Heart Disease

The Good Cholesterol Myth

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Is Everything You Knew About HDL Wrong?

Author: Dr. Stephen Chaney 

HDL CHolesterolOver the past couple of weeks” I have talked about one of the greatest strengths of the scientific method – namely that investigators constantly challenge, and occasionally disprove, existing paradigms. That allows us to discard old models of how things work and replace them with better ones.

Two weeks ago, I shared a study that disproved the myth that low to moderate alcohol consumption is healthier than total abstinence.

Last week I shared a study that disproved the myth about chocolate helping you lose weight weight.

This week I tackle the “good” cholesterol myth. I will share several studies that challenge the belief that HDL cholesterol is good for your heart.

The belief that HDL is good for your heart has all the hallmarks of a classic paradigm.

  • It is supported by multiple clinical studies.
  • Elaborate metabolic explanations have been proposed to support the paradigm.
  • It is the official position of most medical societies, scientific organizations, and health information sites on the web.
  • It is the recommendation of most health professionals.
  • It has been repeated so often by so many trusted sources that everyone assumes it must be true.

Once we accept the HDL/heart health paradigm as true, we can construct other hypotheses on that foundation. For example:

  • Raising your HDL levels naturally takes effort. Pharmaceutical companies have been pursuing the “magic pill” that raises HDL levels without any effort on your part.
  • Low carb diets like the Keto and Paleo diets are high in saturated fat. The low carb enthusiasts claim this is a good thing because saturated fat raises HDL levels, and HDL is good for your heart.

But what if the paradigm that HDL is good for your heart isn’t true? What if it is a myth? These hypotheses would be like the parable of a house built on a foundation of sand. They will be washed away as soon as the paradigm is critically tested.

So, let’s look at experiments that have challenged the HDL/heart health paradigm.

Do Drugs That Increase HDL Levels Work?

The first hint that the HDL/heart health paradigm might be faulty happened when a pharmaceutical company developed a drug that selectively increased HDL levels.

The drug company thought they had found the goose that laid golden eggs. Just imagine. People wouldn’t have to lose weight, exercise, or change their diet. They could simply take a pill and dramatically decrease their heart disease risk. A drug like that would be worth billions of dollars.

The problem was that when they tested their drug (torcetrapib) in clinical trials, it had absolutely no effect on heart disease outcomes (AR Tall et al, Atherosclerosis, Thrombosis, and Vascular Biology 27:257-260, 2007).

The pharmaceutical company couldn’t believe it. Raising HDL levels just had to reduce heart disease risk. They concluded they didn’t have the right drug, and they continued to work on developing new drugs.

That was 18 years ago, and no HDL-increasing drug has made it to market. Have they just not found the right drug, or does this mean the HDL/heart health paradigm is incorrect?

Does Saturated Fat Decrease Heart Disease Risk?

Now let’s turn to two claims of low carb enthusiasts.

#1: Saturated fats decrease your risk of heart disease in the context of a low carb diet. I have debunked that claim in several previous issues of “Health Tips From The Professor”. But let me refer you to two articles here – one on saturated fat and heart disease risk and one on low-carb diets.

#2: Saturated fats decrease heart disease risk because they raise HDL levels. This is the one I will address today.

The idea that saturated fats decrease heart disease risk because they raise HDL levels is based on a simplistic concept of HDL particles. The reality is more complex. Several clinical studies have shown:

  • The type of fat determines the property of the HDL particles.
    • When polyunsaturated fats predominate, the HDL particles have an anti-inflammatory effect. When saturated fats predominate, the HDL particles have a pro-inflammatory effect.
  • Anti-inflammatory HDL particles relax the endothelial cells lining our blood vessels. That makes the lining of our blood vessels more pliable, which improves blood flow and reduces blood pressure.
    • Anti-inflammatory HDL particles also help reduce inflammation of the endothelial lining. This is important because an inflamed endothelial lining is more likely to accumulate fatty plaques and to trigger blood clot formation that can lead to heart attacks and strokes.

So, the question becomes, “What good is it to raise HDL levels if you are producing an unhealthy, pro-inflammatory HDL particle that may increase the risk of high blood pressure, heart attacks, and strokes?”

In short, these studies suggest it isn’t enough to just focus on HDL levels. You need to ask what kind of HDL particles you are creating.

Is HDL Good For Your Heart?

Once the studies were published showing that…

  • Drug-induced increase of HDL levels without any change in health habits is not sufficient to decrease heart attack risk, and…
  • Not all HDL particles are healthy. There are anti-inflammatory and pro-inflammatory HDL particles, which are likely to have opposite effects on heart attack risk…

…some people started to question the HDL/heart health paradigm. And one group came up with the perfect study to test the paradigm.

But before I describe the study, I need to review the term “confounding variables”. Here is a brief synopsis:

  • The studies supporting the HDL/heart health paradigm are association studies. Association studies measure the association between a single variable (in this case, increase in HDL levels) and an outcome (in this case, heart disease events, heart disease deaths, and total deaths).
  • Associations need to be corrected for other variables known to affect the same outcome (things like age, gender, smoking, and diabetes would be examples in this case).
  • Confounding variables are variables that also affect the outcome but are unknown or ignored. Thus, they are not used to correct the associations, which can bias the results.

The Good Cholesterol Myth

strong heartThe authors of this study (M Briel et al, BMJ 2009:338.b92) observed that most interventions that increase HDL levels also lower LDL levels. Lowering LDL is known to decrease the risk of heart disease deaths. But this effect had been ignored in most studies looking at the association between HDL and heart disease deaths.

They hypothesized that the change in LDL levels was a confounding variable that had been ignored in previous studies and may have biased the results.

To test this hypothesis the authors searched the literature and identified 108 studies with 299,310 participants that:

  • Compared the effect of drugs, omega-3 fatty acids, or diet with either a placebo or usual care.
  • Measured both HDL and LDL levels.
  • Measured reduction in cardiovascular risk.
  • Had a randomized control design.
  • Lasted at least 6 months.

They found that every 10 mg/dl decrease in LDL levels in these studies was responsible for a:Heart Disease Study

  • 1% reduction in heart disease events (both heart disease deaths and non-fatal heart attacks).
  • 2% reduction in heart disease deaths.
  • 4% reduction in total deaths.

After correcting for the effect of decreased LDL levels on these heart disease outcomes, the increase in HDL levels had no statistically significant effect on any of the outcomes.

The authors concluded, “Available data suggest that simply increasing the amount of circulating HDL cholesterol does not reduce the risk of coronary heart disease events, coronary heart disease deaths, or total deaths. The results support reduction in LDL cholesterol as the primary goal for lipid modifying interventions.”

In other words, this study:

  • Supports the author’s hypothesis that LDL levels were a confounding variable that biased the studies supporting the HDL/heart health paradigm.
  • Concludes that increasing HDL levels has no effect on heart disease outcomes, thus invalidating the HDL/heart health paradigm.

In short, this study destroyed the “good” cholesterol myth.

Is Everything You Knew About HDL Wrong?

Peek Behind The CurtainDoes that mean that everything you knew about HDL is wrong? Not exactly. It just means that you may need to change your perspective.

Don’t focus on HDL levels. Peek behind the curtain and focus on what’s behind the HDL levels. For example:

  • Losing weight when overweight increases HDL levels. But the decrease in heart disease outcomes is more likely due to weight loss than to the increase in HDL levels.
  • Exercise increases HDL levels. But the decrease in heart disease outcomes is more likely due to exercise than to the increase in HDL levels.
  • Reversing pre-diabetes or type 2 diabetes increases HDL levels. But the decrease in heart disease outcomes is more likely due to the reversal of diabetes than to the increase in HDL levels.
  • High-dose omega-3 fatty acids increase HDL levels. But the decrease in heart disease outcomes is more likely due to the omega-3 fatty acids than to the increase in HDL levels.
  • The Mediterranean diet increases HDL levels. But the decrease in heart disease outcomes is more likely due to the diet than to the increase in HDL levels.

And if you want to go the drug route:

  • Statins and some other heart drugs increase HDL levels, but the reduction in heart disease outcomes is probably due to their effect on LDL levels rather than their effect on HDL levels.

On the other hand:

  • Saturated fats increase HDL levels. But saturated fats increase heart disease risk and create pro-inflammatory HDL particles. So, in this case the increase in HDL levels is not a good omen for your heart.
  • Drugs have been discovered that selectively increase HDL levels. However, there is nothing of value behind this increase in HDL levels, so the drugs have no effect on heart disease outcomes.

The Bottom Line 

In this article I discuss several studies that have challenged the good cholesterol myth – the belief that HDL is good for your heart.

For example, one group of investigators analyzed the studies underlying the HDL/heart health paradigm. They hypothesized that these studies were inaccurate because they failed to account for the effects of LDL levels on heart disease outcomes.

After correcting for the effect of decreased LDL levels on heart disease outcomes in the previous studies, the authors showed that increases in HDL levels had no significant effect on any heart disease outcome.

The authors concluded, “Available data suggest that simply increasing the amount of circulating HDL cholesterol does not reduce the risk of coronary heart disease events, coronary heart disease deaths, or total deaths. The results support reduction in LDL cholesterol as the primary goal for lipid modifying interventions.”

In other words, this study:

  • Supports the author’s hypothesis that LDL levels were a confounding variable that biased the studies supporting the HDL/heart health paradigm.
  • Concludes that increasing HDL levels has no effect on heart disease outcomes, thus invalidating the HDL/heart health paradigm.

Does that mean that everything you knew about HDL is wrong? Not exactly. It just means that you need to change your perspective. Don’t focus on HDL levels. Focus on what’s behind the HDL levels. For more information on that, read the article above.

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

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

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

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

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

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

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About The Author 

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

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

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

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

For the past 53 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

 

The Seed Oil Myths

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The Truth About Seed Oils 

Author: Dr. Stephen Chaney 

The Seed Oil Myths

Myth Versus FactsYou’ve seen the claims. “You should avoid all seed oils. They are toxic.”

Any time you see claims like, “Avoid all…[add the food villain of the day]” or “[a certain food] is toxic” your “truth-meter” should go on high alert. Claims like that are more likely to be hype than truth.

More specifically, the claims about seed oils are:

  • They are heavily processed.
  • They contain toxic ingredients.
  • They are genetically modified.
  • They cause inflammation and oxidative damage.
  • They increase your risk of inflammatory diseases, heart disease, and cancer.
  • A healthier option is to replace seeds oils with animal foods high in saturated fats.

Like any good food myth, there is a kernel of truth to each of these claims. In this article I will describe the kernel of truth associated with each of these claims, put them into perspective, and give practical guidelines for incorporating seed oils into your diet.

The topics I will cover are:

  • The truth about fats.
  • The truth about omega-6 fats.
  • The truth about saturated fats.
  • The truth about canola oil.
  • The truth about seed oils.

The Truth About Fats

The health authorities and media must think the American public is stupid. They oversimplify everything. They tell us:

  • Animal fats are saturated fat.
  • Olive oil is monounsaturated fat.
  • Vegetable oils are omega-6 polyunsaturated fat.
  • Fish oil is omega-3 polyunsaturated fat.

The truth is that every naturally occurring fat and oil is a mixture of all four kinds of fat. And each food contains a unique mixture of fats. The kernel of truth is:

  • Animal fats have a higher percentage of saturated fat than other fats and oils.
  • Olive oil has a higher percentage of monounsaturated fat than other oils.
  • Vegetable oils have a higher percentage of omega-6 polyunsaturated fat than other oils.
  • Fish oil has a higher percentage of omega-3 polyunsaturated fat than other oils.

 

But the full truth is that each food contains a unique mixture of fats. For example,

  • Meat and butter from grass-fed animals contain a greater percentage of omega-3 fats than meat and butter from animals which were fattened on corn.
  • Flaxseed oil has a higher percentage of omega-3 fats than other seed oils.
  • High-oleic sunflower oil has the highest percentage of monounsaturated fat than other seed oils.
    • Other vegetable oils with high monounsaturated fat content include olive oil, avocado oil, and canola oil. [Note: Although olive oil is the source of monounsaturated fat that we hear about most, avocado oil is equally high in monounsaturated fat and has a higher smoke point, which makes it a better choice for high-heat cooking.]
  • Walnuts have a higher percentage of omega-3 fats than other nuts.
  • Macadamia nuts and almonds have the highest percentage of monounsaturated fats than other nuts, with cashews and peanuts not far behind. Nut butters, of course, reflect the fat composition of the nuts.

The point I am making is that while myths are simple, the truth is much more complex.

Take Home Lesson: Every vegetable oil and every seed oil has a unique composition of fats. Each has its unique benefits and unique drawbacks.

That is something you will want to think about the next time you read an article about the dangers or the benefits of all seed oils. Every seed oil is unique. No generalization applies to all of them.

Biochemistry 101 – Essential Fats

ProfessorLet’s start with the most important point.

  • Omega-6 fats and omega-3 fats are essential. Simply put, that means:
  • We can’t make them.
  • They are essential for life.
  • We must get them from our diet.

If they are essential, the next question is, “Why do we need them?” Let me start with a little “Biochemistry 101” and talk about their role in cell membranes and cellular regulation.

Cell Membranes:

  • You might think of cell membranes as a solid protective armor around the cells, but nothing could be farther from the truth. A better analogy would be the ocean that covers vast areas of our planet. Our membranes are quite fluid.
  • And that membrane fluidity is important. Our cell membranes contain receptors like the cholesterol receptor and insulin receptor that must cluster together for cholesterol and insulin to be transported into the cell. Those receptors cluster best when cell membranes are very fluid.
  • Our membranes are most fluid when they contain high levels of polyunsaturated fats (For membrane fluidity it doesn’t matter if they are omega-6 or omega-3). Conversely, our membranes are less fluid when they contain high levels of saturated fats.
  • And here is the most important point. Because our bodies cannot make omega-6 and omega-3 polyunsaturated fats, this is the one time it is literally true that, “We are what we eat”. If our diets are high in saturated fats, our membranes are high in saturated fats. If our diets are high in polyunsaturated fats, our membranes are high in polyunsaturated fats.
    • And the ratio of omega-6 and omega-3 polyunsaturated fats in our membranes reflects the ratio of omega-6 and omega-3 polyunsaturated fats in our diet.

Take Home Lesson: Diets high in omega-6 and/or omega-3 fats help lower cholesterol levels and improve blood sugar regulation.

Cellular Regulation:

  • Our cells also use the polyunsaturated fats in our cell membrane to make hormone-like substances called prostaglandins and leukotrienes that exert profound effects on nearby tissues. [Note: For the sake of simplicity, I will just talk about prostaglandins for the rest of this article, but what I say applies equally to leukotrienes.]
  • The enzymes that make prostaglandins do not distinguish between omega-6 and omega-3 polyunsaturated fats. They just use whatever polyunsaturated fat they come across.
  • That’s important because the effects of omega-6 and omega-3 prostaglandins are often different and are sometimes opposite.
  • Here’s where the “We are what we eat” principle comes into play. The ratio of omega-6 and omega-3s in our diet determines the omega-6 and omega-3 content of our membranes. And that determines the type of prostaglandins our cells produce.

Take Home Lessons:

  • Some of the benefits of omega-6s are unique because they are dependent on omega-6 prostaglandins. These benefits cannot be duplicated by diets high in omega-3s.
  • Because some effects of omega-6 and omega-3 prostaglandins are opposite, we need to look closely at the omega-6 to omega-3 ratio in the diet to optimize the health benefits of these two essential polyunsaturated fats.

Now, with Biochemistry 101 behind us, we are ready to look at the truth about omega-6 fats.

The Truth About Omega-6 Fats

Assortment Of Salad Dressing Bottles

Let’s start by looking at the pros and cons of omega-6 fats. 

Pros Of Omega-6 Fats:

Cellular Health: Omega-6 and fats are important for maintaining proper membrane fluidity. And omega-6 prostaglandins also regulate cell metabolism and cellular repair mechanisms.

Heart Health: Omega-6s are associated with lower risk of heart disease. This is caused by:

  • Lower cholesterol levels due to proper membrane fluidity which allows clustering of cholesterol receptors.
  • More flexible endothelial cells lining our arteries, which helps lower blood pressure and prevent blockage of the arteries by blood clots. This is most likely due to more fluid cell membranes and the production of beneficial prostaglandins.
  • Some of these benefits are duplicated by omega-3 fats, but the American Heart Association stated in a recent Health Advisory (WS Harris et al, Circulation, 119, 902-907, 2009) that omega-6 fats are essential for some heart health benefits. They cannot be replaced by omega-3s.

Brain Health: Omega-3s get most of the press here, but experts feel that omega-6s play an important and independent role as well.

Fetal Growth and Development: Omega-6 fats are essential for normal neural development and growth. The mechanism(s) for this benefit are ill-defined.

Other Benefits:

  • Omega-6 fats support healthy skin, hair, and bones. The mechanisms for these effects are unknown, but most experts feel they are independent of omega-3 fats.
  • Omega-6 fats are also important for reproductive health. Most experts think this is due to the production of omega-6 prostaglandins.

Take Home Lesson: Omega-6 fats are essential for a healthy heart, a healthy brain, and normal fetal growth and development.

Cons Of Omega-6 Fats:

Oxidation: Omega-6 (and omega-3) fats are very susceptible to oxidation, especially at high temperatures. This can lead to free radical formation, which can promote the formation of cancer cells.

You may have seen the statement that omega-6 fats cause cancer. This is an oversimplification. A more accurate statement would be, “Improperly used, any polyunsaturated fat may increase cancer risk. But this is largely avoidable. Here are the precautions I recommend:

  • Choose your source carefully.
  • For seeds and nuts look for freshness. If they look or taste funny, throw them out.
  • For oils choose reputable brands and choose ones that use low-heat processing. Also, look for ones with minimal processing. They may be cloudy rather than clear, but they will also contain naturally occurring antioxidants and polyphenols.
  • Don’t overheat them.
    • Most vegetable oils are only suitable for use as salad dressings and other room temperature cooking.
    • The exceptions are vegetable oils with high smoke points – for example, olive oil for stir fries and avocado oil for higher temperature cooking.
  • Store them safely. Don’t give them a chance to become oxidized.
    • We store sunflower seeds and almonds in our refrigerator and walnuts in our freezer.
    • We buy unsaturated vegetable oils in small quantities (so they are used up quickly) and store them in the refrigerator.

Take Home Lesson: Improperly used, omega-6 fats, like any unsaturated fat, can become oxidized and form free radicals (the kernel of truth). Choose your source carefully. Don’t overheat them. Store them safely.

FlamesInflammation: This is the one you hear the most about. You have been told that omega-6 vegetable oils (seed oils) cause inflammation. As a blanket statement, it is mostly untrue. But it does have a kernel of truth.

Let’s start with the kernel of truth:

  • Omega-6 fats are inflammatory only when compared to omega-3 fats. You have also been told that omega-6 fats are inflammatory when compared to saturated fats. This is false, as I will discuss below.

Let me elaborate on the first statement with a little more Biochemistry 101 (If you haven’t guessed, that’s my favorite topic. Once a professor, always a professor).

  • Omega-6 fats are converted into one inflammatory prostaglandin. Omega-3 fats are converted into several anti-inflammatory prostaglandins (This is an example of some omega-6 and omega-3 prostaglandins having opposite effects).
  • Because of their opposite effects on inflammation, some experts say that the optimal ratio of omega-6 to omega-3 fats is in the range of 1:1 to 4:1. But the typical American diet is around 15:1.

If the omega-6 to omega-3 ratio is important (and not every expert agrees that it is), the statement that we should avoid omega-6-containing vegetable oils (seed oils) because they are inflammatory is mostly untrue.

  • Every omega-6 oil has a different omega-6 to omega-3 ratio. For example,
    • Corn oil has a 50:1 ratio and sesame oil has a 42:1 ratio. If you are just going by omega-6 to omega-3 ratios, you might want to avoid these.
    • Soybean oil has a 7:1 ratio and extra virgin olive oil has a 5:1 ratio. They are almost in the optimal range.
    • Canola oil has a 2:1 ratio. It’s in the optimal range.
    • And flaxseed oil is the clear winner with a 1:4 ratio.

But the truth is also much more complex than you have been led to believe.

  • The kernel of truth is that omega-6 fats can be converted to an inflammatory prostaglandin.
  • But omega-6 fats can also be converted to anti-inflammatory prostaglandins. And some omega-6 fats such as GLA are anti-inflammatory.
  • Human clinical studies find that omega-6 fats either have no effect on inflammation or decrease it slightly (A Poli et al, International Journal of Molecular Sciences, 24, 4567, 2023).

Take Home Lesson: Omega-6 fats are converted into one inflammatory prostaglandin (the kernel of truth). But they are also converted to anti-inflammatory prostaglandins. The net effect in the human body is a slight anti-inflammatory effect.

The Truth About Saturated Fats

You have been told that saturated fats are anti-inflammatory and decrease the risk of heart disease. For many Americans those claims are enticing because it means they don’t have to change their diet. But are the claims true?

You have been told that these claims are based on science. There are clinical studies behind them. Is that true?

The problem is that there are a lot of bad studies on saturated fats in the literature, and the Dr. Strangeloves of the world cherry pick the ones that support their beliefs.

If you want to compare the effect of different kinds of fat on either inflammation or heart health, you must make sure that all other components of the diet are the same. Too many of these studies have compared a whole food diet high in saturated fat with the typical American diet high in omega-6 fats. The results are predictable. Anything is better than the typical American diet.

In a previous issue of “Health Tips From The Professor” I discussed the criteria for a good study of fats. High quality studies must:

  • Show the subjects stick with the new diet for the duration of the study. Subjects find it difficult to adhere to a diet to which they are not accustomed long term and often revert to their more familiar diet. This requires either very close monitoring of what the subjects are eating or measurement of fat membrane composition to verify diet adherence, or both.
  • Carefully control or measure what the saturated fats are replaced with. In good studies only the fat composition of the diet changes. All other components of the diet remain the same.
  • Last two years or more. The fats we eat determine the fat composition of our cell membranes, and that is what ultimately determines both inflammation in our bodies and our risk of dying from heart disease. While it is true to say, “We are what we eat”, changing the fat composition of our cell membranes does not occur overnight. It takes 2 years or more to achieve a 60-70% change in the fat composition of cell membranes.
  • Measures multiple markers of inflammation or actual cardiovascular end points such as heart attack, stroke, and deaths due to heart disease.

When studies are done that meet these criteria the results are as follows:

Inflammation (A Poli et al, International Journal of Molecular Sciences, 24: 4567, 2023):

  • Replacing saturated fats with omega-6 fats reduces inflammation by 8%.
  • Replacing saturated fats with omega-3 fats reduces inflammation by 48%

Heart Disease (FM Sacks et al, Circulation, 136, Number 3, 2017):

  • Replacing saturated fats with omega-6 from decreased the risk of heart disease by 24%.
  • Replacing saturated fats with a mixture of both omega-6 and omega-3 fats decreased the risk of heart disease by 29%. This is equivalent to statin therapy, without the side effects.
  • When the replacement of saturated fats with omega-6 and omega-3 fats occurred in the context of a heart healthy diet such as the Mediterranean diet, heart disease risk was reduced by 47%.

The Food and Nutrition Board of the Institute of Medicine recommends that Americans not exceed 10% of calories from saturated fat.

  • Two thirds of Americans exceed this limit.

The Food and Nutrition Board recommends that omega-6 fats be around 5-6% of calories. Because omega-6 fats play an important role in heart health, the American Heart Association recommends they be at 5-10% of calories.

  • Americans get around 6.5% of their calories from omega-6 fats.

Take Home Lesson: Replacing saturated fat with omega-6 fats reduces both inflammation and heart disease risk. Adding omega-3 fats reduces both even more. So, bringing omega-6 and omega-3 into a better balance is a good idea. But omega-6 fats are essential and are at the recommended intake for most Americans, so don’t do this by cutting back on healthy omega-6 fats. Instead, add some more omega-3s.

The Truth About Canola Oil

There are a lot of things to like about canola oil:

  • It is an excellent source of healthy omega-6 fats.
  • It has a good omega-6 to omega-3 ratio (2:1), which makes it anti-inflammatory.
  • It is also a good source of monounsaturated fats and has a moderate smoke point, which makes it suitable for low heat cooking.

So, why is it so unpopular? Unfortunately, it suffers from a lot of undeserved myths. Each has a kernel of truth. But like a secret passed around the room, the myths have grown with each repetition, and the truth has become unrecognizable.

So, let’s try to separate the myths from the truth.

Myth: It is genetically engineered.

Truth: It was created by old-fashioned plant breeding.

 

Myth: Canola oil contains toxic ingredients.

Truth:

  • Rapeseed oil comes from the oilseed rape plant (a relative of mustard).
  • Rapeseed oil contains erucic acid and glucosinolates, both of which can be toxic in large amounts (the kernel of truth).
  • Baldur Stefansson from the University of Manitoba bred a “double low” variety the oilseed rape plant which produces an oil that contains <2% of both erucic acid and glucosinolates and is safe for human consumption. This new oil was named canola oil (from Canada and ola for oil). This was achieved by conventional plant breeding. Not genetic engineering.
  • Both cultivars of the oilseed rape plant are still grown. Rapeseed oil is used for industrial purposes, and canola oil is used for human consumption.
  • Canola oil is tightly regulated in Canada, the US, and the EU to <2% erucic acid.
  • 98% of the canola oil sold in the US is grown in Canada and the northern US.

Myth: Canola oil is unhealthy.

Truth: Because it is one of the least expensive omega-6 oils, canola oil is often found as an ingredient in unhealthy, highly processed, food (the kernel of truth). The solution is simple. Avoid unhealthy foods. Adding a different kind of fat to unhealthy foods is not going to make them healthier.

The Truth About Seed Oils

By now I have covered most of the myths about seed oils in my sections on omega-6 fats, saturated fats, and canola oil, but here is a quick review.

Myth: All seed oils are…[add your favorite derogatory term here].

Truth: Every seed oil has a unique composition of fats. Each has its unique benefits and unique drawbacks.

 

Myth: Seed oils are genetically modified.

Truth: The plants producing canola oil and high oleic sunflower oil have been modified (the kernel of truth), but they were modified by conventional plant breeding rather than genetic engineering.

 

Myth: Seed oils contain toxic ingredients. This myth is most often directed at canola oil.

Truth: Rapeseed oil contains components that can be toxic at high levels (the kernel of truth). However, the rapeseed plant has been bred to produce canola oil with safe levels of those components.

 

Myth: Seed oils are inflammatory, which increases your risk of inflammatory diseases and heart disease.

Truth: Seed oils contain omega-6 fats which can be converted into one inflammatory prostaglandin (the kernel of truth). But they are also converted to anti-inflammatory prostaglandins. The net effect in well done human clinical trials is a slight anti-inflammatory effect.

 

Myth: Seed oils cause oxidative damage, which increases your risk of cancer.

Truth: Seed oils (like any polyunsaturated fat) are susceptible to oxidation, especially at high temperatures. This can lead to free radical formation and oxidative damage (the kernel of truth). But this is only true when you use them improperly. The solution is to chose your source wisely, store them safely, and to not overheat them when cooking.

 

Myth: Saturated fats are healthier than seed oils. Replacing saturated fat with the omega-6 fats found in seed oils increases inflammation and heart disease risk.

Truth: Many studies in this area of research are poorly designed. Well-designed studies show that replacing saturated fat with the omega-6 fats found in seed oils reduces both inflammation and heart disease risk.

 

Myth: Omega-3 fats are healthier than the omega-6 fats found in seed oils, so we should replace seed oils with omega-3 fats.

Fact: Omega-3 fats are more effective than omega-6 fats at reducing inflammation and heart disease risk (the kernel of truth). However, omega-6 fats are essential for a healthy heart, a healthy brain, and normal fetal growth and development. We can’t make them, so we must get them from our diet. Americans are currently consuming the recommended amount of omega-6 fats. So, we should not decrease the amount of omega-6 fats in our diet. Instead, we would benefit from adding more omega-3s to our diet.

 

Myth: Seed oils are highly processed. High heat processing alters the oils. Processing also removes beneficial antioxidants and polyphenols from the oils.

Truth: This is mostly true. The solution is to choose your brands carefully.

  • For oils choose reputable brands and choose ones that use low-heat processing. Also, look for ones with minimal processing. They may be cloudy rather than clear, but they will also contain naturally occurring antioxidants and polyphenols.
  • It’s not easy to choose your source carefully. But this difficulty is not unique to seed oils. For example:
    • The term EVO is supposed to mean extra virgin olive oil was used, but cheaper oils are sometimes blended into the olive oil to save money.
    • If a company wishes to use the term “grass fed” on their product, they must file a certification with the USDA, but the USDA does not inspect to determine whether the certification is accurate.
    • Seed oils are also found as an ingredient in unhealthy, highly processed foods. The solution here is simple. Avoid unhealthy foods. Adding a different kind of fat to unhealthy foods is not going to make them healthier.

For more details about each of these Truth statements, read the article above.

The Bottom Line

There are many myths about seed oils. Each myth has a kernel of truth but is mostly false. In this week’s “Health Tips From the Professor” I discuss the myths and truths about seed oils. Because this is a complex subject, I have broken it down into individual topics that address one or more seed oil myths before talking about seed oil myths directly.

The topics I covered are:

  • The truth about fats.
  • The truth about omega-6 fats.
  • The truth about saturated fats.
  • The truth about canola oil.
  • The truth about seed oils.

For more details read the article above.

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

_____________________________________________________________________________

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

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

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

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

 _______________________________________________________________________

About The Author 

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

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

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

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

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

 

 

 

The News About Omega-3s Just Got Better

by

What Does This Study Mean For You? 

Author: Dr. Stephen Chaney 

good newsA recent meta-analysis (AA Bernasconi et al, Mayo Clinic Proceedings, 96: 1365-1375, 2021) of randomized clinical studies with over 150,000 patients showed that omega-3s reduced the risk of heart attacks by 13% and fatal heart attacks by 35%. Another major clinical study (T Chao et al, Nutrition, Metabolism and Cardiovascular Disease, 34: 537-547, 2024) with 30,000 patients found that omega-3s reduced all-cause mortality by 10%, cardiovascular mortality by 18%, heart attacks by 33%, and sudden cardiac death by 33%.

In short, the evidence that omega-3s reduce the risk of heart attacks and other forms of cardiovascular disease keeps getting stronger. However, the effect of omega-3s on heart failure is not as clear. Some studies suggest that omega-3s reduce the risk of heart failure and heart failure deaths. But other studies find little or no effect.

That’s unfortunate because heart failure is responsible for 45% of cardiovascular deaths and 14% of all deaths in the United States. In 2023 6.7 million Americans had heart failure, and that number is expected to increase to 8.5 million in 2030.

But numbers don’t tell the whole story. It is the trend in heart failure deaths that is truly concerning. Heart failure deaths per 100,000 Americans decreased by 20% between 1999 and 2012. Then the trend abruptly reversed. By 2021 heart failure deaths per 100,000 people was greater than in 1999. And the increase in heart failure deaths shows no signs of slowing down.

Nobody knows what is causing this rapid increase in heart failure deaths. But clearly the miracles of modern medicine are not working. And because the clinical studies on omega-3s and heart failure risk have been confusing, omega-3s are not currently recommended for heart failure patients.

This study (M A Jawad et al, Mayo Clinic Proceedings, 99: 1895-1904, 2024) was designed to clear up the confusion about omega-3s and heart failure risk.

How Was This Study Done?

clinical studyThis utilized data from the UK Biobank study. The UK Biobank study is an ongoing study that enrolled 502,366 subjects, aged 40-69, from the United Kingdom between April 1, 2007, and December 31, 2010. It regularly collects environmental, lifestyle, and genetic data on these individuals and tracks their health outcomes.

Within the study 273,033 participants had their blood levels of omega-3s determined by mass spectrometry. These measurements were used to calculate the Omega-3 Index (% of membrane fatty acids that are omega-3s) of these participants.

Of these participants:

  • 271,794 did not have a heart failure diagnosis at the time the omega-3 levels were determined. This group was used to evaluate the effect of omega-3s on the risk of developing heart failure.
  • 1,239 had a heart failure diagnosis at the time the omega-3 levels were determined. This group was used to determine whether omega-3s reduced the risk of death in heart failure patients.
  • 20,000 from this group had a repeat measurement of omega-3 levels around 4 years after the first measurement to determine the consistency of omega-3 levels. On average the repeat measurements were slightly lower, but the differences were small.

These participants were followed for an average of 13.7 years.

  • A diagnosis of heart failure was based on international diagnosis standards.
  • Deaths were identified by using the central death registry in the United Kingdom.

The News About Omega-3s Just Got Better

Omega-3s And Heart DiseaseThe data were clear. When participants with an Omega-3 Index in the top 20% were compared to those with an Omega-3 Index in the bottom 20%:

  • The risk of developing heart failure during the 13.7-year follow-up period was reduced by 21%.

When participants with a heart failure diagnosis prior to omega-3 measurement were compared in the same manner:

  • All-cause mortality was reduced by 48%
  • Cardiovascular mortality was reduced by 43%.

When the investigators looked at the effect of omega-3 supplementation in this population:

  • The risk of developing heart failure was 5% lower for those who reported omega-3 supplement use. I will discuss the reason for the discrepancy between comparisons based on omega-3 supplement use and comparisons based on blood levels of omega-3s below.

The authors concluded, “Higher plasma levels of marine omega-3 fatty acids were associated with a lower incidence of heart failure. Furthermore, among patients with preexisting heart failure, higher omega-3 levels were associated with lower risks of all-cause mortality and cardiovascular mortality. These findings suggest that increasing plasma omega-3 levels, whether by diet or supplementation, could reduce both risk for development of heart failure and death in those with prevalent heart failure.”

What Are The Strengths And Weaknesses Of This Study?

strengths and weaknessesThis was a very large, very well-done study. There is the usual caveat for this type of study, namely that it looks at associations and cannot prove cause and effect. However, it would be impossible to perform a double blind, placebo-controlled study with that many people for almost 14 years.

And heart failure does not happen overnight. Studies of the size and length are required to show meaningful effects of diet and/or supplementation on health outcomes like heart failure are not feasible.

Another major strength of this study is that it measured blood levels of omega-3s and showed those blood levels were relatively stable over time rather than relying on participants remembering what they ate and/or what supplements they used.

  • In terms of supplement use, studies like this one simply ask whether omega-3 supplements were used. They do not ask what the dose was, how frequently they were taken, the form of the omega-3 supplement (fish oil, EPA-only, DHA-only), and whether they were consumed with food or not (which affects absorption).
  • Studies that rely on diet recall and/or supplement use also have another weakness, namely individual differences in the absorption and utilization of omega-3 fatty acids. Simply put, two individuals getting the same dose of omega-3s from diet and supplementation may have different levels of omega-3s in their cellular membranes.
  • The authors felt it was these differences that explained why they saw a much stronger and more accurate effect of omega-3s on heart failure when they based their comparison on blood levels of omega-3s rather than omega-3 supplement use.

In short, this study significantly strengthens the evidence that omega-3s reduce the risk of heart failure and improve survival for those with heart failure.

What Does This Study Mean For You?

confusionHere are the take-home lessons from this study:

As I said above, this study significantly strengthens the evidence that omega-3s reduce the risk of heart failure and improve survival for those with heart failure. That means:

  • Optimizing your intake of omega-3s may be a good strategy for reducing your risk of heart failure. More importantly, optimizing omega-3 intake may also be a good strategy for improving your survival if you have been diagnosed with heart failure.
  • The authors said, “Because omega-3 is a well-tolerated over-the-counter nutrient…it is perplexing why this safe and affordable therapy…has not been widely incorporated into guideline-directed medical therapy for heart failure. Omega-3s…should be considered as add-on therapy to the standard regimen in the prevention and treatment of heart failure.” I agree.

But what is the optimum intake of omega-3s? This is what the authors had to say about that:

  • The top 20% of participants in this study had a blood Omega-3 Index of >5.45%, but this is not necessarily optimal.
  • Previous studies have suggested that an Omega-3 Index of 8% is the optimal target for reducing the risk of death from other forms of heart disease, and the authors feel this is also the optimal target for reducing the risk of heart failure.
  • The average American has an Omega-3 Index of 4-5%, which is associated with a high risk of heart disease.
  • Previous studies have indicated that an average intake of 1.4 g/day of EPA + DHA is required to move from an Omega-3 Index of 4% to 8%.

But the key word here is “average”.

  • None of us are average. We all absorb and retain omega-3s with different efficiencies. Many people will do great with 1.4 g/day. But some may need more to achieve an Omega-3 of 8%. And others will need less.
  • That’s why I recommend that you request blood tests of your Omega-3 Index and use those to guide you to an optimal 8% rather than relying on dosage of omega-3 supplements or frequency of omega-3-rich fish consumption alone.
  • However, I recognize that Omega-3 Index determinations are expensive and not all doctor’s offices are equipped to provide them. On average, an intake of 1-2 g/day of EPA + DHA is safe and likely effective at reducing risk of heart failure and other forms of heart disease. But it may not be optimal for you.

The Bottom Line 

Previous studies have shown that an optimal intake of omega-3s is likely to reduce the risk of heart attacks and deaths from heart disease. But the news about omega-3s just got better. A recent study strengthened the evidence that omega-3s also reduce the risk of heart failure and improve survival for those with heart failure.

The authors concluded, “Higher plasma levels of marine omega-3 fatty acids were associated with a lower incidence of heart failure. Furthermore, among patients with preexisting heart failure, higher omega-3 levels were associated with lower risks of all-cause mortality and cardiovascular mortality. These findings suggest that increasing plasma omega-3 levels, whether by diet or supplementation, could reduce both risk for development of heart failure and death in those with prevalent heart failure.”

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

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

_______________________________________________________________________

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

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

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

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

________________________________________________________________________

About The Author 

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

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

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

 

How Much Should You Walk?

by

Walking Your Way To Health 

Author: Dr. Stephen Chaney 

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

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

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

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

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

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

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

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

3) How fast should I walk?

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

How Were These Studies Done?

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

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

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

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

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

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

Walking Your Way To Health

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

#1: Increase in number of steps/day:

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

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

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

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

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

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

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

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

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

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

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

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

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

How Much Should You Walk?

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

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

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

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

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

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

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

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

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

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

The Bottom Line 

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

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

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

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

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

3) How fast should I walk?

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

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

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

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

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

 _____________________________________________________________________________

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

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

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

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

 ______________________________________________________________________

About The Author 

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

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

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

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

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

Are Our Healthy Years Getting Shorter?

by

What Does This Mean For You?

Author: Dr. Stephen Chaney

If you’ve ever traveled the subway system in London, you can’t have missed the “Mind the Gap” signs warning not to put your foot in the gap between the subway and the platform.

That warning is more important than ever in an age where people look at their cell phones rather than where they are walking. Of course, if they are looking at their cell phones, they might miss the sign and…

But today’s “Health Tip” is not about subway gaps. It’s about a far more important gap – the gap between our healthspan (how many years we enjoy good health) and our lifespan (how many years we live).

A recent study (L Gimeno et al, The Journals of Gerontology, Series B, 79(8), gbae113, 2024) suggesting that our healthy years are getting shorter caught my attention.

All of us imagine that our golden years will be ones of vibrant health. We’ll travel to exotic places. We’ll take long walks in the mountains. We’ll play with our grandchildren. Life will be wonderful.

But if this study is correct, none of that will happen for many young Americans. They will be too frail and sick to enjoy their golden years. They will be surviving rather than thriving.

So, in today’s “Health Tips From the Professor” I will review the study and tell you what it means for you.

How Was The Study Done?

clinical studyThe investigators used data on 114,526 adults >50 (average age = 63) from developed countries (the United States, England, and continental Europe). Specifically, they used data from people who participated in the Healthy and Retirement Study (26,939 people in the United States), the English Longitudinal Study on Ageing (14,992 people in England), and the Survey of Health, Ageing, and Retirement (72,595 people in continental Europe) between 2004 and 2018.

These surveys collected data on health-related outcomes every 2 years. The outcomes measured were:

  • Six activities of daily living (ADLs) such as eating, bathing, and walking.
  • Four instrumental activities of daily living (IADLs) related to essential tasks such as grocery shopping or preparing a hot meal.
  • Seven measures of mobility difficulties and motor coordination tasks such as walking one block, lifting 10 pounds, or picking up a small coin from a flat surface.

The assumption was that the severity of limitations was ADL > IADL > mobility difficulties. This is based on previous research showing that a person with ADL limitations is likely to have IADL limitations and mobility difficulties. And a person with IADL limitations is likely to have mobility difficulties. Based on this assumption, they classified participants in this study into 4 disability categories:

  • Mild disability: ≥1 IADL limitations and any number of mobility difficulties.
  • Moderate disability: 1-2 ADL limitations with any number of IADL limitations and mobility difficulties.
  • Severe disability: ≥3 ADL limitations with any number of IADL limitations and mobility difficulties.

The study also measured the prevalence (percent of the population) with:

  • Obesity
  • Heart disease.
  • Diabetes
  • Cancer
  • Lung disease.
  • High blood pressure.
  • High cholesterol.

Finally, the study also measured grip strength because loss of grip strength is considered an indicator of future disabilities.

The unique feature of this study is it compared the health and disability of people who were at the same age when tested but were born in different decades ranging from 1925 to 1955.

Because of the rapid change in diet and lifestyle following World War II, the health and disability of people born in the 1936-1945 decade encompassing World War II was used as the standard to which all other decades were compared.

Are Our Healthy Years Getting Shorter?

Some of you may have skipped over the previous section, so I will repeat the way these data were analyzed because it is crucial to your understanding of the study.

“The unique feature of this study is it compared the health and disability of people who were at the same age when tested but were born in different decades ranging from 1925 to 1955.

Because of the rapid change in diet and lifestyle following World War II, the health and disability of people born in the 1936-1945 decade encompassing World War II was used as the standard to which all other decades were compared.”

When looking at data from the United States, there were two distinct patterns.

The vertical line in the center of the graph represents the health and disability status of people born during World War II because all comparisons in this study were to people born in the decade encompassing World War II. A worsening of health and disabilities is indicated in red and an improvement in health and disabilities is shown in green. 

Pattern A was characteristic of a constant worsening of health and disabilities from people born in the decade starting in 1925 to people born in the decade starting in 1955.

This pattern was seen for:

  • Obesity
  • Heart disease.
  • Diabetes
  • Lung disease.
  • High blood pressure.
  • High cholesterol.
  • Severe disabilities.
  • Reduction in grip strength.

Remember, this study is measuring health and disability of people at the same age. The only difference is when they were born. It tells us people in their 50s, 60s, or 70s born in 1955 or later are in poorer health than people of the same age who were born in 1925.

And it’s not just the United States. For obesity and health parameters the pattern was the same for England and Europe. For severe disabilities the pattern was the same for England but was not as clear for Europe.

Two things should be noted for this pattern:

  • The worsening of health and the increase in severe disabilities comes despite the vast improvements in the health care systems in these countries and improved understanding of the causes of these diseases.
  • Obesity is likely a major driver of our declining health and increased disability. However, it is not the only driver. If the investigators had graphed the percentage of highly processed foods in the diet or the decline in regular exercise, the pattern would have been similar.

Pattern B shows an improvement in the period leading up to World War II and a deterioration in the period after World War II. The authors interpreted the improvement prior to World War II as due to improvements in health care and the deterioration after World War II as due to changes in diet and lifestyle.

This is the pattern seen for mild and moderate disabilities in the United States. The pattern for mild and moderate disabilities was not as clear for England and Europe.

The authors concluded, “In all regions, we found evidence for worsening health across cohorts [groups of people born in successive decades], particularly for those born after 1945.”

What Does This Study Mean For You?

QuestionsI don’t want to overinterpret this study. This study breaks new ground, but it has some limitations that I would characterize with three statements:

  • It is a very difficult study to do perfectly.
  • There are several factors that could affect the interpretation of the data and the outcome of the study.
  • The authors made a valiant effort to correct for any factors that could have affected the outcome.

For more details about the factors that might affect the outcome of the study and how the authors corrected for them, read the study.

However, this is the first study to use this approach to gauge the decrease in healthy years (healthspan) in developed countries over the past 40 years. It has its flaws, but it is consistent with several other studies documenting declining health in the current generation of young adults. For example, in a recent issue of “Health Tips From the Professor” I reviewed a study showing that colon cancer rates are increasing at an alarming rate for young adults in this country.

At the beginning of this article, I talked about the gap between our healthspan (how many years we enjoy good health) and our lifespan (how many years we live).

This study suggests that the onset of significant health issues and disabilities is occurring at a younger age today than for people born before World War II. In short, it suggests that our healthspan (the number of healthy years) is getting shorter.

This study did not look at lifespan, but numerous studies show that our lifespan is still increasing. So, the gap between healthspan and lifespan appears to be getting larger. In simple terms this means that when today’s young adults reach their “golden years”, they may spend more of those years in poor health than those of us born in the 1940’s.

But, what does this mean for you? The take home lesson should be, “This doesn’t have to be. You don’t have to be frail and sickly in your golden years. We know how to prevent this.”

  • It starts with a healthy diet – a whole food, primarily plant-based diet with lots of colorful fruits and vegetables, whole grains, nuts and seeds.
  • Add in a regular exercise program with a mixture of aerobic and resistance exercises.
  • Include an individualized supplement program.

You notice I didn’t list weight control as one of the top three prevention strategies. That’s because I don’t recommend fad diets and rapid weight loss programs. If you do the first three things well, your weight will come off naturally – a little bit at a time.

And once you have mastered all four things, you will increase your healthy years and narrow the gap between your healthspan and your lifespan. You can look forward to golden years filled with vitality and adventure.

The Bottom Line

A recent study used an innovative approach to quantify the deterioration in health and the physical ability to function well in daily activities as we age. The unique feature of this study is it compared the health and disability of people who were at the same age when tested but were born in different decades ranging from 1925 to 1955.

The study found a constant worsening of health and disabilities from people born in the decade starting in 1925 to people born in the decade starting in 1955 for:

  • Obesity
  • Heart disease.
  • Diabetes
  • Lung disease.
  • High blood pressure.
  • High cholesterol.
  • Severe disabilities.

The authors concluded, “We found evidence for worsening health across cohorts [groups of people born in successive decades], particularly for those born since 1945.”

In short, people born in recent years have fewer healthy years (a shorter healthspan) than people born before World War II. And since our lifespans are getting longer, this means the gap between our healthspan and our lifespan is increasing.

All of us imagine that our golden years will be ones of vibrant health. We’ll travel to exotic places. We’ll take long walks in the mountains. We’ll play with our grandchildren. Life will be wonderful.

But if this study is correct, none of that will happen for many of today’s young adults. They will be too frail and sick to enjoy their golden years.

For more details about this study and how you can increase your healthy years, narrow the gap between your healthspan and your lifespan, and look forward to golden years filled with vitality and adventure, read the article above.

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

 ______________________________________________________________________________

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

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

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

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

_______________________________________________________________________

About The Author 

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

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

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

600th Issue Celebration

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Nutrition Advances Over The Last Two Years

Author: Dr. Stephen Chaney 

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

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

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

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

Here are my picks from the last two years:

Weight Loss Diets

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

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

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

Healthy Diets

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

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

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

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

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

Diet And Heart Disease

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

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

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

The Dangers Of Processed Foods 

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

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

This study is interesting for two reasons.

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

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

Maintaining Muscle Mass As We Age

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

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

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

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

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

The Benefits And Risks Of Supplementation

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

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

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

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

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

Prenatal Supplements

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

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

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

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

Exercise

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

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

Did You Know? 

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

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

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

How To Talk With Your Doctor About Cancer 

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

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

The Bottom Line

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

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

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

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

_______________________________________________________________________________

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

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

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

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

 _______________________________________________________________________

About The Author 

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

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

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

Is Olive Oil Overrated?

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What Is The Truth About Olive Oil And You? 

Author: Dr. Stephen Chaney 

You may have seen headlines claiming that olive oil doesn’t deserve its “health halo”. It isn’t as healthy as many experts have claimed. It is overrated.

These headlines aren’t referring to the scandalous practice of selling “extra virgin” olive oil that contains cheaper oils. That is another topic for another day.

The headlines are claiming that, while the Mediterranean diet is healthy, it is fruits, vegetables, whole grains, legumes, and fish that make the Mediterranean diet healthy. Their claim is that olive oil has little to do with it.

To evaluate these claims I have reviewed the study (AK Krenek et al, Journal of the American Heart Association, Volume 13, Number 15:e035034, July 24, 2024) behind the headlines.

And to provide context, I have also reviewed another recent study (M Guasch-Ferre et al, Journal of the American College of Cardiology, Volume 79, Number 2, 2022).

How Were These Studies Done?

clinical studyThe two studies were very different:

The First Study used a randomized cross-over design to compare high and low olive oil diets.

In the randomized cross-over design participants were randomly assigned to one of the two diets at the beginning of the study. They followed that diet plan for 4 weeks. And after a one week “washout” they followed the other diet plan for 4 weeks. In this type of study each participant serves as their own control.

Study participants (50 obese participants, average age = 64, 75% women, 72% white, ≥ 5% risk of heart disease) were all eating a typical American diet.

Each of the experimental diets was a whole food plant-based diet, with comparable amounts of fruits, vegetables, whole grains, legumes, nuts, and seeds. Both diets were high in fiber, low in added sugar, and contained less than an ounce of animal products a day. In other words, the base diet was a healthy plant-based diet.

Participants in the high olive oil group were asked to add 4 tablespoons/day of extra virgin olive oil to their diet while participants in the low olive oil group were asked to restrict their olive oil intake to < 1 teaspoon/day.

No effort was made to control portion sizes or caloric intake. As we will see below, this was a major weakness of the study. As you might expect, fat intake was significantly greater for those on the high olive oil diet (49% of calories) compared to the low olive oil diet (32% of calories). Consequently, caloric intake was also significantly greater on the high olive oil diet.

All participants met with a dietitian/chef at the beginning of the study and were given access to online training programs and a dietitian hotline for questions. Dietary intake was measured by a 24-hour dietary recall 4-7 times prior to the study and 4 times during each diet period.

Fasting blood and urine samples were collected prior to the study and at the end of each 4-week diet period to measure biomarkers with possible predictive value for heart disease, such as LDL cholesterol.

The Second Study was a prospective cohort study using data obtained from 60,582 women in the Nurses Health Study and 31,801 men in the Health Professionals Follow-Up Study.

In a prospective cohort study a cohort or group of people (in this case, the 60,582 women and 31,801 men in the two studies) are followed over time (in this case for 28 years from1990 to 2018). The study then measures the association between some aspect of their diet and lifestyle (in this case the kind of fat in their diet) and health outcomes at the end of the study (in this case all-cause mortality, cardiovascular mortality, cancer mortality, neurodegenerative disease mortality, and respiratory disease mortality).

A strength of this study was that the diet of all participants was assessed every 4 years, which allowed the investigators to track changes in their diet over time. The intake of most fats was remarkably stable over the entire 28-year duration of the study.

However, as the bad news about margarine and the good news about olive oil entered the popular media, margarine consumption declined, and olive oil consumption increased. Because the investigators were able to track these changes over time, they were able to correct for them in their data analysis.

Is Olive Oil Overrated?

thumbs down symbolResults From The First Study: If we restrict ourselves to statistically significant observations, the results were as follows:

  • Switching from the baseline diet (typical American diet) to either the high olive oil or low olive oil diets for 4 weeks resulted in a significant decrease in total cholesterol, LDL cholesterol, HDL cholesterol, and blood glucose levels.
  • In this case, there was no statistically significant difference between the two diets.

However, when transitioning from the low olive oil diet to the high olive oil diet and from the high olive oil diet to the low olive oil diet, some statistically significant differences were observed.

For example, transitioning from the high olive oil diet to the low olive oil diet resulted in:

  • A 7% decrease in total cholesterol.
  • An 11% decrease in LDL-cholesterol.
  • A 2.2% decrease in HDL-cholesterol.
  • A 2% decrease in blood glucose levels.

And transitioning from the low olive oil diet to the high olive oil diet resulted in:

  • A 14% increase in total cholesterol.
  • A 14% increase in LDL-cholesterol.
  • A 15% increase in HDL-cholesterol.
  • A 17% decrease in blood glucose levels.

The authors of this study said, “Although both [whole food, primarily plant-based] diets improved [risk factors for heart disease], a low olive oil intervention may provide superior LDL-cholesterol lowering in individuals at highest risk [of heart disease]. Future studies are needed to determine if these short-term effects are sustainable and translate to improvements in cardiac outcomes…Nevertheless, a whole food primarily plant-based diet with relatively lower olive oil may be a useful tool for clinicians for improving cardiovascular risk compared with greater olive oil intake.”

The authors also went on to say, “…olive oil may not be the beneficial additive of a Mediterranean diet.”

thumbs upResults From The Second Study:

Higher intake of olive oil (>0.5 tablespoons/day compared to ≤1 teaspoon/day) resulted in:

  • A 19% decrease in the risk of all-cause mortality. And when that was broken down by cause it amounted to:
    • A 19% decrease in the risk of cardiovascular mortality.
    • A 17% decrease in the risk of cancer mortality.
    • A 29% decrease in the risk of neurodegenerative disease mortality.
    • An 18% decrease in the risk of respiratory disease mortality.

In a substitution analysis calculating the effect of consuming 10 g/day of olive oil instead of 10 g/day of:

  • Butter resulted in a 14% decrease in the risk of all-cause mortality.
  • Margarine or dairy fat resulted in a 13% decrease in the risk of all-cause mortality.
  • Mayonnaise resulted in a 9% decrease in the risk of all-cause mortality.
  • Other vegetable oils had no effect on all-cause mortality.
  • Results were similar when the investigators looked at the effect of replacing fats with olive oil on mortality due to cardiovascular disease, cancer, neurodegenerative disease, and respiratory disease.

The authors of the second study concluded, “Higher olive oil intake was associated with lower risk of total and cause-specific mortality. Replacing margarine, butter, mayonnaise, and dairy fat with olive oil was associated with lower risk of mortality.”

How can we reconcile these conflicting viewpoints? Let me start by looking at the flaws in the first study. Then I will summarize the “truth” about olive oil based on what these two studies tell us.

Is The Study Behind The Headlines Misleading?

flawsFirst let me summarize why I consider the study to be misleading. Then I will discuss why the headlines about the study are misleading.

Why The Study Is Misleading: The main conclusion of this study was that adding olive oil to a primarily plant-based diet increased the risk of heart disease. While this study is well-designed in some respects, it is flawed in others. I will summarize the flaws here:

Flaw Number 1: The authors rely on the relative effects of the high and low olive oil diets on LDL-cholesterol levels in predicting the effect of the two diets on heart disease risk. However, there is a major problem with this argument:

  • HDL-cholesterol levels move in the same direction. Both are decreased in the transition from the high olive oil to the low olive oil diet. Both are increased in the transition from the low olive oil to high olive oil diet. The ratio of HDL to LDL cholesterol changes very little, so it is almost impossible to predict what effect these changes will have on heart disease outcomes.

Flaw Number 2: This is related to the flaw I mentioned earlier. No effort was made to control portion size or caloric intake of participants on these diets. The high olive oil diet added 4 tablespoons of olive oil to the low olive oil diet. This significantly increased the fat and caloric intake of participants on the high olive oil diet.

  • Participants lost weight on both diets, but weight loss was significantly greater on the low olive oil diet. In their discussion, the authors admitted that the greater reduction in LDL-cholesterol on the low olive oil diet could have been due to the greater reduction in weight on that diet.

Flaw Number 3: I call this the “straw man” flaw. By adding 4 tablespoons of olive oil to the high olive oil diet the authors created the equivalent of a straw man that was easy knock over. Even if their conclusions were correct, nobody has recommended the addition of 4 tablespoons of olive oil to any diet as a heart-healthy approach.

Mediterraneans don’t add 4 tablespoons of olive oil to their diet. Olive oil is part of the foods they eat and the way they prepare their food.

Why The Headlines Are Misleading: Of course, the headlines were misleading because they ignored the many flaws of the study.

However, I find it amusing that some of the headlines came from “Forks Over Knives” an organization that advocates for a very low-fat plant-based diet. They were using this study to question the value of olive oil as part of a whole-food plant-based diet.

However, when you look at the study, 32% of calories came from fat in the low olive oil diet, and 49% of calories came from fat in the high olive oil diet.

For perspective:

  • The low-fat whole-food plant-based diet recommended by “Forks Over Knives” has <10-15% of calories from fat.
  • The Mediterranean diet typically contains 35-40% of calories from fat.
    • Around 18-19% of that is monounsaturated fat.
    • Around 8% of that is saturated fat.
  • The typical American diet also contains 35-40% of calories from fat.
    • Around 12-14% of that is monounsaturated fat.
    • Around 12% of that is saturated fat.

In other words, the low olive oil diet in this study resembles the fat content of the Mediterranean and typical American diets, not the low-fat whole food plant-based diet recommended by “Forks Over Knives”.

And the high olive oil diet contains fat levels not seen in any natural diet. Except for a few keto enthusiasts, I don’t know of any experts who think getting almost 50% of your calories from any kind of fat is a good thing.

What Is The Truth About Olive Oil And You?

The TruthAs described above, the study behind the headlines is a very small, very short study with multiple flaws. So, you can ignore headlines like “Olive oil is overrated” or “Olive oil doesn’t deserve its health halo.”

The second study I discussed is much larger (92,383 participants) and of much longer duration (28 years). More importantly, it measures health outcomes, not blood biomarkers that might predict health outcomes.

Finally, the second study was not measuring the health benefits of the Mediterranean diet, as many other studies have done. It was looking at the effect of varying olive oil intakes in the American diet. The high olive oil intakes in this study were less than those seen in the Mediterranean diet. This is good news for the average American who may feel overwhelmed trying to adopt to a Mediterranean diet.

This study reinforces previous studies showing that olive oil is healthy. But let me put this into context.

  • Olive oil is not a superfood. This study showed that it is no healthier than other plant oils. It is, however, considered one of the best vegetable oils for sauteing. It is also less susceptible to oxidation than seed oils, although I still recommend you store it in the refrigerator.
  • It is not something you add to your diet. It is something you incorporate into your diet. People who live in Mediterranean regions:
    • Cook with olive oil.
    • Use olive oil in their salad dressings and drizzle a little olive oil on cooked vegetable and pasta dishes instead of adding butter.
    • Dip their bread in olive oil rather than using butter or mayonnaise.
    • Use it in spreads like tapenade or hummus.
    • Use olives in cooking.
  • Finally, look for extra virgin olive oil. That doesn’t mean you need to spend “an arm and a leg”. But I would do a little online research before I bought the cheapest brand at the discount store.

The Bottom Line

You may have seen recent headlines claiming that olive oil is overrated and that it doesn’t deserve its “health halo”. So, I looked at the study behind the headlines.

It was a very small, very short study with multiple flaws. You can forget the headlines.

For context I also reviewed another recent study. It was a much larger (92,383 participants) and longer duration (28 years) study. More importantly, it measured actual health outcomes, not just blood biomarkers that might predict health outcomes.

It concluded that olive oil is good for us. It is healthier than most fats commonly found in the American diet, but it is no healthier than other plant oils.

For more details on these studies, what they mean for you, and how to incorporate more olive oil into your diet read the article above.

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

______________________________________________________________________________

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

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

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

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

_____________________________________________________________________

About The Author 

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

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

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

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

 

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

Are All Plant-Based Diets Healthy?

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Why Are Plant-Based Diets Healthy?

Author: Dr. Stephen Chaney

Unless you are like Rip van Winkle and have been asleep for the past 30 years, you have probably heard that plant-based diets are good for you. In fact, that advice is sound. It is based on multiple long-term studies.

But you may still be hesitant to make the switch. You are probably wondering if you have to be a vegan purist to benefit from a plant-based diet. If so, you are wondering whether you can make that drastic a change in your diet. Or, you may have already decided “that is a bridge too far” and don’t want to even consider it.

So, one important question is, “Do you have to go vegan to benefit from a plant-based diet?”

On the other hand, “Big Food, Inc” has made it easier than ever to switch to more “plant-based” eating. After all, sugar comes from plants. And highly processed grains come from plants. Add a few chemicals and you can come up with an endless supply of highly processed plant-based foods.

So, another important question is, “Can a diet of highly processed plant-based foods be as healthy as a diet of whole, unprocessed plant-foods?”

The study (Y. Wang et al., Nutrition Journal, 22: 46, 2023) I am reviewing today was designed to answer these two questions. It also represents the first meta-analysis to combine data from studies on the effects of plant-based diets on diabetes, heart disease, cancer, and mortality into a single study.

How Was The Study Done?

clinical studyThe investigators performed a meta-analysis of 76 studies with 2,230,443 participants that looked at the associations of plant-based dietary patterns and the incidence of type 2 diabetes, cardiovascular disease, cancer, and mortality among adults 18 years or older.

The characteristics of study participants ranged from:

  • 25 to 87 years old.
  • BMI of 20 to 30.

And the duration of the studies within the meta-analysis ranged from 2 to 36 years.

The adherence to plant-based diets was defined as higher consumption of plant-based foods and lower consumption or exclusion of animal-based foods.

The meta-analysis also included studies looking at the effect of changing from a more animal-based to a more plant-based dietary pattern.

The meta-analysis included studies looking at the benefit of vegan and vegetarian diets. In terms of participants these studies represented just over 50% of the data in the meta-analysis. So, this meta-analysis was ideally positioned to determine whether vegan and vegetarian diets were more beneficial than other primarily plant-based dietary patterns that included some animal foods.

The methodology used to classify diets as primarily plant-based varied from study to study. But in each case the study participants were divided into quartiles ranging from consuming the most plant-based diet to consuming the least plant-based diet.

The study then compared study participants with the highest adherence to plant-based diets to those with the lowest adherence to plant-based diets with respect to type 2 diabetes, cardiovascular disease, cancer, and mortality.

Finally, the study also compared adherence to healthy plant-based dietary patterns (whole or minimally processed fruits, vegetables, whole grains, beans, nuts, and seeds) to unhealthy plant-based dietary patterns (foods and drinks with added sugar, highly processed plant foods, and starchy vegetables).

Are Plant-Based Diets Healthy?

When comparing highest to lowest adherence to plant-based dietary patterns the risk of:

  • Type-2 diabetes was reduced by 18%.
  • Cardiovascular disease was reduced by 10%.
  • Cancer was reduced by 12%.
  • Mortality was reduced by 16%.

In short, all the news was good for primarily plant-based dietary patterns.

Are All Plant-Based Diets Healthy?

Increased adherence to a healthy plant-based dietary pattern (That term is defined in the methods section above) was associated with an even better reduction in disease risk. For example:

  • Type-2 diabetes was reduced by 21%.
  • Cardiovascular disease was reduced by 15%.
  • Cancer was reduced by 13%.
  • Mortality was reduced by 14%, which was statistically indistinguishable from the reduction in mortality associated with all plant-based dietary patterns above.

Factory FarmIn contrast, increased adherence to an unhealthy plant-based dietary pattern was associated with increased risks of disease. For example:

  • The risk of type 2 diabetes increased by 8%.
  • The risk of cardiovascular disease increased by 14%.
  • The risk of cancer increased by 7%.
  • The risk of mortality increased by 16%.

In short, plant-based dietary patterns consisting of whole or minimally processed plant foods are good for you. Plant-based dietary patterns consisting of highly processed plant foods are not.

Are Vegan and Vegetarian Diets More Beneficial Than Other Plant-Based Dietary Patterns?

Mediterranean Diet FoodsTwenty seven of the studies within this meta-analysis compared vegetarian or vegan dietary patterns with animal-based dietary patterns. These studies had 1,343,967 participants, which amounts to 57% of the participants in the meta-analysis.

Thus, this meta-analysis was well positioned to determine relative benefits of vegan and vegetarian diets compared to other primarily plant-based dietary patterns that include some animal foods. The investigators reported that:

  • The risk reduction for type 2 diabetes was greater in studies with vegan and vegetarian diets than in studies with other primarily plant-based diets.
  • No other statistically significant benefits were observed for vegan and vegetarian diets compared to other primarily plant-based diets.

In short, you don’t need to become a vegan to experience the health benefits of a plant-based diet.

In contrast, increased adherence to an unhealthy plant-based dietary pattern was associated with increased risks of disease. For example:

  • The risk of type 2 diabetes increased by 8%.
  • The risk of cardiovascular disease increased by 14%.
  • The risk of cancer increased by 7%.
  • The risk of mortality increased by 16%.

In short, plant-based dietary patterns consisting of whole or minimally processed plant foods are good for you. Plant-based dietary patterns consisting of highly processed plant foods are not.

What If You Change From An Animal-Based To A Plant-Based Diet?

Food ChoicesIf you have been consuming an animal-based diet for years, you may be wondering whether it is too late to change. Has the damage already been done?

Six studies within this meta-analysis examined the effect of changing from an animal-based diet to a plant-based diet on type 2 diabetes and mortality. Changing to a more plant-based dietary pattern:

  • Reduced diabetes by 17% and mortality by 5%.

In short, it’s never too late to switch to a more plant-based dietary pattern.

Why Are Plant-Based Diets Healthy?

The short answer is that we don’t know for sure, but the authors mentioned several popular hypotheses.

  • Obesity is a risk factor for type 2 diabetes, cardiovascular disease, and certain types of cancer. And studies have shown that people consuming plant-based diets tend to weigh less.
  • The increased fiber content and higher ratio of polyunsaturated fats to saturated fats lower cholesterol levels and improve blood lipid profiles, which are associated with a lower risk of cardiovascular disease.
  • Plant-based diets are anti-inflammatory, which reduces the risk of all three diseases.
  • Plant foods are rich in polyphenols and other phytonutrients that are associated with reduced risk of cardiovascular disease, lower blood pressure, and improvements in insulin sensitivity.
  • Plant foods are metabolized by gut bacteria to metabolites that are associated with reduced risk of type 2 diabetes and cardiovascular disease.
  • Plant foods support healthy gut bacteria associated with a reduced risk of several diseases.
  • Finally, plant-based dietary patterns are associated with no or reduced consumption of red and processed meats, which increase the risk of type 2 diabetes, cardiovascular disease, and certain types of cancer.

For a more detailed discussion read the article).

What Does This Study Mean For You?

The authors of this study concluded, “Higher adherence to plant-based dietary patterns, especially from healthy sources, may be universally beneficial for the primary prevention of type 2 diabetes, cardiovascular disease, cancer, and mortality. The current study provides further evidence in support of current recommendations that emphasize consuming high-quality plant-based foods for achieving optimal health.”

“Future studies are needed to elucidate…mechanistic pathways linking plant-based diets with multiple disease outcomes.”

I would just like to emphasize a few points:

  • These are all association studies. It takes decades for diseases like diabetes, heart disease, and cancer to develop. So, it is impossible to confirm these findings with double blind, placebo-controlled studies. However, when you have 76 studies with over 2 million participants all pointing to the same conclusion, it is hard to ignore the findings.
  • The good news is that you don’t have to become a vegan to experience these benefits. There are many healthy primarily plant-based diets available. Choose the one that best fits your food preferences and lifestyle.
  • Be aware that whatever diet you choose, Big Food Inc is only too happy to provide you with highly processed foods that fit that dietary pattern. Don’t fall for that trap. Stick with whole or minimally processed plant foods.
  • If your current diet isn’t the best, it is never too late to switch to a healthier primarily plant-based diet.

The Bottom Line

A recent meta-analysis of 76 studies with 2,230,443 participants looked at the associations of plant-based dietary patterns and the incidence of type 2 diabetes, cardiovascular disease, cancer, and mortality among adults 18 years or older.

The authors of the study concluded, “Higher adherence to plant-based dietary patterns, especially from healthy sources, may be universally beneficial for the primary prevention of type 2 diabetes, cardiovascular disease, cancer, and mortality. The current study provides further evidence in support of current recommendations that emphasize consuminh high-quality plant-based foods for achieving optimal health.”

Other key points from the study are:

  • These are all association studies. It takes decades for diseases like diabetes, heart disease, and cancer to develop. So, it is impossible to confirm these findings with double blind, placebo-controlled studies. However, when you have 76 studies with over 2 million participants all pointing to the same conclusion, it is hard to ignore the findings.
  • The good news is that you don’t have to become a vegan to experience these benefits. There are many healthy primarily plant-based diets available. Choose the one that best fits your food preferences and lifestyle.
  • Be aware that whatever diet you choose, Big Food Inc is only too happy to provide you with highly processed foods that fit that dietary pattern. Don’t fall for that trap. Stick with whole or minimally processed plant foods.
  • If your current diet isn’t the best, it is never too late to switch to a healthier primarily plant-based diet.

For more details about how the authors came to these conclusions and what they mean for you, read the article above.

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

_______________________________________________________________________________

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

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

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

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

 ______________________________________________________________________

About The Author 

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

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

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

Are Calcium Supplements Safe?

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What Does This Study Mean For You?

Author: Dr. Stephen Chaney 

Pendulum
Pendulum

Should you avoid calcium supplements because they increase your risk of heart disease? Some headlines and blog posts would have you believe that. You may have been told that by your doctor. But is it true?

Unfortunately, this is another example of the swinging pendulum that we often see in supplement studies. One day a study comes out saying that calcium supplements increase the risk of heart disease. A few months later another study comes out saying that is not true. Calcium supplements don’t increase heart disease risk.

The pendulum keeps swinging until you are totally confused. You don’t know what to believe. And “experts” (including your doctor) pick one side or the other depending on what they believe about supplements in general.

I have told you before that good scientists wait until multiple studies have been done and base their opinion based on what the preponderance of studies show. I can tell you that multiple studies have been done and the preponderance of studies show that calcium supplements do not increase the risk of heart disease. But that doesn’t prove that calcium supplements are safe. It just shows they are likely to be safe.

That is why the authors of the current study (X Huo et al, Current Developments In Nutrition, volume 7, Issue 3: 100046, March 2023) analyzed the weaknesses of previous studies and tried to design a study that lacked those weaknesses.

How Was This Study Done?

clinical studyThe investigators searched through the literature to identify all placebo-controlled, randomized clinical trials (the gold standard for clinical studies) assessing the effects of calcium supplements alone or calcium supplements with vitamin D on heart disease, stroke, and all-cause mortality.

They restricted their analysis to studies with at least 500 participants that lasted for at least a year. They further restricted their analysis to studies whose authors were willing to share unpublished data on the number of participants in each treatment group who had a heart attack, stroke, or any other kind of heart disease; died from heart disease; or died from all causes during the study.

They ended up with 11 clinical studies in their analysis. The breakdown was as follows:

  • Seven studies with 8,634 participants compared calcium alone with placebo.
    • Participants in these studies averaged 71 years old and were 79% female.
    • The daily calcium dose varied from 1.0 to 1.5 g/day.
    • The mean duration of treatment was 4.1 years (range = 2-5 years).
  • Six studies with 46,804 participants compared calcium plus vitamin D with placebo.
    • Participants in these studies averaged 65 years old and were 98% female.
    • The daily calcium dose varied from 1.0 to 1.5 g/day and the daily vitamin D dose ranged from 400 to 2,000 IU/d.
    • The mean duration of treatment was 6 years (range = 1.5-7 years).
  • In case you were wondering about the math, some studies included both calcium alone versus placebo and calcium plus vitamin D versus placebo.

The authors then combined the data from all 11 studies and performed a meta-analysis on the effect of calcium alone on adverse heart outcomes and calcium plus vitamin D on adverse heart outcomes.

Are Calcium Supplements Safe? 

calcium supplementsThe results were clear-cut.

  • Calcium alone was not significantly associated with any increased risk of heart attack, stroke, heart disease of any kind, deaths from heart disease, and deaths from all causes.
  • Calcium with vitamin D was not significantly associated with any excess risk of heart attack, stroke, heart disease, deaths from heart disease, and deaths from all causes.

In their discussion, the authors pointed out two caveats to their conclusions:

  • In the calcium only portion of the meta-analysis the number of participants who experienced a stroke or types of heart disease other than heart attack and stroke was very small. So, they could not exclude an absolute increased risk of 0.3-0.5% per year for these types of rare events.
  • The participants in the 11 studies included in their meta-analysis were not selected based on their risk of heart disease. So, the authors could not exclude the possibility that calcium supplements might increase the risk of heart disease in people who were already at high risk of heart disease.

The authors concluded, “This meta-analysis demonstrated that calcium supplements were not associated with any significant hazard for heart disease, stroke, or all-cause mortality…Hence, for people with low bone density and low absolute risks of heart disease, the present report demonstrates no concern about excess heart disease risks associated with calcium supplements.

However, further large trials are needed to assess the efficacy and safety of combined supplementation with calcium and vitamin D for the prevention of osteoporotic fracture in older people at high risk of heart disease.”

What Does This Study Mean For You?

Questioning WomanAs I said above, the preponderance of evidence suggests that calcium supplementation does not increase your risk of heart disease. This study reinforces that conclusion.

I can’t guarantee that some future study won’t come to the opposite conclusion, and the pendulum will swing again. And I can’t guarantee that your doctor has kept up with the most recent literature on calcium supplementation and heart disease risk.

The authors of this study also pointed out that we don’t have any clinical studies on the effect of calcium on heart disease risk if you are already at high risk of heart disease. So, if you are at high risk of heart disease, any advice that I or your doctor give you about calcium supplementation might be wrong. We simply don’t know.

Finally, I realize that you may be equally confused about whether calcium supplementation can strengthen your bones and reduce your risk of osteoporosis. I won’t discuss that question today. Instead, I will refer you to two previous articles I have written in “Health Tips From the Professor” on that topic.

The first article discusses the flaws in previous studies claiming that calcium supplements are ineffective at increasing bone density and preventing osteoporotic fracture.

The second article describes a bone-healthy lifestyle.

The Bottom Line

While the preponderance of studies have shown that calcium supplementation does not increase the risk of heart disease, that conclusion remains controversial.

To clarify that issue, a group of investigators searched through the literature to identify all placebo-controlled, randomized clinical trials (the gold standard for clinical studies) assessing the effects of calcium supplements alone or calcium supplements with vitamin D on heart disease, stroke, and all-cause mortality. They then performed a meta-analysis of those clinical studies.

Their meta-analysis showed that:

  • Calcium alone was not significantly associated with any increased risk of heart attack, stroke, heart disease of any kind, deaths from heart disease, and deaths from all causes.
  • Calcium with vitamin D was not significantly associated with any excess risk of heart attack, stroke, heart disease, deaths from heart disease, and deaths from all causes.

This study strengthens the conclusion that calcium supplementation does not increase the risk of heart disease.

For more details about the study and references discussing the effect of calcium supplementation on bone density, read the article above.

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

______________________________________________________________________________

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

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

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

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

_______________________________________________________________________

About The Author

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

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

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

Omega-3 Supplements Are Safe

by

Why Do Clinical Studies Disagree? 

Author: Dr. Stephen Chaney 

Pendulum
Pendulum

Six weeks ago, the title of my “Health Tips From the Professor” article was, “Are Omega-3 Supplements Safe?” That’s because I was reviewing a study that claimed long-term use of omega-3 supplements increased the risk of atrial fibrillation and stroke. And it had led to headlines like, “Omega-3 Supplements May Increase the Risk of Heart Disease” and “Fish Oil Supplements May Increase The Risk of Stroke and Heart Conditions”.

This week, the title of my article is, “Omega-3 Supplements Are Safe”. I did not choose this title to express my opinion, although I am in general agreement with the statement. I chose that title because the omega-3 pendulum has swung again. The article (M Javaid et al, Journal of The American Heart Association, Volume 13, Number 10: e032390, 2024) I am reviewing today came to the conclusion that omega-3 supplements don’t increase the risk of stroke.

I understand your confusion. You are wondering how scientists can tell you one thing today and the total opposite tomorrow. It is conflicting results like this that cause the public to lose faith in science. And when people lose faith in science they are easily influenced by “snake oil” charlatans on the internet.

So, after I describe this study, I will discuss why scientific studies come up with conflicting results and compare these two studies in detail. That is probably the most important part of this article.

How Was This Study Done?

clinical studyScientists from Freeman Hospital and Newcastle University in the UK conducted a meta-analysis combining the data from 120,643 patients enrolled in 11 clinical trials that evaluated the effects of omega-3 supplementation. The inclusion criteria for this meta-analysis were as follows:

  • The studies were randomized trials that compared omega-3 supplements with placebo or standard treatment. Half the patients received the omega-3 supplement.
  • The patients were either previously diagnosed with heart disease or were at high risk of developing heart disease.
  • The studies reported the incidence of bleeding events.

The study asked whether omega-3 supplementation increased the risk of bleeding events (defined as hemorrhagic stroke, intracranial bleeding, or gastrointestinal bleeding) compared to a placebo or standard treatment.

Omega-3 Supplements Are Safe

Omega-3s And Heart DiseaseThe results were reassuring for omega-3 supplement users. When compared to a placebo or standard treatment, omega-3 supplements.

  • Did not increase the risk of overall bleeding events.
  • Did not increase the risk of hemorrhagic stroke, intracranial bleeding, or gastrointestinal bleeding.
  • Did not increase the risk of bleeding in patients who were also taking blood thinners (Blood thinners reduce the ability of blood to clot and can lead to bleeding events. This study found that adding omega-3 supplements to these drugs did not increase bleeding risk.

But here is where it gets interesting. One of the 11 studies included in the meta-analysis used a high dose (4 grams/day) of Vascepa, a highly purified ethyl ester of EPA produced by the pharmaceutical company Amarin. When the authors analyzed the data from this study alone, they found that Vascepa:

  • Increased the relative risk of bleeding by 50% compared to the control group.
    • While this sounds scary, the absolute risk of bleeding was only increased by 0.6% compared to the control group.
    • I will explain the difference between relative risk and absolute risk below. But for now, you can think of absolute risk as a much more accurate estimate of your actual risk.

The authors of the meta-analysis speculated that the increased bleeding risk associated with the use of Vascepa could be due to the:

  • High dose of EPA (4 gm/day) or…
  • Lack of DHA and other naturally occurring omega-3s in the formulation. The authors said:
    • The effect of DHA on the endothelial lining is weaker than that of EPA (EPA makes the endothelial lining “less sticky” which reduces its ability to trigger blood clot formation. This is one of the mechanisms by which EPA is thought to decrease blood clot formation.)
    • The ability of DHA to inhibit oxidation of Apo-B-containing particles was less sustained than that of EPA (Oxidized Apo-B-containing particles increase the risk of blood clot formation. Inhibition of that oxidation by EPA is another of the mechanisms by which EPA is thought to decrease blood clot formation.)

The authors concluded, “Omega-3 PUFAs [polyunsaturated fatty acids] were not associated with increased bleeding risk. Patients receiving high-dose purified EPA [Vascepa] may incur additional bleeding risk, although its clinical significance is very modest.”

What Is The Difference Between Relative And Absolute Risk?

Question MarkRelative risk is best defined as the percentage increase or decrease in risk compared to the risk found in a control group. Absolute risk, on the other hand, is the actual increase or decrease in risk in the group receiving the intervention.

Relative risk is an excellent tool for identifying risks. However, it magnifies the extent of the risk, so it can be misleading. For example,

  • If the absolute risk of some event occurring in the general population was 40%, a 50% increase in relative risk would increase the absolute risk by 20% (40% X 0.5 = 20%) to give a total risk of 60% (40% + 20%). In this case, both the relative and absolute risk are significantly large numbers.
  • However, if the absolute risk in the general population was 1%, a 50% increase in relative risk would only increase the absolute risk to 1.5%, a 0.5% increase in absolute risk. In this case, the increase in relative risk appears significant, but it is misleading because the absolute increase in risk is a modest 0.5%.
  • The latter resembles the situation in this study when the authors compared bleeding events in patients receiving Vascepa to those receiving a placebo. The absolute risk of bleeding events in the control group was 1.2%. The risk of bleeding events in the Vascepa group was 1.8%. That is a 50% increase in relative risk but only a 0.6% increase in absolute risk.

Why Do Clinical Studies Disagree?

Confusion Clinical StudiesAs I have said many times before, there is no perfect clinical study. Every study has its strengths and its flaws. So, it is perhaps instructive to compare this study and the previous study I reviewed 6 weeks ago. Here are some of the questions I ask when evaluating the strengths and weaknesses of clinical studies.

#1: What kind of study is it?

  • The previous study was an association study. It can only report on associations. It cannot determine cause and effect. Outcomes like atrial fibrillation and strokes could have been caused by unrelated variables in the population studied.
  • The current study was a meta-analysis of 11 randomized controlled clinical trials. Because the only difference between the two groups is that one received omega-3 supplements, it can determine cause and effect.

#2: How many people were in the study?

  • Both studies were very large, so this was not a factor.

#3: How long was the study?

  • The previous study lasted 12 years. The clinical trials within this meta-analysis lasted one to five years. This is a slight advantage for the previous study because it might be better able to detect risks of chronic use of omega-3 supplements.

#4: How were participants selected?

  • Participants in the previous study had no previous diagnosis of heart disease while participants in the current study either had a previous diagnosis of heart disease or were at high risk of developing heart disease.

This difference would be relevant if both studies were looking at the benefits of omega-3 supplements. However, the current study was only looking at the side effects of omega-3 supplements, so this is not an important consideration.

Doctor With Patient#5: How was omega-3 intake monitored?

  • This was a significant flaw of the previous study. Use of omega-3 supplements was determined by a questionnaire administered when the subjects entered the study. No effort was made to determine whether the amount of omega-3s consumed remained constant during the 12-year study.
  • The clinical studies within the current meta-analysis were comparing intake of omega-3 supplements to placebo and monitored the use of the omega-3 supplements throughout the study.

#6: What is the dose-response?

  • This was another serious flaw of the previous study. There was no dose-response data.
  • The current study provided limited dose-response data. From the data they presented it appeared that the risk of bleeding events was only slightly dose-dependent except for the clinical study with the high dose (4 gm/day) EPA-only Vascepa drug. It was a clear outlier, which is why they analyzed the data from that study independently from the other studies.

#7: What outcomes were measured?

  • The only common outcome measured in the two studies was hemorrhagic stroke.
  • The previous study reported that omega-3 supplementation increased the risk of stroke by 5% in the general population. However:
    • That result just barely reached statistical significance.
    • It was a 5% increase in relative risk. The authors did not report absolute risk.
    • It was an association study, so it could not determine cause and effect.
  • The current study found omega-3 supplementation had no effect on the risk of stroke in a population that either had heart disease or were at high risk of heart disease.
    • The exception, of course, was the group taking the high dose Vascepa drug (see below).

Heart Disease Study#8: Was the risk clinically significant?

  • As I said above, the previous study only reported relative risk, which can be misleading. However, absolute risk can be calculated from their data. For example,
    • The risk of developing atrial fibrillation in the group taking omega-3 supplements was 4.4% (calculated from Table 2 of the manuscript). The authors said that represented a 13% increase in relative risk compared to the group not taking omega-3 supplements. This means the absolute (actual) increase in risk is about 0.6%.
    • The risk of stroke in the group taking omega-3 supplements was 1.5% (calculated from Table 2 of the manuscript). The authors said that represented a 5% increase in relative risk compared to the group not taking omega-3 supplements. This means the absolute (actual) increase in risk is about 0.08%.
  • In the current study the increased risk of stroke in the group taking the high-dose (4 gm/day) EPA-only Vascepa drug was 50% for relative risk, but only 0.6% for absolute risk.
    • The authors of the current study argued that, based on absolute risk, the risk of stroke for people taking Vascepa was “clinically insignificant”. I would argue the same is true for the results reported in the previous study and the headlines they generated.

#9: Who sponsored the study? 

  • The previous study was supported by the Bill and Melinda Gates Foundation, an organization that has no obvious interest in the outcome of the study.
  • The current study is sponsored by Amarin, the pharmaceutical company that manufactures and markets Vascepa.
    • However, to their credit, the authors made no effort to hide the negative data about Vascepa.
      • In fact, they highlighted the negative data, noted that the increased bleeding risk with Vascepa was different from the omega-3 supplements studied, and offered possible explanations for why a high potency, EPA-only supplement might increase the risk of bleeding more than a lower potency omega-3 supplement containing both EPA and DHA.
    • They did, however, choose to emphasize the 0.6% absolute increase in bleeding risk rather than the 50% relative increase in bleeding risk. However, as I noted above absolute risk is a more accurate way to report risk, especially when the risk in the control group is only 1.2%.

Perspective On This Comparison:

You may be tempted to conclude that the previous study was garbage. Before you do, let me provide some perspective.

  • The data for that study came from the UK Biobank, which is a long-term collection of data by the British government from over 500,000 residents in the United Kingdom. The data are made available to any researcher who wants to study links between genetic and environmental exposure to the development of disease. However, the data were not collected with any particular study in mind.

This is why omega-3 intake was only determined at the beginning of the study and there was no dose-response information included. The experimental design would have been different if the study were specifically designed to measure the influence of omega-3 supplementation on health outcomes. However, because of cost, the sample size would have been much smaller, which would have made it difficult to show any statistically significant results.

  • Relative risk rather than absolute risk is almost universally used to describe the results of clinical studies because it is a larger number and draws more attention. However, as I described above, relative risk can be misleading. In my opinion, both relative and absolute risk should be listed in every publication.

What Does This Study Mean For You?

ConfusionScientists know that every study has their flaws, so we don’t base our recommendations on one or two studies. Instead, we look at the totality of data before making recommendations. When looking at the totality of data two things stand out.

  • The bleeding risk with Vascepa is not unique. There are some studies suggesting that high dose (3-4 gm/day) omega-3 supplements containing both EPA and DHA may increase bleeding risk, although probably not to the same extent as Vascepa.
  • An optimal Omega-3 Index of 8% is associated with a decreased risk of heart disease and does not appear to increase the risk of atrial fibrillation or bleeding events such as hemorrhagic stroke. And for most people, an 8% Omega-3 Index can be achieved with only 1-2 gm/day of omega-3s.

So, my recommendations are the same as they were 6 weeks ago.

  • Be aware that high-dose (3-4 gm/day) of omega-3 supplements may cause an increased risk of atrial fibrillation and stroke, but the risk is extremely small.
  • Omega-3 supplementation in the 1-2 gm/day range appears to be both safe and effective.
  • I recommend getting your Omega-3 Index determined, and if it is low, increasing your omega-3 intake to get it into the 8% range.

The Bottom Line

A recent meta-analysis concluded that omega-3 supplementation does not increase the risk of bleeding events, including hemorrhagic stroke, intracranial bleeding, and gastrointestinal bleeding.

The exception was the high-dose (4 gm/day), EPA-only drug Vascepa, which increases bleeding risk from 1.2% to 1.8%, a 0.6% increase in absolute risk.

This study contradicts a previous study I shared with you only six weeks ago, so I made a detailed comparison of the strengths and weaknesses of each study.

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

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

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

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

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

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

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About The Author 

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

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

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

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

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

Health Tips From The Professor