Dr. Steve Chaney, Author at Health Tips From The Professor

Are Seniors Taking Too Many Medications?

March 29, 2016 by Dr. Steve Chaney

The Dangers of Polypharmacy

Author: Dr. Stephen Chaney

Modern medicines are truly miraculous. They control the symptoms associated with many major diseases. At their best they save lives. But have we become too reliant on medications to cure everything that ails us?

Every medication has side effects, and many medications interact with each other in harmful ways. That has become a major concern for our senior citizens because many of them end up on 5 or more medications, something the medical profession refers to as polypharmacy.

Why Are Seniors Taking So Many Medications?

It starts innocently enough:

Your cholesterol edges up a bit, and your physician recommends that you go on a statin to reduce your risk of a heart attack. This is in spite of the fact that it has been almost impossible to prove that statins actually decrease heart attack risk in people who have not yet had a heart attack (See “Do Statins Really Work?” (https://www.chaneyhealth.com/healthtips/cholesterol‐lowering‐ drugs‐right/) and “Does An Apple A Day Keep Statins Away?” (https://www.chaneyhealth.com/healthtips/apple‐day‐keep‐statins‐ away/))
Sometimes your cholesterol may not even be elevated. In today’s world statins are often recommended if you are over a certain age, are overweight, and have some other risk factor such as pre‐ diabetes or high blood pressure.
Your blood pressure starts to inch up (something that happens to most people as they get older), and your physician recommends one or two blood pressure medications.
Your blood sugar gets a bit high, and your physician recommends a drug to control your blood sugar to prevent your pre‐diabetes from turning into diabetes.
Perhaps you develop a minor arrhythmia (something else that often happens as we get older), and your physician recommends one drug to control your heart’s rhythm and another drug to thin your blood.

Before you know it you are on several medications. As if that weren’t bad enough, each of these medications has side effects, so you often need to add other medications to control the side effects of the original medications. For example:

Perhaps you develop heartburn, gas, and/or bloating from the statin, so your physician recommends a drug to control those side effects.
Perhaps you develop headaches, depression, or g.i. symptoms from your blood pressure medication, and your physician gives you one or more drugs to control those symptoms.

I could go on, but I think you get the point. It is easy for senior citizens to end up on multiple medications. The question is whether that is a good thing or a bad thing.

Are Seniors Taking Too Many Medications?

A recent study (Qato et al, JAMA Internal Medicine, doi:10.1001/jamainternmed.2015.8581, published online March 21, 2016) shows just how big a problem this has become. The authors conducted a longitudinal, nationally representative sampling of community‐dwelling adults aged 62 to 85 years old. They conducted in‐home interviews that included medication inspections with 2351 participants in 2005‐2006 and again with another 2206 participants 5 years later in 2010‐2011. The results were startling:

Simultaneous use of at least 5 prescription medications increased from 30.6% in 2005‐ 2006 to 35.8% in 2010‐2011. That is a 17% increase in just 5 years!
The percentage of adults using medication combinations with the potential for major drug‐ drug interactions increased from 8.4% in 2005‐2006 to 15.1% in 2010‐2011. That’s almost double in just the last 5 years! To put that into perspective, it means that almost 1 out of every 6 seniors in this country is at risk of major drug‐drug interactions.
Most of those dangerous interactions were due to physician prescribed medications, although interactions with over the counter medications also contributed to the total.

The authors of the study concluded “These findings suggest that unsafe use of multiple medications is a growing public health problem.”

The Most Dangerous Drug-Drug Interactions

The problem is that these drug‐drug interactions aren’t minor inconveniences. They can kill you. Here are some of the more dangerous drug‐drug interactions the authors listed: Let’s start with those drug‐drug interactions for physician‐ prescribed medication.

Statins used in combination with some blood pressure medications or with Coumadin can lead to excessive bleeding, muscle damage and kidney failure.
The combination of those same blood pressure medications with anti‐platelet blood thinning medications like Plavix dramatically increases the risk of a heart attack and death.

And, it’s not just interactions of physician‐prescribed drugs that are of concern. Interactions between physician‐prescribed drugs and over the counter medications can be equally dangerous.

These interactions are particularly insidious because patients often don’t tell their doctors about over the counter medications they are using. For example:

The combination of blood thinners with pain relievers such as aspirin or Aleve generally leads to excessive bleeding.
However, the combination of certain anti‐platelet blood thinning medications such as Plavix and either pain medications like Aleve or acid reflux medications like Prilosec can have the opposite effect – causing blot clot formation (such as deep vein thrombosis) which can lead to heart attacks and cardiovascular death.

Is There a Better Way?

In an editorial that accompanied this study (JAMA Internal Medicine, doi:10.1001/jamainternalmedicine.2015.8597) Dr. Michael A, Steinman said “There are many older adults who would be healthier if they threw away half of their medications. Yet, there are people with multiple chronic diseases who can benefit from multidrug therapy…We [currently] do not have methods that allow us to reliably evaluate medication therapy…for the outcomes that really matter, namely whether a drug is actually helping the patient, causing adverse effects, or is necessary at all.”

If your doctor doesn’t really know for sure whether the medications you are taking help you, hurt you, or have no effect, you might be wondering whether there is a better way. The answer is a clear YES!

Multiple studies have shown that lifestyle change is more effective than medications for keeping blood pressure under control (for example: Guzman‐Castillo et al, BMJ Open, doi:10.1136/bmjopen‐2014‐006070).
Studies have also shown that lifestyle change is more effective than medications for controlling diabetes (for example: Knowler et al, New England Journal of Medicine, 346: 393‐403, 2002).
The evidence for heart disease is so strong that both the National Institutes of Health and the American Heart Association recommend that a little TLC (Therapeutic Lifestyle Change) be tried before resorting to statins and other medications to lower cholesterol and reduce heart attack risk (http://www.nhlbi.nih.gov/health/resources/heart/cholesterol‐ tlc).

Fortunately, you don’t need different lifestyle changes for different diseases. One size fits all! I have talked about a healthy lifestyle in great detail in past issues of “Health Tips From the Professor.” In brief, a healthy lifestyle consists of a mostly plant‐based diet with healthy fats, healthy carbohydrates, and healthy proteins. Then add in exercise, weight control, and appropriate supplementation and you have a winning combination.

Why risk the dangers of multiple medications when there is a better way?

The Bottom Line

A recent study has clearly demonstrated that the use of multiple medications in senior citizens aged 62 and older is starting to reach dangerous levels. Between 2005 and 2010:
- The percentage of seniors using 5 or more medications has increased from 30.6% to 35.8%. That’s a 17% increase in just 5 years.
- The percentage of seniors using medication combinations with the potential for major drug‐drug interactions has increased from 8.4% to 15.1%. That’s almost double and represents 1 out of every 6 senior citizens.
These dangerous drug interactions aren’t trivial. They include excessive bleeding, heart attack and stroke, renal failure and death, just to name a few.
There is a better way. Studies have shown that lifestyle change is more effective than medication at controlling many chronic diseases such as heart disease, high blood pressure, and diabetes. Lifestyle change has no side effects and no dangerous interactions. More importantly, you don’t need different lifestyle changes for different diseases. One size fits all! I have talked about a healthy lifestyle in great detail in past issues of “Health Tips From the Professor” (https://www.chaneyhealth.com/healthtips). In brief, a healthy lifestyle consists of:
- A mostly plant based diet that includes healthy fats, healthy carbohydrates, and healthy proteins.
- Exercise, weight control, and appropriate supplementation.
So if you or someone you love are taking multiple medications, talk with your doctor about the lifestyle changes that you are willing to make. Most doctors would be delighted to reduce the medications you are taking if you are willing to do your part.

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.

Exercise and Weight Loss

March 22, 2016 by Dr. Steve Chaney

Author: Dr. Stephen Chaney

Are you confused yet? Just as you were starting to wrap your mind around the current consensus recommendations that we engage in 30 minutes of moderate intensity exercise 5 days/week, news stories are starting to appear saying that might not be enough exercise if you want to lose weight!

So how much exercise DO you need, and why is there so much confusion with exercise and weight loss?

Let me start by reviewing a couple of studies that appeared a few years ago on weight loss in middle aged, overweight women.

Exercise and Fat Loss

The first study looked at the effect of exercise intensity on abdominal fat loss over a 16-week period(Irving et al, Medicine & Science In Sports & Exercise,40: 1863-1872, 2008).

The women in this study were divided into three groups:the control group that just continued their normal exercise pattern (little or none), a group that engaged in supervised moderate intensity exercise 5 days per week, and a group that engaged in supervised, high intensity exercise 3 days per week and moderate intensity exercise the other two days.

The diet was identical for all three groups and the calories expended by exercise were also identical (the high intensity exercise was performed for shorter periods of time so that the calories expended were the same).

The results were striking. Weight loss was similar in the two exercise groups (calories do count). However, the women in the high intensity exercise group lost a significant amount of abdominal fat while the other two groups did not! As you may know, abdominal fat appears to be much more damaging metabolically than fat stores in other parts of our bodies.

Exercise and Weight Loss

The second study looked at the effect of exercise duration on weight loss over a 24-month period (Jackcicet al, Archives of Internal Medicine, 168: 1550-1559,2008).

In this case the diet and the intensity of the exercise(moderate intensity) were the same. The difference was in the duration of the exercise. In this case the calories expended by exercise was not kept the same. The group that exercised for longer burned significantly more calories than those who exercise for a shorter time.

Again the results were striking. Only those study participants who exercised for at least 275 minutes/week (an average of almost 60 minutes a day for 5 days) were able to lose 10% or more of their weight and keep the weight off over a 24-month period.

How Much Exercise is Enough?

So what does all of this mean to you?

When most Americans decide to shed a few pounds, one of the first things they think of is getting more exercise. After all, it’s much easier to walk around the block during lunch hour than to actually change what you are eating.

The question then becomes how much exercise is enough? Is the recommended 30 minutes a day of moderate intensity exercise 5 days per week enough?

If you actually work through the math, it is pretty easy to guess that it might not be enough. For example, a recent study looked at how much moderate intensity exercise would be required for a 155-pound woman to burn off the calories in same popular fast foods. For example, to burn off the calories:

In a MacDonald’s Big Mac, she would need to cycle at a moderate pace for 1 hour.

In an Arby’s Reuben, she would need to walk at a moderate pace for 3 hours.

In a Super Sonic Double Cheeseburger with Mayo, she would need to do low impact aerobics for 3 hours.

Of course, if she had fries and a soda with any of those meals she would need to do even more exercise.

These estimates are not just hypothetical. The studies described above clearly show that if you are relying on exercise alone to shed your excess pounds and/or excess fat, you are going to need higher intensity exercise and/or longer duration moderate intensity exercise than the current consensus recommendations suggest.

In other words, the current recommendations of 30 minutes of moderate intensity exercise 5 days per week probably won’t make much of a dent in your weight unless the exercise is coupled with a very good weight loss program.

But, if you have ever relied on exercise alone for weight loss, you have probably guessed that already!

Of course, the consensus recommendations are still valid for what they were designed to accomplish. 30 minutes a day of moderate intensity exercise 5 days per week is sufficient to improve fitness and reduce cardiovascular risk factors. And fitness reduces your risk of disease even if you are still overweight.

Furthermore, since many Americans probably don’t get even 30 minutes of exercise in a week, 30 minutes 5 days per week is a great starting goal.

The Bottom Line

Recent studies show that the current recommendations of 30 minutes of moderate intensity exercise 5 days per week probably won’t make much of a dent in your weight unless the exercise is coupled with a very good weight loss program.

Don’t freak out about all of the conflicting exercise recommendations. Here’s what I suggest:

1) Consult with your physician before you start any exercise program.

2) Get active. Start slowly and start by choosing activities that are fun and accessible to you.

3) Set your goal of 30 minutes of moderate intensity exercise 5 days per week. If you want to lose weight, couple that with a well-designed weight loss program.

4) If your combination of exercise and diet isn’t putting a dent in your weight and weight loss is important to you, pick up the pace or increase the duration of exercise.

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.

Chronic Hip Pain Relief

March 15, 2016 by Dr. Steve Chaney

You Can Enjoy Pain Free Living From Home

Author: Julie Donnelly, LMT –The Pain Relief Expert

Editor: Dr. Steve Chaney

You may not be an Irish dancer like the woman who sent this question, but if you are a runner, golfer, or you play tennis – or if you are just having chronic hip pain – you’ll find answers to the cause of your pain, and what you can do to resolve it!

The Cause of Bridget’s Chronic Hip Pain

I received this question recently.

I am a competitive Irish dancer. I love what I do, it is my passion. I am 40 years old and I have been Irish dancing since I was 35.

The pillar of Irish dancing is core muscles and hamstrings. The better I have gotten with my dancing, the worst my everyday pain in my high hamstrings right at the hip joint (Bicep Femoris). I have been in pain for 4 years now. It only gets worse.can you please advise.

Bridget

Obviously “Bridget” is overusing all of her muscles. She doesn’t have a “chronic hip pain condition” she has overuse syndrome, and it CAN be reversed easily. It’s just a matter of discovering what is causing the pain, finding the source of the pain, and then eliminating it with simple self-treatments.

My Answer For Bridget’s Chronic Hip Pain

Hi,

I LOVE Irish dancing, and I’ve always appreciated how grueling it is for the dancers from their hips to their feet. I’m happy to tell you that it is easy to treat each of the muscles, but it’s more than just your hip joint and hamstrings. This chronic hip pain pattern actually starts from your quadriceps, specifically your rectus femoris.

It will help you follow this discussion if you first read my article on hip joint pain relief . You’ll see that your quadriceps cause your leg to go straight after you bend your knee, so it is being repetitively strained from all of the dancing.

The rectus femoris is the only one of the four quadriceps that originates on the tip of your pelvis, so when it is being repetitively strained – and therefore shortening – it is pulling DOWN on your pelvis and UP on your knee.

As your pelvis rotates down from this strain, it causes the muscles of your hamstrings to become OVERSTRETCHED. The worst thing to do is to stretch your hamstrings without first treating the muscles that have caused your pelvis to rotate.

The overstretching occurs because the origin of your hamstrings are on the base of your pelvis. So as your posterior pelvis is pulling your hamstrings, which have their own spasms occurring and are tying the fibers into knots, they are now being overstretched as the pelvis moves.

The muscles of your hip become involved because they are twisted as your pelvis pulls them down in the front, and contracts them as your pelvis moves up in the back. This puts a great strain on the top of your thigh bone, called the greater trochanter.

You need to do your self-treatments in a specific way to sequentially release your muscles in a manner that will reverse the domino-effect your rectus femoris is putting on your pelvis. As you release each muscle in what is called the Julstro Protocol , your pelvis will be able to release.

As a dancer, I suggest you self-treat each of the muscles regularly, even daily. This will force out the toxins that are created as you dance for hours, and will enable your muscles to heal while you sleep so you’ll be fresh in the morning and not carrying around yesterday’s pain.

You can release all of the muscles that are causing your chronic hip pain, and you’ll find that you’re dancing better, with more flexibility, and you’ll also feel stronger.

Wishing you well,

Julie Donnelly

About The Author

Julie Donnelly is a Deep Muscle Massage Therapist with 20 years of experience specializing in the treatment of chronic joint pain and sports injuries. She has worked extensively with elite athletes and patients who have been unsuccessful at finding relief through the more conventional therapies.

She has been widely published, both on – and off – line, in magazines, newsletters, and newspapers around the country. She is also often chosen to speak at national conventions, medical schools, and health facilities nationwide.

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.

Antioxidants and Aging

March 8, 2016 by Dr. Steve Chaney

Author: Dr. Stephen Chaney

Modern medicine has helped mankind greatly extend our lifespan, but what about our “healthspan”? Aging is often associated with major degenerative diseases and loss of physical and mental functioning. As the saying goes: “Aging isn’t for sissies”. But, what if you could live healthy into your 80s and 90s? What if you had the health to truly enjoy the wisdom that comes with your years of experience? In this article we will explore antioxidants and aging.

While healthy aging is a very personal issue for all of us in our golden years, it is a very important societal issue as well. The United Nations estimates that by 2050 more than 1/3 of the population of developed countries will be over 60. Unless we can find a way to preserve the health of these older adults, health care costs will bankrupt even the richest of countries.

That’s why the recently published study on the effect of antioxidant supplements on healthy aging in French adults (Assmann et al, American Journal of Epidemiology, 182: 694-704, 2015) is so interesting.

How Was The Study Designed?

This study was a follow-up to the “Supplementation With Antioxidant Vitamins and Minerals” study that was conducted in France during 1994-2002. That was a double blind, placebo controlled study in which participants were given either a placebo or a supplement containing 120 mg of vitamin C, 6 mg of beta-carotene, 30 mg of vitamin E, 100 ug of selenium, and 20 mg of zinc every day for an eight-year period. These nutrient levels were designed to be equivalent to the quantities provided by a balanced diet rich in fruits and vegetables.

The follow-up study was conducted approximately 5 years later with 3,996 of the original participants. The investigators specifically selected participants who were disease free when they entered the original study. These study participants were equally divided between men and women and had an average age of 65.3 years.

The participants were put through a battery of screens and assigned a “healthy aging score” based on:

Absence of cancer, heart disease and diabetes
Good physical and cognitive function
No limitations in activities associated with daily living
No depressive symptoms
No health-related limitations in social life
Good overall perceived health
No function-limiting pain

In short those participants with a high healthy aging score had good health and good quality of life.

Are Antioxidants the Secret to Healthy Aging?

When the investigators looked at the group as a whole, the results were pretty discouraging:

Antioxidant supplementation provided no significant benefit to the population as a whole.

Antioxidant supplementation also provided no significant benefit to the women in the group.

However, when they looked at subgroups, the results were much more encouraging:

Antioxidant supplementation increased the probability of healthy aging by 18% for the men in the study.

For those participants with low serum vitamin C levels at the beginning of the study antioxidant supplementation increased the probability of healthy aging by 28%

For those participants with low serum zinc levels at the beginning of the study antioxidant supplementation increased the probability of healthy aging by 26%

For those participants consuming very few fruits and vegetables at the beginning of the study, antioxidant supplementation increased the probability of healthy aging by 17%

The conflicting results for men and women were puzzling, but the investigators pointed out that very few women had low serum vitamin C status at the beginning of the study, while 25% of the men had low serum vitamin C levels at the beginning of the study. The investigators speculated that supplementation may have been less effective in women simply because they had better diets than the men in the study. That certainly wouldn’t surprise me.

What Are The Strengths And Weaknesses Of This Study?

Let’s start with the strengths. This is the very first double-blind, placebo-controlled study to look at the role of antioxidant nutrients in healthy aging. A number of previous studies looking at the effect of antioxidant nutrients on individual components of aging have given conflicting results. The investigators pointed out that this study may have shown more beneficial effects of antioxidants than previous studies because:

Most previous studies have been relatively short in duration. This was an 8-year study with a 5-year follow-up period (total study length = 13 years).

Most previous studies did not measure baseline intake of the nutrients. This study shows that individuals with low baseline intake or low serum levels at the beginning of the study are significantly more likely to benefit from supplementation.

Most previous studies have measured the effects of single antioxidant nutrients, or at most combinations of 2 or 3 antioxidant nutrients. This study used a combination of 5 different antioxidant nutrients. The synergy between these nutrients may have increased the magnitude of the observed benefits.

The weaknesses of the study are also pretty apparent.

Since it is the first study of its kind, it does need to be validated by additional studies.

There is no universally accepted index for healthy aging (This is a problem for aging research as a whole, not just this study).

The participants in the study were not evaluated for healthy aging criteria at the beginning of the study so we have no idea how their healthy aging score changed over time.

The beneficial effect of antioxidant nutrients, while significant, were relatively small. You are obviously not going to live healthy to 100 by consuming antioxidant supplements alone.

Antioxidants and Aging: Will Antioxidant Nutrients Help You?

This study does suggest that antioxidant supplements may help you achieve healthy aging. This study also makes three other very important points:

A holistic approach to supplementation – one involving multiple antioxidant nutrients – is much more likely to be beneficial than individual antioxidant supplements.

Supplementation is most likely to be beneficial for those individuals who are consuming a poor diet.

Supplementation is also most likely to be beneficial for those individuals who have low serum level of essential nutrients. This can be due to poor diet, but low serum levels of individual nutrients can also be caused by individual differences in metabolism or genetic make-up.

However, as noted above:

The study has some weaknesses and needs to be repeated.

The beneficial effects of antioxidant nutrients were relatively small.

That means that holistic approaches to healthy aging are more likely to be beneficial than individual supplements. Based on what we currently know a holistic approach to healthy aging includes:

Consuming a combination of a balanced diet and supplementation that provides sufficient levels of all the essential nutrients, not just the antioxidant nutrients. This would include things like omega-3 fatty acids and polyphenols.

Avoiding saturated and trans fats, excess sugar, red and processed meats, which may have bad effects on your health.

Controlling your weight.

Staying mentally and physically active.

Maintaining strong social networks.

Maintaining a positive outlook on life.

The Bottom Line

A recent study suggests that antioxidant supplements may help you achieve healthy aging. This study also makes two other very important points:

A holistic approach to supplementation – one involving multiple antioxidant nutrients – is much more likely to be beneficial than individual antioxidant supplements.

Supplementation is most likely to be beneficial for those individuals who are consuming a poor diet and/or have low serum levels of essential nutrients.

Since the beneficial effect of antioxidant nutrients on healthy aging was relatively small, this suggests the antioxidant nutrients are just one part of a holistic approach to healthy aging that includes.

Consuming a combination of a balanced diet and supplementation that provides sufficient levels of all the essential nutrients, not just the antioxidant nutrients. This would include things like omega-3 fatty acids and polyphenols.

Avoiding saturated and trans fats, excess sugar, red and processed meats, which may have bad effects on your health.

Controlling your weight.

Staying mentally and physically active.

Maintaining strong social networks.

Maintaining a positive outlook on life.

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

8 Weight Loss Myths

March 1, 2016 by Dr. Steve Chaney

Why Your Weight Is Increasing Rather Than Decreasing

Author: Dr. Stephen Chaney

Usually I review scholarly publications of clinical studies, but occasionally I find an article in the popular press that’s so good I just have to share it with you. The lead article about weight loss by Bonnie Liebman in the April 2015 issue of Nutrition Action is just such an article. She called it “8 Weight Mistakes”, but I think “8 Weight Loss Myths” would be a better title.

There are certain weight loss myths that are repeated so often that most people believe they are true. Unfortunately, each one of these myths is a “fat trap” that can sabotage your efforts to achieve a healthy weight. If your New Year’s weight loss resolution isn’t going as well as you would like, it may be because you are still holding on to one or more of these myths.

Weight Loss Myth #1: I Can Lose It Later

It’s easy to tell yourself that you don’t need to watch your weight during the holidays or while you are on vacation. After all you can cut back a bit when those special occasions are over and lose that extra weight. What makes that belief particularly insidious is that it actually worked for you when you were in your teens or early twenties. Why doesn’t it work anymore? There are 4 reasons:

On most diets you lose muscle as well as fat. I have talked about this in a previous article, High Protein Diets and Weight Loss , but muscle is important because it burns off calories much faster than fat.

Your organs become smaller. For example, as you lose weight your heart doesn’t have to service as many miles of blood vessels, so it can become smaller as well. That’s important because your heart works so hard pumping blood that it burns off calories much faster than resting muscle.

Once you have lost a significant amount of weight exercise burns fewer calories. If you don’t believe that, try lugging an extra 10 or 20-pound weight up a flight of stairs.

Your metabolism slows down. This is particular true if you try to lose weight too fast as I have explained in my “3 Things Every Successful Diet Must Do” eBook, which is available at Health Tips From the Professor.

Just in case you are still a doubter, Ms. Liebman shared a study in her article that showed most people never lose all of the weight they gained during the holidays before the next holiday season starts. Does that sound familiar?

Weight Loss Myth #2: Once It’s Off, It’ll Stay Off

You’ve heard this one before. However, even on the most successful diets, weight loss is temporary. Most people eventually regain all the weight they’ve lost and more. Again I’ve also covered the reason for this in my “3 Things Every Successful Diet Must Do” eBook, which is available at Health Tips From the Professor. To spare you the trouble of reading the book I will share the secret with you. Simply put: “Diets never work long term. Only true lifestyle change can lead to long term weight loss.”

However, that doesn’t stop people from believing that the next “magic” diet will be their ticket to permanent weight loss. It always amazes me that people fall for this same myth time after time.

Weight Loss Myth #3: Fat Is Fat, No Matter Where It Is

Most of you probably already knew that belly fat (the so-called apple shape) is metabolically more dangerous to our health than thigh & leg fat (the so-called pear shape). However, some of the other information Ms. Liebman shared was a surprise to me.

It turns out that belly fat is actually easier to lose than thigh & leg fat. As you add fat to your lower body you create lots of new fat cells (2.6 billion new fat cells for every 3.5 pounds of fat). Once you add that extra fat to your lower body you’re pretty much stuck with it.

Of course, you can’t add new fat to your belly forever without creating new fat cells, and once you’ve created those new fat cells you may be stuck with your belly fat as well.

Weight Loss Myth #4: You Have To Go Out Of Your Way To Overeat

It’s really difficult to understand how anyone could believe in this myth. The fact is that we live in a “fat world”. There are fast food restaurants on virtually every street corner in every city and in virtually every mall in this country. Restaurant portion sizes are through the roof. Every social interaction seems to be centered around food or drink.

You don’t need to go out of your way to overeat. Overeating has become the American way. You actually need to go out of your way to avoid overeating.

Weight Loss Myth #5: All Extra Calories Are Equal

Research has confirmed what many of you probably suspected already. All calories are NOT equal. Calories from alcohol, saturated fats, trans fats and sugars make a beeline for your belly where they are converted into the most dangerous form of fat.

Weight Loss Myth #6: I Can Just Boost My Metabolism

Many Americans cling to the false hope that they can eat whatever they want as long as they take some sort of magic herb or pill to boost their metabolism. The fact is that natural metabolic boosters like green tea have a very modest effect on metabolism. They can play a role in a well-designed diet program, but they will never allow you to eat whatever you want and lose weight.

As for those magic herbs and drugs that promise to burn off fat calories without you lifting a finger, my advice is to avoid them like the plague. I’ve talked about many of them in my previous “Health Tips From the Professor” articles. For example, you might be interested in my articles “Are Dietary Supplements Safe?” or “Are Diet Pills Safe?”. The bottom line is that these metabolic boosters are dangerous – and they just might kill you.

Weight Loss Myth #7: There’s A Magic Bullet Diet

Hope springs eternal. Perhaps that’s why so many new diets appear each year. Some diets are low fat, some are low carbohydrate, some hearken back to cave man times, and others are just plain weird. Some of them actually do give better weight loss than others short term. However, when you follow people on those diets for two years or more, none of them work very well (see myth #2), and there isn’t a dimes worth of difference between them.

Weight Loss Myth #8: I Can Work Off The Extra Calories

This is perhaps the most pervasive myth of all. This is the one that sells millions of gym memberships every January.

Don’t get me wrong. Diet plus exercise can be very beneficial because it helps you retain muscle mass as you are losing weight, especially if you are consuming enough protein to support the exercise.

However, exercise alone isn’t going to help you nearly as much as you think.

You’d have to ride your bicycle for an hour and 25 minutes to offset the 500 calorie dessert you just consumed at your favorite restaurant.

Exercise helps some people more than others. Studies show that some people get hungrier when they exercise. As a result, they eat more calories and actually gain weight rather than losing it.

Finally, don’t rely on your fitness trackers. Most of them grossly overestimate the calories you burn through exercise. If you use a fitness tracker you should cut their estimates for calories burned by 50% or more.

The Bottom Line

A recent article shared the 8 most common weight loss myths. If you actually believe any of these myths, you will have a very difficult time getting your weight under control.

I can lose it later.

Once it’s off, it’ll stay off.

Fat is fat, no matter where it is.

You have to go out of your way to overeat.

All extra calories are equal (A calorie is a calorie).

I can just boost my metabolism.

There is a magic bullet diet.

I can work off the extra calories.

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 B Vitamins Reduce Heart Disease Risk?

February 23, 2016 by Dr. Steve Chaney

What Role Do B Vitamins Play in a Heart Healthy Lifestyle?

Author: Dr. Stephen Chaney

Two weeks ago I shared some studies that challenge the claim that vitamin E doesn’t reduce heart attack risk. To close out “Heart Health” month, I want to share some information that may change how you think about B vitamins and heart disease risk. Once again, you’ve seen the headlines: “B Vitamins Do Not Reduce the Risk of Heart Disease”. In fact, these headlines have been repeated so many times that virtually every expert thinks that it has to be true. Once again, I’m going to share some information with you that I learned from a seminar by Dr. Jeffrey Blumberg who disagrees with this commonly held belief.

Dr. Blumberg is a Professor in the Friedman School ofNutrition Science and Policy at Tufts. Dr. Blumberg has over 200 publications in peer-reviewed scientific journals. He is considered one of the world’s top experts on supplementation, and his specialty is conducting and analyzing clinical studies. He believes that the media has seriously misinterpreted the studies on B vitamins and heart disease risk. You might call this “The Rest of the Story” because you (and your doctor) definitely did not hear this part of the story in the news.

Do B Vitamins Reduce Heart Disease Risk?

The study in question is called the “Heart Outcomes Prevention Evaluation-2“. In that study a group of middle aged men and women received 2.5 mg of folate, 50 mg of vitamin B6 and 1 mg of vitamin B12 versus a placebo and were followed for an average of 5 years.

The headlines that you may have seen said “B vitamins do not reduce the risk of major cardiovascular events in patients with vascular disease”. But, the headlines did not tell the whole story.

In the first place, that was only true for heart attacks and cardiovascular death. Strokes were reduced by 25%. I don’t know about you, but I consider strokes to be fairly major.

However, even when we focus on heart attacks and cardiovascular deaths the headlines didn’t tell the whole story. You see, even the best intentioned studies sometimes contain fatal flaws that aren’t obvious until after the study has been completed.

The Flaws In The Study

There were two major flaws in this study.

Flaw #1 was that 70% of the study subjects were eating foods fortified with folate and had adequate levels of that nutrient in their bloodstream before the study started.

For those people who were already getting enough folate in their diet, B vitamin supplementation didn’t make much of a difference. However, for those people not getting adequate levels of folate in their diet, B vitamin supplementation decreased their risk of heart disease by ~15%.

Flaw #2 was that ~90% of the people in the study had a history of coronary artery disease and most of them were already on cholesterol lowering medications.

To understand why this is a problem you have to understand both the proposed mechanism by which B vitamin supplementation has been proposed to lower the risk of heart disease AND how the cholesterol lowering drugs work.

Deficiencies of folate, B6 and B12 are thought to increase the risk of heart disease because the B vitamin deficiency causes an increase in homocysteinelevels in the blood, and high homocysteine levels are thought to increase inflammation – which is a risk factor for heart disease. So supplementation with folate, B6 and B12 has been proposed to decrease heart disease risk by decreasing inflammation.

The problem is that the most commonly used cholesterol lowering medications also decrease inflammation.So you might not be surprised to learn that those people who had a history of coronary artery disease(and were taking cholesterol lowering medication that reduces inflammation) did not receive much additional benefit from B vitamin supplementation.

For those people in the study who were not taking cholesterol lowering medication, B vitamin supplementation also reduced their risk of heart attacks by ~15% – but there were too few people in that group for the results to be statistically significant.

So the headlines from this study really should have said “B vitamins do not reduce the risk of heart attacks or cardiovascular deaths in people who are already getting adequate folate from their diet or in people who are taking drugs that reduce the bad effects of B vitamin deficiency”. But that kind of headline just wouldn’t sell any newspapers.

What Does This Study Mean For You?

There are two very important take-home lessons from this study.

Lesson #1: Once again this study makes the point that supplementation makes the biggest difference when people have an increased need. The studies discussed in Vitamin E and Heart Disease two weeks ago illustrated increased need because of age, pre-existing disease, and genetic predisposition. This study illustrated increased need because of inadequate diet.

Lesson #2: This study also illustrates a problem that is becoming increasingly common in studies of supplementation. It is considered unethical to not provide participants in both groups with what is considered the standard of care for medical practice. In today’s world the standard of care includes multiple drugs with multiple side effects, and some of those drugs may have the same mechanism of action as the supplement.

I have discussed this problem in the context of omega-3 fatty acids and heart disease in a previous “Health Tips From the Professor,” Is Fish Oil Really Snake Oil? In many cases it is no longer possible to ask whether supplement X reduces the risk of a particular disease. It is now only possible to ask whether supplement X provides any additional benefit for patients who are taking multiple drugs, with multiple side effects. That’s not the question that many of my readers are interested in.

The Bottom Line

Headlines have proclaimed for years the “B Vitamins Do Not Reduce Heart Disease Risk”. Dr. Jeffrey Bloomberg of Tufts University has reviewed one of the major studies behind this claim and found the headlines to be misleading.

For example, the study showed that B vitamin supplementation reduced strokes by 25%, which is a pretty significant finding in itself.

When he analyzed the portion of the study looking at heart attacks, he found two major flaws:

#1: 70% of the people in the study were already getting adequate amounts of B vitamins from their diet and would not be expected to benefit from supplementation. For the 30% who weren’t getting adequate amounts of B vitamins from their diet, supplementation reduced their risk of heart attack by 15%.

#2: 90% of the people in the study were taking a drug that masks the beneficial effects of B vitamin supplementation. For the 10% who weren’t taking the drug, supplementation with B vitamins also reduced their risk of heart attack by 15%, but there were too few people in that group for the results to be statistically significant.

Obviously, there were only a handful of people in the study who weren’t getting enough B vitamins from their diet AND weren’t on medication, so we have no idea what the effect of B vitamin supplementation was in that group.

Once again this study makes the point that supplementation makes the biggest difference when people have an increased need. The studies discussed in “Health Tips From the Professor” two weeks ago illustrated increased need because of age, pre-existing disease, and genetic predisposition. This study illustrated increased need because of inadequate diet.

This study also illustrates a problem that is becoming increasingly common in studies of supplementation. It is considered unethical to not provide participants in both groups with what is considered the standard of care for medical practice. In today’s world the standard of care includes multiple drugs, some of which may have the same mechanism of action as the supplement.

In many cases it is no longer possible to ask whether supplement X reduces the risk of a particular disease. It is now only possible to ask whether supplement X provides any additional benefit for patients who are taking multiple drugs, with multiple side effects. That’s not the question that many of my readers are interested in.

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.

Plantar Fasciitis Causes and Treatment

February 16, 2016 by Dr. Steve Chaney

You Can Enjoy Pain Free Living From Home

Author: Julie Donnelly, LMT –The Pain Relief Expert

Editor: Dr. Steve Chaney

Recently a woman came in to see me who was suffering from severe plantar fasciitis pain, her arch hurt so much she could barely walk. She’d been to several specialists and has so far bought three pair of orthotics (at $400 each!). Plantar fasciitis is getting to be a commonplace condition in my office. I love working with athletes, but I’m finding this isn’t only a problem for athletes.

Because of driving a car for long distances her right foot was worse than her left, which makes sense since the muscles that enable you to press down on the gas and brake pedals, are the same ones that are the cause of plantar fasciitis.

Plantar Fasciitis Causes: Are Muscles The Culprit?

Muscles are seldom considered when searching for the answer to plantar fasciitis pain. Instead the foot is considered to be the problem, instead of the symptom, and orthotics are commonly recommended. In many cases, when muscles are the cause of the plantar fasciitis symptoms, the orthotics will cause more pain.

The analogy I always use is, if you pull your hair at the end, your scalp will hurt. But you don’t need to massage your scalp, you don’t need to take pain-killers for the headache, and you don’t need brain surgery — you just need to let go of your hair! It’s the same with joint pain. Muscles pull on tendons, and the tendons insert into a joint. When the muscle is tight you will feel the pain at the joint. But you don’t need to rub the joint, or take pain-killers, or have surgery—you need to release the spasms in the muscle fibers.

In the case of plantar fasciitis, the muscles are in your lower leg, and the insertion of the tendon is in your arch – so when the muscles are tight your arch will hurt.

The two muscles are the tibialis anterior and the peroneal. The tibialis anterior runs along the entire length of the shin bone and then the tendon inserts onto the first metatarsal (the long bone that is on the inside of your arch and goes up to your big toe), while the peroneal runs along the entire outside of your lower leg, goes behind your ankle, and the tendon inserts on the fifth metatarsal (the bone on the outside of your foot) and also on the first metatarsal at the same point as the insertion of your tibialis anterior. This is important to visualize so you can see how the tendons pulling on the bones will put pressure on your arch and cause the arch muscles to be strained — causing plantar fasciitis pain in the bottom of your foot.

Self-Treatment For Plantar Fasciitis Pain

There are several muscles that all impact your arch and cause the pain of plantar fasciitis. This picture is doing the treatment for the muscle that runs down the outside of your lower leg, called peroneal. The peroneal is neglected by most therapists when searching for an answer to foot pain, yet it is often one of the key muscles that needs to be treated to get relief.

Sit as shown in the picture and use either the Julstro Perfect Ball, or a new tennis ball, and press the outside of your leg directly onto the ball. You’ll find a very tender point at the same level as shown in this picture.

When you find it, hold the pressure steady, and then slightly move your leg so the ball rolls up and down the outside of your leg. Use your hand as shown to press down on your leg to increase the pressure.

You’ll be thrilled when you see how quickly you’ll feel relief! You’ll be able to go back out and enjoy your life pain-free!

Plantar fasciitis causes are often centered around muscles in the legs, therefore plantar fasciitis pain relief is also.

Wishing you well,

Julie Donnelly

About The Author

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.

Check It Out!

If you would like easy to follow instructions on how to relieve joint pain and muscle tightness from head to toe click here (http://www.triggerpointyoga.com/product/triggerpoint-yoga-full-body-kit/?ap_id=SteveChaneyTips) to check out Julie Donnelly’s Trigger Point Yoga instruction kit today. Whenever, I have pain and stiffness I use her techniques. They work!

Vitamin E And Heart Disease

February 9, 2016 by Dr. Steve Chaney

Does Vitamin E Reduce Heart Attack Risk?

Author: Dr. Stephen Chaney

Since February is “Heart Health Month”, I thought I would share some information with you that might change how you think about vitamin E and heart disease risk. You’ve seen the headlines: “Vitamin E Does Not Reduce the Risk of Heart Disease”. In fact, these headlines have been repeated so many times that virtually every expert thinks that it has to be true. Let me share the opinion of one expert who disagrees. This week I’m going to share some information with you that I learned from a seminar by Dr. Jeffrey Blumberg from Tufts University.

But first let me tell you who Dr. Blumberg is. Dr. Blumberg is a Professor in the Friedman School of Nutrition Science and Policy at Tufts. Dr. Blumberg has over 200 publications in peer-reviewed scientific journals. He is considered one of the world’s top experts on supplementation.

Now back to what I learned at his seminar. Dr. Blumberg’s specialty is conducting and analyzing clinical studies, and his perspective on some very influential clinical studies is a bit different from what you may have heard from media reports. He believes that the media has seriously misinterpreted several recent studies. You might call this “The Rest of the Story” because you (and your doctor) definitely did not hear this part of the story in the news.

Does Vitamin E Reduce Heart Disease Risk In Women?

Let’s start with vitamin E and the risk of cardiovascular disease in women. The most influential study on this subject was the Women’s Health Study (Lee et al., JAMA, 294:56-65, 2005). This was a major study in which 39,876 women were given either 600 IU of vitamin E every other day or a placebo and followed for 10 years.

The headlines said “Vitamin E Supplements Do Not Reduce Risk Of Cardiovascular Death, Heart Attack And Stroke In Women”. That was true if you looked at the total population of women in the study.

But Dr. Blumberg pointed out that when you looked at women who were 65 or older in that study vitamin E supplementation caused a…

24% decrease in cardiovascular deaths,

26% decrease in major cardiovascular events,

21% decrease in venous thromboembolism (blood clots forming in the veins),

…and all of these decreases were statistically highly significant. That’s important because the risk of heart disease in pre-menopausal women is extremely low. It’s the over 65 group who have a high risk of heart disease.

Perhaps the headlines should have said: “Vitamin E reduces the risk of cardiovascular disease and cardiovascular deaths in those women at high risk of heart attacks”. But, of course, they didn’t. Perhaps that wasn’t considered newsworthy.

Other Studies On Vitamin E and Heart Disease Risk In Women

If this were the only study suggesting the vitamin E might benefit women at high risk of having a heart attack or stroke, it might be easy to dismiss it, but it’s not the only study showing this effect.

For example, a subsequent study called the “Women’s Antioxidant Cardiovascular Study” looked at the effect of 600 IU of vitamin E every other day on cardiovascular events in 8171 women health professionals (Cook et al, Archives of Internal Medicine, 167:1610-1618, 2007).

Once again the headlines said that vitamin E supplementation had no effect on cardiovascular events in women. But, when the authors looked at those women who already had cardiovascular disease at the beginning of the study (and were, therefore, at high risk of suffering a cardiovascular event during the study) vitamin E supplementation caused a 23% decreased risk of heart attack, stroke and cardiovascular death.

Another important study was the HOPE (Heart Outcomes Prevention Evaluation) study (Levy et al, Diabetes Care, 27: 2767, 2004). The overall study results were similar to several other recent trials – no significant effect of vitamin E supplementation on cardiovascular health in the population group as a whole.

However, by the time that study was performed it was clear that a particular genetic variation in the haptoglobin gene called the haptoglobin 2-2 genotype lead to a significant increase in oxidative damage to the vascular wall (the professor will collect your quizes at the end of this email).

When the data were reanalyzed by genotype, it became clear that people with the haptoglobin 2-2 genotype experienced a significant decrease in both heart attack and cardiovascular death with vitamin E supplementation. This finding has been confirmed by a subsequent double-blind, placebo-control study specifically designed to look at the cardioprotective effects of vitamin E in people with different haptoglobin genotypes (Milman et al, Arterioscler. Thromb. Vasc. Biol., 24: 136, 2008).

In short, the headlines from all three studies should have said: “Vitamin E reduces the risk of cardiovascular disease and cardiovascular deaths in those women at high risk of heart attacks” – and, it doesn’t appear to matter whether the increased risk is due to age, pre-existing disease, or genetic predisposition.

Does Vitamin E Reduce Heart Disease Risk In Men?

For men the most influential study was called the “Physician’s Health Study II” (H. D. Sesso et al, JAMA, 300: 2123-2133, 2008). In this study male physicians aged 40-84 were invited to participate in a double-blind clinical trial in which they were randomly assigned into groups who were given 400 IU of vitamin E every other day or placebo. They were followed for an average of 8 years during which data on both total mortality and cardiovascular mortality were obtained.

Once again, the headlines read “Vitamin E Does NotPrevent Cardiovascular Disease in Men”. But let me tell you what Dr. Blumberg said so that you understand “The Rest of the Story”. It starts by looking at the selection process for the Physician Health Studies.

Dr. Sesso and his colleagues sent out a letter asking 261,248 male physicians in the US if they would be willing to participate in the study. Only 112,528 responded and, of those responding, only 59,272 indicated that they were willing to participate. Of those who said that they were willing to participate only 32,223 met the selection criteria.

The exclusion criteria eliminated anyone who already had suffered a heart attack, stroke, angina or was on a blood thinner – in other words those people who were at greatest risk of suffering a heart attack or stroke during the study.

Finally, the study had an 18 week “run in” period to eliminate those people who were unwilling or unable to comply with the study protocol. This eliminated another 10,000 participants, leaving only 22,071 participants – less than 10% of the original.

This is where it gets really interesting. Dr. Sesso and his colleagues used publicly available databases to evaluate total and cardiovascular mortality in each group (H. D. Sesso et al, Controlled Clinical Trials, 23: 686-702, 2002). It turns out that at each stage of the selection process the incidence of both total and cardiovascular mortality during the 8-year period decreased.

In fact, the doctors who were actually included in the study were 67% less likely to die from all causes and 73% less likely to die from cardiovascular disease than the male physician population as a whole.

The bottom line is that the selection process eliminated almost all of the physicians at significant risk of having a heart attack or stroke during the study. The only ones who were actually enrolled in the study were those physicians who were at very low risk for having a fatal heart attack or stroke – or dying from any cause – during the study.

So the headlines describing this study should have read “Vitamin E Does Not Prevent Cardiovascular Disease in Men Who Are At Very Low Risk Of Heart Attack And Stroke”.The irony is that there was nothing wrong with the design of the study. It’s probably just a male ego thing. Guys who were unhealthy just didn’t want to participate in a study that might show how unhealthy they really were.

What Does This Mean For You?

These studies illustrate the true story of supplementation. For those of us who are at low risk of disease, supplementation is just a form of health insurance. But for those of us at high risk of disease, supplementation can make a huge difference in our health. That increased risk can be due to many things, as we have seen in the studies above. It can be due to poor diet, age, pre-existing disease, and/or genetic predisposition.

The problem is that most of us don’t really know whether we are at low risk or high risk until it’s too late. For millions of Americans the first sign of heart disease is sudden death.

The Bottom Line

The experts have been saying for years that vitamin E does not reduce the risk of heart disease. That claim is true, if you look at the general population, most of which is at low risk of developing heart disease – at least during the time frame of the clinical studies. However, when you look at people who are at high risk of developing heart disease, the answer is different.

For example, when you look at clinical studies with women, vitamin E significantly decreased the risk of heart attacks in women who…

Were over 65,

Had pre-existing heart disease at the beginning of the study,

Or, had a genetic predisposition to heart disease.

The headlines from these studies should have read “Vitamin E reduces the risk of cardiovascular disease in those women at high risk of heart attacks”, but they didn’t.

For men the story is a bit different. The Physician’s Health Study is considered the definitive study on the subject. However, most of the unhealthy male physicians either didn’t enroll in the study or dropped out before its completion. In fact, the doctors who were actually included in the study were 67% less likely to die from all causes and 73% less likely to die from cardiovascular disease than the male physician population as a whole. The headlines describing this study should have read “Vitamin E Does Not Prevent Cardiovascular Disease in Men Who Are At Very Low Risk Of Heart Attack And Stroke”.

These studies illustrate the true story of supplementation. For those of us who are at low risk of disease, supplementation is just a form of health insurance. But for those of us at high risk of disease, supplementation can make a huge difference in our health. That increased risk can be due to many things, as we have seen in the studies above. It can be due to poor diet, age, pre-existing disease, and/or genetic predisposition.

The problem is that most of us don’t really know whether we are at low risk or high risk until it’s too late. For millions of Americans the first sign of heart disease is sudden death.

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 Calcium Supplements Prevent Bone Fractures? – Part2: Preventing Osteoporosis

February 2, 2016 by Dr. Steve Chaney

Creating A “Bone Healthy” Lifestyle

Author: Dr. Stephen Chaney

$prevent bone fractures$ A recent study (Tai et al, British Medical Journal, BMJ/2015; 351:h4183 doi: 10.1136/bmj.h4183)reported that calcium supplementation for women over 50 resulted in only a very small increase in bone density, which translated into a very small (5-10%) decrease in the risk of bone fractures. They concluded that the standard RDA recommendation of 1,000 – 1,200 mg/day of calcium for adults over 50 is unlikely to help in preventing osteoporosis or reducing the risk of bone fractures.

In last week’s issue of “Health Tips From the Professor,” I discussed the many flaws of the study. In brief:

The study was a meta-analysis of 51 published clinical studies. Normally, meta-analyses are very strong, but they have an “Achilles Heel” – something called the Garbage-In, Garbage-Out Simply put, this means that the meta-analysis is only as strong as the individual studies that went into it. The authors included 40 years of clinical studies in their meta-analysis, and most of those studies had an inadequate design by today’s standards.

The study also made a number of what I would call apples to oranges comparisons that were of questionable validity.

In this week’s issue of “Health Tips From The Professor”, I would like to explore the other side of the coin. I would like to consider the possibility that the study might be correct and discuss what that might mean for you.

What Is A “Bone Healthy” Lifestyle?

Despite the concerns I just mentioned, let’s assume for a minute that the study might just be correct in spite of its many flaws. Let’s assume that the “one size fits all” RDA recommendation of 1,000 – 1,200 mg/day of calcium if you are over 50 may actually be flawed advice. If so, perhaps it’s time to say good riddance! It may finally be time to put away the “magic bullet”, “one size fits all” thinking and start seriously considering holistic approaches.

Now that I have your attention, let’s talk about what you can do to prevent osteoporosis – and the role that supplementation should play. Let’s talk about a “bone healthy” lifestyle.

#1: Let’s start with supplementation: Bone is not built with calcium alone. Bone contains significant amounts of magnesium along with the trace minerals zinc, copper and manganese – and all of these are often present at inadequate levels in the diet. Most of us know by now that vitamin D is essential for bone formation, but recent research has shown that vitamin K is also essential (Kanellakis et al, Calcified Tissue International, 90: 251-262, 2012). An ideal calcium supplement should contain all of those nutrients.

#2: Next comes diet: Many of you probably already know that some foods are acid-forming and other are alkaline-forming in our bodies – and that it is best to keep our bodies on the alkaline side. What most of you probably don’t know is that calcium is alkaline and that our bones serve as a giant buffer system to help keep our bodies alkaline. Every time we eat acid-forming foods a little bit of bone is dissolved so that calcium can be released into the bloodstream to neutralize the acid. (My apologies to any chemists reading this for my gross simplification of a complex biological system).

Consequently, if we want strong bones, we should eat less acid-forming foods and more of alkaline-forming foods. Among acid-forming foods, sodas are the biggest offenders, but meat, eggs, dairy, and grains are all big offenders as well. Alkaline-forming foods include most fruits & vegetables, peas, beans, lentils, seeds and nuts. In simple terms, the typical American diet is designed to dissolve our bones. Calcium from diet or supplementation may be of little use if our diet is destroying our bones as fast as the calcium tries to rebuild them.

#3: Test your blood 25-hydroxyvitamin D level: 25-hydroxy vitamin D is the active form of vitamin D in our bloodstream. We need a sufficient (20-50 ng/mL) blood level of 25-hydroxy vitamin D to be able to use calcium efficiently for bone formation. We now know that some people who seem to be getting adequate vitamin D in their diet still have low 25-hydroxyvitamin D levels. In fact, various studies have shown that somewhere between 20-35% of Americans have insufficient blood levels of 25-hydroxy vitamin D. You should get your blood level tested. If it is low, consult with your health professional on how much vitamin D you need to bring your 25-hydroxy vitamin D into the sufficient range.

#4: Beware of drugs:The list of common medications that dissolve bones is a long one. Some of the worst offenders are anti-inflammatory steroids such as cortisone & prednisone, drugs to treat depression, drugs to treat acid reflux, and excess thyroid hormone.

I’m not suggesting that you avoid prescribed medications that are needed to treat a health condition. I would suggest that you ask your doctor or pharmacist (or research online) whether the drugs you are taking adversely affect bone density. If they do, you may want to ask your doctor about alternative approaches, and you should pay a lot more attention to the other aspects of a “bone healthy” lifestyle.

#5: Exercise is perhaps the most important aspect of a bone healthy lifestyle:Whenever our muscles pull on a bone it stimulates the bone to get stronger. I’ll put the benefits of exercise in perspective in the next section.

Exercise Is A Critical Part of Preventing Osteoporosis

Instead of just quoting more boring studies, I’m going to share a couple of stories that help put the importance of exercise into perspective.

The first is my wife’s story. She ate a very healthy diet with minimal meat and lots of fruits and vegetables for years. She took calcium supplements on a daily basis. She walked 5 miles per day and took yoga classes several days each week. Yet when her doctor recommended a bone density scan in her early sixties she discovered she had low bone density. She was in danger of becoming osteoporotic!

Her doctor prescribed Fosamax. My wife tried it for one day and decided the side effects were worse than the disease. So she started asking holistic health practitioners what she should do. They recommended she find a personal trainer and start pumping iron. That was not an easy solution, but it was the right one. When she went in for her second bone scan 3 months later, her doctor excitedly announced that her bone density had increased by 7%. Her doctor said “We never get results that good with Fosamax”. When my wife told her she wasn’t taking Fosamax, her doctor became even more excited. (Most doctors actually do prefer holistic approaches. They just don’t recommend them.)

The moral of this story is that you can be doing everything else right, but if you’re not doing weight bearing exercises – if you’re not pumping iron, everything else you are doing may be for naught. Weight bearing exercise is an absolutely essential part of a “bone healthy” lifestyle!

But, can exercise do it alone? Some people seem to think so. That brings up my second story. About 30 years ago one of my UNC colleagues, who was an expert on calcium metabolism, was doing a bone density study on female athletes at UNC. One of the tennis players was nicknamed “Tab.” Tab was a popular soft drink at that time, and Tab was all she drank – no milk, no water, only Tab. When my colleague measured the bone density of her playing arm, it was normal for a woman of her age. When he measured the bone density of her non-playing arm, it was that of a 65 year old woman. The reason is simple. When we exercise a particular bone, our body will add calcium to that bone to make it stronger. If we are not getting enough calcium from our diet, our body simply dissolves the bones elsewhere in our body to get the calcium that it needs.

The moral of this story is that exercise alone is not enough. In terms of bone health, we absolutely need exercise to take advantage of the calcium in our diet, and we absolutely need sufficient calcium in our diet to take advantage of the exercise.

This is the most glaring deficiency of the meta-analysis I described last week. None of those studies included exercise. No wonder the increase in bone density was minimal!

Putting It All Together – A “Bone Healthy” Lifestyle

If you seriously want to minimize your risk of osteoporosis, there are a few simple steps you can take (simple, but not easy).

Consume a “bone healthy” diet that emphasizes fresh fruits and vegetables, minimizes meats, and eliminates sodas and other acidic beverages. For more details on whether your favorite foods are acid-forming or alkaline-forming, you can find plenty of charts on the internet.

Minimize the use of medications that adversely affect bone density. You’ll need to work with your doctor on this one.

Get plenty of weight bearing exercise. This is an absolutely essential part of a bone healthy lifestyle. Your local Y can probably give you guidance if you can’t afford a personal trainer. Of course, if you have physical limitations or have a disease, you should consult with your health professional before beginning any exercise program.

Get your blood 25-hydroxy vitamin D level tested. If it is low, take enough supplemental vitamin D to get your 25-hydroxy vitamin D level into the sufficient range – optimal is even better. Sufficient blood levels of 25-hydroxy vitamin D are also absolutely essential for you to be able to utilize calcium efficiently.

Consider a calcium supplement. Even when you are doing everything else correctly, you still need adequate calcium in your diet to form strong bones. “I’m not necessarily recommending a “one-size fits all” 1,000 to 1,200 mg/day. Supplementation is always most effective when you actually need it. For example:

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

If you are taking medications that decrease bone density, that may increase your need for supplemental calcium. Unfortunately, we don’t yet have guidelines on how much is needed.

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

Unfortunately, we don’t really have good guidelines for how much calcium you need. Studies like the one described above are challenging the old RDAs, but we don’t yet have enough studies to know how much calcium we need to build strong bones when we are following a “bone healthy” lifestyle that includes proper diet, sufficient 25-hydroxy vitamin D blood levels and plenty of exercise.

What About Medications For Preventing Bone Loss?

The danger is that, as the conclusions of this meta-analysis get widely publicized and doctors stop prescribing calcium supplements, they probably aren’t going to recommend a holistic approach. They probably won’t recommend a “bone healthy” lifestyle. Instead, they will most likely recommend drugs to prevent bone loss. In fact, the authors of the study described last week specifically praised the use of bisphosphonate drugs (Fosamax and Zometa), and a related drug (Xgeva) that works by a similar mechanism because they increased bone density by 5-9% over 3 years.

However, these drugs have a dark side, and it’s not just the acid reflux, esophageal damage and esophageal cancer that you hear about in the TV ads. These drugs all act by blocking bone resorption, the ability of the body to break down bone. In the short term, this prevents the bone loss associated with aging and reduces the risk of bone fractures.

However, you might remember from last week’s article that bone resorption is also an essential part of bone remodeling, the process that keeps our bones young and strong. When these drugs are used for more than a few years you end up with bones that are dense, but are also old and brittle. Long term use of these drugs is associated with jaw bones that simply dissolve and bones that easily break during everyday activities. This is yet another example of drugs with side effects that look a lot like the disease you were taking the drug for in the first place.

The Bottom Line

A recent study has reported that the RDA recommendation of 1,000 – 1,200 mg/day of calcium for people over 50 provides only a minimal increase in bone density (0.7-1.8%) over the first year or two. This translates into a very small (5-10%) decrease in risk of bone fractures. It did not matter whether the calcium came from dietary sources or from supplementation. The authors concluded that adding extra calcium to the diet, whether from foods or supplements, was not a very efficient way to increase bone density and prevent fractures.

2. This study suffers from some serious flaws, which I discussed in last week’s “Health Tips From the Professor”

3. Unfortunately, many doctors are likely to take this study to heart. They are likely to stop recommending calcium and other natural approaches and start relying even more heavily on drugs to preserve bone mass. That’s bad news because, while the most frequently proscribed drugs do increase bone mass and prevent fractures short term, they also cause your bones to age more rapidly. After a few years you end up with bones that are dense, but are also incredibly brittle and fracture very easily. That’s right. If you use these drugs long enough, they will cause the very condition you were trying to prevent.

4. We should also consider the possibility that this study may just be correct. Let’s assume for a minute that the RDA recommendation of 1,000 – 1,200 mg/day of calcium for everyone over 50 may actually be flawed advice. If so, it may finally be time to put away the “magic bullet” thinking and start seriously considering holistic approaches to preserving bone mass.

5. A far better choice is to follow a “bone healthy” lifestyle.

Start with a “bone healthy” diet. Avoid acid-forming foods like sodas, meats, eggs, dairy, and grains. Instead choose alkaline-forming foods like most fruits & vegetables, peas, beans, lentils, seeds and nuts.

Check on the medicines you are using. If they are ones that adversely affect bone density, ask your health professional if there are bone-healthier options.

Check your blood level of 25-hydroxy vitamin D on a regular basis. If it is low, consult with your health professional on the amount of vitamin D you need to take to bring your 25-hydroxy vitamin D into the optimal range.

Get plenty of weight bearing exercise. This means pumping iron. It is an absolutely essential part of a bone healthy lifestyle. Of course, if you have physical limitations or have a disease, you should consult with your health professional before beginning any exercise program.

If you are not getting sufficient calcium from your diet, consider a complete calcium supplement. In addition to calcium and vitamin D, a bone-healthy calcium supplement should at the very least contain magnesium and vitamin K. I also recommend it contain zinc, copper, and manganese.

Just don’t rely on a calcium supplement alone to keep your bone density where it should be. If your 25-hydroxy vitamin D isn’t where it should be and/or you aren’t doing weight bearing exercise on a regular basis, your calcium supplement may be almost useless. All the aforementioned may aid in preventing osteoporosis. In my opinion, that may be the biggest take-home lesson from the recent meta-analysis.

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 Calcium Supplements Prevent Bone Fractures? – Part1

January 26, 2016 by Dr. Steve Chaney

Why The Recent Headlines May Be Misleading

Author: Dr. Stephen Chaney

Does calcium help prevent bone fractures? Osteoporosis is a debilitating and potentially deadly disease associated with aging. It affects 54 million Americans. It can cause debilitating back pain and bone fractures. 50% of women and 25% of men over 50 will break a bone due to osteoporosis. Hip fractures in the elderly due to osteoporosis are often a death sentence.

For that reason, the RDA for calcium has been set at 1,000 to 1,200 mg/day to reduce the risk of osteoporosis, and calcium supplements are often recommended to reach that target.However, recent headlines are proclaiming that calcium supplements do not actually prevent bone fractures and might increase your risk of a heart attack. Are the RDA recommendations wrong? Should you throw out your calcium supplements?

In this article I will review the article behind the study and help you put it into perspective. After all, you don’t really want to know whether calcium supplementation is beneficial for the average adult. You want to know whether it will be beneficial for you.

Let me start by putting the heart attack myth to rest. I have covered this in detail in a previous “Health Tips From The Professor” article, Calcium Supplements Increase Heart Attack Risk . If you don’t want to go to the trouble of reading my previous article, the short version is that:

Most of the studies suggesting an increased risk of heart attacks are flawed.

A very large study (74,000 women followed for 24 years) has shown fairly convincingly that calcium supplements do not increase heart attack risk. If anything, they decrease heart attack risk.

Unfortunately, like most other nutrition myths, this one is still being repeated – even after it has been refuted by subsequent studies.

Bone Metabolism and Osteoporosis

Before you can truly understand osteoporosis and how to prevent it, you need to know a bit about bone metabolism. We tend to think of our bones as solid and unchanging, much like the steel girders in an office building. Nothing could be further from the truth. Our bones are dynamic organs that are in a constant change throughout our lives.

Cells called osteoclasts and osteoblasts constantly break down old bone (a process called resorption) and replace it with new bone (a process called accretion). Without this constant renewal process our bones would quickly become old and brittle (I’ll discuss more about this next week when I talk about the side effects of drugs commonly used to increase bone density).

When we are young the bone building process exceeds bone resorption and our bones grow in size and in density. During most of our adult years, bone resorption and accretion are in balance so our bone density stays constant. However, as we age bone the bone building process (accretion) slows down and we start to lose bone density. Eventually our bones look like Swiss cheese and break very easily. This is called osteoporosis.

We should also think of our bones as calcium reservoirs. We need calcium in our bloodstream 24 hours a day for our muscles, brain, and nerves to function properly, but we only get calcium in our diet at discrete intervals. Consequently, when we eat our body tries to store as much calcium as possible in our bones. Between meals, we break down bone material so that we can release the calcium into our bloodstream that our muscle, brain & nerves need to function.

If we lead a “bone healthy” lifestyle, all of this works perfectly. We build strong bones during our growing years, maintain healthy bones during our adult years, and only lose bone density slowly as we age – maybe never experiencing osteoporosis. We always accumulate enough calcium in our bones during meals to provide for the rest of our body between meals.

What is a “bone healthy” lifestyle, you might ask. Because calcium is a major component of bone, the medical and nutrition communities have long focused on calcium as a “magic bullet” that can assure bone health. Once the importance of vitamin D was understood, it was added to the equation. For years we have been told that if we just get enough calcium and vitamin D in our diets, we would build strong bones when we were young, maintain bone density most of our adult years, and lose bone density as slowly as possible as we age.It is this paradigm that the current study challenges.

Do Calcium Supplements Prevent Bone Fractures?

$prevent bone fractures$ Let’s start by looking at the study behind the headlines (Tai et al, British Medical Journal, BMJ/2015; 351:h4183 doi: 10.1136/bmj.h4183). This was a meta-analysis that included 15 studies (1533 participants) looking at dietary sources of calcium and 51 studies (12,257 participants) looking at calcium supplementation in women.

The results of the meta-analysis were thought provoking, but do not exactly support the headlines you have been reading. For example:

The headlines say “Calcium Supplements Do Not Prevent Broken Bones”.

This study did not actually look at calcium supplementation and the risk of bone fractures. That was a previous study (Boland et al, BMJ 2015, 351:h4580) by the same authors.
This study showed that calcium supplementation increased bone density by 0.7-1.8%, which the authors concluded was sufficient to reduce fracture risk by about 5-10%. That’s a disappointingly small effect, but it is not zero – as the headlines suggested.

The headlines say “It’s better to get your calcium from food than from supplements”.

This study showed that it did not matter whether the calcium came from food or from supplements. The increase in bone density was identical.

Garbage-In, Garbage-Out

Meta-analyses such as this one can be very strong, but they can also suffer from the “garbage-in, garbage-out” phenomenon. In short, if most of the studies that went into the meta-analysis were poorly designed, the conclusions of the meta-analysis will be unreliable.

The problem is that many of the individual studies were conducted 10, 20, 30 or 40 years ago when our knowledge of bone metabolism was incomplete.

Thirty or 40 years ago it was “state of the art” to just use a calcium supplement. Then we learned that adequate vitamin D was essential for efficient calcium utilization.

Most of the studies included in this meta-analysis looked at calcium supplementation without vitamin D. Only 13 of the studies (25%) included vitamin D.

Ten or 20 years ago it was “state of the art” to just use a calcium supplement with vitamin D. Then we learned that the blood level of 25-hydroxyvitamin D (the active form of vitamin D in the bloodstream) did not necessarily reflect vitamin D intake from the diet. In today’s world a study in which the 25-hydroxy vitamin D level is not measured should be considered sub-standard.

Only 18 (35%) of the studies measured baseline 25-hydroxy vitamin D levels.

If dietary calcium intake at baseline is already adequate, it is illogical to expect additional calcium to significantly increase bone density.

The baseline calcium intake was <800 mg/day (clearly inadequate) in only 26 (51%) of the studies. Baseline calcium intake was either not determined in the other studies or was already in the adequate range prior to supplementation.

In the future, we will probably want to include exercise as a component in the study (more about that next week). None of the studies included exercise as a component

In short, by today’s standards many, if not most, of the studies included in the meta-analysis had an inadequate design.

If I had designed the meta-analysis, I would have been a lot more restrictive in the studies I included.

I would have started by including only studies in which the baseline intake of calcium was <800 mg/day. If you want to critically evaluate whether calcium supplementation has a beneficial effect, you need to start with people who have an inadequate dietary intake of calcium. If their diets are already calcium sufficient, supplementation is unlikely to have any benefit.

At the very least I would only include studies that used calcium supplements containing 400-800 IU of vitamin D as well. In fact, based on the latest data, I would make sure that the calcium supplement I used also contained adequate levels of magnesium, vitamin K, zinc, copper and manganese. All of those have been shown to be important for bone formation and we cannot assume they are present at sufficient levels in their diet (more about that next week).

I would only include studies that measured blood levels of 25-hydroxy vitamin D at baseline and following supplementation with vitamin D so that we knew that the 25-hydroxy vitamin D level was sufficient to support optimal calcium utilization.

Finally, I would only include studies that specifically measured the effect of exercise on calcium utilization or included exercise as an integral part of their study.

The number of studies included in the meta-analysis would be much less, but they would all be high quality studies.

Finally, the authors also noted that a number of studies in the supplement group showed significantly greater (2.5 – 5.0%) increase in bone density. They dismissed them as outliers. I would have preferred a closer look at those studies to see if there was anything about the population group or study design that might explain the greater bone density increase in those studies.

Apples and Oranges

Because the authors included a wide variety of clinical studies, they were able to state that “Increases in bone mineral density were similar in trials of calcium monotherapy [calcium by itself] versus co-administered calcium and vitamin D…and in trials where baseline dietary calcium intake was <800 [clearly insufficient] versus >800 [probably sufficient] mg/day.” This could be considered a strength of their meta-analysis, but they are only valid comparisons if other important features of the studies being compared were uniform – i.e. they were comparing apples to apples.

But what if they were comparing apples and oranges?

For example, we know that vitamin D is required for efficient calcium utilization. When the authors compared studies having a baseline calcium intake of <800 mg/day with studies having a baseline calcium intake of >800 mg/day, they did not even check to see whether use of vitamin D was evenly distributed between the two groups. If most of the studies with a baseline calcium intake of <800 mg/day did not include vitamin D with their calcium supplements, the authors would be comparing apples and oranges. The comparison would be invalid.

Similarly, we also know that if calcium intake at baseline is adequate, adding more calcium is unlikely to increase bone density significantly. When the authors compared studies with and without vitamin D, they did not even check to see whether baseline calcium intake was evenly distributed between the two groups. If the participants in most of the studies utilizing supplements providing both calcium and vitamin D were already consuming sufficient calcium at baseline, they would be comparing apples to oranges. Again, the comparison would be invalid.

The authors of the meta-analysis simply did not provide the detail needed to determine whether their comparisons were apples to apples or apples to oranges. Thus, what seemed to be a strength of their study is actually a major weakness.

The Bottom Line

A recent study has reported that the RDA recommendation of 1,000 – 1,200 mg/day of calcium for people over 50 provides only a minimal increase in bone density (0.7-1.8%) over the first year or two. This translates into a very small (5-10%) decrease in risk of bone fractures. It did not matter whether the calcium came from dietary sources or from supplementation. The authors concluded that adding extra calcium to the diet, whether from food or supplements, was not a very efficient way to increase bone density and prevent fractures.

This study suffers from some serious flaws. It is a meta-analysis of previous clinical trials looking at the effects of calcium on bone density. Meta-analyses can be very strong studies because they average the effects of many individual studies. However, meta-analyses can also suffer from the “garbage-in, garbage-out” phenomenon. Simply put, the quality of the meta-analysis is only as good as the studies that go into it. In this case the meta-analysis included many clinical studies that were done 10, 20, 30 and even 40 years ago. Based on what we now know about bone metabolism, the design of many of those early studies was clearly inadequate (details are given in the article).

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

The Dangers of Polypharmacy

Why Are Seniors Taking So Many Medications?

Are Seniors Taking Too Many Medications?

The Most Dangerous Drug­-Drug Interactions

The Bottom Line

Exercise and Fat Loss

Exercise and Weight Loss

How Much Exercise is Enough?

The Bottom Line

You Can Enjoy Pain Free Living From Home

The Cause of Bridget’s Chronic Hip Pain

My Answer For Bridget’s Chronic Hip Pain

Are Antioxidants the Secret to Healthy Aging?

Antioxidants and Aging: Will Antioxidant Nutrients Help You?

The Bottom Line

Weight Loss Myth #1: I Can Lose It Later

Weight Loss Myth #2: Once It’s Off, It’ll Stay Off

Weight Loss Myth #3: Fat Is Fat, No Matter Where It Is

Weight Loss Myth #4: You Have To Go Out Of Your Way To Overeat

Weight Loss Myth #5: All Extra Calories Are Equal

Weight Loss Myth #6: I Can Just Boost My Metabolism

Weight Loss Myth #7: There’s A Magic Bullet Diet

Weight Loss Myth #8: I Can Work Off The Extra Calories

The Bottom Line

What Role Do B Vitamins Play in a Heart Healthy Lifestyle?

Do B Vitamins Reduce Heart Disease Risk?

The Bottom Line

Plantar Fasciitis Causes: Are Muscles The Culprit?

Self-Treatment For Plantar Fasciitis Pain

Does Vitamin E Reduce Heart Attack Risk?

Does Vitamin E Reduce Heart Disease Risk In Women?

Other Studies On Vitamin E and Heart Disease Risk In Women

Does Vitamin E Reduce Heart Disease Risk In Men?

The Bottom Line

Creating A “Bone Healthy” Lifestyle

What Is A “Bone Healthy” Lifestyle?

Exercise Is A Critical Part of Preventing Osteoporosis

Putting It All Together – A “Bone Healthy” Lifestyle

What About Medications For Preventing Bone Loss?

The Bottom Line

Bone Metabolism and Osteoporosis

Do Calcium Supplements Prevent Bone Fractures?

The Bottom Line

The Most Dangerous Drug-Drug Interactions