Is The Mediterranean Diet Healthy For Women?

What Does This Study Mean For You? 

Author: Dr. Stephen Chaney 

There is a well-known health disparity in clinical studies related to health. For years most of the studies have been done by men for men. Women have been assumed to experience the same benefits and risks from diet choices as men. But that hasn’t always proven to be true.

The Mediterranean diet is no exception. For example, it has garnered a reputation of reducing heart disease risk for both men and women.

However, most studies on the Mediterranean diet have included primarily male participants or did not report sex specific differences in outcomes.

And the few studies that reported sex specific outcomes have been inconsistent.

  • Some studies have found that men and women benefitted equally from the Mediterranean diet.
  • Other studies have reported that men benefitted more than women.

However, these were all small studies. No meta-analyses have been reported that focused on the heart benefits of the Mediterranean diet for women.

The study (A Pant et al., Heart; 109: 1208-1215, 2023) I will describe today was designed to fill that gap.

How Was The Study Done?

clinical studyThe investigators started by screening the literature to find studies that:

  • Measured adherence to the Mediterranean diet using the original MDS (Mediterranean Diet Score) or more recent modifications of the MDS.
  • Included women ≥18 years without previous diagnosis of clinical or subclinical heart disease.
  • Performed the study with only women participants or organized their data so that the data pertaining to women could be extracted from the study.

The investigators then performed a meta-analysis on data from 722,495 women in 16 studies published between 2006 and 2021 that met these criteria. These studies followed the women for an average of 12.5 years. The studies were primarily conducted in the United States and Europe.

The individual studies divided participants into either quintiles or quartiles and compared participants with the highest adherence to the Mediterranean diet to those with the lowest adherence.

  • The primary outcomes measured were total mortality and the incidence of CVD, cardiovascular disease (defined as including CHD (coronary heart disease), myocardial infarction (heart attack), stroke, heart failure, and cardiovascular death).
  • The secondary outcomes measured were stroke and CHD, coronary heart disease (heart disease caused by atherosclerotic plaque build up in the coronary arteries).

Is The Mediterranean Diet Healthy For Women?

Mediterranean Diet FoodsWhen comparing the highest to the lowest adherence to the Mediterranean diet:

  • The incidence of CVD (cardiovascular disease) was reduced by 24%.
  • Total mortality during the ~12.5-year follow-up was reduced by 23%.
  • The incidence of CHD (coronary heart disease) was reduced by 25%.
  • The risk of stroke was reduced by 13%, but that risk reduction was not statistically significant.
    • The risk reduction for both CVD and total mortality was similar to that previously reported for men.
    • Risk reduction for CVD was slightly higher for women of European descent (24%) than for women of non-European descent (21%). The later category included women of Asian, Native-Hawaiian, and African – American descent.

The authors concluded, “This study supports a beneficial effect of the Mediterranean diet on the primary prevention of CVD and death in women and is an important step in enabling sex-specific guidelines.”

I would add that the data from women of non-European decent suggests that genetic background and/or ethnicity may influence the effectiveness of the Mediterranean diet at reducing heart disease risk, but this effect appears to be small.

What Does This Mean For You?

The results of this study are not unexpected. But that doesn’t mean that studies with women are not valuable. There have been several examples in recent years where health or medical advice based on studies with men needed to be modified for females once the studies were repeated with women.

Before covering what this study means for you, I should point out that while women often fear breast cancer most, heart disease is their number one killer, as the graph on the left shows. In fact, a woman’s risk of dying from coronary heart disease is 6 times greater than her risk of dying from breast cancer.

This study shows that following a Mediterranean–style diet lowers their risk of developing and dying from heart disease. But the Mediterranean diet is not alone in providing these health benefits. It is simply a whole food, primarily plant-based diet that reflects the food preferences of the Mediterranean region.

The DASH diet, which reflects the food preferences of Americans, and the Nordic diet, which reflects the food preferences of the Scandinavian countries, are equally heart healthy. In fact, any whole food, primarily plant-based diet will reduce the risk of heart disease. You should choose the one that best fits your food preferences and lifestyle.

Of course, diet is just part of a holistic approach for reducing heart disease risk. Other important risk reduction strategies include:

  • Don’t smoke.
  • Exercise and maintain a healthy weight.
  • Manage stress.
  • Avoid or limit alcohol.
  • Know your numbers (cholesterol, triglycerides, and blood pressure, for example).
  • Manage other health conditions that increase the risk of heart disease (high blood pressure, diabetes, and high cholesterol, for example).

The Bottom Line

Most studies on the heart health benefits of the Mediterranean diet have been done with men or have not analyzed the data from men and women separately. A recent meta-analysis combining data from 16 studies with 722,495 women showed that the Mediterranean diet was just as heart healthy for women as it was for men.

The authors concluded, “This study supports a beneficial effect of the Mediterranean diet on the primary prevention of CVD and death in women and is an important step in enabling sex-specific guidelines.”

For more details on this study and information on other diets that are heart healthy, 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 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.

Do Omega-3s Improve Recovery From A Heart Attack?

Where Do We Go From Here? 

Author: Dr. Stephen Chaney 

Omega-3s And Heart DiseaseDespite years of controversy, the benefits of omega-3s remain an active area of research. Over the next few weeks, I will review several groundbreaking omega-3 studies. This week I will focus on omega-3s and heart health.

I don’t need to tell you that the effect of omega-3s on heart health is controversial. One month a new study is published showing an amazing health benefit from omega-3 supplementation. A month or two later another study comes up empty. It finds no benefit from omega-3 supplementation.

That leads to confusion. On one hand you have websites and blogs claiming that omega-3s are a magic elixir that will cure all your ills. On the other hand, there are the naysayers, including many health professionals, claiming that omega-3 supplements are worthless.

I have discussed the reasons for the conflicting results from omega-3 clinical studies in previous issues of “Health Tips From the Professor”. You can go to https://www.chaneyhealth.com/healthtips/ and put omega-3s in the search box to read some of these articles.

Or if you prefer, I have also put together a digital download I call “The Omega-3 Pendulum” which briefly summarizes all my previous articles. It’s available on my Chaney Health School Teachable website.

Today I will discuss a study (B Bernhard et al, International Journal of Cardiology, 399; 131698, 2024) that asks whether 6 months of high dose omega-3 supplementation following a heart attack reduced the risk of major cardiovascular events over the next 6.6 years.

You might be wondering why the study didn’t just look at the effect of continuous omega-3 supplementation for 6 years following a heart attack. There are two very good reasons for the design of the current study.

1) The investigators wanted to do a double blind, placebo controlled clinical trial, the gold standard for clinical studies. However, that kind of study is impractical for a multi-year clinical trial. It would be prohibitively expensive, and patient compliance would be a big problem for a study that long.

2) The months immediately after a heart attack are critical in determining the long-term recovery of that patient. There is often a period of massive inflammation following a heart attack. And that can lead to further damage to the heart and reclosing of the arteries leading to the heart, both of which increase the risk of future adverse cardiac events.

Previous studies have shown that high dose omega-3s immediately following a heart attack can reduce inflammation and damage to the heart. However, those studies did not determine whether the cardioprotective effect of omega-3 supplementation immediately after a heart attack lead to improved long-term outcomes, something this study was designed to determine.

How Was The Study Done?

clinical studyThe investigators enrolled 358 patients who had suffered a heart attack from three Boston area medical centers between June 2008 and August 2012.

The patient demographics were:

  • Gender = 70% female.
  • Average age = 59
  • Average BMI = 29 (borderline obese).
  • Patients with high blood pressure = 64%
  • Patients with diabetes = 25%.

The patients were divided into two groups. The first group received capsules providing 4 gm/day of EPA, DHA, and other naturally occurring omega-3 fatty acids. The other group received a placebo containing corn oil. This was a double-blind study. Neither the patients nor the investigators knew which patients received the omega-3 fatty acids and which ones received the placebo.

The patients were instructed to take their assigned capsules daily for 6 months. At the beginning of the study, blood samples were withdrawn to determine the percentage of omega-3s in the fatty acid content of their red cell membranes (something called omega-3 index). Patients were also tested for insulin resistance and given a complete cardiovascular workup. This was repeated at the end of the 6-month study.

[Note: Previous studies have shown that an omega-3 index of 4% or lower is associated with high risk of heart disease, and an omega-3 index of 8% or above is associated with a low risk of heart disease.]

At 2-month intervals the patients were contacted by staff using a scripted interview to determine compliance with the protocol and their cardiovascular health. Once the 6 months of omega-3 supplementation was completed, the patients were followed for an additional 6.6 years. They were contacted every 6 months for the first 3 years and yearly between 3 years and 6 years.

The investigators quantified the number of major cardiac events (defined as recurrent heart attacks, the necessity for recurrent coronary artery bypass grafts, hospitalizations for heart failure, and all-cause deaths) for each patient during the 6.6-year follow-up period.

Patients in both groups were treated according to current “standard of care” protocols which consisted of diet and exercise advice and 5-6 drugs to reduce future cardiovascular events.

Do Omega-3s Improve Recovery From A Heart Attack?

heart attacksWhen the investigators looked at the incidence of adverse cardiac events during the 6.6-year follow-up period, there were three significant findings from this study.

1) There were no adverse effects during the 6-month supplementation period with 4 gm/day of omega-3s. This is significant because a previous study with 4 gm/day of high purity EPA had reported some adverse effects which had led some critics to warn that omega-3 supplementation was dangerous. More study is needed, but my hypothesis is that this study did not have side effects because it used a mixture of all naturally occurring omega-3s rather than high purity EPA only. 

However, this could also have been because of the way patients were screened before entering this study. I will discuss this in more detail below.

2) When the investigators simply compared the omega-3 group with the placebo group there was no difference in cardiovascular outcomes between the two groups. This may have been because this study faced significant “headwinds” that made it difficult show any benefit from supplementation. I call them “headwinds” rather than design flaws because they were unavoidable. 

    • It would be unethical to deny the standard of care to any patient who has just had a heart attack. That means that every patient in a study like this will be on multiple drugs that duplicate the beneficial effects of omega-3 fatty acids – including lowering blood pressure, lowering triglycerides, reducing inflammation, and reducing plaque buildup and blood clot formation in the coronary arteries.

That means that this study, and studies like it, cannot determine whether omega-3 fatty acids improve recovery from a heart attack. They can only ask whether omega-3 fatty acids have any additional benefit for patients on multiple drugs that duplicate many of the effects of omega-3 fatty acids. That significantly reduces the risk of a positive outcome.

    • As I mentioned above, it would have been impractical to continue providing omega-3 supplements and placebos during the 6.6-year follow-up.

And the study was blinded, meaning that the investigators did not know which patients got the omega-3s and which patients got the placebo. That meant the investigators could not advise the omega-3 supplement users to continue omega-3 supplementation during the follow-up period.

Consequently, the study could only ask if 6 months of high-dose omega-3 supplementation had a measurable benefit 6.6 years later. I, for one, would be more interested in knowing whether lower dose omega-3 supplementation continued for the duration of this study reduced the risk of major coronary events.good news

3) When the investigators compared patients who achieved a significant increase in their omega-3 index during the 6-month supplementation period with those who didn’t, they found a significant benefit of omega-3 supplementation.

This was perhaps the most significant finding from this study.  

If the investigators had stopped by simply comparing omega-3 users to the placebo, this would have been just another negative study. We would be wondering why it did not show any benefit of omega-3 fatty acid supplementation.

However, these investigators were experts on the omega-3 index. They knew that there was considerable individual variability in the efficiency of omega-3 uptake and incorporation into cell membranes. In short, they knew that not everyone taking a particular dose of omega-3s will achieve the same omega-3 index.

And that is exactly what they saw in this study. All the patients in the 6-month omega-3 group experienced an increase in omega-3 index, but there was considerable variability in how much the omega-3 index increased over 6 months.

So, the investigators divided the omega-3 group into two subgroups – ones whose omega-3 index increased by ≥ 5 percentage points (sufficient to move those patients from high risk of heart disease to low risk) and ones whose omega-3 index increased by less than 5 percentage points.

When the investigators compared patients with ≥ 5% increase in omega-3 index to those with <5% increase in omega-3 index:

  • Those with an increase in omega-3 index of ≥ 5% had a 2.9% annual risk of suffering major adverse cardiac events compared to a 7.1% annual risk for those with an increase of <5%.
  • That’s a risk reduction of almost 60%, and it was highly significant.

The authors concluded, “In a long-term follow-up study, treatment with [high dose] omega-3s for 6 months following a heart attack did not reduce adverse cardiac events compared to placebo. However, those patients who were treated with omega-3s and achieved ≥ 5% rise in omega-3 index experienced a significant reduction of adverse cardiac events after a median follow-up period of 6.6 years…Additional studies are needed to confirm this association and may help identify who may benefit from omega-3 fatty acid treatment following a heart attack.”

What Does This Study Mean For You? 

Questioning WomanI should start by saying that I do not recommend 4 gm/day of omega-3 fatty acids following a heart attack without checking with your doctor first.

  • If you are on a blood thinning medication, the dose of either the medication or the omega-3 supplement may need to be reduced to prevent complications due to excess bleeding.
  • In addition, the investigators excluded patients from this study who might suffer adverse effects from omega-3 supplementation. This is a judgement only your doctor can make.

With that advice out of the way, the most important takeaway from this study is that uptake and utilization of omega-3 fatty acids varies from individual to individual.

The omega-3 index is a measure of how well any individual absorbs and utilizes dietary omega-3s. And this study shows that the omega-3 index is a much better predictor of heart health outcomes than the amount of omega-3 fatty acids a person consumes.

This is not surprising because multiple studies have shown that the omega-3 index correlates with heart health outcomes. It may also explain why many studies based on omega-3 intake only have failed to show a benefit of omega-3 supplementation.

Vitamin D supplementation is a similar story. There is also considerable variability in the uptake of vitamin D and conversion to its active form in the body. 25-hydroxy vitamin D levels in the blood are a marker for active vitamin D. For that reason, I have long recommended that you get your 25-hydroxy vitamin D level tested with your annual physical and, with your doctor’s help, base the dose of the vitamin D supplement you use on that test.

This study suggests that we may also want to request an omega-3 index test and use it to determine the amount of supplemental omega-3s we add to our diet.

Where Do We Go From Here?

Where Do We Go From HereThe idea that we need to use the omega-3 index to determine the effectiveness of the omega-3 supplement we use is novel. As the authors suggest, we need more studies to confirm this effect. There are already many studies showing a correlation of omega-3 index with heart health outcomes. But we need more double blind, placebo-controlled studies like this one.

More importantly, we need to understand what determines the efficiency of supplemental fatty acid utilization so we can predict and possibly improve omega-3 utilization. The authors suggested that certain genetic variants might affect the efficiency of omega-3 utilization. But the variability of omega-3 utilization could also be affected by:

  • Diet, especially the presence of other fats in the diet.
  • Metabolic differences due to obesity and diseases like diabetes.
  • Gender, ethnicity, and age.
  • Design of the omega-3 supplement.

We need much more research in these areas, so we can personalize and optimize omega-3 supplementation on an individual basis.

The Bottom Line 

A recent study asked whether high dose omega-3 supplementation for 6 months following a heart attack reduced major cardiac events during the next 6.6 years.

  • When they simply compared omega-3 supplementation with the placebo there was no effect of omega-3 supplementation on cardiac outcomes.
  • However, when they based their comparison on the omega-3 index (a measure of how efficiently the omega-3s were absorbed and incorporated into cell membranes), the group with the highest omega-3 index experienced a 60% reduction in adverse cardiac events over the next 6.6 years.

This is consistent with multiple studies showing that the omega-3 index correlates with heart health outcomes.

More importantly, this study shows there is significant individual variation in the efficiency of omega-3 absorption and utilization. It also suggests that recommendations for omega-3 supplementation should be based on the omega-3 index achieved rather than the dose or form of the omega-3 supplement.

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.

 ______________________________________________________________________________

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 Heart Healthy?

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

Author: Dr. Stephen Chaney

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

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

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

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

How Was This Study Done?

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

The studies included in this analysis:

  • Used calcium doses from 500 mg/day to 2,000 mg/day.
  • Used supplements with calcium coming from a variety of sources (calcium carbonate, calcium citrate, calcium gluconolactate, and tricalcium phosphate).
  • Ranged from 18 months to almost 12 years in length.
  • Were performed with population groups from a wide range of countries (United States, England, France, Australia, New Zealand, European Union, Denmark, and Thailand).
  • Included calcium supplements with and without vitamin D.
  • Were primarily (86% of participants) conducted with post-menopausal women. One small study (0.3% of participants) was conducted with non-osteoporotic men. The rest were conducted with mixed populations (men and women) diagnosed with colorectal adenoma.

Are Calcium Supplements Heart Healthy?

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

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

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

  • Calcium supplements with and without vitamin D.
  • Dosage of calcium in the supplements (The dosage ranged from 500 mg/day to 2,000 mg/day).
  • Females (I suspect the number of males in this study was too small to come to a statistically significant conclusion).
  • Duration of calcium supplementation ≤ 5 years (The shortest duration of calcium supplementation in these studies was 18 months).
  • Different geographical regions.

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

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

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

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

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

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

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

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

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

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

    • Age or ethnicity of participants.
    • Other preexisting health conditions.
    • Other lifestyle factors (exercise is probably the most important, but others may be involved as well).
    • Diet context. For example, we already know that the effect of eggs and dairy on heart health is influenced by diet context. [I have covered this for eggs in a previous issue of “Health Tips From the Professor”.]
    • Other unanticipated variables.

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

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

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

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

    • The current RDAs are based on calcium needs for people consuming the typical American diet and following the typical American lifestyle. If that is you, the current RDAs probably apply.
    • However, strong bones are absolutely dependent on three things, adequate calcium, adequate vitamin D, and adequate weight-bearing exercise. Most recent studies of calcium supplementation and bone density include adequate vitamin D, but almost none of them include exercise. Previous studies have been inadequate.
    • The best calcium supplements contain certain nutrients besides vitamin D that optimize bone formation. I have listed those nutrients in the article cited above.
    • Our ability to use calcium to build strong bones is dependent on diet (something I call a bone-healthy diet) and lifestyle (something I call a bone-healthy lifestyle).
    • For more information on each of these points, read the article I referenced above.

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

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

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

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

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

    • Choose a calcium supplement that provides RDA levels of vitamin D plus other nutrients shown to support strong bone formation.
    • Choose a calcium supplement supported by clinical studies showing it is effectively utilized for bone formation.

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

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

    • The average American gets around 740 mg of calcium/day from their diet. That is probably enough for the small percentage of Americans following a bone healthy diet and lifestyle. But it is 260-460 mg short of the 1,000-1,200 mg/day recommended for older adults with the typical American diet and lifestyle.
      • And for the average American, around 70% of their calcium intake comes from dairy foods.

       

      • So, Americans who are following a typical American diet and lifestyle and are restricting dairy may require 800-1,000 mg/day of supplemental calcium unless they carefully plan their diets to optimize calcium intake.

       

      • Finally, vegans average about 550 mg/day from their diet. That might be borderline even if they were following a bone healthy lifestyle.
    • In short, we cannot assume our diet will provide enough calcium for strong bones unless we include dairy foods and/or plan our diet very carefully. Some degree of supplementation may be necessary.

How Much Calcium Do You Need?

Questioning Woman

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

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

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

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

  • The current RDAs of 1,000 – 1,200 mg/day are a good guideline for how much calcium you need if you follow the typical American diet and lifestyle.
  • If you a one of the few people who follow a bone healthy diet and lifestyle (For what that involves, read this article) you may only need 700-800 mg/day. But we don’t have clinical studies that can tell us what the actual RDA for calcium should be under those circumstances.

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

  • We should avoid calcium supplements that brag about how quickly and efficiently the calcium is absorbed. That could lead to calcium spikes. Instead, we should look for calcium supplements that are backed by clinical studies showing they are efficiently utilized for bone formation.
  • We should look for calcium supplements that include RDA levels of vitamin D and other nutrients that optimize bone formation. You will find more information on that in the same article I referenced above.
  • Some experts recommend that calcium supplements be taken between meals. But it is probably better to take them with meals because foods will likely slow the rate at which calcium is absorbed and reduce calcium spikes in the blood.
  • We are told to limit calcium supplements to less than 500 mg at any one time because calcium absorption becomes inefficient at higher doses. It might be even better to limit calcium to 250 mg or less at a time to reduce calcium spikes in the blood.

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

  • Many Americans do not get enough calcium from diet alone, especially if they avoid dairy foods. So, some degree of calcium supplementation may be necessary. I have given some guidelines depending on your diet and lifestyle above.
  • The amount of supplemental calcium needed is relatively small. I do not recommend exceeding the RDA unless directed to by your health professional.

The Bottom Line 

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

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

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

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

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

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

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

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

 _____________________________________________________________________________

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. Steve ChaneyDr. 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.

 

What Can Twins Tell Us About Diet?

What Are The Pros And Cons Of Twin Studies? 

Author: Dr. Stephen Chaney 

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

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

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

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

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

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

How Was The Study Done? 

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

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

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

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

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

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

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

What Can Twins Tell Us About Diet? 

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

  • LDL-cholesterol was reduced by 12% for the twin on the vegan diet, while it remained unchanged for the twin on the omnivorous diet.
  • The fasting insulin level was reduced by 21% for the twin on the vegan diet, while it remained unchanged for the twin on the omnivorous diet. This suggests the twin on the vegan diet was experiencing improved blood sugar control after just 8 weeks.
  • The twin on the vegan diet lost 4 pounds in 8 weeks, while weight remained the same for the twin on the omnivorous diet. This occurred even though neither twin was instructed to eat less nor to lose weight. It is most likely a consequence of the lower caloric density of the vegan diet (See my discussion of caloric density in last week’s issue of “Health Tips From the Professor”.
  • The changes in LDL-cholesterol and fasting insulin were remarkable because none of the twins in this study had elevated LDL-cholesterol or problems with blood sugar control at the beginning of the study.

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

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

Were There Any Downsides To The Vegan Diet? 

thumbs down symbolThis study also highlighted two well-known limitations of vegan diets.

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

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

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

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

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

I concur.

What Are The Pros And Cons Of Twin Studies? 

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

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

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

  • But there are several studies showing that the vegan diet is associated with lower weight and reduced risk of heart disease and diabetes.
  • And there are dozens of studies showing that primarily plant-based omnivorous diets reduce the risk of heart disease and diabetes.

This study is fully consistent with those studies.

The Bottom Line 

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

  • LDL-cholesterol was reduced by 12% for the twin on the vegan diet, while it remained unchanged for the twin on the omnivorous diet.
  • The fasting insulin level was reduced by 21% for the twin on the vegan diet, while it remained unchanged for the twin on the omnivorous diet. This suggests the twin on the vegan diet was experiencing improved blood sugar control after just 8 weeks.
  • The twin on the vegan diet lost 4 pounds in 8 weeks, while weight remained the same for the twin on the omnivorous diet. This occurred even though neither twin was instructed to eat less or to lose weight. It is most likely a consequence of the lower caloric density of the vegan diet.
  • The changes in LDL-cholesterol and fasting insulin were remarkable because none of the twins in this study had elevated LDL-cholesterol or problems with blood sugar control at the beginning of the study.

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

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

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

 _____________________________________________________________________________

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. Steve ChaneyDr. 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.

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

Which Diets Are Heart Healthy?

Which Diet Is Best For You?

Author: Dr. Stephen Chaney 

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

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

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

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

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

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

How Was The Study Done?

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

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

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

Using these criteria:

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

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

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

Which Diets Are Heart Healthy?

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

Compared to minimal intervention,

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

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

Which Diet Is Best For You?

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

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

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

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

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

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

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

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

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

The Bottom Line 

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

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

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

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

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

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

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

___________________________________________________________________________

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

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

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

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

Which Diets Are Heart Healthy?

What Does A Heart Healthy Diet Look Like?

Author: Dr. Stephen Chaney 

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

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

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

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

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

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

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

Why Are Americans Confused About Diet And Heart Disease Risk?

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

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

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

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

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

And, the words of the authors,

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

What Does A Heart Healthy Diet Look Like?

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

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

Here are my comments on these guidelines:

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

Which Diets Are Heart Healthy?

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

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

Here are the results:

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

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

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

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

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

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

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

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

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

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

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

The Bottom Line 

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

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

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

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

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

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

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

____________________________________________________________________________

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

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

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

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

Is Whole Fat Dairy Healthy?

Is It Dairy Or Diet?

Author: Dr. Stephen Chaney 

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

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

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

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

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

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

How Was This Study Done?

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

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

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

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

This is different from most other healthy diet recommendations.

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

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

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

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

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

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

Is Whole Fat Dairy Healthy?

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

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

 

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

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

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

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

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

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

2) You don’t have to be perfect.

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

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

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

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

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

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

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

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

Is It Dairy Or Diet?

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

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

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

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

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

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

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

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

On the other hand,

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

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

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

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

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

The Bottom Line 

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

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

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

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

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

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

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

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

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

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

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

_________________________________________________________________________

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

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

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

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

Are All Carbs Bad?

Are Low Carb Enthusiasts Right About The Dangers Of Carbohydrates?

Author: Dr. Stephen Chaney 

Low carb enthusiasts have been on the warpath against carbohydrates for years.

Almost everyone agrees that sugar-sweetened sodas and highly processed, refined foods with added sugar are bad for us. But low carb enthusiasts claim that we should also avoid fruits, grains, and starchy vegetables. Have they gone too far?

Several recent studies suggest they have. For example, both association studies and randomized controlled studies suggest that total carbohydrate intake is neither harmful nor beneficial for heart health.

In addition, recent studies suggest that free sugar intake is associated with both elevated triglyceride levels and an increase in heart disease risk.

But those studies have mostly looked at free sugar intake from sugar-sweetened sodas. The authors of this study (RK Kelley et al, BMC Medicine, 21:34, 2023) decided to look more carefully at the effect of all free sugars and other types of carbohydrates on triglyceride levels and heart disease risk.

How Was This Study Done?

clinical studyThe 110,497 people chosen for this study were a subgroup of participants in the UK Biobank Study, a large, long-term study looking at the contributions of genetic predisposition and environmental exposure (including diet) to the development of disease in England, Scotland, and Wales.

The participants in this study were aged between 37 and 73 (average age = 56) on enrollment and were followed for an average of 9.4 years. None of them had a history of heart disease or diabetes or were taking diabetic medications at the time of enrollment.

During the 9.4-year follow-up, five 24-hour dietary recalls were performed, so that usual dietary intake could be measured rather than dietary intake at a single time point. The people in this study participated in an average of 2.9 diet surveys, and none of them had less than two diet surveys.

The averaged data from the dietary recalls were analyzed for the amount and kinds of carbohydrate in the diet. With respect to the types of carbohydrate, the following definitions would be useful.

  • The term free sugars includes all monosaccharides and disaccharides added to foods by the manufacturer, cook, or consumer, plus sugars naturally present in honey, syrups, and unsweetened fruit juices.
  • The term non-free sugars includes all sugars not in the free sugar category, mostly sugars naturally occurring in fruits, vegetables, and dairy products.
  • The term refined grains includes white bread, white pasta, white rice, most crackers and cereals, pizza, and grain dishes with added fat.
  • The term whole grains includes wholegrain bread, wholegrain pasta, brown rice, bran cereal, wholegrain cereals, oat cereal, and muesli.

Finally, the study looked at the association of total carbohydrate and each class of carbohydrate defined above with all heart disease, heart attacks, stroke, and triglyceride levels.

Are All Carbs Bad?

Question MarkThe study looked at total carbohydrate intake, free sugar intake, and fiber intake. In each case, the study divided the participants into quartiles and compared those in the highest quartile with those in the lowest quartile.

Using this criterion:

  • Total carbohydrate intake was not associated with any cardiovascular outcome measured (total heart disease risk, heart attack risk, and stroke risk).
  • Free sugar intake was positively associated with all cardiovascular outcomes measured. Each 5% increase in caloric intake from free sugars was associated with a:
    • 7% increase in total heart disease risk.
    • 6% increase in heart attack risk.
    • 10% increase in stroke risk.
    • 3% increase in triglyceride levels.
  • Fiber intake was inversely associated with total heart disease risk. Specifically, each 5 gram/day increase in fiber was associated with a:
    • 4% decrease in total heart disease risk.

The investigators also looked at the effect of replacing less healthy carbohydrates with healthier carbohydrates. They found that:

  • Replacing 5% of caloric intake from refined grains with whole grains reduced both total heart disease risk and stroke risk by 6%.
  • Replacing 5% of caloric intake from free sugars (mostly sugar-sweetened beverages, fruit juices, and processed foods with added sugar) with non-free sugars (mostly fruits, vegetables, and dairy products) reduced total heart disease risk by 5% and stroke risk by 9%.

Are Low Carb Enthusiasts Right About The Dangers Of Carbohydrates?

With these data in mind let’s look at the claims of the low-carb enthusiasts.

Claim #1: Carbohydrates raise triglyceride levels. This study shows:

  • This claim is false with respect to total carbohydrate intake and high fiber carbohydrate intake (fruits, vegetables, and whole grains. This study did not measure intake of beans, nuts, and seeds, but they would likely be in the same category).
  • However, this claim is true with respect to foods high in free sugars (sugar-sweetened beverages, fruit juices, and processed foods with added sugar).

Claim #2: Carbohydrates increase heart disease risk. This study shows:

  • That claim is false with respect to total carbohydrate intake and high fiber carbohydrate intake.
  • However, this claim is true with respect to foods high in free sugars.

Claim #3: Carbohydrates cause weight gain [Note: Low carb enthusiasts usually word it differently. Their claim is that eliminating carbohydrates will help you lose weight. But that claim doesn’t make sense unless you believed eating carbohydrates caused you to gain weight.] This study shows:

  • This claim is false with respect to total carbohydrate intake and high fiber carbohydrate intake.
  • Once again, this claim is true with respect to foods high in free sugars.

The data with high fiber carbohydrates was particularly interesting. When the authors compared the group with the highest fiber intake to the group with the lowest fiber intake, the high-fiber group:

  • Consumed 33% more calories per day.
  • But had lower BMI and waste circumference (measures of obesity) than the low-carbohydrate group.

This suggests that you don’t need to starve yourself to lose weight. You just need to eat healthier foods.

And, in case you were wondering, the high fiber group ate:

  • 5 more servings of fruits and vegetables and…
  • 2 more servings of whole grain foods than the low fiber group.

This is consistent with several previous studies showing that diets containing a lot of fruits, vegetables, and whole grains are associated with a healthier weight.

The authors concluded, “Higher free sugar intake was associated with higher cardiovascular disease incidence and higher triglyceride concentrations…Higher fiber intake and replacement of refined grain starch and free sugars with wholegrain starch and non-free sugars, respectively, may be protective for incident heart disease.”

In short, with respect to heart disease, the type, not the amount of dietary carbohydrate is the important risk factor.

What Does This Mean For You?

Questioning WomanForget the low carb “mumbo jumbo”.

  • Carbohydrates aren’t the problem. The wrong kind of carbohydrates are the problem. Fruit juice, sugar-sweetened sodas, and processed foods with added sugar:
    • Increase triglyceride levels.
    • Are associated with weight gain.
    • Increase the risk for heart disease.
  • In other words, they are the villains. They are responsible for the bad effects that low carb enthusiasts ascribe to all carbohydrates.
  • Don’t fear whole fruits, vegetables, dairy, and whole grain foods. They are the good guys.
    • They have minimal effect on triglyceride levels.
    • They are associated with healthier weight.
    • They are associated with a lower risk of heart disease and diabetes.

So, the bottom line for you is simple. Not all carbs are created equal.

  • Your mother was right. Eat your fruits, vegetables, and whole grains.
  • Avoid fruit juice, sodas and other sugar-sweetened beverages, and processed foods with added sugar. [Note: Artificially sweetened beverages are no better than sugar-sweetened beverages, but that’s another story for another day.]

And, if you were wondering why low carb diets appear to work for weight loss, it’s because any restrictive diet works short term. As I have noted previously, keto and vegan diets work equally well for short-term weight loss.

The Bottom Line 

Low carb enthusiasts have been telling us for years to avoid all carbohydrates (including fruits, starchy vegetables, and whole grains) because carbohydrates:

  • Increase triglyceride levels.
  • Cause weight gain.
  • Increase our risk for heart disease.

A recent study has shown that these claims are only true for some carbohydrates, namely fruit juices, sodas and other sugar-sweetened beverages, and processed foods with added sugar.

Whole fruits, vegetables, and whole grain foods have the opposite effect. They:

  • Have a minimal effect on triglyceride levels.
  • Are associated with a healthier weight.
  • Are associated with a lower risk of heart disease and diabetes.

So, forget the low carb “mumbo jumbo” and be sure to eat your fruits, vegetables, and whole grains.

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.

___________________________________________________________________________

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

Are Low Carb Diets Healthier?

The “Goldilocks Effect”

Author: Dr. Stephen Chaney

Goldilocks EffectThe low-carb wars rage on. Low-carb enthusiasts claim that low-carb diets are healthy. Many health experts warn about the dangers of low-carb diets. Several studies have reported that low-carb diets increase risk of mortality (shorten lifespan).

However, two recent studies have come to the opposite conclusion. Those studies reported that high carbohydrate intake increased mortality, and low carbohydrate intake was associated with the lowest mortality.

One of those studies, called the Prospective Urban Rural Epidemiology (PURE) study was published a few years ago. It included data from 135,335 participants from 18 countries across 5 continents. That’s a very large study, and normally we expect very large studies to be accurate. The results from the PURE study had low-carb enthusiasts doing a victory lap and claiming it was time to rewrite nutritional guidelines to favor low-carb diets.

Whenever controversies like this arise, reputable scientists are motivated to take another look at the question. They understand that all studies have their weaknesses and biases. So, they look at previous studies very carefully and try to design a study that eliminates the weaknesses and biases of those studies. Their goal is to design a stronger study that reconciles the differences between the previous studies.

A third study published a year later (SB Seidelmann et al, The Lancet, doi.org/10.1016/S2468-2667(18)30135-X was such a study. This study resolved the conflicting data and finally answered the question: “How much carbohydrate should we be eating if we desire a long and healthy life?” The answer is “Enough”.

I call this “The Goldilocks Effect”. You may remember “Goldilocks And The Three Bears”. One bed was too hard. One bed was too soft. But one bed was “just right”. One bowl of porridge was too hot. One was two cold. But one was “just right”. According to this study, the same is true for carbohydrate intake. High carbohydrate intake is unhealthy. Low carbohydrate intake is unhealthy. But moderate carbohydrate intake is “just right”.

How Was The Study Done?

clinical studyThis study was performed in two parts. This first part drew on data from the Atherosclerosis Risk in Communities (ARIC) study. That study enrolled 15,428 men and women, aged 45-64, from four US communities between 1987 and 1989. This group was followed for an average of 25 years, during which time 6283 people died. Carbohydrate intake was calculated based on food frequency questionnaires administered when participants enrolled in the study and again 6 years later. The study evaluated the association between carbohydrate intake and mortality.

The second part was a meta-analysis that combined the data from the ARIC study with all major clinical studies since 2007 that measured carbohydrate intake and mortality and lasted 5 years or more. The total number of participants included in this meta-analysis was 432,179, and it included data from previous studies that claimed low-carbohydrate intake was associated with decreased mortality.

Are Low Carb Diets Healthier?

GravestoneThe results from the ARIC study were:

  • The relationship between mortality and carbohydrate intake was a U-shaped curve.
    • The lowest risk of death was observed with a moderate carbohydrate intake (50-55%). This is the intake recommended by current nutrition guidelines.
    • The highest risk of death was observed with a low carbohydrate intake (<40%).
    • The risk of death also increased with very high carbohydrate intake (>70%).
  • When the investigators used the mortality data to estimate life expectancy, they predicted a 50-year old participant would have a projected life expectancy of:
    • 33.1 years if they had a moderate intake of carbohydrates.
    • 4 years less if they had a low carbohydrate intake.
    • 1.1 year less if they had a very high carbohydrate intake.
  • The risk associated with low carbohydrate intake was affected by what the carbohydrate was replaced with.
    • When carbohydrates were replaced with animal protein and animal fat there was an increased risk of mortality on a low-carb diet. The animal-based low-carb diet contained more beef, pork, lamb, chicken, and fish. It was also higher in saturated fat.Beans and Nuts
    • When carbohydrates were replaced with plant protein and plant fats, there was a decreased risk of mortality on a low-carb diet. The plant-based low-carb diet contained more nuts, peanut butter, dark or whole grain breads, chocolate, and white bread. It was also higher in polyunsaturated fats.
  • The effect of carbohydrate intake on mortality was virtually the same for all-cause mortality, cardiovascular mortality, and non-cardiovascular mortality.
  • There was no significant effect of carbohydrate intake on long-term weight gain (another myth busted).

The results from the dueling meta-analyses were actually very similar. When the data from all studies were combined:

  • Both very low carbohydrate diets and very high carbohydrate diets were associated with increased mortality.
  • Meat-based low-carb diets increased mortality, and plant-based low-carb diets decreased mortality.
  • Once again, the results were the same for total mortality, cardiovascular mortality, and non-cardiovascular mortality.

The authors concluded: “Our findings suggest a negative long-term association between life-expectancy and both low carbohydrate and high carbohydrate diets…These data also provide further evidence that animal-based low carbohydrate diets should be discouraged. Alternatively, when restricting carbohydrate intake, replacement of carbohydrates with predominantly plant-based fats and proteins could be considered as a long-term approach to healthy aging.”

Simply put, that means if a low carb diet works best for you, it is healthier to replace the carbs with plant-based fats and protein rather than animal-based fats and protein.

The “Goldilocks Effect”

low carb dietThis study also resolved the discrepancies between previous studies. The authors pointed out that the average carbohydrate intake is very different in Europe and the US than in Asian countries and low-income countries.

In the US and Europe mean carbohydrate intake is about 50% of calories and it ranges from 25% to 70% of calories. With that range of carbohydrate intake, it is possible to observe the increase in mortality associated with both very low and very high carbohydrate intakes.

The US and European countries are affluent, which means that low-carb enthusiasts can afford diets high in animal protein.

White rice is a staple in Asian countries, and protein is a garnish rather than a main course. Consequently, overall carbohydrate intake is greater in Asian countries and very few Asians eat a truly low carbohydrate diet. High protein foods tend to be more expensive than high carbohydrate foods. Thus, very few people in developing countries can afford to follow a very low carbohydrate diet, and overall carbohydrate intake also tends to be higher.

Therefore, in Asian and developing countries the average carbohydrate intake is greater (~61%) than in the US and Europe, and the range of carbohydrate intake is from 45% to 80% of calories. With that range of intake, it is only possible to see the increase in mortality associated with very high carbohydrate intake.

Both the studies that low-carb enthusiasts quote to support their claim that low-carb diets are healthy relied heavily on data from Asian and developing countries.ARIC Study

In fact, when the authors of the current study overlaid the data from the PURE study with their ARIC data, there was an almost perfect fit. The only difference was that their ARIC data covered both low and high carbohydrate intake while the PURE study touted by low-carb enthusiasts only covered moderate to high carbohydrate intake.

[I have given you my rendition of the graph on the right. If you would like to see the data yourself, look at the paper.]

Basically, low-carb advocates are telling you that diets with carbohydrate intakes of 30% or less are healthy based on studies that did not include carbohydrate intakes below 40%. That is misleading. The studies they quote are incapable of detecting the risks of low carbohydrate diets.

What Does This Study Mean For You?

QuestionsThere are several important take-home lessons from this study:

  • All major studies agree that very high carbohydrate intake is unhealthy. In part, that reflects the fact that diets with high carbohydrate intake are likely to be high in sodas and sugary junk foods. It may also reflect the fact that diets which are high in carbohydrate are often low in plant protein or healthy fats or both.
  • All studies that cover the full range of carbohydrate intake agree that very low carbohydrate intake is also unhealthy. It shortens the life expectancy of a 50-year-old by about 4 years.
  • The studies quoted by low carb enthusiasts to support their claim that low-carb diets are healthy don’t include carbohydrate intakes below 40%. That means their claims are misleading. The studies they quote are incapable of detecting the risks of low carbohydrate diets.
  • Meat-based low-carb diets decrease life expectancy while plant-based low carb diets increase life expectancy. This is consistent with previous studies. For more details on those studies, see my article, “Are Any Low-Carb Diets Healthy?”, in “Health Tips From The Professor” or my book, “Slaying The Food Myths”.

The health risks of meat-based low-carb diets may be due to the saturated fat content or the heavy reliance on red meat. However, the risks are just as likely to be due to the foods these diets leave out – typically fruits, whole grains, legumes, and some vegetables.

Proponents of low-carb diets assume that you can make up for the missing nutrients by just taking multivitamins. However, each food group also provides a unique combination of phytonutrients and fibers. The fibers, in turn, influence your microbiome. Simply put, whenever you leave out whole food groups, you put your health at risk.

The Bottom Line

The low-carb wars are raging. Several studies have reported that low-carb diets increase risk of mortality (shorten lifespan). However, two studies published a few years ago have come to the opposite conclusion. Those studies have low-carb enthusiasts doing a victory lap and claiming it is time to rewrite nutritional guidelines to favor low-carb diets.

However, a study published a year later resolves the conflicting data and finally answers the question: “How much carbohydrate should we be eating if we desire a long and healthy life?” The answer is “Enough”.

I call this “The Goldilocks Effect”. According to this study, high carbohydrate intake is unhealthy. Low carbohydrate intake is unhealthy. But, moderate carbohydrate intake is “just right”.

Specifically, this study reported:

  1. Moderate carbohydrate intake (50-55%) is healthiest. This is also the carbohydrate intake recommended by current nutritional guidelines.

2) All major studies agree that very high carbohydrate intake (60-70%) is unhealthy. It shortens life expectancy of a 50-year old by about a year.

3) All studies that cover the full range of carbohydrate intake agree that low carbohydrate intake (<40%) is also unhealthy. It shortens life expectancy of a 50-year old by about 4 years.

4) The studies quoted by low carb enthusiasts to support their claim that low-carb diets are healthy don’t include carbohydrate intakes below 40%. That means their claims are misleading. The studies they quote are incapable of detecting the risks of low carbohydrate diets.

5) Meat-based low-carb diets decrease life expectancy while plant-based low carb diets increase life expectancy. This is consistent with the results of previous studies.

The authors concluded: “Our findings suggest a negative long-term association between life-expectancy and both low carbohydrate and high carbohydrate diets…These data also provide further evidence that animal-based low carbohydrate diets should be discouraged. Alternatively, when restricting carbohydrate intake, replacement of carbohydrates with predominantly plant-based fats and proteins could be considered as a long-term approach to healthy aging.”

Simply put, that means if a low carb diet works best for you, it is healthier to replace the carbs with plant-based fats and protein rather than animal-based fats and protein.

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.

Are Easter Eggs Bad For You?

Clearing Up The Eggfusion 

Author: Dr. Stephen Chaney

The Easter Bunny will be here soon bringing beautifully decorated eggs for all the children. But wait. Aren’t eggs bad for us? Should we really be encouraging our kids to eat Easter eggs? Maybe we should encourage them to eat Easter candy instead (just kidding).

What is the truth about eggs on our health? Perhaps it’s time for the professor to clear up the “eggfusion” (That’s short for egg confusion). Let me start with a brief historical summary:

  • First there were the warnings that eggs were bad for your heart because egg yolks contained cholesterol, and cholesterol was to be avoided at all costs.
  • Then experts decided that dietary cholesterol wasn’t all that bad for you. It was saturated fats, obesity, and lack of exercise that raised “bad” (LDL) cholesterol levels in your bloodstream.
  • That was followed by several US studies suggesting that eggs in moderation (one per day) did not affect your risk of heart disease.
  • Then a major study claimed that an egg a day actually lowered your risk of heart disease.

Now, the most recent headlines claim that eggs increase your risk of heart disease, and you should avoid them. No wonder you are experiencing eggfusion. Let me review the latest study and put it into perspective by comparing it to previous studies. Let me clear up the eggfusion.

But let me warn you. This is a bit complex, as the truth often is. When I try to explain the contradictions between major studies on egg consumption and heart health, I think the best analogy might be the tale of the blind men trying to tell what an elephant was like by touching different parts of the elephant. None of them could provide an accurate description because none of them could see the whole elephant.

We need to look at the “whole elephant” to see what these studies missed.

How Was The Study Done?

Heart Disease StudyThis study (WW Zhong et al, JAMA, 321: djw322, 2017) combined the data from 6 clinical trials in the United States that assessed dietary intake and measured cardiovascular health outcomes. In all, these studies included 29,615 adults who were followed for an average of 17.5 years.

The diet of the participants was assessed upon entry into each of the clinical trials. The primary variables derived from the dietary information were cholesterol and egg consumption. Diet was not assessed at later times in these studies.

The primary outcomes measured were heart disease and all-cause mortality. In this study heart disease was an umbrella term that included fatal and non-fatal heart attacks, stroke, heart failure, and death from other heart-related causes.

Do Eggs Increase Heart Disease Risk?

heart attacksHere are the main findings from this study.

  • Each additional half an egg consumed per day (which is equivalent to 3-4 eggs per week) was associated with a:
    • 6% increased risk of heart disease. While that doesn’t sound like much, the increased risk was over 13% for one egg per day and almost 27% for two eggs per day.
  • The increased heart disease risk associated with one half egg per day was greater for:
    • Women (13% increase) than men (3% increase).
    • People who already had high blood cholesterol (7% increase), not people who already had low cholesterol levels (0% increase). This suggests that the effect of eggs on heart disease risk primarily affects people who are already having trouble controlling their blood cholesterol levels – either due to genetics or due to diet & lifestyle.

Of course, the question is whether it was the eggs that increased the risk of heart disease or was it something else in the diet. This study attempted to answer that question by systematically subtracting out other variables that affect heart disease risk to see whether that correction eliminated the association between egg consumption and heart disease risk. When this was done:

  • The association between egg consumption and heart disease risk disappeared after correcting for dietary cholesterol intake.
  • The association between egg consumption and heart disease risk remained significant after correcting for other components of the diet, such as fats, animal protein, fiber, sodium, or overall “diet quality”. There were 3 main measures of diet quality.
    • The Med diet score measures how closely the diet resembles the Mediterranean diet.
    • The DASH diet score measures how closely the diet resembles the DASH diet.
    • The Healthy Eating Index (HEI) measures how closely the diet aligns with the USDA Dietary Guidelines For Americans. Basically, the HEI recommends a whole food diet containing foods from all 5 food groups with a heavy emphasis on fruits, vegetables, whole grains, and legumes. It also recommends limiting saturated and trans fats, added sugars, and sodium.

In simple terms the authors concluded that the effect of eggs on heart disease risk was primarily due to their cholesterol content and was not influenced by other components of the overall diet. [I will revisit this conclusion latter.]

What Are The Strengths And Weaknesses Of The Study?

SkepticThe strengths are obvious. This was a very large study (29,615 participants) and the people enrolled in the study were followed for a long time (an average of 17.5 years). The primary variables in the study (cholesterol consumption, egg consumption, heart disease, and all-cause mortality) were accurately measured in each of the clinical trials included in the study.

However, there were some significant weaknesses as well:

  • Cholesterol and egg consumption were only measured by a single dietary survey when people entered the study. This study assumes they did not change over the course of the study. That is very unlikely. Both cholesterol intake and egg consumption in the US population have waxed and waned over the years, in part due to variations in dietary guidelines.
  • The measurements of diet quality used were based on US and European food preferences. That is significant because the only studies showing that egg consumption lowers heart disease risk were performed in China and Japan, where the diet is closer to semi-vegetarian than to US or European diets.

Are Easter Eggs Bad For You?

thumbs down symbolThis is very large, well designed study that combines the data from 6 clinical trials spanning the years 1974 to 2013.

The strongest conclusions from the study are:

  • In the context of a Western diet (the US diet) egg consumption slightly increases your risk developing heart disease. The increased risk is ~6% for 3-4 eggs/week, ~13% for 1 egg per day, and ~27% for two eggs per day.
  • The increased risk of heart disease appears to be almost entirely due to the cholesterol content of eggs.

The significance of this study needs to be weighed in the context of:

  • Recent studies in the US and Europe showing eggs do not increase heart disease risk.
  • Studies in China and Japan (where the diets can best be described as semi-vegetarian) showing that eggs decrease heart disease risk.

The significance of this study also needs to be weighed in the context of:

  • Studies showing that obesity, saturated fat, and physical inactivity have bigger effects on serum cholesterol levels and heart disease risk than dietary cholesterol from foods like eggs.

What Did This Study Miss?

EggsIf, as this study suggests, the effect of eggs on heart disease risk is due to their cholesterol content, this study (and most previous studies) missed a very important point. The effect of dietary cholesterol on blood cholesterol levels is not strongly affected by the overall composition of the diet. It is affected by the composition of the diet at the time foods containing dietary cholesterol are eaten.

  • The kind of fiber found in certain fruits, vegetables, whole grains, and legumes bind to dietary cholesterol, preventing it from being absorbed as it passes through the intestine.
  • Certain phytonutrients in plant foods affect how dietary cholesterol is utilized by the body.
  • However, to blunt the effect of dietary cholesterol on blood cholesterol levels the fiber and phytonutrient-containing foods must be consumed at the same meal.

Simply put, if your breakfast consists of eggs, sausage, biscuits, and hash browns, the cholesterol in the eggs will likely increase your blood cholesterol level, which in turn increases your risk of heart disease. This will occur even if you eat lots of fruits, vegetables, whole grains, and legumes with your other meals.

If, on the other hand, your breakfast consists of eggs and fiber-rich plant foods like oatmeal and beans, the cholesterol in the eggs will likely have a much smaller effect on your blood cholesterol levels and your heart disease risk.

The fact that previous studies have not looked at what foods were consumed along with the eggs may explain some of the variation in their conclusions about the effect of egg consumption on heart disease risk.

The Professor’s Story

professor owlLet me share my story with you. About 25 years ago, my doctor told me that my cholesterol levels were getting high and wanted to put me on statins. I didn’t take a stain, and I didn’t stop eating eggs for breakfast. I changed breakfast.

Now I soft boil my eggs or fry them in olive oil. I eat them along with oatmeal, which contains a fiber that binds cholesterol, and walnuts, which contain omega-3s and phytonutrients that lower blood cholesterol. I also include whatever fruit is in season. Finally, I take a supplement providing 2 grams of plant stanols and sterols, which blocks cholesterol absorption from the intestine.

My blood cholesterol levels have been low ever since. I have not had to take statins, and I get to enjoy the taste and health benefits of an egg any time I want to. Of course, what worked for me may not work for you. The effect of dietary cholesterol on blood cholesterol levels is also affected by genetics, weight, and fitness, just to name the top three.

Are Easter Eggs Good For You?

thumbs upOnce you get past the cholesterol problem, eggs are a very healthy food.

  1. Studies have shown that egg protein results in improved blood sugar control, better satiety (feeling of fullness), and reduced subsequent food intake in healthy and overweight individuals. In layman’s terms that means egg protein can help you achieve and maintain a healthy weight.

2) Egg yolks are a good source of lutein and zeaxanthin. We think of lutein and zeaxanthin as good for eye health. They also play an important role in protecting against oxidation, inflammation, and atherosclerosis.

3) Egg yolks also contain choline. We think of choline as good for brain and nerves. But, choline and other phospholipids in the yolk also raise HDL levels and enhance HDL function.

4) Eggs are a good source of vitamin A, vitamin D, vitamin B12, riboflavin, selenium and iron.

5) Eggs contain almost twice as much monounsaturated and polyunsaturated fats as saturated fats.

Clearing Up The “Eggfusion”

egg confusion

  1. The latest study suggests that eggs may increase your risk of heart disease, and this is due to their cholesterol content.

2) This study needs to be considered in the context of recent studies in the US showing that egg consumption did not increase heart disease risk and studies in China and Japan showing that egg consumption lowered heart disease risk.

3) It is also important to consider that egg consumption in China and Japan is in the context of a semi-vegetarian diet. This suggests that diet plays a role in determining the effect of egg consumption on heart disease risk.

4) However, if you take this study at face value, there are two things you can do to reduce your risk of heart disease:

  • Reduce dietary cholesterol by avoiding eggs or using egg whites.
    • Eat eggs in moderation along with fiber- and phytonutrient-rich plant foods that negate the effect of dietary cholesterol on blood cholesterol levels. I recommend oatmeal or beans, nuts or seeds, and fiber rich fruits and vegetables. These should be consumed at the same meal to minimize the effect of the cholesterol in the eggs on blood cholesterol levels. As for Easter eggs, they are a perfect addition to a green salad.
    • Eggs are a very healthy food, so I recommend the second option if possible. Get your blood cholesterol levels measured to determine which approach works best for you.

5) Finally, we need to recognize that egg consumption plays a relatively minor role in determining heart disease risk. Other factors play a much larger role in influencing heart disease risk. For example:

    • Smoking, obesity, inactivity, saturated and trans fats significantly increase your risk of heart disease.
    • Omega-3s, antioxidants, and a primarily plant-based diet like the Mediterranean diet significantly decrease your risk of heart disease.

If we wish to reduce our risk of heart disease, this is where we should focus most of our attention. We can minimize the effect of egg consumption on heart disease risk by changing the foods we eat with the eggs. For more information on how to reduce your risk of heart disease, read my books, “Slaying The Food Myths” and “Slaying The Supplement Myths”.

The Bottom Line

1) The latest study suggests that eggs increase your risk of heart disease because of their cholesterol content.

2) This was a very large study. It combined the data from 6 clinical trials spanning the years 1974 to 2013. It followed 29,615 people for an average of 17.5 years. However, it has two significant weaknesses:

  • It only determined cholesterol intake and egg consumption at the time people entered the clinical trials. Both cholesterol intake and egg consumption have waxed and waned considerably over the years covered by these clinical trials.
  • It did not measure what foods were consumed along with the eggs. Foods consumed along with eggs have a strong influence on how much the cholesterol in the eggs influences blood cholesterol levels, which, in turn, influences the effect eggs have on heart disease risk.

3) This study also needs to be considered in the context of recent studies in the US showing that egg consumption did not increase heart disease risk and studies in China and Japan showing that egg consumption lowered heart disease risk.

4) However, if you take this study at face value, there are two things you can do to reduce your risk of heart disease:

  • Reduce dietary cholesterol by avoiding eggs or using egg whites.
  • Eat eggs in moderation along with fiber- and phytonutrient-rich plant foods that negate the effect of dietary cholesterol on blood cholesterol levels. I recommend oatmeal or beans, nuts or seeds, and fiber rich fruits and vegetables. These should be consumed at the same meal to minimize the effect of the cholesterol in the eggs on blood cholesterol levels. As for Easter eggs, they are a perfect addition to a green salad.
  • Eggs are a very healthy food, so I recommend the second option if possible. Get your blood cholesterol levels measured to determine which approach works best for you.

5) Finally, we need to recognize that egg consumption plays a relatively minor role in determining heart disease risk. Other factors play a much larger role in influencing heart disease risk. For example:

  • Smoking, obesity, inactivity, saturated and trans fats significantly increase your risk of heart disease.
  • Omega-3s, antioxidants, and a primarily plant-based diet like the Mediterranean diet significantly decrease your risk of heart disease.

For more information on how to reduce your risk of heart disease, read my books, “Slaying The Food Myths” and “Slaying The Supplement Myths”.

For more details and to learn what the professor does about egg consumption, 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.

 

 

 

Health Tips From The Professor