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Weight Gain During Pregnancy

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How Much Weight Should You Gain And Why?

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

Editor: Dr. Steve Chaney

Pregnant CoupleWeight gain during pregnancy is a challenge for many women.  The Centers for Disease Control has stated that 48% of women gained more than the recommended amount of weight during pregnancy, only one third (32%) of women gained the recommended amount and 21% of women gained too little[i]

Weight is a big thing to be concerned about and to work on prior to and during pregnancy. Why do you need to worry about this?   One’s weight prior to pregnancy can make it more difficult to become pregnant. And weight gain during pregnancy carries lifelong implications for both the mother and infant.

Many women think that during pregnancy, that they must “Eat for Two”, thus giving them the feeling that they should eat more to nourish a developing baby.  However, this saying needs to be re-examined, as I explain below.

Nutrition during pregnancy is really, really important.  It lays down the physical foundation for your baby and has lifelong implications for both mother and baby.  Keep in mind, you are growing a baby!

So how much weight should I gain during pregnancy? Weight gain in pregnancy will be based upon your body mass index or BMI.

What is the body mass index?  The Body mass index (BMI) is a measure of body fat based on height and weight that applies to adult men and women.  A calculator is used to determine your BMI. [ii] Calculators to measure BMI can be downloaded from the Apple store and Google Play.

It is going to be the determining factor for how much weight you should gain during pregnancy.

So, Based On Your BMI, How Much Weight Should You Gain During Pregnancy?

The Institute of Medicine recommends that, based upon your pre-pregnancy BMI, weight gain during pregnancy can range from zero pounds up to 40 pounds during pregnancy.

  • If you are underweight, weight gain between 28 and 40 pounds is recommended.
  • If you are at normal weight, the recommended weight gain is between 25 to 35 pounds.
  • If you are overweight, the recommended weight gain is 15 to 25 pounds.
  • And if you are obese, the weight gain is 11 to 20 pounds during your pregnancy.[i]

Recent recommendations have proposed that obesity should be broken into three different categories. BMI 1, BMI 2 and BMI 3, and that total weight gain should be limited to zero to 15 pounds gain based on these BMI categories.[ii]  Research is ongoing on these recommendations.

Proposed Weight Gain Recommendations for Pregnant Women with Obesity†
BMI Category Current IOM Recommendations (lbs) Proposed Recommendations (lbs)
BMI 1 (30-34.9) 11-20 5-15
BMI 2 (35-39.9) 11-20 <10
BMI 3 (≥ 40) 11-20 Maintain prepregnancy weight

J. Clin. Invest. 2019 129: 4567-4569

Where Does The Weight Go During Pregnancy?

Your baby and changes in your body during pregnancy account for the 25 to 35 pounds weight gain during pregnancy.

  • Baby – 6-8 pounds.
  • Placenta and surrounding water – 4-6 pounds.
  • Uterus – 2-3 pounds.
  • Enlarged breast tissue – 2-3 pounds.
  • Increased blood (blood volume increases 40% to 50% during pregnancy) – 4 pounds.
  • Fluids in the maternal tissue throughout your body – 2-3 pounds.
  • Fat stores – 5-8 pounds.

How Many Calories Should You Eat Each Day?

During the first trimester, it is recommended that women gain no more than four pounds.  In the second and third trimesters of pregnancy, it is recommended that women should gain between one half pound to one pound per week[i].

One pound is equal to 3,500 calories.  This equals to 500 calories per day which is equal to a sandwich and a glass of milk.  This is definitely not “eating for two”. If you are carrying twins or triplets, this amount will increase.

What Happens If You Are Underweight Or Overweight?

Implications for mother and baby are as follows:

Overweight[i]

Mother:

  • May take longer to get pregnant.
  • Increased risk of miscarriage
  • Increased risk of developing pre-eclampsia.
  • Increased risk of diabetes.
  • Having a longer labor which can result in postpartum hemorrhage.
  • Increased possibility of needing to use internal monitors as external monitors cannot pick up fetal heart tone due to fat density.
  • Increased risk of cesarean section.
  • Increased risk of shoulder dystocia because the baby is also big.
  • Weight stays on after pregnancy, which increases the risk of overweight and obesity.
  • Increased risk of developing diabetes later in life.
  • Increased risk of repeat cesarean section.

Baby:

  • Increased risk of neural tube defects.
  • Increased risk of heart defects.
  • Baby is too big for weeks of pregnancy (gestational age baby).
  • Hyperglycemia, meaning that the baby’s blood sugar is too high.
  • Possibility of trauma when the baby is being born.
  • Long-term obesity for that child resulting in childhood obesity.
  • Daughters that are large for gestational age are more likely to be obese and deliver larger babies.

Underweight

Mother:

  • Difficulty with getting pregnant.
  • Increased risk of having a pre-term birth (your baby is born before 37 weeks of pregnancy).

Baby:

  • Increased risk for prematurity.
  • Increased risk that baby is small for gestational age or low birth weight.
  • Problems with oxygen levels at birth.
  • Trouble staying warm because the baby doesn’t have the fat stores that give the calories to help the baby to stay warm.
  • Breathing problems.
  • Increased problems with infection.
  • Nervous system problems with possible long-term effects of cerebral palsy, blindness, developmental delays where your baby is not developing on time.

What Resources Are Available To Help You Gain The Appropriate Amount Of Weight During Pregnancy?

There are many resources available, including weight gain trackers.[i]  It would be wise to seek the help of a registered dietitian.  If you are underweight or obese, their services may be covered under your health insurance.

The Bottom Line

  1. Women who are overweight or underweight prior to pregnancy can have difficulty becoming pregnant.
  1. Many women carry the idea that during pregnancy, that they are “Eating for Two”. This idea can lead to excessive weight gain for the mother that persists after pregnancy and childhood obesity for the infant.
  1. Weight gain during pregnancy is determined by one’s pre-pregnancy body mass index (BMI).
  1. Based upon the prepregnant BMI, weight gain during pregnancy can range from 11 pounds to 40 pounds during pregnancy. Ongoing studies are suggesting a weight gain amount of zero to 15 pounds for Obesity Categories I through III.
  1. It is recommended that during pregnancy, mothers gain up to a total of four pounds in the first trimester and between one half to one pound per week in the second and third trimesters. This amount of weight gain equals to an additional 500 calories per day which is equal to a sandwich and one glass of whole milk additionally per day.
  1. Weight gain during pregnancy carries lifelong implications for both mother and infant.
  1. Seek help from a registered dietitian if you are overweight or underweight. Weight gain trackers are also available for mothers to track their weight during pregnancy at the Centers for Disease Control website.[ii]
[1] https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-weight-gain.htm
[1] https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm
[1] https://nap.nationalacademies.org/resource/12584/Resource-Page—Weight-Gain-During-Pregnancy.pdf
[1] https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2013/01/weight-gain-during-pregnancy
[1] https://nap.nationalacademies.org/resource/12584/Resource-Page—Weight-Gain-During-Pregnancy.pdf
[1] https://www.womenshealth.gov/healthy-weight/weight-fertility-and-pregnancy
[1] https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-weight-gain.htm
[1] Ibid
[i] https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-weight-gain.htm
[ii] Ibid

Visit My You Tube Channel

For more information on how to have a healthy pregnancy and healthy child, especially if you are black, visit my You Tube Channel.

https://www.youtube.com/@carolyncurtis-thecarabcompany

Carolyn Curtis

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

About The Author

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

  • More than 40 years’ experience in the oversight of domestic and international programs and the provision of nursing and midwifery integrated service delivery in maternal child health, family planning, reproductive and women’s health care.
  • Twenty years’ experience in teaching, mentoring, and providing clinical oversight to undergraduate and graduate public health, medical, nursing and midwifery students.

 

Which Diets Are Heart Healthy?

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Which Diet Is Best For You?

Author: Dr. Stephen Chaney 

strong heartThe top 3 claims the advocates of every popular diet make are:

  • It will help you lose weight.
  • It reduces your risk of diabetes.
  • It reduces your risk of heart disease.

The truth is any restrictive diet helps you lose weight. And when you lose weight, you improve blood sugar control. Which, of course, reduces your risk of developing diabetes.

But what about heart disease? Which diets are heart healthy? When it comes to heart disease the claims of diet advocates are often misleading. That’s because the studies these advocates use to support their claims are often poor quality studies. Many of these studies:

  • Look at markers of heart disease risk rather than heart disease outcomes. Markers like LDL cholesterol, triglycerides, c-reactive protein, etc. are only able to predict possible heart disease outcomes. To really know which diets are heart healthy you have to measure actual heart disease outcomes such as heart attacks, stroke, and cardiovascular deaths.
  • Are too short to provide meaningful results. Many of these studies last only a few weeks. You need much longer to measure heart disease outcomes.
  • Are too small to provide statistically significant results. You need thousands of subjects to be sure the results you are seeing are statistically significant.
  • Have not been confirmed by other studies. The Dr. Strangeloves of the world like to “cherry pick” the studies that support the effectiveness of their favorite diet. Objective scientists know that any individual study can be wrong. So, they look for consensus conclusions from multiple studies.

A recent study (G Karam et al, British Medical Journal, 380: e072003, 2023) avoided all those pitfalls. The investigators conducted a meta-analysis of 40 high-quality clinical studies with 35,548 participants to answer the question, “Which diets are heart healthy?”

How Was The Study Done?

Clinical StudyThe authors started by searching all major databases of clinical studies for studies published on the effect of diets on heart disease outcomes through September 2021.

They then performed a meta-analysis of the data from all studies that:

  • Compared the effect of a particular diet to minimal dietary intervention (defined as not receiving any advice or receiving dietary information such as brochures or brief advice from their clinician with little or no follow-up).
  • Looked at heart disease outcomes such as all cause mortality, cardiovascular mortality, non-fatal heart attacks, stroke, and others.
  • Lasted for at least 9 months (average duration = 3 years).
  • Were high-quality studies.

Using these criteria:

  • They identified 40 studies with 35,548 participants for inclusion in their meta-analysis.
    • From those 40 studies, they identified 7 diet types that met their inclusion criteria (low fat (18 studies), Mediterranean (12 studies), very low fat (6 studies), modified fat (substituting healthy fats for unhealthy fats rather than decreasing fats, 4 studies), combined low fat and low sodium (3 studies), Ornish (3 studies), Pritikin (1 study).

One weakness of meta-analyses is that the design of the studies included in the meta-analysis is often different. Sometimes they don’t fit together well. So, while the individual studies are high-quality, a combination of all the studies can lead to a conclusion that is low quality or moderate quality.

Finally, the data were corrected for confounding factors such as obesity, exercise, smoking, and medication use.

Which Diets Are Heart Healthy?

Now that you understand the study design, we are ready to answer the question, “Which diets are heart healthy?” Here is what this study found:

Compared to minimal intervention,

  • The Mediterranean diet decreased all cause mortality by 28%, cardiovascular mortality by 45%, stroke by 35%, and non-fatal heart attacks by 52%.
  • Low fat diets decreased all cause mortality by 16% and non-fatal heart attacks by 23%. The effect of low fat diets on cardiovascular mortality and stroke was not statistically significant in this meta-analysis.
    • For both the Mediterranean and low fat diets, the heart health benefits were significantly better for patients who were at high risk of heart disease upon entry into the study.
    • The evidence supporting the heart health benefits for both diets was considered moderate quality evidence for this meta-analysis. [Remember that the quality of any conclusion in a meta-analysis is based on both the quality of evidence of the individual studies plus how well the studies fit together in the meta-analysis.]
  • While the percentage of risk reduction appears to be different for the Mediterranean and low fat diets, the effect of the two diets on heart health was not considered significantly different in this study.
  • The other 5 diets provided little, or no benefit, compared to the minimal intervention control based on low to moderate quality evidence.

The authors concluded, “This network meta-analysis found that Mediterranean and low fat dietary programs probably reduce the risk of mortality and non-fatal myocardial infarction [heart attacks] in people at increased cardiovascular risk. Mediterranean dietary programs are also likely to reduce the risk of stroke. Generally, other dietary programs were not superior to minimal intervention.”

Which Diet Is Best For You?

confusionThe fact that this study found both the Mediterranean diet and low fat diets to be heart healthy is not surprising. Numerous individual studies have found these diets to be heart healthy. So, it is not surprising when the individual studies were combined in a meta-analysis, the meta-analysis also concluded they were heart healthy. However, there are two important points I would like to make.

  • The diets used in these studies were designed by trained dietitians. That means the low fat studies did not use Big Food, Inc’s version of the low fat diet in which fatty foods are replaced with highly processed foods. In these studies, fatty foods were most likely replaced with whole or minimally processed foods from all 5 food groups.
  • The Mediterranean diet is probably the most studied of current popular diets. From these studies we know the Mediterranean diet improves brain health, gut health, and reduces cancer risk.

As for the other 5 diets (very low fat, modified fat, low fat and low sodium, Ornish, and Pritikin), I would say the jury is out. There is some evidence that these diets may be heart healthy. But very few of these studies were good enough to be included in this meta-analysis. Clearly, more high-quality studies are needed.

Finally, you might be wondering why other popular diets such as paleo, low carb, and very low carb (Atkins, keto, and others) were left out of this analysis. All I can say is that it wasn’t by design.

The authors did not select the 7 diets described in this study and then search for studies testing their effectiveness. They searched for all studies describing the effect of diets on heart health. Once they identified 40 high-quality studies, they grouped the diets into 7 diet categories.

I can only conclude there were no high-quality studies of paleo, low carb, or very low carb diets that met the criteria for inclusion in this meta-analysis. The criteria were:

  • The effect of diet on heart health must be compared to a control group that received no or minimal dietary advice.
  • The study must measure heart disease outcomes such as all cause mortality, cardiovascular mortality, non-fatal heart attacks, and stroke.
  • The study must last at least 9 months.
  • The study must be high-quality.

Until these kinds of studies are done, we have no idea whether these diets are heart healthy or not.

So, what’s the takeaway for you? Which diet is best for you? Both low fat diets and the Mediterranean diet are heart healthy provided the low fat diet consists of primarily whole or minimally processed foods. Which of these two diets is best for you depends on your food preferences.

The Bottom Line 

Many of you may have been warned by your doctor that your heart health is not what it should be. Others may be concerned because you have a family history of heart disease. You want to know which diets are heart healthy.

Fortunately, a recent study answered that question. The authors performed a meta-analysis of 40 high-quality studies that compared the effect of various diets with the effect of minimal dietary intervention (doctors’ advice or diet brochure) on heart disease outcomes.

From this study they concluded that both low fat diets and the Mediterranean diet probably reduce mortality and the risk of non-fatal heart attacks, and that the Mediterranean diet likely reduces stroke risk.

Other diets studied had no significant effect on heart health in this study. That does not necessarily mean they are ineffective. But it does mean that more high-quality studies are needed before we can evaluate their effect on heart health.

So, what’s the bottom line for you? Both low fat diets and the Mediterranean diet are heart healthy provided the low fat diet consists of primarily whole or minimally processed foods Which of these two diets is best for you depends on your food preferences.

For more information on this study, read the article above.

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

___________________________________________________________________________

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

Your Pectineus Muscle And Groin Pain

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Treating Groin Pain Naturally

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

The holidays are inching up on us, and this month is one of my favorites.  I love Halloween because the children have so much fun dressing up and going to parties.

Back when I was a child we could roam around the neighborhood, knocking on doors and having our candy dropped into the pumpkin basket or pillowcase our moms gave us.  We traveled in a pack, and our parents knew we were safe as long as we stayed in our neighborhood because everyone knew everyone.

Nowadays children go to “Trunk or Treat” parties, often with mom or dad in tow. They’re still having fun, and it’s great to see their excitement when they’re sharing with each other how many goodies they have collected.

Now, even just LOOKING at that candy makes me gain 5 lbs!  Oh well!

Happy October to you and your family!

Your Pectineus Muscle And Groin Pain

Today, we will be discussing how a small muscle that most people aren’t even aware of can cause groin pain. I’ve been working with athletes since 1989 and I’ve seen this small muscle cause such pain that it was preventing the athlete from continuing with his/her sport.  And it’s so simple to treat!

The pectineus muscle is in your adductor muscle group. The adductors are responsible for hip flexion and adduction.

Adduction is when you bring your leg closer to the opposite leg, such as when you cross your legs when you are sitting down.  Athletes who play soccer, or who ride a horse, are heavily using their adductor muscles.

As you look at the graphic on the left, the muscles on the left side (right leg) are the larger adductor muscles.

The pectineus is shown on the right side (left leg) so that it is more visible, helping you see the location of the muscle.  In reality, all the muscles are on both sides.

Since the pectineus muscle is so close to the pubic bone, it is more difficult to self-treat. You need to sit on the floor and twist yourself, so the sore side is pressing into the floor.

The pectineus muscle is often overlooked, but it can cause significant pain when in spasm or injured. Here are some of the symptoms, causes, and a simple self-treatment I have developed for a tight pectineus.

Quick Facts About Groin Pain And Your Pectineus Muscle

Causes of Spasms of the Pectineus and Adductors:

  • Muscular injuries of the adductors, the iliopsoas muscle, and abdominal musculature are the most frequent causes of acute groin pain in sportsmen and sportswomen.
  • Spasms in your pectineus muscle are also a common cause of groin pain and are often overlooked.
  • Pectineus pain often stems from an injured groin muscle. Common causes include running, kicking a soccer ball, riding a horse, and sitting with a crossed leg.

Symptoms Of Groin Pain Caused By Your Pectineus Muscle:

  • Groin pain is any discomfort in the area between your abdomen and thigh, located where your abdomen ends, and your legs begin.
  • Localized pain on the pubic bone, in the groin area, on one side or the other, is a primary indication of injury to the pectineus.
  • Pain on palpation of the involved muscle and pain on adduction (moving your legs closer together against resistance) is also an indication of injury to the pectineus.

Treating Groin Pain Naturally

You are trying to be pressing close to your pubic bone, which is shown in the graphic above.

Sit as shown and use a ball to press deeply into your adductors. Start the treatment at the very top of the muscles, close to your pubic bone, and move down toward your knee.

If you find any tender points, called “trigger points,” hold  the pressure on the spasm until it stops hurting.

You can also “pump” the trigger point, applying pressure for 15 seconds, then stay where you are but release the pressure for 5 seconds, and repeat this sequence several times until the pain point stops hurting.

You may get better leverage if you lift up your opposite hip (lift up the right hip in this demonstration), bending your right leg so you can press your right elbow into your thigh to get better pressure.

If it’s difficult with the ball, use your right hand fingertips to press on the muscle on your left side.

In conclusion, the pectineus muscle can cause groin pain when injured.

If this simple self-treatment doesn’t help, it would be important to seek medical attention to determine the underlying cause, especially if it is severe or accompanied by other symptoms.

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.

Is Time-Restricted Eating Better Than Other Diets?

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Is Time-Restricted Eating Right For You?

Author: Dr. Stephen Chaney 

Time-restricted eating is the latest fad. If you read Dr. Strangeloves’ blogs, he or she will tell you that eating for 8-10 hours and fasting the rest of the day will change your metabolism. They tell you that:

  • You don’t need to change what you eat.
  • You don’t have to restrict calories.
  • You don’t have to restrict fats or carbs.
  • You will feel fuller and naturally eat less.
  • The pounds will just drop away magically.

And you will have benefits like:

  • Better blood sugar control.
  • Lower levels of heart-unhealthy lipids like LDL and triglycerides.
  • Enhanced cellular repair, which might help you live longer.

Are these claims true? Is there something special about time-restricted eating, or is it simply another way to cut calories?

Two recent studies (EA Thomas et al, Obesity; 30: 1027-1038, 2022) and (D Liu et al, New England Journal of Medicine, 386: 1495-1505, 2023) answered these questions by cutting calories to the same extent for people following a time-restricted eating pattern and people who had no restrictions on when they ate.

How Were These Studies Done?

clinical studyStudy 1: The authors enrolled 81 adults aged 18 to 50 years (average = 38 years, 69% female) with BMIs of 27 to 45 (overweight to morbidly obese).

The study lasted 39 weeks with measurements taken at baseline, 12 weeks, and 39 weeks.

The participants were divided into two groups:

  • A time-restricted eating group that was advised to restrict their eating to start eating within 3 hours of waking and restrict their eating to 10 hours.
  • A calorie restricted group that was given no time limitations on when they could eat.

Both groups were:

  • given a personalized calorie goal which represented a 35% caloric restriction based on measurements of their resting energy expenditure.
  • enrolled in a 39-week, group-based, comprehensive weight-loss program. Groups were taught by registered dietitians and met weekly through the first 12 weeks, and monthly between weeks 13 and 39.

Study 2: The authors enrolled 139 adults 18 to 75 years (average age = 32, 64% female) with BMIs of 28 to 45. The study lasted 12 months.

The participants were divided into two groups:

  • A time-restricted eating group that was advised to restrict their eating to between 8 AM and 4 PM (an 8-hour window) each day.
  • A calorie restricted group that was given no time limitations on when they could eat.

Both groups:

  • Were told to reduce calories by 25% which represented a 1500-1800 calorie/day diet for men and a 1200-1500 calorie/day diet for women.
  • Received dietary information booklets that provided portion advice and sample menus.
  • Were required to write in a daily dietary log, photograph the food they ate, and note the time they ate it using a mobile app.
  • Received follow up phone calls or app messages twice per week and met with trained health coaches every two weeks.

Is Time Restricted Eating Better Than Other Diets?

Here are the results of the two studies.

Study 1: There was no difference between the time-restricted group and the group who were just told to cut calories at either 12 or 39 weeks for:

  • Weight loss.
  • Body composition (fat loss and lean muscle mass loss).
  • Appetite and eating behaviors.
  • HDL cholesterol, LDL cholesterol, total cholesterol, and HbA1c (a measure of blood sugar control).

The authors concluded two things:

  1. “Time-restricted eating with caloric restriction was found to be an acceptable dietary strategy, resulting in similar levels of adherence and weight loss compared to caloric restriction alone.”

2) “The addition of behavioral support and caloric restriction to a time-restricted eating intervention results in a clinically significant weight loss, a reduction in caloric input, and an improvement in diet quality.”

Study 2: There was no difference between the time-restricted group and the group who were just told to cut calories at 12 months for:

  • Weight loss, BMI, and waist circumference.
  • Body composition (fat loss and lean muscle mass loss).
  • Appetite and eating behaviors.
  • Blood pressure, HDL cholesterol, LDL cholesterol, total cholesterol, fasting blood sugar levels, and several measures of blood sugar control.

The authors concluded, “Among patients with obesity, a regimen of time-restricted eating was not more beneficial with regard to reduction in body weight, body fat, or metabolic risk factors than daily caloric restriction.”

Is Time-Restricted Eating Right For You?

Questioning WomanThe take-home lessons are the same for both studies.

  1. You can forget the metabolic mumbo-jumbo of the Dr. Strangeloves of our world. When you restrict calories to the same extent, time-restricted eating is no more successful and no healthier than any other diet.”

2) Like any other diet, time-restricted eating works best when you focus on eating healthy foods and reducing your caloric intake.

So, what does this mean for you? I have two thoughts:

1) If you find it easier to cut calories by restricting the time you eat, then time-restricted eating is right for you. If not, choose a healthy, reduced calorie diet that best fits your food preferences and lifestyle.

2) Time-restricted eating works best when you are in complete control of when and what you eat. They don’t work as well for travel, holidays with friends and family, and other social occasions. If your lifestyle is such that you are often not in control of when and what you eat, you might want to choose a more flexible diet.

The Bottom Line 

Time-restricted eating is the latest fad. If you read Dr. Strangeloves’ blogs, he or she will tell you that eating for 8-10 hours and fasting the rest of the day will change your metabolism, the weight will fall away effortlessly, and your health will be better.

But is this true? Two recent studies tested the hypothesis that time-restricted eating offers a special advantage by cutting calories to the same extent for people following a time-restricted eating pattern and people who had no restrictions on when they ate.

Both studies found there was no difference between the time-restricted group and the group who were just told to cut calories for:

  • Weight loss.
  • Body composition (fat loss and lean muscle mass loss).
  • Appetite and eating behaviors.
  • HDL cholesterol, LDL cholesterol, total cholesterol, and HbA1c (a measure of blood sugar control).

The take-home lessons are the same for both studies.

  1. You can forget the metabolic mumbo-jumbo of the Dr. Strangeloves of our world. When you restrict calories to the same extent, time-restricted eating is no more successful and no healthier than any other diet.”

2) Like any other diet, time-restricted eating works best when you focus on eating healthy foods and reducing your caloric intake.

For more information on this study and a discussion of whether time-restricted eating might be right for you, read the article above.

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

 ___________________________________________________________________________

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

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

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

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

Do Produce Prescriptions Improve Health?

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What Are The Pros And Cons Of Produce Prescriptions?

Author: Dr. Stephen Chaney 

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

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

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

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

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

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

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

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

How Was The Study Done?

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

The pilot programs enrolled:

  • Adults at risk for poor cardiometabolic health (at risk for both heart disease and diabetes). The enrollment criteria included being overweight or obese and having either diabetes or elevated blood pressure.
  • Children who were overweight or obese.
  • People recruited from health centers serving predominantly low-income neighborhoods who were food insecure.

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

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

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

The adults:

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

The children:

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

Overall:

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

Finally, the programs lasted an average of 6 months.

Do Produce Prescriptions Improve Health?

The results were encouraging:

  • At the beginning of the study fruit and vegetable intake was 2.7 cups/day for adults and 3.4 cups/day for children.
  • By the end of the study fruit and vegetable intake increased by 0.85 cups/day for adults and 0.26 cups/day for children.

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

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

I could go on, but you get the point.

  • So, perhaps a better way to think about these results would be to say both adults and children in these low-income households were eating around 3.6 cups/day of fruit and vegetable intake – a 31% increase for adults and a 7.6% increase for children.
  • Another way of thinking about it would be to say that produce prescription programs got both adults and children in food-insecure households up to a healthier 3.6 cups/day of fruits and vegetables.

As for other outcomes:

  • Food insecurity dropped by one third for families participating in these programs.
  • The families reported that they felt healthier.
  • BMI (a measure of overweight and obesity) decreased for both adults and children.
  • HbA1c (a measure of blood sugar control) and blood pressure decreased in adults with cardiometabolic disease (heart disease and diabetes) at the beginning of the programs.

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

What Are The Pros And Cons Of Produce Prescriptions?

pros and consThe pros are obvious.

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

  • “Food insecurity is strongly associated with poor health outcomes and higher health care costs.
  • Food-insecure individuals under use medications and choose cheaper, unhealthful foods due to costs.
  • [There are] stark disparities in household food insecurity…by race/ethnicity, with 7.1% of White, non-Hispanic households experiencing food insecurity compared with 21.7% of Black, non-Hispanic households, and 17.2% of Hispanic households.”

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

But there are cons as well.

  • While the results of these programs were statistically and clinically significant, they were relatively modest. In the words of the authors, “Produce prescriptions may need to be of longer duration or combined with additional components…”
  • Most Americans have the income to buy more fruits and vegetables but chose not to. Programs like this can reduce health disparities but are unlikely to improve the health of the American population as a whole.
  • There was no mention of the cost of implementing this program nationwide in the article, but that is likely to be a major stumbling block.

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

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

The Bottom Line 

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

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

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

In addition:

  • Food insecurity dropped by one third for families participating in these programs.
  • The families reported that they felt healthier.
  • BMI (a measure of overweight and obesity) decreased for both adults and children.
  • HbA1c (a measure of blood sugar control) and blood pressure decreased in adults with cardiometabolic disease (heart disease and diabetes) at the beginning of the programs.

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

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

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

____________________________________________________________________________

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

Which Diets Are Heart Healthy?

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What Does A Heart Healthy Diet Look Like?

Author: Dr. Stephen Chaney 

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

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

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

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

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

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

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

Why Are Americans Confused About Diet And Heart Disease Risk?

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

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

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

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

  • Many of the most popular diets fall outside of the “Acceptable Macronutrient Range”.
  • Many popular diets exclude heart-healthy food groups.

And, the words of the authors,

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

What Does A Heart Healthy Diet Look Like?

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

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

Here are my comments on these guidelines:

  • If you have been reading my “Health Tips From the Professor” blog for a while, you probably realize that these aren’t just guidelines to promote heart health. These guidelines also reduce the risk of diabetes, cancer, inflammatory diseases, and much more.
  • If you have read my post on coconut oil, you will know that I have a minor disagreement with the AHA recommendation to avoid it. There is no long-term evidence that coconut oil is bad for the heart. But there is also no long-term evidence that it is good for the heart. My recommendation is to use it sparingly.
  • And you probably know there has been considerable discussion recently about whether full fat dairy is actually bad for the heart. In my most recent review of the topic, I concluded that if full fat dairy is heart healthy, it is only in the context of a primarily plant-based diet and may only be true for fermented dairy foods like unpasteurized yogurt and kefir.
  • Finally, guideline 10 may need some translation. Basically, this guideline is just asking how easy it is to follow the diet when you are away from home.

Which Diets Are Heart Healthy?

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

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

Here are the results:

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

  • DASH, Nordic, Mediterranean, Pescetarian (vegetarian diets that allow fish), and Ovo-Lacto Vegetarian (vegetarian diets that allow dairy, eggs, or both).
  • You will notice that these are all primarily plant-based diets.

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

  • The Vegan diet received 0 points for category 10 (ease of following the diet when eating out). It was also downgraded in category 7 for not having clear guidance for the use of salt when preparing foods.
  • The other low-fat diets were downgraded in categories 7, 10, and 5 (use of tropical oils).

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

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

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

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

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

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

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

The Bottom Line 

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

  • Tier 1 diets (the most heart healthy diets) were DASH, Nordic, Mediterranean, Pescetarian (vegetarian diets that allow fish), and Ovo-Lacto Vegetarian (vegetarian diets that allow dairy, eggs, or both).
  • Tier 2 diets were Vegan and other low-fat diets (TLC, Volumetrics).
  • Tier 3 diets included very-low fat diets (<10% fat, very strict vegan diets) and low-carb diets (Zone, South Beach, Low-Glycemic Index).
  • Tier 4 diets (the least heart healthy diets) were the Paleo diet and very low-carb diets (Atkins and Ketogenic).

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

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

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

For more information on this study, read the article above.

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

____________________________________________________________________________

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

Do Processed Foods Cause Cancer?

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How Can You Reduce Your Cancer Risk?

Author: Dr. Stephen Chaney 

We are facing a food crisis in this country. Big Food Inc is taking over our diet. Currently, 73% of our food supply is processed. And because these are manufactured foods, not real foods, they are 52% cheaper than the whole unprocessed foods we should be eating.

And Big Food Inc has seduced us. They know our weaknesses. The foods they make are convenient and easy to prepare. They also know our bodies were created with an ingrained craving for sweet, salty, and fatty foods. These cravings served us well in prehistoric times, but in today’s world Big Food Inc has weaponized them. Their foods are designed to satisfy every craving. They have done their best to make their processed foods irresistible!

The result is no surprise. In 2018 (LG Baraldi et al, BMJ Open, 2018, 8(3) e020574 60% of the calories the Average American consumes came from processed foods, and the percentage has only increased since then.

This is alarming because higher consumption of processed foods has been linked to increased risk of obesity, diabetes, and all-cause mortality.

Some studies have suggested that higher consumption of processed foods may also be linked to increased risk of cancer. The authors of the current study (K Chang, eClinicalMedicine 2023;56: 101840) set out to test this hypothesis.

How Are Processed Foods Defined In This Study?

Before I proceed with describing the findings of this study, I should probably contrast the common definition of processed foods with the current scientific definition of processed foods. The scientific community has recently developed something called “The NOVA food classification system” to describe the various levels of food processing.

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

  1. Unprocessed or minimally processed foods.
    • This category includes foods like fruit, vegetables, milk, and meat.

2) Processed culinary ingredients.

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

3) 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 call ultra-processed foods. Since the term “ultra-processed foods” has not yet entered the popular vocabulary, I will use the term “processed foods” in describing the results of this study because it is more understandable to the average reader.

How Was This Study Done?

clinical studyThe authors of this study started by using data from the UK Biobank study. The UK Biobank study is a long-term study in the United Kingdom that is investigating the contributions of genetics and environment to the contribution of disease.

The authors focused on 197,426 (54.6% women) participants in the study who completed up to five 24-hour dietary recalls between 2009 and 2012. The participants were age 58 (range 40 to 69) when they entered the study and were followed for an average of 9.8 years. None of the participants had been diagnosed with cancer at the time of their enrollment in the study.

The purpose of this study was to examine the correlation between percent of “processed food” in the participant’s diets and both the frequency of newly diagnosed cancer and the frequency of cancer deaths during the 9.8 years of follow-up.

More importantly, the size of this study allowed the authors to examine associations between processed food consumption and both the risk of cancer and cancer mortality for 34 site-specific cancers – something most previous studies were unable to do.

  • The percentage “processed food” in their diets was calculated from the 24-hour dietary recalls using the NOVA scoring system.
  • The frequency of newly diagnosed cancers and cancer deaths was obtained by linking the data in this study with the national cancer and mortality registries, provided by the National Health Service.

Do Processed Foods Cause Cancer?

CancerThe authors started by dividing participants into four equal quartiles based on their consumption of processed foods:

  • For quartile 1 processed foods made up between 0 and 13.4% of calories (average = 9.2%).
  • For quartile 2 processed foods made up between 13.5 and 20% of calories (average = 16.7%).
  • For quartile 3 processed foods made up between 20.1 and 29.4% of calories (average = 24.3%).
  • For quartile 4 processed foods made up between 29.5 and 100% of calories (average = 41.4%).

They started by looking at the risk of developing cancer during the 9.8-year follow-up period. A total of 15,921 participants developed cancer during that time. When the authors compared the group consuming the most processed foods with the group consuming the least processed foods:

  • The risk of overall cancer of any type increased by 7%.
  • The risk of lung cancer increased by 25%.
  • The risk of ovarian cancer increased by 45%.
  • The risk of diffuse large B-cell lymphoma increased by 63%.
  • The risk of brain cancer increased by 52%.

Furthermore, every 10% increase in processed food consumption was associated with:

  • A 2% increase in overall cancer incidence…and…
  • A 19% increase in ovarian cancer incidence.

A total of 4,009 participants died from cancer during that time. When the authors compared the group consuming the most processed foods with the group consuming the least processed foods:

  • Overall cancer mortality increased by 17%.
  • Lung cancer mortality increased by 38%.
  • Ovarian cancer mortality increased by 91%.

Furthermore, every 10% increase in processed food consumption was associated with:

  • A 6% increase in overall cancer mortality.
  • A 16% increase in breast cancer mortality.
  • A 30% increase in ovarian cancer mortality.

The authors concluded, “Our UK-based study suggests that higher [processed food] consumption may be linked to an increased [frequency] and mortality for overall and certain site-specific cancers especially ovarian cancer in women…These findings suggest that limiting [processed food] consumption may be beneficial to prevent and reduce the modifiable burdens of cancer.”

How Can You Reduce Your Cancer Risk?

American Cancer SocietyLet’s start with the American Cancer Society recommendations to limit cancer risk:

1) Avoid tobacco use. 

2) Get to and stay at a healthy weight.

If you are already at a healthy weight, stay there. If you are carrying extra pounds, try to lose some. Losing even a small amount of weight can reduce your risk of cancer and have other health benefits. It is a good place to start.

3) Be physically active and avoid time spent sitting.

Current recommendations are to get at least 150-300 minutes of moderate intensity or 75-150 minutes of vigorous intensity activity each week. Getting to or exceeding 300 minutes is ideal.

In addition, you should limit sedentary behavior such as sitting, lying down, watching TV, and other forms of screen-based entertainment. This is especially important if you spend most of your working day sitting.

4) Follow a healthy eating plan.

A healthy eating pattern includes a variety of vegetables, fiber-rich legumes (beans and peas), fruits in a variety of colors, and whole grains. It is best to avoid or limit red and processed meats, sugar-sweetened beverages, highly processed foods, and refined grain products. This will provide you with key nutrients in amounts that help you get to and stay at a healthy weight.

5) It is best not to drink alcohol.

It is best not to drink alcohol. People who choose to drink alcohol should limit their intake to no more than 2 drinks per day for men and 1 drink a day for women.

This study adds an exclamation point to the American Cancer Society’s recommendation to avoid or limit “processed meats, sugar-sweetened beverages, highly processed foods, and refined grain products”.

You may be asking, “What is so harmful about processed foods?” The most obvious harm is that they are replacing healthier foods that reduce cancer risk, such as “a variety of vegetables, fiber-rich legumes (beans and peas), fruits in a variety of colors, and whole grains” that the American Cancer Society recommends for reducing cancer risk.

But there are other reasons as well. In the words of the authors:

  • “Evidence has been accumulating on the strong obesity and type-2 diabetes-promoting potential of [processed foods], both of which are risk factors for many cancers including those of the digestive tract and some hormone-related cancers in women.
  • Emerging research has suggested other common properties of [processed foods] that may contribute to adverse cancer outcomes, including the use of controversial food additives, contaminants such as acrylamide that form during [food processing], and toxic contaminants such as phthalates and bisphenol-F that migrate from food packaging [into the food].”

The Bottom Line 

You probably know that processed foods are bad for you. But do processed foods cause cancer? A very large study (197,426 people followed for 9.8 years) suggests the answer to that question appears to be yes.

When the authors of the study compared the group consuming the most processed foods with the group consuming the least processed foods:

  • The risk of overall cancer of any type increased by 7%.
  • The risk of lung cancer increased by 25%.
  • The risk of ovarian cancer increased by 45%.
  • The risk of diffuse large B-cell lymphoma increased by 63%.
  • The risk of brain cancer increased by 52%.

And when they looked at cancer deaths and did the same comparison:

  • Overall cancer mortality increased by 17%.
  • Lung cancer mortality increased by 38%.
  • Ovarian cancer mortality increased by 91%.

The authors concluded, “Our study suggests that higher [processed food] consumption may be linked to an increased [frequency] and mortality for overall and certain site-specific cancers especially ovarian cancer in women…These findings suggest that limiting [processed food] consumption may be beneficial to prevent and reduce the modifiable burdens of cancer.”

These results are alarming because the most recent study shows that 60% of calories in the American diet comes from processed foods, and the percentage is increasing each year. We need to reverse this trend!

For more information on this study, why processed foods increase your risk of cancer, and what the American Cancer Society recommends to reduce your risk of cancer, read the article above.

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

____________________________________________________________________________

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

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

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

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

 

 

Is Whole Fat Dairy Healthy?

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Is It Dairy Or Diet?

Author: Dr. Stephen Chaney 

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

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

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

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

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

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

How Was This Study Done?

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

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

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

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

This is different from most other healthy diet recommendations.

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

  • Determining the median intake for each of the 6 food groups included in their PURE diet (fruits, vegetables, legumes, nuts, fish, and whole fat dairy).
  • Assigning each participant in the study a score of 0 or 1 depending on whether their intake for that food group was below or above the median intake.
  • Adding up the points. Since 6 food groups were included in the PURE diet, this means that each participant in the study was assigned a PURE diet score ranging from 0-6.

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

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

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

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

Is Whole Fat Dairy Healthy?

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

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

 

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

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

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

  • All-cause mortality was reduced by 30%.
  • Cardiovascular disease was reduced by 18%.
  • Heart attacks were reduced by 14%.
  • Strokes were reduced by 19%.
  • The PURE healthy eating score was slightly better at predicting health outcomes than the Mediterranean, DASH, and HEI (Healthy Eating Index) scores. But the differences were small. So, I still recommend choosing the healthy diet that best fits your preferred foods and your lifestyle.
  • The PURE healthy eating score was significantly better at predicting health outcomes than the Planetary diet score. I will discuss the nutritional inadequacy of “sustainable diets” like the Planetary diet in next week’s “Health Tips From the Professor” article.

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

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

2) You don’t have to be perfect.

    • A 20% increase (one quintile) in PURE score was associated with a 6% lower risk of major cardiovascular events and an 8% lower risk of mortality. In other words, even small improvements in your diet may improve your health outcomes.
    • The health benefits of the PURE diet started to plateau at a score of 3 (with 6 being the highest score). The authors concluded that most of the health benefits were associated with a modestly higher consumption of healthy foods compared to little or no consumption of healthy foods.

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

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

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

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

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

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

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

Is It Dairy Or Diet?

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

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

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

  • Let’s start with a description of the PURE diet. It is a diet that emphasizes fruits, vegetables, legumes, nuts, and fish. In other words, it is a primarily plant-based diet.
  • Although the authors keep referring to the diet as one that includes whole fat dairy. It would be more accurate to say that it includes dairy, which was 30% low-fat and 70% whole fat.
  • The authors said that removal of any one food group from this combination reduced the predictive power of the PURE diet. In other words, the beneficial effect of 70% whole fat dairy is best seen in the context of a primarily plant-based diet.
  • The PURE diet was most effective at predicting health outcomes in low-income countries where a significant percent of the population consumes a primarily plant-based diet because meats are expensive.

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

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

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

  • Milk and other dairy foods are excellent sources of calcium, vitamin B12, and iodine and good sources of protein, vitamin D, choline, zinc, and selenium – nutrients that are often low or missing in plant-based diet. And this is true whether the dairy foods are low-fat or whole fat.
  • Primarily plant-based diets tend to be low in saturated fat, so the potential negative effects of adding a small amount of saturated fat to the diet may be outweighed by the beneficial effects of the nutrients dairy foods provide.

On the other hand,

  • The typical American or European diet provides plenty of protein and vitamin B12 and significantly more choline, vitamin D, iodine, and zinc than a plant-based diet. The added nutrients from adding dairy foods to this kind of diet is still beneficial, but the benefits are not as great as adding dairy foods to a primarily plant-based diet.
  • If you read the American Heart Association statement on saturated fats, it does not say that any amount of saturated fat is bad for you. In fact, small amounts of saturated fats play some beneficial roles in our bodies. The American Heart Association says, “Eating too much saturated fat can raise the level of LDL cholesterol in your blood…[which] increases your risk of heart disease and stroke.”
  • Here is where the problem lies. The typical American or European diet already contains too much saturated fat. Whole fat dairy just adds to that excess.

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

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

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

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

The Bottom Line 

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

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

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

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

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

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

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

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

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

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

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

_________________________________________________________________________

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

Treating Tension Headaches Naturally

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Which Muscles Cause Tension Headaches?

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

The snowbirds are long gone!  The plus is that it’s easier to get into restaurants, and the roads aren’t as crowded.  Of course, the minus is the weather. August is the hottest month of the year.

August is definitely a s-l-o-w month in Florida.  The temperature is in the mid-upper 90’s, which isn’t really too bad for a Floridian, but the humidity feels like it’s 120°!

You walk out of your cool house, and it hits you like a wet washcloth, immediately making you sweat from your hair to your toes.

So, it’s time to just relax, enjoy the beach and read a good book.   And thank heaven for air-conditioning!

Topic Of The Month – Tension Headaches

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

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

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

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

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

Which Muscles Cause Tension Headaches?

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

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

(Please don’t get confused with the Posterior Deltoid showing in the right graphic, or the jaw muscles on the left graphic…I just didn’t know how to delete them from the graphic)

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

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

Treating Tension Headaches Naturally

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

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

 

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

 

 

 

Lean into the corner of a wall, as shown. headache relief shoulder muscle pressure using wall

 

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

 

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

 

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

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

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

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

How to Learn the Other Treatments for Headaches

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

Have a Happy Summer!  Please remember to drink a lot of water to keep yourself hydrated.  😊

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.

Do Muscadine Polyphenols Reduce Skin Aging?

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What Does This Study Mean For You?

Author: Dr. Stephen Chaney 

Red WineNormally, I don’t discuss results from pilot studies. I wait until larger studies have been published in peer reviewed journals. But I thought this study might be of interest to you.

Polyphenols from muscadine grapes and muscadine wine have been reported to reduce cellular aging. So, scientists from the University of Florida decided to do a pilot study asking whether muscadine polyphenols in the diet might improve signs of an aging skin. They reported their results in a poster (L Christman and L Gu, Dealcoholized Muscadine Wine Improved Skin Health, Reduced Oxidative Stress, and Inflammation in Women in a Randomized Controlled Trial, July 24, 2023) presented at the American Society for Nutrition’s NUTRITION 2023 meeting.

They enrolled 17 healthy women ages 40-67 to participate in a randomized, single-blinded, placebo controlled, cross-over study. Simply put, that means:

  • The study started with a 7-day “run-in period” in which their diet was standardized.
  • Then they were asked to drink 10 ounces/day of dealcoholized muscadine wine or a placebo drink for 6 weeks. Since participants did not know which beverage they were given, this is the “single-blind” part of the experimental design.
  • This was followed by a 21-day “wash-out” period to allow muscadine polyphenols to be flushed out of their system.
  • They then were switched to the opposite beverage for an additional 6 weeks. This was the “cross-over” portion of the experimental design.

Their skin conditions and blood markers of inflammation and oxidative stress were measured at the start (baseline) and end of each 6-week portion of the study.

When compared to both baseline and placebo, the dealcoholized muscadine wine significantly improved:

  • Skin elasticity, which prevents the skin from sagging as it ages.
  • Retention of moisture at the skin surface, which indicates the skin is providing a more effective barrier against aging.
  • Skin smoothness.
  • Blood glutathione peroxidase activity, a measure of antioxidant protection.

The authors concluded, “This randomized controlled trial demonstrated that consumption of polyphenol-rich dealcoholized muscadine wine improved skin conditions associated with aging. This is likely due to decreases in inflammation and oxidative stress.”

What Does This Study Mean For You?

Questioning WomanAs for what this study means for you, I have two words, “Stay tuned”.

On the plus side, while muscadine polyphenols have been shown to reduce markers of skin aging when applied to the skin, this is the first study to suggest those same benefits may be seen from the inside out – i.e., from dietary muscadine polyphenols.

On the minus side, this is a pilot study. Pilot studies are meant to test hypotheses to see whether there is enough evidence to justify larger studies. In the words of the authors, “…repeating this study with a larger and more diverse group of people would help to confirm and strengthen the findings going forward.”

So, stay tuned. When the results of larger studies have been published in peer-reviewed scientific journals, I will give you an update.

The Bottom Line 

Scientists at the University of Florida recently did a pilot study to see whether muscadine polyphenols in the diet might improve signs of an aging skin. When compared to a placebo, dealcoholized muscadine wine significantly improved skin elasticity, moisture retention, and smoothness. It also increased blood glutathione peroxidase activity, a measure of antioxidant protection.

The authors concluded, “This randomized controlled trial demonstrated that consumption of polyphenol-rich dealcoholized muscadine wine improved skin conditions associated with aging. This is likely due to decreases in inflammation and oxidative stress.”

On the plus side, while muscadine polyphenols have been shown to reduce markers of skin aging when applied to the skin, this is the first study to suggest those same benefits may be seen from the inside out – i.e., from dietary muscadine polyphenols.

On the minus side, this is a pilot study. Pilot studies are meant to test hypotheses to see whether there is enough evidence to justify larger studies. In the words of the authors, “…repeating this study with a larger and more diverse group of people would help to confirm and strengthen the findings going forward.”

So, stay tuned. When the results of larger studies have been published in peer-reviewed scientific journals, I will give you an update.

For more information on this study read the article above.

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

 ___________________________________________________________________________

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

 

 

Health Tips From The Professor