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How Much Protein Do Post-Menopausal Women Need?

March 19, 2024 by Dr. Steve Chaney

Does The Design Of The Protein Supplement Matter?

Author: Dr. Stephen Chaney

You’ve probably heard the saying, “It’s all downhill after 30”. That’s a particularly gloomy way of looking at it, but Father Time does take a toll on our body. I’m going to focus on age-related loss of muscle mass today, a physiological process called sarcopenia.

There are three factors that influence the rate at which we lose muscle mass as we age:

1) Our physiology changes. Our bodies break down our protein stores more rapidly and we have a harder time utilizing the protein in our diet to replenish those protein stores.

2) We become less active. In some cases, this reflects physical disabilities, but all too often it is because we are not giving weight-bearing exercises the proper priority in our busy lives.

3) Our diets become inadequate. The major driver of this phenomenon is loss of appetite which results in decreased caloric intake. However, physical disability, isolation, and insufficient income also contribute.

Sarcopenia in turn results in:

Loss of muscle strength. Even the simple act of picking up a grandchild or a bag of groceries can become problematic.

Increased risk of falls and fractures.

Lower quality of life.

Obviously, sarcopenia is a major health issue for those of us in our golden years. If you are younger, it is a concern for your parents or grandparents. Sarcopenia is a health issue that affects everyone.

But what can be done to prevent sarcopenia? We can’t change our physiology, but we can change our activity level and our diet. Weight-bearing exercise tugs on our muscle fibers. That stimulates those fibers to incorporate protein into new muscle cells. It is no wonder that weight-bearing exercise is recommended for preventing sarcopenia.

What about diet? Are older adults getting enough protein in their diet to benefit from weight-bearing exercise? I have shared studies showing that older adults need more protein and higher levels of the amino acid leucine to benefit from their workouts.

But those studies were done with men. There have been no studies comparing younger and older women until now.

In this article, I discuss a recent study (CF McKenna et al, Journal of Applied Physiology, Feb 22, 2024 doi.org/10.1152/applphysiol.00886.2023) that asks how much protein is needed to stimulate muscle protein synthesis following a workout in post-menopausal women and compares it to the protein needs of younger women.

How Was The Study Done?

The investigators enrolled 16 post-menopausal women who were part of a much larger study investigating exercise and nutritional regimens that preserve and/or enhance muscle mass in women.

The women in this study were on average 60 years old with a BMI of 26 (overweight). They had no heart disease, dietary restrictions, and did not take any supplements that could affect protein metabolism.

They were compared to a cohort of pre-menopausal women (average age = 24, BMI = 25 (borderline overweight)) recruited from the same large study. The experimental protocol was the same for the pre-menopausal and post-menopausal cohorts.

The study design was what is called a parallel-group design. Simply put, one leg was exercised using a leg extension machine, while the other leg was rested. The rested leg served as the control for each participant in the study.

Participants were tested ahead of time to determine the “one-repetition maximum” (1RM) weight for complete leg extension for each participant.

On the day of the experiment participants arrived in the laboratory after an overnight fast. One iv line was inserted, and a labeled amino acid was infused into the bloodstream, so the investigators could measure new protein synthesis at any time during the 4-hour experiment. Another iv line was inserted, so the investigators could withdraw blood samples.

At the beginning of the experiment, each participant was given either a whey protein drink (whey protein isolate fortified with vitamins C, B1, B2, B3, folate, B6, and B12 and minerals calcium, magnesium, iron, zinc, and potassium) or water. They then performed a bout of single-leg extensions starting with a warm-up of 2 sets of repetitions at 30% 1RM followed by 3 sets of 12 repetitions at 65% 1RM with 90 seconds of rest provided between sets.

Immediately following exercise, muscle biopsies were collected from both legs (t=0). Muscles biopsies were also collected at 120 and 240 minutes after exercise. Blood samples were collected continually during the experiment.

Muscle tissue was isolated from each biopsy, and something called myofibrillar protein synthesis (protein synthesis in muscle fibers) was determined based on the amount of labeled amino acid incorporated into muscle protein. The amount of protein synthesis due to exercise was determined by subtracting the incorporation of labeled amino acid in muscle fibers in the rested leg from that in the exercised leg.

What Is Leucine?

Leucine is an essential amino acid. It is present in all dietary proteins, but it is more abundant in whey and soy protein than in some vegetable proteins.

Leucine is also one of three branched-chain amino acids (valine and isoleucine are the other two). If you are familiar with the weightlifting and body-building world, you will know that branched-chain amino acids are thought to be important for muscle gain. However:

It turns out that leucine is the only branched chain amino acid that stimulates muscle protein synthesis (Am J Physiol Endocrinol Metab 291: E381-E387, 2006). And protein is what gives muscles their strength and their bulk.

The other branched chain amino acids appear to play a supporting role in the quantities that occur naturally in most proteins. And adding extra valine and isoleucine to a protein supplement appears to reduce the effectiveness of leucine at stimulating muscle gain (Am J Physiol Endocrinol Metab 291: E381-E387, 2006).

What Have Previous Studies Shown?

With respect the amount of protein needed to optimize muscle gain after workouts, previous studies have shown that:

The optimal protein intake for maximizing muscle gain post workout is 15-20 gm for young men (Katsanos et al, Am J Clin Nutr 82: 1065-1073, 2005; Moore et al, Am J Clin Nutr, 89: 161-168, 2009) and 20-25 gm for older men (Symons et al, Am J Clin Nutr 86: 451-456, 2007).

More protein isn’t necessarily better. The effect of protein intake on post workout muscle gain maxes out at around 25 gm for young men and 30 gm for older men (Symons et al, J Am Diet Assoc 109: 1582-1586, 2009).

Whey protein is the best choice for enhancing muscle gain immediately after a workout. Other protein sources (soy, casein, chicken) are better choices for sustaining muscle gain over the next few hours.

A previous study by the authors of the present study showed that 15 gm of whey protein was sufficient to stimulate muscle protein synthesis in young women (average age 20). Thus, young women and young men both appear to benefit from 15 gm of protein after a workout.

How Much Protein Do Post-Menopausal Women Need?

This is a complex study, so let’s just start with the big takeaway from the study:

The same whey protein supplement that increased muscle mass in younger women failed to stimulate “cumulative muscle protein synthesis” [net increase in muscle mass] in post-menopausal women. (This was measured by determining net accumulation of labeled amino acids into the muscle fibers of the exercised leg compared to the rested leg.)

With that out of the way, we can focus on some less important findings:

There was a short-term (0-2h) transient increase in muscle protein synthesis following exercise with and without the whey protein supplement, but the result was not cumulative. In other words, the transient protein synthesis did not result in an increase in muscle mass.

There was a long-term (2-4h) transient increase in muscle protein synthesis following exercise for the group taking the whey protein supplement, but, again, the result was not cumulative. It did not result in a net increase in muscle mass.

In the group taking the whey protein supplement there was a transient increase in both insulin and leucine in the blood between 2 and 4 hours. Either or both could have driven the transient increase in protein synthesis observed during that same times.

In the words of the authors, “Ingestion of 15 gm whey protein failed to stimulate [net] myofibrillar (muscle) protein synthesis in post-menopausal women. While resistance exercise with and without feeding stimulate late (2-4 h) and early (0-2h) increases in myofibrillar protein synthesis, further exercise and nutritional manipulations may be necessary to robustly stimulate the skeletal muscle adaptive response to exercise.”

They went on to say that increased exercise intensity and/or increased protein intake may be necessary for post-menopausal women to maintain or increase muscle mass.

What Does This Study Mean For Post-Menopausal Women?

I should start by acknowledging that this was a small study, as are most studies in this field of research. In part this reflects the expense of these experiments and the lack of major government support. But it also reflects the difficulty in recruiting subjects for this kind of experiment. They are hooked up to two iv’s for over four hours and have three muscle biopsies removed from each leg during that time. That’s a pretty invasive experimental protocol.

With this limitation in mind, the biggest takeaway from this study is that post-menopausal women need more protein to build muscle mass than younger women. Young women, just like young men, can build muscle mass with as little as 15 gm of protein post-workout.

Unfortunately, this study did not determine how much protein post-menopausal women need to build muscle mass post-workout. And that is a critical question, because women typically have less muscle mass than men when sarcopenia starts to set in. Resistance (weight-bearing) exercise and adequate protein intake are key to preventing the debilitating effects of sarcopenia in post-menopausal women.

In their conclusion, the authors said that “…further exercise and nutritional manipulations may be necessary [to optimize the post-workout gain in muscle mass for post-menopausal women].”

From an exercise standpoint, the authors speculated that higher intensity exercise may be needed to increase muscle mass in post-menopausal women. However, the exercise protocol they used was based on public health recommendations for resistance training for older adults. A more rigorous exercise protocol might not be suitable for many post-menopausal women.

From a nutritional standpoint, they noted that a previous study had shown that 35 gm of protein post-workout was sufficient to build muscle mass in post-menopausal women. However, they considered 35 gm of protein to be a dangerously high intake for a single serving of protein for post-menopausal women. I concur.

In summary, we know that 15 gm of protein post-workout is too little for postmenopausal women, and while 35 gm of protein is sufficient, it is probably too much. Until further studies are performed in post-menopausal women, I would recommend the 20-25 gm of protein shown to support post-workout muscle gain in older men.

But it is not just the amount of protein that is important. The design of the protein supplement also matters.

Does The Design Of The Protein Supplement Matter?

While the amount of protein in a post-workout supplement is important, the design of the protein supplement also matters. While there are lots of crazy claims on the internet, there are two natural ways to maximize the effect of a protein supplement on muscle mass. Insulin and the amino acid leucine both drive muscle protein synthesis and help maximize post-workout muscle gain.

Recent research has shown that 2-3 gm of leucine (2 gm for young men; 3 gm for older men) is sufficient to maximize post workout muscle gain if protein levels are adequate (Am J Physiol Endocrinol Metab 291: E381-E387, 2006). We don’t know the corresponding leucine requirements for women, so we will need to assume they are similar.

- A 15-gram serving of whey protein isolate only provides 1.4 gm of leucine, far below what is likely to be needed to drive post-workout muscle gain in post-menopausal women.

- If you are a man over 50 or a post-menopausal woman, you should look for a post-workout protein supplement containing added leucine. And even younger adults will get “more bang for your buck” by choosing protein supplements with added leucine.

The insulin response is maximized when the carbohydrate to protein ratio is around 2.5 to 1. The manuscript did not list carbohydrates among the ingredients used in the whey protein supplement used in this study. But if it is like many whey protein supplements nowadays, it probably contained little or no carbohydrate.

- Although less popular in today’s low carbohydrate world, post-workout supplements with a high carbohydrate to protein ratio are also effective in maximizing post-workout muscle gain.

The Bottom Line

Sarcopenia (age-related muscle loss) is a major concern for older Americans. Sarcopenia can result in:

Loss of muscle strength. Even the simple act of picking up a grandchild or a bag of groceries can become problematic.

Increased risk of falls and fractures.

Lower quality of life.

Sarcopenia can be prevented by a combination of resistance exercise and adequate amounts of protein following the workout.

We know that older men require more protein than young men in a post-workout supplement designed to help them maximize the muscle gain associated with resistance exercise. But similar experiments had not been performed with women until now.

In the article above I share a study that shows that post-menopausal women need more protein than young women in a post-workout supplement. But the study did not determine how much protein they need.

I also discuss the amount of protein post-menopausal women likely need in a post-workout supplement, and how that protein supplement could be designed to maximize muscle gain and prevent sarcopenia.

For more information on this study and my recommendations read the article above.

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

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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

_______________________________________________________________________

About The Author

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 Oats Bad For You?

March 12, 2024 by Dr. Steve Chaney

What Does This Study Mean For You?

Author: Dr. Stephen Chaney

If you are gluten sensitive like me, grains that have taste, texture, and fiber are few. Oatmeal is one of my favorites. In fact, I start every day with a bowl of oatmeal. So, when I first saw the headlines suggesting that oats might be bad for me because they might be contaminated with a toxic chemical, my first reaction was, “Say it isn’t so”.

Naturally, I did some research on the subject and looked up the study (AM Temkin et al, Journal of Exposure Science & Environmental Epidemiology, published February 15, 2024) behind the headlines.

The study documented the presence of a potentially toxic agricultural chemical called chlormequat found in our food supply and in our urine. If you are like me, you have probably never heard of chlormequat before, so a little explanation is in order.

What Is Clormequat?

Chlormequat is an agricultural chemical that is widely used on oat, barley, and wheat crops in Europe and Canada. It is not a pesticide or herbicide. It does not enhance the nutritional value of the grains it is sprayed on.

It is a growth regulator. Its sole role is to decrease the stem height of these crops and prevent them from bending over, so that mechanical harvesting of the crops is more efficient. It is a perfect example of the industrialization of modern agriculture.

No human studies have been done on clormequat, but animal studies suggest it may affect fertility, harm the reproductive system, and lead to altered fetal growth and development.

The US Environmental Protection Agency:

First allowed the import of clormequat in oat, wheat, and barley imported into the United States in 2018.
Increased the allowable amount of chlormequat on imported oats in 2020.
Is currently considering allowing the use of chlormequat on oats, barley, and wheat grown in the United States.

How Was This Study Done?

Urine samples were collected from US adults from three geographical regions between 2017 and 2023.

21 urine samples from Charleston, South Carolina in 2017.
25 urine samples from between October 2017 and September 2022 from Maryland Heights, Missouri.
50 urine samples from Florida in 2023.

All the urine samples were analyzed for chlormequat by LC MS/MS.

Food samples (25 conventional and 8 organic oat products and 9 conventional wheat products) were purchased from US grocery stores in the Washington DC area between June 2022 and May 2023 and analyzed for chlormequat levels by the same method.

Are Oats Bad For You?

The results of the study were surprising.

Overall chlormequat was detected in 80 % of the urine samples. Moreover, the trend was concerning. Clormequat was detected in:

- 69% of the urine samples collected in 2017.

- 74% of the urine samples collected between 2018 and 2022.

- 90% of the urine samples collected in 2023.

The average level of chlormequat detected in the urine in 2023 was 3 times higher than in previous years.

The authors speculated that the large increase of chlormequat in the urine of US citizens in 2023 represented the time it took for chlormequat-contaminated grains to work their way into the US food supply after the EPA increased the amount of allowable chlormequat in imported grains in 2020.

When the investigators measured chlormequat contamination in foods derived from oats and wheat in 2022 and 2023 they found chlormequat contamination in:

92% (23 out of 25) conventional oat-based products. This included popular brands such as Quaker Oatmeal and Cheerios.

5% (1 out of 8) organic oat-based products.

22% (2 of 9) conventional wheat-based products. The level of chlormequat contamination was also around 10-fold lower in wheat-based products than in oat-based products.

The authors concluded. “This study reports the detection of chlormequat, an agricultural chemical with developmental and reproductive toxicity, in the U.S. population and the U.S. food supplies for the first time…This work highlights the need for more expansive monitoring of chlormequat in U.S. foods and in human specimens, as well as toxicological and epidemiological study on chlormequat, as this chemical is an emerging contaminant with documented low-dose adverse health effects in animal studies.”

What Does This Study Mean For You?

It would be easy to dismiss this study, and the headlines that go with it, as alarmist.

The toxic effects of chlormequat on the reproductive system have only been seen in a handful of animal studies. There are no human studies correlating levels of chlormequat in the body with reproductive issues or other health outcomes.

The chlormequat levels seen in urine in this study were far below the minimum thresholds published by the US EPA and the European Food Safety Authority.

However, this is a troubling component of a much larger pattern.

Currently, there are over 3,000 chemicals in our food supply that have not been tested for safety by the FDA. Chlormequat is just the latest addition to the list.

One recent study identified over 700 potentially toxic chemicals in human blood.

Another study found over 200 potentially toxic chemicals in newborn umbilical cord blood.

This is a witch’s brew of chemicals. While most of these chemicals in our blood are far below the minimum levels set by the EPA, nobody has studied how they interact with each other. In short, the danger for each chemical individually may be small, but nobody knows what the cumulative risk is for hundreds of chemicals working together.

So, while we may be able to ignore the current headlines about toxic oats, we should not ignore the larger and growing concern about thousands of untested chemicals in our food supply and hundreds of potentially toxic chemicals in our blood.

My recommendation, of course, is to buy organic whenever possible. For example, my wife purchases our oatmeal at the farmer’s market from a local farmer who grows his oats organically and grinds his own oatmeal.

The Bottom Line

You may have seen recent headlines saying that oats are bad for you, because they might be contaminated with a toxic chemical.

In the article above I review the study behind the headlines and put it into perspective for you.

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

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

______________________________________________________________________________

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.

Is Supplementation Important For Hospitalized Patients?

March 5, 2024 by Dr. Steve Chaney

Why Does Supplementation Matter During Hospitalization?

Author: Dr. Stephen Chaney

I have often said that age doesn’t necessarily bring wisdom, but it does bring perspective. When I first started teaching medical students in the early 70’s, the idea that optimal nutrition was important for hospitalized patients was new and exciting.

A series of groundbreaking papers documented that many patients, especially elderly patients, were in poor nutritional status when they entered the hospital. For these patients optimizing their nutrition while they were in the hospital and shortly thereafter:

Reduced mortality and increased recovery from whatever treatment they were undergoing.

Reduced the incidence of sepsis (systemic infection) and other severe side effects of the treatment.

Reduced recovery time in the hospital.

Allowed them to return to their normal daily activities more quickly after they left the hospital.

Those discoveries revolutionized medicine. Every hospital now provides tube feeding and iv infusions for very ill and nutritionally compromised patients. And these innovations have improved the effectiveness of hospital care.

So, when I saw a recent paper (GE Baggs et al, Clinical Nutrition, 42: 2116-2123, 2023) with the title “Impact of a specialized oral nutritional supplement on the quality of life in older adults following hospitalization”, my initial thought was this was old news.

But then I read further. You see, feeding tubes and iv infusions are very effective. But if you or a loved one has ever been hospitalized for a serious illness or accident, you also know they are very expensive.

When I read this study, I realized they were talking about a less expensive option, the equivalent of providing these patients with a multivitamin and a protein shake providing certain critical nutrients. That got my attention.

How Was This Study Done?

This study utilized data from something called the NOURISH [Nutrition effect On Unplanned Readmissions and Survival in Hospitalized patients] trial. This trial enrolled hospitalized older adults with malnutrition. As the title of the trial suggests, this study tested the effect of the nutritional intervention I will describe below on unplanned readmissions after hospitalization (which you want to be as low as possible) and survival after hospitalization (which you want to be as long as possible).

That study reported that hospitalized patients who received the prescribed supplement experienced:

Improved nutritional status.

Improved survival and reduced readmission after leaving the hospital.

This study re-analyzed the same data set to determine whether the same patients also experienced improved quality of life. Here are the specifics of the study:

Elderly (average age = 78) patients who were recently admitted to the hospital with a diagnosis of congestive heart failure, acute myocardial infarction (heart attack), pneumonia, or COPD were screened for nutritional status. From this group, 622 patients with moderate or severe malnutrition were selected for the study. Patients with this combination of age, severe cardiopulmonary disease, and poor nutritional status generally have poor outcomes and increased risk of readmission.

The patients were randomly split into two groups. One group received standard care. The second group received a beverage containing 20 grams of protein, 1.5 grams of beta-hydroxy-beta-methylbutyrate (HMB), plus vitamin D and other essential micronutrients.

[Note: HMB is a metabolite of the amino acid leucine. And, like leucine, HMB stimulates an increase in muscle protein synthesis, reduces loss of muscle mass during hospitalization, and enhances the regain of muscle mass during recovery. HMB and leucine give essentially equivalent results.]

The second group received a placebo beverage containing 12 grams of carbohydrate, 10 mg of vitamin C, but no protein, HMB, or other micronutrients.

Patients were instructed to drink 2 servings of the beverage a day during hospitalization and for the first 90 days after discharge from the hospital.

On the day they were discharged from the hospital (day 0) and on 30, 60, and 90 days after discharge the patients met with trained coordinators who administered questionnaires assessing their quality of life.

Is Supplementation Important For Hospitalized Patients?

When compared to the placebo, the supplement described above provided significant improvements in:

General health on days 0, 30, 60, and 90 after leaving the hospital.

Mental health on days 60 and 90 after leaving the hospital.

Vitality and social functioning on day 90 after leaving the hospital.

In addition, there was a trend towards improvement for:

Physical functioning, reduced body pain, and mental health-related role limitations [for example, taking care of a spouse].

The authors concluded, “Among malnourished, hospitalized patients (aged ≥ 65 years), supplementation with S-ONS [their acronym for the supplement used in this study] during hospitalization and 90 days post discharge resulted in improved quality of life. These benefits complement survival benefits previously shown in the NOURISH trial analysis.”

Why Was This Supplement Effective?

You will notice that the beverage used was relatively high in protein (20 grams) and included added HMB to help increase muscle mass. It also contained a variety of micronutrients.

There are two reasons for this design.

You have heard the saying, “It’s all downhill after age 30.” With muscle mass the downhill slide starts around age 50. This age-related loss of muscle mass is referred to as sarcopenia.

Sarcopenia can be slowed by resistance training plus diet or supplementation that provides around 20 grams of protein plus either leucine or HMB 2-3 times a day.

However, many older adults have trouble fixing healthy meals and end up protein and micronutrient deficient.

Severely ill patients enter what is referred to as a catabolic state. They break down their muscle and energy stores at a high rate. This is also true for patients recovering from major surgery or trauma.

The catabolic state dramatically increases protein and calorie needs just to prevent the body from cannibalizing its own tissue. Again, previous studies have shown that a protein supplement providing around 20 grams of protein and either HMB or leucine can slow this process.

What Does This Mean For You?

There are two major take home lessons from this study.

1) Who needs supplementation?

I have covered this topic in previous issues of “Health Tips From the Professor”, but let me summarize the key points here.

Supplementation can fill the gaps in an inadequate diet. Multiple studies have shown that most Americans get inadequate levels of one or more essential nutrients from their diet. And restrictive diets ranging from vegan to keto create additional nutritional deficiencies.

- And, for this purpose, supplementation need not be complicated. A multivitamin and a plant protein shake to replace some of the animal protein in the typical American diet would suffice.

Supplementation can reduce the risk of certain chronic diseases. We should not think of supplementation as a “magic bullet”, but I do recommend it as part of a holistic approach to wellness.

- In this case supplementation starts with a protein shake and a multivitamin, but often includes targeted nutrients such as omega-3s.

But this study reminds us of another key point about supplementation.

We should supplement before we need it most. The seniors in this study were already “behind the 8 ball” when they were admitted to the hospital because they were malnourished – something that likely could have been prevented with a simple program of supplementation and exercise.

This is a lesson that applies to all of us.

- Chronic diseases like high blood pressure, diabetes, and cancer “sneak up on us”. They often develop years before we or our doctors recognize them. Studies show that diet and supplementation reduce the risk of developing these diseases, but they are much more difficult to reverse once you have them.

- Most hospitalizations are unplanned. And if we enter the hospital with optimal nutritional status, the outcome of our treatment is much better than if we enter the hospital in poor nutritional status.

- Colds and viruses strike without warning. We are much more likely toward them off or recover more quickly if we are in good nutritional status when we are exposed.

2) What kind of supplement do we need? Don’t misunderstand me. There are times when tube feeding and iv infusions are absolutely essential for some hospitalized patients.

But this study showed that a well-designed protein supplement containing the essential micronutrients was sufficient for most elderly, malnourished patients hospitalized with severe cardiopulmonary diseases.

The formulation used in this study was produced by a pharmaceutical company. However, any high-quality protein supplement providing 20 grams of protein with added leucine or HMB plus a multivitamin supplement should provide the same benefits at a lower cost. The multivitamin could be in tablet or powder form.

The catabolic state associated with hospitalization also increases energy requirements. The protein supplement used in these studies had 350 calories and 44 grams of carbohydrate.

Most commercial protein supplements are designed for weight loss or weight maintenance and have fewer calories. So, for hospitalized patients extra calories would need to be provided in the form of foods containing healthy carbohydrates and fat.

The Bottom Line

Recent studies have shown that providing elderly, malnourished patients with a simple, inexpensive supplement regimen during and following hospitalization leads to better outcomes and better quality of life for the hospitalized patients. These findings illustrate two important concepts about supplementation:

The time to supplement is before you need it. Most hospitalizations are unplanned, and your outcome will be much better if you enter the hospital in optimal nutritional status.

Supplementation need not be complex and expensive. The supplement regimen used in this study is equivalent to a high-quality protein supplement with added leucine or HMB plus a multivitamin.

For more details about these studies read the article above.

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

______________________________________________________________________________

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

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

_______________________________________________________________________

About The Author

Is The Blood Type Diet A Myth?

February 27, 2024 by Dr. Steve Chaney

What Does This Study Mean For You?

Author: Dr. Stephen Chaney

In 1997 Dr. Peter J. D’Adamo wrote a book about the blood type diet called “Eat Right 4 Your Type”. Dr. D’Adamo claims that people with different blood types process food differently, so their blood type determines the type of diet that is healthiest for them. Specifically, he claims that people with:

Blood group O are descended from hunters and should consume meat-oriented diets.

Blood group A are descended from farmers and should consume a near vegetarian diet – completely avoiding red meats.

Blood group B are descended from nomads. They have the most flexible digestive system and can eat the widest variety of foods – even dairy products, which he does not recommend for any of the other blood types.

Blood group AB is an enigma and are somewhere between blood group A and blood group B.

It’s an interesting concept. Dietary recommendations are made for populations and there is tremendous genetic variation for individuals in every population. Because of this genetic variation, there is no perfect diet for everyone. Every knowledgeable health expert will tell you that.

The question then becomes “How do you know what kind of diet is healthiest for you?”

The blood type diet is a very simple system. Your blood type is easy to determine. Once you know your blood type you know what to eat. There’s no guesswork.

Could it really be so simple? Over 7 million copies of Dr. D’Adamo’s book have been sold. Several celebrities swear by it. Millions of people believe in this concept. So, it is only fitting to ask, “Is it true?”

There is no doubt that blood type is related to some human genetic and physical traits, especially inflammation and immunity. It is also associated with disease risk.

Type A individuals are more likely to have elevated total and LDL cholesterol are slightly more likely to develop heart disease.

Type O individuals are slightly more likely to develop type 2 diabetes.

But the important question is whether blood type is related to the health outcomes of different diets – the central thesis of Dr. D’Adamo’s book.

In this article, I discuss a recent study (ND Barnard et al, Journal of the Academy of Nutrition and Dietetics, 121: 1080-1086, 2021) that asks whether the beneficial effects of a vegan diet (the ultimate vegetarian diet) are influenced by blood type. I will also reference previous studies with other diets that asked the same question.

How Was The Study Done?

The investigators enrolled 244 people from the Washington DC area in a 16-week study to measure the metabolic effects of a low-fat vegan diet. Because of the resources necessary to support the study, the subjects were enrolled into 4 replications of the study with 60+ people each between January 2017 and December 2018.

During the second replication of the study (68 participants) blood typing was done to determine whether blood type had any influence on the results. A low-fat vegan diet is the ultimate vegetarian diet. It allows no meat, no dairy, and no animal fats. According to the Blood Type Diet, type A individuals should have much better results on a vegan diet than type O individuals.

The subjects were randomly divided into two groups. One group was assigned to follow a low-fat vegan diet for 16 weeks. The other group was told to follow their regular diet for 16 weeks. Subjects in both groups were advised to follow their usual level of physical activity.

The vegan diet group was instructed to avoid animal products; eat a variety of fruits, vegetables, grains, and legumes; and to limit added oils, nuts, and seeds. They were provided with a B12 supplement to assure none of them developed a B12 deficiency.

The vegan group attended weekly classes that provided dietary guidance and encouraged diet adherence. The classes were conducted by study physicians and registered dietitians. And participants were given handouts at each class to help them follow the diet.

Finally, compliance was assessed by a 3-day diet record interview conducted by trained experts at baseline and week 16.

Is The Blood Type Diet A Myth?

The baseline characteristics of study participants were:

80% female

Average age = 54.

Average BMI = 32 (obese).

Average HbA1c = 5.6 (normal blood sugar control).

Total cholesterol = 195 mg/dL (at the high end of normal).

LDL cholesterol = 115 mg/dL (at the high end of normal).

And, as expected from previous studies, type A individuals had higher total and LDL cholesterol than other groups. They were borderline high in both categories.

Across all blood type groups, 16 weeks on a low-fat vegan diet significantly decreased:

Weight (14 pounds).

BMI (7%).

Fat mass (11%).

Belly fat (15%).

HbA1c (15%).

Total cholesterol (9%).

LDL cholesterol (11%).

But the important observations were that:

When type A individuals were compared with all non-type A individuals there were no significant differences for any of those parameters.

When type O individuals were compared with all non-type O individuals there were no significant differences for any of those parameters.

More importantly, no significant differences were observed between type A and type O individuals for any of these parameters.

But the authors also said, “This does not discount the possibility that the effects of diet on health may be dependent on other genetic components.”

What Do Other Studies Show?

Two previous studies have looked at the relationship between blood groups and the effect of diet and health parameters.

The Toronto Nutrigenomics and Health Study (J Wang et al, PLoS One, 9(1):e84740, 2014) was a cross-sectional examination of young adults aged 20-29 to determine whether there was any association of blood type with the optimal diet of those individuals. It found:

Those with the closest adherence to a blood type A diet had lower BMI, waist circumference, serum cholesterol, serum triglycerids, and blood sugar control) regardless of which blood type they were.

Those with the closest adherence to a type O diet had lower serum triglycerides regardless of which blood type they were.

The Toronto Health Diet Study ( DJA Jenkins et al, Journal of the American College of Cardiology, 69: 1103-1112, 2017) was a 6-month intervention study that emphasized plant-derived foods but did not exclude meat and dairy. It found:

Those with best adherence to the prescribed diet had improved levels of several cardiometabolic risk factors (cholesterol, triglycerides, and blood sugar control) regardless of which blood type they were.

In other words, both previous studies showed that primarily plant-based diets significantly reduce multiple risk factors for heart disease and diabetes. They also showed that blood types had no effect on the correlation between diets and health.

The most recent study reinforced these conclusions because it was an intervention study utilized the most rigid form of a plant-based diet. If there were any effect of blood type on the optimal diet, the vegan diet should have produced radically different results in individuals with different blood types.

What Does This Study Mean For You?

First and foremost, the Blood Type Diet is a myth. It has now been proven to be false in multiple clinical studies. If you have a copy of Dr. D’Adamo’s book, my best advice is to throw it in the trash. Normally, I would favor recycling, but I would hate for a book that inaccurate to influence someone else.

And to my friends who have in the past said that they were blood type O and the type O (meat based) blood type diet worked for them, I would refer them to the words of the authors when they said, “This does not discount the possibility that the effects of diet on health may be dependent on other genetic components.”

In other words, there may be some people who do better on a meat-based diet. And that may be based on certain yet-unidentified genes. But it is not based on blood type.

But this study also brings the benefits of primarily plant-based diets into focus. As I have said in previous issues of “Health Tips From the Professor”:

Short term studies show that whole food, primarily plant-based diets reduce risk factors associated with multiple chronic disease.

Long term studies show that whole food, primarily plant-based diets reduce the risk of heart disease, diabetes, and some kinds of cancer.

A well designed and supplemented vegan diet is very healthy. However:

- Vegan diets are rigid and hard for most Americans to maintain. That’s why only 4% of Americans follow a vegan diet on a regular basis.

Fortunately, you don’t have to go full vegan to reap the benefits of a plant-based diet. Diets ranging from semi-vegetarian to Mediterranean, DASH, and MIND provide similar benefits. For example, the diet used in the Toronto Health Study referenced above was very similar to the DASH diet.

Finally, clinical studies are based on averages. The current studies tell us that most Americans benefit from a primarily plant-based diet.

- However, we cannot currently exclude the possibility that some people might benefit from a primarily meat-based diet. Unfortunately, we have no long-term studies that support that possibility.

The Bottom Line

Dr. Peter J. D’Adamo wrote a book about the blood type diet called “Eat Right 4 Your Type”. Dr. D’Adamo claims that people’s blood type determines the type of diet that is healthiest for them. For example, he claims that blood type A individuals do best with a plant-based diet and blood type O individuals do best with a meat-based diet.

A recent study asked whether the beneficial effects of a vegan diet (the ultimate plant-based diet) are influenced by blood type. It found:

Individuals put on a vegan diet for 16 weeks had reduced weight, BMI, body fat, belly fat, cholesterol levels, and blood sugar control and those benefits were not affected by blood type.

The authors concluded, “These results indicate that blood type is not associated with the effect of a plant-based diet on body weight, body fat, plasma lipid [cholesterol] concentrations or glycemic [blood sugar] control.” These results are supported by two previous studies that reached the same conclusion using less rigid primarily plant-based diets.

But the authors also said, “This does not discount the possibility that the effects of diet on health may be dependent on other genetic components.”

For more information on this and previous 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.

_____________________________________________________________________________

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

What Kind Of Protein Is Best For Strength?

February 13, 2024 by Dr. Steve Chaney

What Kind Of Protein Is Best For You?

Author: Dr. Stephen Chaney

Every bodybuilder “knows” that whey is the best protein for building strong muscles. After all, it:

Is absorbed more rapidly than some other proteins.
Contains all nine essential amino acids.
Is naturally rich in leucine, a branched chain amino acid that stimulates increased muscle mass.

However, as someone who is not a vegan but who follows the vegan literature, I frequently come across testimonials from bodybuilders and elite athletes who say they get all the strength and muscle mass they need from plant proteins.

I’ve always assumed they must have dietitians designing the perfect plant protein diet for them. But a recent study surprised me. It challenged that assumption.

Before I talk about this study, let me change our focus. Most of us will never be bodybuilders or elite athletes, but all of us face a common challenge. We all tend to lose muscle mass as we age, something referred to as sarcopenia. I have discussed this in a previous issue of “Health Tips From the Professor”.

Simply put, sarcopenia results in:

Loss of muscle strength. Even the simple act of picking up a grandchild or a bag of groceries can become problematic.
Increased risk of falls and fractures.
Lower quality of life.

Sarcopenia is a major health issue for those of us in our golden years. If you are younger, it is a concern for your parents or grandparents. Sarcopenia is a health issue that affects everyone.

In my previous article I discussed the role of adequate protein intake and exercise in preventing age-related sarcopenia. But I did not discuss what kind of protein was best for preventing muscle loss, and the frailty that comes with it, as we age.

The article (EA Struijk et al, Journal of Cachexia, Sarcopenia and Muscle, 13: 1752-1761, 2022) I will discuss today suggests that plant protein is best for preventing frailty in women as they age. It’s a surprising conclusion, so join me as I evaluate this study.

How Was This Study Done?

The data for this study came from the Nurses Health Study which started in 1976 with 121,700 women nurses and is still ongoing. This study followed 85, 871 female nurses for an average of 22 years starting when they were 60.

Food frequency questionnaires were administered to the participants in the study every four years starting in 1980. The questionnaires were used to calculate:

Total calories consumed.
Percent of calories from protein, carbohydrate, and fat.
Percent of calories from different kinds of protein.
The overall quality of the diet.
Saturated fat, polyunsaturated fat, cholesterol, and alcohol intake.

For this study the investigators used the cumulative average values from all questionnaires completed by participants in the study from age 60 until the onset of frailty.

Frailty was assessed every four years starting in 1992 using something called the FRAIL scale. The FRAIL scale defines frailty based on five self-reported criteria: fatigue, low strength, reduced aerobic capacity, having 5 or more chronic illnesses, and recent significant unintentional weight loss.

It is important to note that strength is only one of the five criteria used to identify frailty, although decreased muscle mass can contribute to lack of energy and reduced aerobic activity.

It is also worth pointing out that multiple studies have shown that primarily plant-based diets are associated with a decrease in chronic diseases.

I will come back to both of these points when I discuss the results of this study.

What Kind Of Protein Is Best For Strength?

I will start with the “big picture” results from this study and then cover some of the important details.

Average intake of:

Total protein was 18.3% of calories consumed.
Animal protein was 13.3% of calories consumed.
Plant protein was 5.0% of calories consumed.
Dairy protein was 3.8% of calories consumed.

When protein intake was divided into quintiles (5 equal parts) and women consuming the most protein were compared to those consuming the least protein for an average of 22 years:

Those consuming the most total protein had a 7% increased risk of developing frailty.

Those consuming the most animal protein had a 7% increased risk of developing frailty. (It is perhaps not surprising that the results were essentially the same for total and animal protein since animal protein was 73% of the total protein consumed by women in this study.)

Those consuming the most plant protein had a 14% decreased risk of developing frailty.

Consumption of dairy protein did not affect frailty.

Substituting as little as 5% of calories of plant protein for:

Dairy protein decreased the risk of developing frailty by 32%.

Animal protein decreased the risk of developing frailty by 38%.

Non-dairy animal protein (meat, fish, and eggs) decreased the risk of developing frailty by 42%.

In addition, substituting as little as 5% of calories of dairy protein for non-dairy animal protein decreased the risk of developing frailty by 14%.

But, as I said above, the frailty scale used in this study included the criteria of developing 5 or more chronic illnesses, and long-term consumption of plant protein is known to reduce the risk of developing chronic illnesses. So, it is important to break the study down into its component parts. When that was done the statistically significant results were:

Those consuming the most total protein had a 7% increased risk of low strength and a 25% increased risk of developing 5 or more chronic diseases.

Those consuming the most animal protein had a 9% increased risk of low strength and a 35% increased risk of developing 5 or more chronic diseases.

Those consuming the most plant protein had an 18% decreased risk of low strength. (It is interesting to note that plant protein consumption did not have a statistically significant effect on the development of chronic diseases in this study. That suggests that the “protective” effect of plant protein may simply be due to the absence of animal protein from the diet.)

Consumption of dairy protein did not affect any of the frailty criteria.

Finally, prevention of strength loss due to age-related sarcopenia is known to require exercise as well as adequate protein intake.

So, it was somewhat surprising that no difference in the association between protein intake and frailty was seen in women with high physical activity compared with those with lower physical activity levels. However, this may be because the range in activity level between the women in this study was relatively small. There didn’t appear to be a significant number of “gym rats” among the women in this study.

What Kind Of Protein Is Best For You?

One take-away from this study is clear. If you are a woman and want to minimize sarcopenia (loss of muscle mass and strength as you age), plant protein is an excellent choice.

A variety of plant proteins is best, so you get all the essential amino acids.

You don’t need to become a vegan. This study showed that replacing as little as 5% of your calories from animal protein with plant protein can have a significant benefit. Any healthy primarily plant-based diet will do.

This study enrolled only women aged 60 or above, so we don’t know whether the results apply to men or to younger women.

We don’t know why plant protein is better than animal protein at preventing age-related sarcopenia.

It could be because primarily plant-based diets are anti-inflammatory, and inflammation plays a role in sarcopenia.

Or it could be because primarily plant-based diets reduced the risk of chronic diseases, and chronic diseases can lead to loss of strength.

To be clear, this is a study that focuses on the type of protein that is best for long-term health and strength as we age. This is not a study of the best protein for increasing muscle mass following a workout.

Multiple studies show that whey protein can be a good post-workout choice.

However, other studies show that plant protein can also be a good post-workout choice if extra leucine is added to make it equivalent to whey protein in terms of leucine content.

The Bottom Line

You have probably heard that it is all downhill after age 30. But it doesn’t have to be.

One of the downhill slopes we all face is something called sarcopenia (age-related muscle loss). The resulting loss of strength and agility can severely impact our quality of life in our golden years.

We can prevent sarcopenia with the combination of a high protein diet and resistance training (weight bearing exercise).

But what kind of protein is best? In this issue of “Health Tips From the Professor” I review a large, well-designed study that suggests plant protein is the best choice for women if they wish to reduce age-related muscle loss and the weakness that comes with it.

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

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

______________________________________________________________________________

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

Your Popliteus Muscle And Knee Pain

February 13, 2024 by Dr. Steve Chaney

Treating Your Popliteus Muscle Safely

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

While February is the shortest month of the year, to our northern family and friends it is the longest, seemingly endless, month because it seems like winter is never going to go away.

Where I live in Sarasota Florida, winter brings us near-perfect days and cooler nights. It’s my favorite time of year. And of course, we all celebrate the holiday of love – Valentine’s Day!

Just a bit of trivia: In 1868, Richard Cadbury released the first Valentine’s Day box of chocolates, followed in 1902 with the first Valentine hearts from the New England Confectionery Company. In the 1840s, Esther A. Howland created the first commercial Valentine’s Day cards in the United States. Hallmark first offered Valentine’s Day cards in 1913 and began producing them in 1916. (Thanks to Wikipedia for all this interesting info).

I was reviewing last year as I was deciding on a topic for this month. We discussed:

*Heel pain

*Groin pain

*Low back pain

*Restless leg

*Foot pain

*We spent two months discussing various causes of headaches,

*And now we are in 2024, this will be the second month explaining some of the many causes of knee pain.

In each of these I showed, or explained to you, how to do a simple self-treatment that can help to relieve the pain. Each of the treatments are in my books, and many people have decided to just order one of the books, so they had the full treatment protocol for aches and pains from your head to your foot.

I’ve done self-treatment videos, and if you have come to the office, you know that I teach you how to do specific self-treatments that relate to your personal area of pain.

Before I change the way I do things, let’s finish off knee pain by talking about a little muscle that causes pain deep inside your knee joint. It’s a muscle called popliteus.

Your Popliteus Muscle And Knee Pain

The popliteus is a small muscle that causes a LOT of deep-knee pain. It is located at the back of your knee joint. It attaches to the bone in your lower leg, crosses the joint, and inserts into your thigh bone. You can get a good look at it and read all about it by going to https://en.wikipedia.org/wiki/Popliteus_muscle.

Because of the location of the origination and insertion points, when it contracts normally you bend your knee. In fact, its nickname is “the key that unlocks the knee.”

The muscle shortens and you bend your knee so you can sit down. However, you are sitting for a while and the muscle experiences muscle memory, so the muscle now “thinks” it is supposed to be shorter.

You then try to straighten your leg and stand up. However, the muscle is too short to make that movement, and it pulls hard on your knee joint. Since the muscle is so deep, you feel the pain deep inside the joint, and it may feel like a knife cutting into the back of your knee.

Treatment…

Fortunately, all you need to do is press your fingertips into the muscle, hold it for about 15 seconds, and then s-l-o-w-l-y straighten your leg. The pressure will force toxins out of the fibers, and straightening your leg will stretch the fibers.

Prevention…

When you are sitting for extended periods of time, simply stretch out your legs every 10 minutes or so. That will stretch the muscle before it has the chance for muscle memory to shorten the fibers.

What’s New For This Year?

This year I’m going to continue explaining why various muscles cause pain from the top of your head to your feet. The difference will be that I’ve already posted most of the self-treatments, and if you have one of my books, you definitely have all of the self-treatments.

Plus, there’s something exciting happening in 2024!

I’ve been working with my webmaster to start a yearly membership program where people can join and get:

*24/7 lifetime online access to my eBook: The Pain-Free Athlete

*a Perfect Ball (free shipping in the USA only),

*two 15 minute Zoom consultations where we can isolate the member’s pain situation, and

*access to several members-only group Zoom meetings over the course of the year.

This membership program will be renewable each year (sans the book and ball) so members will be able to quickly discover the source of their pain before it becomes an issue.

This book has been called “the bible” by athletes because they could find all their answers in it.

You can also have it in your home so you can Stop Pain FAST!

https://julstromethod.com/product/pain-free-athlete-book/

Watch for more new and exciting changes happening in 2024!

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.

About The Author

Julie 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

Are Calcium Supplements Heart Healthy?

February 6, 2024 by Dr. Steve Chaney

Should You Follow Your Doctor’s Advice About Calcium Supplementation?

Author: Dr. Stephen Chaney

Are calcium supplements good for your heart or bad for your heart? If you don’t know the answer to that question, don’t feel badly. You have every right to be confused. Some studies say that calcium supplements increase heart disease risk while others say they decrease heart disease risk. The headlines have veered between “killer calcium” and “beneficial calcium”.

The trend appears to be moving in a positive direction. In recent years most of the studies have suggested that calcium supplements either decrease heart disease risk or have no effect on heart disease risk.

However, the medical profession has been slow to take note of this trend. Most medical societies and health professionals have focused on earlier studies and are still recommending that their patients get calcium from food rather than from supplements. I will talk more about that recommendation below.

With this context in mind, this week I will review and discuss the results from the latest study (MG Sim et al, Heart, Lung and Circulation, 32: 1230-1239, 2023) on the effect of calcium supplementation on heart disease risk.

How Was This Study Done?

The authors of this study performed a meta-analysis of 12 double-blinded randomized clinical trials with 87,899 participants comparing the effect of a calcium supplement versus a placebo on heart disease outcomes (heart attack, stroke, heart failure, cardiovascular mortality, and all-cause mortality).

The studies included in this analysis:

Used calcium doses from 500 mg/day to 2,000 mg/day.

Used supplements with calcium coming from a variety of sources (calcium carbonate, calcium citrate, calcium gluconolactate, and tricalcium phosphate).

Ranged from 18 months to almost 12 years in length.

Were performed with population groups from a wide range of countries (United States, England, France, Australia, New Zealand, European Union, Denmark, and Thailand).

Included calcium supplements with and without vitamin D.

Were primarily (86% of participants) conducted with post-menopausal women. One small study (0.3% of participants) was conducted with non-osteoporotic men. The rest were conducted with mixed populations (men and women) diagnosed with colorectal adenoma.

Are Calcium Supplements Heart Healthy?

This is the largest meta-analysis performed to date of double-blind, placebo-controlled randomized clinical trials on the effect of calcium supplementation versus a placebo on heart disease outcomes. This study found no effect of calcium supplementation on:

Heart attack.
Stroke
Heart failure.
Cardiovascular mortality.
All-cause mortality.

This study also evaluated potential confounding variables and found no effect of calcium supplementation on heart disease risk for:

Calcium supplements with and without vitamin D.

Dosage of calcium in the supplements (The dosage ranged from 500 mg/day to 2,000 mg/day).

Females (I suspect the number of males in this study was too small to come to a statistically significant conclusion).

Duration of calcium supplementation ≤ 5 years (The shortest duration of calcium supplementation in these studies was 18 months).

Different geographical regions.

However, this meta-analysis reported considerable variation between studies included in the analysis. Simply put,

Some studies showed an increase in heart disease risk.
Some studies showed a decrease in heart disease risk.
Some studies showed no effect on heart disease risk.

What this analysis showed was that when you combine all the studies, the aggregated data is consistent with calcium supplementation having no effect on heart disease risk.

The authors concluded, “Calcium supplementation was not associated with myocardial infraction [heart attack], stroke, heart failure, and cardiovascular/all-cause mortality. Further studies are required to examine and understand these associations.

Should You Follow Your Doctor’s Advice About Calcium Supplementation?

As I said above, most medical societies and health professionals have focused on earlier studies and are still recommending that their patients get calcium from food rather than from supplements. That may be the advice you are getting from your doctor.

Before you assume your doctor isn’t keeping up with the latest science and ignore his or her advice, we should ask why they are giving that advice. The top three reasons most medical societies give for recommending dietary sources of calcium are:

1) Some studies do show an increased risk of heart disease associated with calcium supplementation. The prime directive for health professionals is to do no harm. Yes, the average of all studies shows no effect of calcium supplementation on heart disease risk. But what if the studies showing increased risk are true for some of their patients? Those patients could be harmed.

Are you someone who might be at increased risk for heart disease if you take calcium supplements. The short answer is we don’t know because previous studies have not asked the right questions.

In my opinion, it is time to pause additional studies and meta-analyses on calcium supplementation and heart health until we have gone over existing studies with a fine-tooth comb to figure out why the results differ so wildly. For example, we need to ask whether the effect of calcium supplements on heart disease risk is influenced by things like:

- Age or ethnicity of participants.

- Other preexisting health conditions.

- Other lifestyle factors (exercise is probably the most important, but others may be involved as well).

- Diet context. For example, we already know that the effect of eggs and dairy on heart health is influenced by diet context. [I have covered this for eggs in a previous issue of “Health Tips From the Professor”.]

- Other unanticipated variables.

Only when we have identified variables that might influence the effect of calcium supplements on heart disease risk, will the scientific community be able to design studies to identify the population groups who might be adversely affected by calcium supplementation.

This would allow health professionals to make informed decisions about which of their patients should avoid calcium supplementation and which of their patients would benefit from calcium supplementation.

2) We really don’t need the recommended RDAs for calcium to build strong bones. The recommended RDAs for calcium are 1,000 mg/day for adults 19-50, 1,000 mg/day for men and 1,200 mg/day for women 51-70, and 1,200 mg/day for both men and women over 70. But do we really need that amount of calcium to build healthy bones?

I have discussed this topic in detail in a previous issue of “Health Tips From the Professor”. Here are the key points:

- The current RDAs are based on calcium needs for people consuming the typical American diet and following the typical American lifestyle. If that is you, the current RDAs probably apply.

- However, strong bones are absolutely dependent on three things, adequate calcium, adequate vitamin D, and adequate weight-bearing exercise. Most recent studies of calcium supplementation and bone density include adequate vitamin D, but almost none of them include exercise. Previous studies have been inadequate.

- The best calcium supplements contain certain nutrients besides vitamin D that optimize bone formation. I have listed those nutrients in the article cited above.

- Our ability to use calcium to build strong bones is dependent on diet (something I call a bone-healthy diet) and lifestyle (something I call a bone-healthy lifestyle).

- For more information on each of these points, read the article I referenced above.

In short, I agree that the current calcium RDAs may be too high for individuals consuming a bone-healthy diet and following a bone-healthy lifestyle. But the current calcium RDAs are likely accurate for people consuming the typical American diet and following the typical American lifestyle.

- While we do not have a calcium RDA for populations following a bone healthy diet lifestyle, some studies suggest that 700-800 mg of calcium/day may be sufficient for this group.

3) Calcium from supplements is absorbed faster and gives higher blood level spikes than calcium from foods. That could be a problem because high blood levels of calcium are associated with calcification of our arteries, which is associated with increased heart disease risk.

This is a theoretical concern, because high blood calcium levels from supplementation are transitory, while it is continuous high blood calcium levels that are associated with calcification of our arteries.

However, it is a plausible concern because most supplement companies design their calcium supplements based on how quickly they get calcium into the bloodstream rather than how effectively the calcium is utilized for bone formation. Here are my recommendations:

- Choose a calcium supplement that provides RDA levels of vitamin D plus other nutrients shown to support strong bone formation.

- Choose a calcium supplement supported by clinical studies showing it is effectively utilized for bone formation.

4) We should be getting our calcium from foods rather than supplements.

While it is always easy for doctors to recommend that we get our nutrients from food rather than supplements, they need to ask whether we are getting those nutrients from our diet. For calcium the data are particularly sobering.

- The average American gets around 740 mg of calcium/day from their diet. That is probably enough for the small percentage of Americans following a bone healthy diet and lifestyle. But it is 260-460 mg short of the 1,000-1,200 mg/day recommended for older adults with the typical American diet and lifestyle.

- - And for the average American, around 70% of their calcium intake comes from dairy foods.
  - So, Americans who are following a typical American diet and lifestyle and are restricting dairy may require 800-1,000 mg/day of supplemental calcium unless they carefully plan their diets to optimize calcium intake.
  - Finally, vegans average about 550 mg/day from their diet. That might be borderline even if they were following a bone healthy lifestyle.

- In short, we cannot assume our diet will provide enough calcium for strong bones unless we include dairy foods and/or plan our diet very carefully. Some degree of supplementation may be necessary.

How Much Calcium Do You Need?

I have covered a lot of territory in this article, so let me summarize the four concerns of the medical community and answer your most important question, “Should you take calcium supplements?”

1) Calcium supplements may increase the risk of heart disease for some people.

That is true, but we have no idea at present who is at increased risk and who isn’t. So, we should minimize our risk by taking the precautions I describe below.

2) We don’t need RDA levels of calcium to build strong bones. That is probably true if you are one of the few people who follows a bone healthy diet and lifestyle, but it isn’t true if you follow the typical American diet and lifestyle.

The current RDAs of 1,000 – 1,200 mg/day are a good guideline for how much calcium you need if you follow the typical American diet and lifestyle.

If you a one of the few people who follow a bone healthy diet and lifestyle (For what that involves, read this article) you may only need 700-800 mg/day. But we don’t have clinical studies that can tell us what the actual RDA for calcium should be under those circumstances.

3) Calcium from supplements is absorbed faster and gives higher blood calcium spikes than calcium from foods. You may remember that the theoretical concern is that even short-term spikes of high blood calcium may lead to calcification of your arteries, which increases your risk of heart disease. So, the important question becomes, “What can we do to minimize these spikes in blood calcium levels?”

We should avoid calcium supplements that brag about how quickly and efficiently the calcium is absorbed. That could lead to calcium spikes. Instead, we should look for calcium supplements that are backed by clinical studies showing they are efficiently utilized for bone formation.

We should look for calcium supplements that include RDA levels of vitamin D and other nutrients that optimize bone formation. You will find more information on that in the same article I referenced above.

Some experts recommend that calcium supplements be taken between meals. But it is probably better to take them with meals because foods will likely slow the rate at which calcium is absorbed and reduce calcium spikes in the blood.

We are told to limit calcium supplements to less than 500 mg at any one time because calcium absorption becomes inefficient at higher doses. It might be even better to limit calcium to 250 mg or less at a time to reduce calcium spikes in the blood.

4) We should get calcium from foods rather than supplements.

Many Americans do not get enough calcium from diet alone, especially if they avoid dairy foods. So, some degree of calcium supplementation may be necessary. I have given some guidelines depending on your diet and lifestyle above.

The amount of supplemental calcium needed is relatively small. I do not recommend exceeding the RDA unless directed to by your health professional.

The Bottom Line

Some studies say that calcium supplements increase heart disease risk while others say they decrease heart disease risk. The headlines veer between “killer calcium” and “beneficial calcium”.

A recent meta-analysis of 12 double-blinded randomized clinical trials with 87,899 participants comparing the effect of a calcium supplement versus a placebo on heart disease outcomes has just been published. This study found no effect of calcium supplementation on:

Heart attack.
Stroke.
Heart failure.
Cardiovascular mortality.
All-cause mortality.

The authors of the study concluded, “Calcium supplementation was not associated with myocardial infraction [heart attack], stroke, heart failure, and cardiovascular/all-cause mortality.

For more details and advice on whether you should follow your doctor’s recommendations for calcium supplementation read the article above.

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

_____________________________________________________________________________

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

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

____________________________________________________________________

About The Author

What Can Twins Tell Us About Diet?

January 30, 2024 by Dr. Steve Chaney

What Are The Pros And Cons Of Twin Studies?

Author: Dr. Stephen Chaney

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

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

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

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

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

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

How Was The Study Done?

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

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

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

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

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

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

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

What Can Twins Tell Us About Diet?

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

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

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

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

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

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

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

Were There Any Downsides To The Vegan Diet?

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

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

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

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

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

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

I concur.

What Are The Pros And Cons Of Twin Studies?

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

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

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

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

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

This study is fully consistent with those studies.

The Bottom Line

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

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

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

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

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

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

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

_____________________________________________________________________________

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

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

_______________________________________________________________________

About The Author

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

Why Does Processed Food Make You Fat?

January 23, 2024 by Dr. Steve Chaney

How Can You Enjoy Eating Without Getting Fat?

Author: Dr. Stephen Chaney

You are probably tired of hearing about how bad processed foods are for you. If you have been following the headlines, you probably already know that diets high in processed foods are linked to obesity, type 2 diabetes, heart disease, some forms of cancer, memory loss, liver disease, kidney disease, depression, risk of dying from any cause, and much more.

And this is a serious problem because 60-70% of the American diet comes from processed foods.

In fact, you may have seen these headlines so frequently that your eyes glaze over, and your mind shuts down any time you see the words “processed foods” in the title.

This week I will be sharing the latest studies on why processed foods make us fat. Stick with me on this. This is not just another article on processed foods. While the focus of the article is on processed foods, the studies it covers are valuable because they also identify some unprocessed foods that can make us fat.

Spoiler alert! Today’s “Health Tip” is important because it teaches us that weight control is not as simple as eliminating processed foods from our diet. We also need to know which unprocessed or minimally processed foods to eat less of.

Before I proceed, I should give you a brief review of how processed foods are defined because that definition has changed in recent years.

What Are Processed Foods?

Everyone used to have a good understanding of which foods were processed. But several years ago, the scientific community introduced a new food classification system called “The NOVA food classification system” and introduced a new category – ultra-processed foods. I have covered this classification system in previous “Health Tips From the Professor” articles, but I will review it here.

The NOVA system categorizes foods into four groups according to the extent of processing they have undergone:

Unprocessed foods.

- This category includes foods like fruit, vegetables, milk, eggs, and meat.

2) Processed culinary ingredients.

- This category includes foods you might find in restaurants or prepare yourself to which things like salt, sugar, vegetable oils, butter, or cream were added in the preparation.

3) Minimally processed foods.

- This category includes foods like canned vegetables, freshly made breads, and cheeses.

4) Ultra-processed foods.

- This category includes foods like soft drinks, chips, packaged snacks, most breakfast cereals, chicken nuggets & fish sticks, fast food burgers, hot dogs, and other processed meats.

The actual list is much longer, but you get the idea. What we call processed foods, scientists now call ultra-processed foods. The article I am discussing used the term “ultra-processed foods” in the title.

But, since the term “ultra-processed foods” has not yet entered the popular vocabulary, I will use the term “processed foods” in this article because it is more understandable to the average reader.

Does Processed Food Make You Fat?

I shared a study in a previous issue of “Health Tips From the Professor” that suggested that the answer was yes, but did not answer the question of why. That’s because of the way the experiment was designed.

The ultra-processed diet and unprocessed diets were matched with respect to:

Total calories in the food portions given to the subjects.

Caloric density (calories per serving size). That’s because caloric density has been linked to overeating (I’ll discuss that in more detail below.) The authors of the study eliminated that variable.

Macronutrients (carbohydrate, fat, & protein). I’m sure you’ve seen blogs suggesting that carbohydrates or fat cause weight gain. And you’ve probably seen blogs suggesting that high protein diets cause weight loss. The authors eliminated these variables.

Total sugar, fiber, and sodium. That’s because the sugar, fat, and sodium content of foods increase their tastiness (palatability), which has been linked to overeating (more below). The authors eliminated this variable.

In short, this study compared a tasty, healthy ultra-processed food diet with a tasty, healthy unprocessed food diet. [Note: This does not represent the real world. In the real world the ultra-processed foods eaten by most Americans are higher in caloric density, sugar, fat, and sodium and lower in fiber than unprocessed foods.]

However, in the scientific world, this was an excellent study design. By eliminating variables thought to explain the correlation between ultra-processed food consumption and obesity, the study was able to focus on two questions:

#1: With those variables eliminated, do ultra-processed foods still lead to overeating? Here the answer was a clear, yes.

The study participants eating ultra-processed foods ate 500 more calories per day than those eating unprocessed foods. (Both groups were presented with meals and snacks containing the same number of calories and told to eat as much as they wanted.)

Participants eating ultra-processed foods gained 2 pounds in just two weeks, while those eating unprocessed foods lost 2 pounds.

#2: If so, what else about ultra-processed foods leads to overeating? One popular theory of why ultra-processed foods lead to overeating is that they cause large blood sugar spikes and crashes, which stimulates appetite. But the authors of the study were disappointed to find no large blood sugar spikes following consumption of ultra-processed food meals.

However, I don’t think their data disproves the blood sugar spike theory. Remember that this was a “healthy ultra-processed food diet”. The amount of sugar and fiber was identical in the ultra-processed and unprocessed food diets. More importantly, when I looked at the sample menus provided by authors as supplementary information, each meal contained a significant percent of whole, low-glycemic foods. This was a “healthy ultra-processed food” diet designed by a dietitian, not what the typical American eats.

So, why did the ultra-processed food group eat more in this study? This study did not provide an answer to that question, but other studies (described below) have provided probable answers to that question.

Why Does Processed Food Make You Fat?

What do other studies tell us about why processed foods make us overeat and gain weight? Here are the top 7 mechanisms that have been suggested and what they mean for us.

#1: Caloric Density: Simply put, caloric density is the number of calories in a serving of food. When you consume foods with a high caloric density, you are more likely to consume excess calories without even thinking about it.

When I was still teaching medical students, I used this example to illustrate the effect of caloric density on calories consumed. “There are the same number of calories in a 2-ounce candy bar and a pound of apples. You can eat a 2-ounce candy bar and be ready to eat more. If you eat a pound of apples, you are done for a while”.

Since most processed foods have a higher caloric density than unprocessed foods, the simplest solution to weight control is to limit processed foods in your diet.

However, how you or your favorite restaurant prepares unprocessed foods is important as well. For example, the addition of cheese or cream sauces can significantly increase the caloric density of the food. This is why the NOVA food classification system I described above created a new category of “culinary foods” to describe these kinds of foods.

#2: Hyper-palatability: In prehistoric times foods that were sweet, salty, and fatty were essential for survival, so we are hardwired to desire those foods. Here is why:

We need a certain amount of sugar for our brain, red blood cells, and a few other tissues to function. Wild game provides almost no carbohydrate. Fruits were the best source of sugar, but fruits were scarce prior to farming. The craving for sweetness drove us to forage far and wide to find fruits and other plant sources of sugar and carbohydrate.

Sodium is essential for survival, but unprocessed plant and animal foods provide very little. That’s why even in Biblical times, salt was worth its weight in gold.

In prehistoric times, food was sometimes scarce, especially in winter. It might be a week or more between meals. Fat stores got prehistoric man through these times of scarcity, so it was important to eat fatty meals in times of plenty. [Note: We no longer live in times of scarcity, and those fat stores have gone from being an asset to being a health concern.]

Unfortunately, “Big Food, Inc” has weaponized these hardwired desires for sweet, salty, and fatty foods. Simply put, processed foods taste good because they fulfil our hardwired taste desires. Scientists call it “hyper-palatability”. But whatever you call it, we want to eat more, and that leads to overeating.

And again, the way we prepare the foods we eat also matters. It’s only natural to add extra salt, sugar, and/or fat to the foods we prepare so they taste better. And if we add too much, we make the healthy foods we eat hyper-palatable, and we are tempted to overeat.

On a personal note, I never knew you might want to add sugar and fat to the vegetables you cook before my family moved to the south. On the other hand, I had never eaten collard greens before either.

#3: Food Consistency: When you look at studies on the effect of food consistency on calories consumed, you find that there are several different ways of defining food consistency, but they are all looking at the same thing from a different perspective – like the fable of the 6 blind men trying to describe an elephant.

Food Structure: The classic study, published in 2009, compared the effect of sliced apples, applesauce, and apple juice eaten shortly before a meal on the number of calories consumed at the meal. In terms of calories consumed during the meal, the results were clear. It was apple juice > applesauce > apple slices.

This drew attention to the effect of food structure on calories consumed. Apples are a whole food with cellular structure intact. Applesauce contains all the nutrients, phytonutrients, and fiber of whole apples, but the cellular structure has been lost. Apple juice contains most of the nutrients and phytonutrients of applesauce, but the fiber has been lost.

Why does the structure of whole foods matter?

- Cell structure must be destroyed before digestion can occur, the release of sugar and carbohydrates from the food is delayed. This reduces the spikes and valleys of blood sugar that can increase appetite.

- Transit time of the food through the intestine is also delayed. Thus, the feeling of fulness persists longer, which reduces appetite.

There are two takeaway lessons from this study that may not be so obvious:

- Neither applesauce nor apple juice meet the NOVA definition of an ultra-processed food. So, simply removing processed foods from your diet may not be enough to reduce your appetite and, therefore, your caloric intake.

- In addition, adding fiber back to apple juice did not make it equivalent to applesauce in reducing appetite. So, despite what Big Food Inc tells you, adding fiber to processed foods does not turn them into health foods.

Soft Versus Hard Foods: Many processed foods are soft, and most unprocessed foods are hard. So, you could think of this as a description that separates processed foods from unprocessed foods.

But, if you consider the apples versus applesauce comparison I described above, it is obvious that soft versus hard description also pertains to minimally processed foods such as applesauce and whole, unprocessed foods such as apples.

For example, one recent study comparing soft versus hard foods found it didn’t matter whether the soft foods were processed or unprocessed. People in the study ate more calories from all soft foods than from hard, unprocessed foods such as raw fruits and vegetables.

Fast Versus Slow Foods: This description separates foods based on the speed at which they are digested and pass through the intestine. Once again, you might think of this as a description that separates processed and unprocessed foods until you think about applesauce versus apples comparison.

And, as you might expect, a recent study comparing “fast” versus “slow” foods found it didn’t matter whether the fast and slow foods were processed or unprocessed. People in the study ate more calories from fast foods than from slow foods.

[Note: This study defined “slow” foods as harder, chunkier, more solid, and more viscous. While the first three adjectives describe what other scientists also refer to as “hard” foods, the final adjective broadens the category to include “soft” foods like oatmeal.]

How Can You Enjoy Eating Without Getting Fat?

For most Americans, weight is a constant uphill battle. Their weight increases by a few pounds every year, and over time that continuing weight gain adds up. Diets are never enjoyable, which is part of the reason they almost always fail in the long term. You want to control your weight, but you also want to enjoy what you eat. Why is that so hard?

The secret to a healthy weight is to find foods you enjoy that don’t increase your appetite – foods that fill you up, so you eat less naturally. Here are my 4 tips for eating foods you enjoy without getting fat.

Tip #1: Limit processed foods. Processed foods tend to have a high caloric density; are hyper-palatable, soft, and fast; and lack the intact cellular structure of whole, unprocessed foods. And multiple studies, such as the one I cited above, agree that processed foods cause us to eat more and to gain weight. So, the single most important step you can take to control your weight is to limit your intake of processed foods.

Tip #2: Choose minimally processed foods wisely. The studies I shared above suggest that avoiding processed foods may not be enough. We also need to look at the minimally processed foods we eat (applesauce, for example). These studies suggest we should also favor whole, unprocessed foods over minimally processed foods that are softer and faster (more quickly digested).

By now, you might be saying, “Wait a minute. I thought you said I could enjoy eating without getting fat. How can I enjoy eating if I have to give up my favorite processed and minimally processed foods?”

My short answer would be, “No. But you might want to broaden your horizons”. We all tend to be creatures of habit. We eat a relatively small variety of foods on a regular basis. When my wife and I decided to eat healthier, we kept trying new foods until we found new, healthier foods we loved.

The category of whole unprocessed foods offers many options. There are fruits, vegetables, many varieties of 100% whole grains, beans, nus, seeds, eggs, and meats. And we are blessed to live in a country with abundant choices. When you walk into your local supermarket you will find dozens of foods in each of these categories that you have never tried before. Be daring. Keep trying new foods until you find new favorite foods you love.

Tip #3: Be aware of how foods are prepared. The studies described above also suggest how we prepare the food is important. We can start out with a whole unprocessed food and end up with something no better than processed food if we prepare it incorrectly. If we add lots of cream, cheese, butter, and/or sugar, we increase the caloric density. And this can lead to us consuming more calories without even thinking about it.Throw in some salt and we have also made the food hyper-palatable, which makes us want to eat more.

Now you might be saying, “But I grew up with my food being cooked this way. This is my comfort zone. Do I have to completely change the way I cook my food, and the items I choose at my favorite restaurant?”

Again, my short answer would be, “No, but you might want to try new recipes.” I am not a cooking guru. That would be my wife. But I do know there are lots of books and web sites featuring healthy recipes. Once again, be bold. Try new recipes until you find new favorites. Try new items on your favorite restaurant’s menu or try new restaurants until you find healthier, restaurant foods you love.

Tip #4: Never say never. This is perhaps the most important tip. Whenever we tell ourselves we can never eat a food again, it becomes irresistible. We are setting ourselves up for failure. The goal should be to change unhealthy foods and unhealthy recipes from an everyday occurrence to an occasional pleasure.

The Bottom Line

Multiple studies show that eating processed foods leads to weight gain. It may be no coincidence that 60-70% of the foods Americans eat is highly processed and 60-70% of us are overweight or obese.

In the article above, I summarize recent studies asking why processed foods make us fat. If you think these studies are only of interest to scientists, you would be wrong. These studies also help us to identify unprocessed and minimally processed foods in our diet that can make us fat.

For more information on these studies, and 4 tips on how you can enjoy eating without getting fat, read the article above.

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

_____________________________________________________________________________

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

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

Your Rectus Femoris Muscle And Knee Pain

January 16, 2024 by Dr. Steve Chaney

Treating Your Rectus Femoris Muscle Safely

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

I hope that 2023 was kind to you and your family. Covid seemed to come and go, with new strains popping up every time we turned around. And then there is RSV and the flu. What a year!

In December the foods all seemed to be fattening – delicious for sure, but fattening. Which brings me to the topic of the month. Maybe you are trying to walk off some of the extra calories you put on last month.

Walking will help burn calories, but it can also come with aches and pains from muscles getting used repetitively.

This month I want to focus on pain that prevents you from bending your knee after several days of walking more than your body is used to. It can reduce your walks to a slow hobble at best. And that isn’t going to burn off any extra calories.

One Quadricep Muscle is the Source of Pain from the Low Back to the Knee.

You likely already know that there are four quadriceps that form the front of your thigh. You probably also know that they are responsible for straightening your leg when you want to stand up from sitting. But there is so much more…especially for one of the quads…the rectus femoris.

Your Rectus Femoris Muscle And Knee Pain

The rectus femoris is a long muscle located in the front, and a bit toward the outside of your thigh.

The rectus femoris is the only one of the four quads that originate on the tip of your pelvis (ASIS), the rest: vastus lateralis, vastus intermedius, and vastus medialis, all originate along your thigh bone (femur). These four muscles join together and attach to your kneecap (patella).

This picture shows the muscle but fails to show the tendon that starts at the top of your kneecap, goes over your kneecap (patella), and inserts into the front of your shin bone (tibia).

It is the patella tendon that causes knee pain and can prevent you from bending your knee when you sit down or want to walk up steps.

Think of the analogy I use so frequently. When you pull your hair, your head hurts, but you don’t need to rub your head, take pain pills, or have brain surgery. You just need to let go of your hair!

In the same way, the muscle is pulling down on the front of your hip and may cause anterior hip pain, and it’s pulling up on your patella tendon, causing your kneecap to move up so you can’t bend your knee, and putting stress on your shin bone.

Your knee and front of your hip are NOT the problem, they are the symptom!

The Function Of The Rectus Femoris Muscle:

Since the muscle originates on the tip of your pelvis,

The rectus femoris flexes (bends) the hip along with two other muscles I’ve discussed in the past, the sartorius and iliopsoas. The four quads pull up on your lower leg at the knee, straightening your leg so you can stand up.

Injury To The Rectus Femoris Muscle:

In acute rectus femoris muscle injuries, a person may feel a tearing sensation at their knee, with an abrupt onset of pain.

Subacute injuries may present with gradual onset of pain at either the front of your hip or your knee. If you enjoy running, you may also have knee pain while you’re running uphill.

You may feel that you have arthritis in your knee joint. If that is the case, it is beneficial to see a deep muscle massage therapist to eliminate tight muscles from the diagnosis. You can also do the Julstro self-treatment that is shown below to release the tension in the muscle.

When a muscular strain injury occurs, a person may also have moderate to severe pain in the groin.

Pain can be sudden, like kicking the ball in soccer or sprinting from a standing position. Or it may build up gradually as an overuse problem with repeated tearing and repeated stress.

Stretching, without first releasing the tension in the muscle, can cause tearing where the muscle inserts into the tendon, or tear the tendon fibers from the bone.

Spasms in your rectus femoris can also be caused by contractions in the muscles that impact your lower back and pelvis. If this is the case, you need to treat each of the muscles before your thigh muscles release. I demonstrate the full treatment in my books in the chapter about the Julstro Protocol.

Treating Your Rectus Femoris Muscle Safely

There are multiple ways to treat your rectus femoris muscle and I show them to you in my books: The Pain-Free Athlete and Treat Yourself to Pain-Free Living.

Using a 12” length of 1” PVC pipe, place the pipe as shown in this picture. This is the perfect position to treat the rectus femoris.

Hold the pipe loosely in your hand or hold your four fingers straight out so you are not curling them around the pipe. This will prevent tension from forming in your forearm muscles.

Press into your thigh and slide, don’t roll, down your thigh to just above your knee.

Do this to your entire thigh, outside/front/inside so you treat all four quadriceps.

I suggest you treat both thighs, even if you are only having pain in one leg.

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.

About The Author

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

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