adulterants. The answers to those two questions should be, “hundreds” and “yes”.
  • How many quality controls do they do on their final product before they release it to the public. The answer should be “dozens” to “hundreds” depending on how many ingredients they have in the product. And don’t be fooled because they tell you their products are “third party tested”. Ask the same questions about the third party that is testing them.
  • How many clinical studies have they published in peer-reviewed scientific journals showing their products are safe and effective. The answer should be “hundreds”.

If you can’t find answers to these specific questions on the company’s website or through direct inquiry, move on. Find another company that can give the correct answers to these questions.

No matter how impressive the claims sound, a company’s product is only as good as the testing and proof behind it.

The Bottom Line

A recent study looked at adulteration (the substitution of worthless ingredients for the active ingredient) of the top 5 botanical ingredients used in herbal supplements in the United States.

The results of this study were depressing. The extent of adulteration was:

  • 56.7% for ginkgo.
  • 42.2% for black cohosh.
  • 28.5% for echinacea.
  • 17.1% for elderberry.
  • 16.5% for turmeric.

And this is just the tip of the iceberg.

The authors concluded,

  • “The data show that a substantial portion of botanical dietary supplements do not contain what is on their labels.”
  • “Quality control methods used by suppliers, manufacturers, researchers, and regulators need to be sufficiently specific to detect possible adulterants in botanical ingredients and produce high-quality authentic products.”
  • “There are numerous examples where analytical methods used in industry quality control…have been shown to be inadequate to detect adulteration and properly authenticate botanical materials.”

For more details about this study and how you can protect yourself from worthless supplements by becoming an informed consumer, read the article above.

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

_______________________________________________________________________________

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

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

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

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

________________________________________________________________________

About The Author 

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

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

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

600th Issue Celebration

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Nutrition Advances Over The Last Two Years

Author: Dr. Stephen Chaney 

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

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

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

  • Articles that have debunked long-standing myths about nutrition and health.
  • Articles that have corrected some of the misinformation that seems to show up on the internet on an almost daily basis.
  • Articles about the issues that most directly affect your health.

Here are my picks from the last two years:

Weight Loss Diets

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

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

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

Healthy Diets

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

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

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

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

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

Diet And Heart Disease

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

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

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

The Dangers Of Processed Foods 

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

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

This study is interesting for two reasons.

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

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

Maintaining Muscle Mass As We Age

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

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

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

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

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

The Benefits And Risks Of Supplementation

Omega-3s And Heart DiseaseIf you listen to Big Pharma or the medical profession, you hear a lot about the “risks” of supplementation and very little about the benefits. In “Health Tips From the Professor” I try to present a more balanced view of supplementation by sharing high-quality studies showing benefit from supplementation and studies that put the supposed risks into perspective.

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

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

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

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

Prenatal Supplements

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

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

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

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

Exercise

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

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

Did You Know? 

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

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

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

How To Talk With Your Doctor About Cancer 

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

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

The Bottom Line

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

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

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

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

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

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

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

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

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About The Author 

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

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

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

Health Tips From The Professor