Past Issues - Health Tips From The Professor

What Can Twins Tell Us About The Vegan Diet?

September 8, 2026 by Dr. Steve Chaney

Are There Any Downsides To The Vegan Diet?

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

How Was The Study Done?

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

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

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

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

For the first four weeks the participants were provided with all their meals by a nationwide food delivery company. The participants were also provided with training in 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 The Vegan Diet?

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

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

The fasting insulin level was reduced by 21% for the twin on the vegan diet, while it remained unchanged for the twin on the omnivorous diet.

This suggests the twin on the vegan diet was experiencing improved LDL cholesterol and blood sugar control after just 8 weeks.

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

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

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

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

Were There Any Downsides To The Vegan Diet?

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

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

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

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

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

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

I concur. That is why I recommend a whole-food, primarily plant-based diet rather than a strict vegan diet.

What Are The Pros And Cons Of Twin Studies?

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

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

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

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

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

This study and the conclusions of the authors are fully consistent with these 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.

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

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

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

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

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

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

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

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

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About The Author

Dr Chaney 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 54 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.

Processed Food And Obesity

September 1, 2026 by Dr. Steve Chaney

Why Do Processed Foods Make Us Fat?

Author: Dr. Stephen Chaney

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

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

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

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

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

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

What Are Processed Foods?

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

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

Unprocessed or minimally processed foods.

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

Processed culinary ingredients.

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

Minimally processed foods.

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

Ultra-processed foods.

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

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

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

Do Processed Foods Make You Fat?

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

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

Total calories in the food portions given to the subjects.

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

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

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

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

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

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

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

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

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

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

Processed Food And Obesity

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Why does the structure of whole foods matter?

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

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

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

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

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

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

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

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

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

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

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

How Can You Enjoy Eating Without Getting Fat?

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

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

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

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

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

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

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

Tip #3: Be aware of how foods are prepared. The studies described above also suggest how we prepare the food is important. We can start out with a whole unprocessed food and end up with something no better than processed food if we prepare it incorrectly.

If we add lots of cream, cheese, butter, and/or sugar, we increase the caloric density. And this can lead to us consuming more calories without even thinking about it.

Throw in some salt and we have also made the food hyper-palatable, which makes us want to eat more.

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

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

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

The Bottom Line

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

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

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

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

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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

Does Genetics Determine Your Destiny?

August 25, 2026 by Dr. Steve Chaney

The Influence Of Genetics And Diet On Type 2 Diabetes

Author: Dr. Stephen Chaney

Does it ever feel like you have drawn the short straw?

Everyone in your family has succumbed to heart disease, diabetes, or cancer at a young age. Are you doomed to the same fate?

You ordered a DNA test. It sounded like fun. But when the gene report came back it said you had a “bad” genetic profile. You were told you are at high risk of diabetes, heart attack, stroke, cancer, or dementia. Are you doomed to a short and sickly life?

In both cases, you are probably wondering, “Is there anything I can do to improve my odds of a healthy life? What if I lost some of those extra pounds, exercised more, and ate a healthier diet? Would that make a difference?”

The study (J Merino et al, PLoS Medicine 19(4): e1003972, April 26, 2022) I will describe today was designed to answer these questions.

But before I describe the study, I should probably cover what I call Genetics 101: “How Genes Affect Your Health”.

Genetics 101: How Genes Affect Your Health

If you studied genetics in school, you probably learned about diseases like sickle cell anemia, which is caused by a single mutation in a single gene. If you get two copies of the “bad” gene, you will have sickle cell anemia. If you get one copy of the “bad” gene and one copy of the normal gene, you have sickle cell trait, which is much less severe.

Simply put, you either have the disease, or you don’t. It’s dependent on your genetics, and you can’t do much about it.

If you know someone who has been treated for breast cancer, you are probably familiar with a more complex relationship between genetics and health. There are several “bad” genes that increase the risk of breast cancer. And knowing which gene is involved is important for selecting the best treatment regimen.

But most of the diseases that shorten our lives (like diabetes, heart disease, most cancers, and dementia) are what we call polygenetic diseases. Simply put, that means that there are dozens of genes that increase the risk of these diseases. Each gene makes a small contribution to the increased risk. So, we can only measure the genetic contribution to these diseases by measuring hundreds of mutations in dozens of genes, something called a polygenetic risk score.

The study I will be describing today looked at the relative effect of genetics (measured as the type 2 diabetes polygenic risk score) and diet quality (measured as the Alternative Healthy Eating Index (AHEI)) on the risk of developing type 2 diabetes.\

How Was This Study Done?

The data for this study were obtained from 3 long-term clinical studies conducted in the United States – the Nurses’ Health Study (121,700 participants), the Nurses’ Health Study II (116,340 participants), and the Health Professionals Follow-Up Study (51,529 participants).

These studies measured lifestyle factors (including diet) every 4 years and correlated them with disease outcomes over 20+ years.

The study I will be discussing today was performed with 35,759 participants in those 3 studies for whom DNA sequencing data was available.

The DNA sequence data were used to generate a type 2 diabetes polygenic risk score for each participant in this study.

Food frequency questionnaires obtained every 4 years in these studies were used to calculate the Alternative Healthy Eating Index (AHEI) score for each participant.

- The AHEI is based on higher intake of fruits, whole grains, vegetables, nuts and legumes, polyunsaturated fatty acids, long-chain omega-3 fatty acids, moderate intake of alcohol, and lower intake of red and processed meats, sugar sweetened drinks and fruit juice, sodium, and trans-fat).

The investigators used these measurements to estimate the relative effect of genetics and diet quality on the risk of developing type 2 diabetes.

The Influence Of Genetics And Diet On Type 2 Diabetes

The participants were divided into low, intermediate, and high genetic risk based on their type 2 diabetes polygenic risk score. Compared with low genetic risk:

Intermediate genetic risk increased the risk of developing type 2 diabetes by 26%.

High genetic risk increased the risk of developing type 2 diabetes by 75%.

Put another way, each 1 standard deviation increase in the polygenetic risk score:

Increased the risk of developing type 2 diabetes by 42%.

Simply put, bad genes can significantly increase your risk of developing type 2 diabetes. That’s the bad news. But that doesn’t mean you should think, “Diabetes is in my genes. There is nothing I can do.”

The investigators also divided the participants into those who had a high-quality diet, those who had an intermediate quality diet, and those who had a low-quality diet based on their AHEI (Alternative Healthy Eating Index) score.

Finally, they divided the participants into groups depending on their BMI, a measure of obesity.

Compared to an obese person consuming a low-quality diet, a lean person consuming a high-quality diet:

Reduced their risk of developing type 2 diabetes by around 43% for each category of genetic risk.

More specifically, a lean person consuming a high-quality diet reduced their risk of developing type 2 diabetes:

- By 41% if they were at low genetic risk.

- By 50% if they were at intermediate genetic risk.

- By 38% if they were at high genetic risk.

The investigators then made a statistical adjustment to remove BMI from their calculations, so they could focus on the effect of diet alone on the risk of developing type 2 diabetes.

Compared to a low-quality diet, a high-quality diet:

Reduced the risk of developing type 2 diabetes by around 33% for each category of genetic risk.

More specifically, a high-quality diet reduced the risk of developing type 2 diabetes:

- By 31% for those at low genetic risk.

- By 39% for those at intermediate genetic risk.

- By 29% for those at high genetic risk.

Looking at it another way:

When people at high genetic risk consumed a high-quality diet, their risk of developing type 2 diabetes was only 13% higher than people at intermediate genetic risk who consumed a low-quality diet (such as the typical American diet).

When people at intermediate genetic risk consumed a high-quality diet, their risk of developing type 2 diabetes was 5% less than people at low genetic risk who consumed a low-quality diet.

Simply put:

If you are at intermediate genetic risk, a high-quality diet may completely reverse your risk of developing type 2 diabetes.

If you are at high genetic risk, a high-quality diet can partially reverse your risk of developing type 2 diabetes.

In short, the good news is that bad genes do not doom you to type 2 diabetes. Your genetics doesn’t have to determine your destiny.

The investigators did not provide similar information for the effect of an ideal weight on the risk of developing type 2 diabetes, but it is likely that the combination of diet plus weight management would result in an even more significant reduction in risk of developing type 2 diabetes for individuals in the even the highest risk category.

The authors concluded, “These data provide evidence for the independent associations of genetic risk and diet quality with incident type 2 diabetes and suggest that a healthy diet is associated with lower diabetes risk across all levels of genetic risk.”

Does Genetics Determine Your Destiny?

At the beginning of this article I posed the question, “Does Genetics Determine Your Destiny?”

Based on this study, the good news is that bad genes don’t doom you type 2 diabetes. And just because most of your relatives are diabetic doesn’t mean that must be your fate.

This study shows that a healthy diet significantly reduces your risk of developing type 2 diabetes at every genetic risk level.

And the study suggests that a healthy diet plus a healthy weight is even more beneficial at reducing your risk of type 2 diabetes.

While not included in this study, other studies have shown that exercise also plays a role in reducing type 2 diabetes risk.

None of this information is new. What is new is that a healthy diet is equally beneficial at reducing type 2 diabetes risk even in individuals with a high genetic risk of developing the disease. Simply put, your genetics doesn’t have to determine your destiny. You can make a positive difference in your health no matter how how bad were the genes you inherited!

“And what is this magic diet?”, you might ask. In this study, it was based on AHEI score. Someone with a high AHEI score consumes:

Lots of fruits, whole grains, vegetables, nuts and legumes, polyunsaturated fatty acids, and long-chain omega-3 fatty acids.

Moderate or no amounts of alcohol.

Little or no red and processed meats, sugar sweetened drinks, fruit juices, sodium, and foods with trans-fat.

Any whole food, primarily plant-based diet from vegan to Mediterranean or DASH fits the bill.

Finally, while this study focused just on type 2 diabetes, other studies have come to similar conclusions for other diseases.

Should You Get Your DNA Tested?

If you are looking for guidance on how to reduce your risks, the answer is, “No”. In this study, the same diet and lifestyle changes lowered the risk of type diabetes at every genetic risk level. Despite what some charlatans may tell you, there is no special diet or magic potion for people with a high genetic risk for developing type 2 diabetes.

If you are looking for motivation, the answer may be, “Yes”. If knowing you are at high risk makes it more likely that you will make the diet and lifestyle changes needed to lower your risk of type 2 diabetes, a DNA test may be just what you need.

The Bottom Line

If a serious disease runs in your family or if you have had your DNA tested and found out you are at high risk for some disease, you are probably wondering whether there is anything you can do or whether your bad genes have doomed you to a short and sickly life.

A recent study answered that question for type 2 diabetes. It showed a healthy diet significantly reduces the risk of type 2 diabetes even in people at high genetic risk of developing the disease.

Other studies have come to similar conclusions for other diseases. In short, your genetics doesn’t have to determine your destiny. You can make a positive difference in your health no matter how how bad were the genes you inherited!

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

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

_______________________________________________________________________________________________

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

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

_____________________________________________________________________________________

About The Author

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

Building Healthy Bones Part2

August 18, 2026 by Dr. Steve Chaney

Creating A Bone-Healthy Lifestyle

Author: Dr. Stephen Chaney

A major study (Tai et al, British Medical Journal, BMJ/2015; 351:h4183) reported that calcium supplementation in women over 50 resulted in only a very small increase in bone density, which translated into a very small (5-10%) decrease in the risk of bone fractures.

The authors concluded that the standard RDA recommendation of 1,000 – 1,200 mg/day of calcium for adults over 50 is unlikely to prevent osteoporosis or reduce the risk of bone fractures.

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

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

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

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

Creating A “Bone Healthy” Lifestyle

Despite the concerns I just mentioned. Let’s assume for a minute that the study might just be correct in spite of its many flaws. Let’s assume that the “one size fits all” RDA recommendation of 1,000 – 1,200 mg/day of calcium if you are over 50 may be flawed advice.

If so, perhaps it’s time to say good riddance! It may finally be time to put away the “magic bullet”, “one size fits all” thinking and start seriously considering holistic approaches.

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

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

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

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

#3: Test your blood 25-hydroxyvitamin D level: 25-hydroxy vitamin D is the active form of vitamin D in our bloodstream. We need a sufficient (20-50 ng/mL) blood level of 25-hydroxy vitamin D to be able to use calcium efficiently for bone formation. We now know that some people who seem to be getting adequate vitamin D in their diet still have low 25-hydroxy vitamin D levels.

In fact, various studies have shown that somewhere between 20-35% of Americans have insufficient blood levels of 25-hydroxy vitamin D. You should get your blood level tested. If it is low, consult with your health professional on how much vitamin D you need to bring your 25-hydroxy vitamin D into the sufficient range.

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

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

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

Exercise Is A Critical Part of a “Bone Healthy” Lifestyle

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

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

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

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

But can exercise do it alone? Some people seem to think so. That brings up my second story. About 40 years ago one of my colleagues at UNC, who was an expert on calcium metabolism, was doing a bone density study on female athletes at UNC. One of the tennis players was nicknamed “Tab”. Tab was a popular soft drink at that time, and Tab was all she drank – no milk, no water, only Tab.

When my colleague measured the bone density of her playing arm, it was normal for a woman of her age. When he measured the bone density of her non-playing arm, it was that of a 65-year-old woman. The reason is simple. When we exercise a particular bone, our body will add calcium to that bone to make it stronger. If we are not getting enough calcium from our diet, our body simply dissolves the bones elsewhere in our body to get the calcium that it needs.

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

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

Putting It All Together – Building Healthy Bones

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

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

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

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

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

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

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

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

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

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

What About Medications For Preventing Bone Loss?

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

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

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

The Bottom Line

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

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

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

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

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

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

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

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

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

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

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

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

_________________________________________________________________________________________________

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

Building Healthy Bones Part1

August 11, 2026 by Dr. Steve Chaney

Do Calcium Supplements Prevent Bone Fractures?

Author: Dr. Stephen Chaney

Building Healthy Bones Part1

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

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

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

Bone Metabolism and Osteoporosis

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

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

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

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

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

What is a “bone healthy” lifestyle, you might ask. Because calcium is a major component of bone, the medical and nutrition communities have long focused on calcium as a “magic bullet” that can assure bone health. Once the importance of vitamin D was understood, it was added to the equation.

For years we have been told that if we just get enough calcium and vitamin D in our diets, we would build strong bones when we were young, maintain bone density most of our adult years, and lose bone density as slowly as possible as we age. It is this paradigm that recent studies challenge.

Do Calcium Supplements Prevent Bone Fractures?

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

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

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

This study did not actually look at calcium supplementation and the risk of bone fractures. That was a previous study (Boland et al, BMJ 2015, 351:h4580) by the same authors.

This study showed that calcium supplementation increased bone density by 0.7-1.8%, which the authors concluded was sufficient to reduce fracture risk by about 5-10%. That’s a disappointingly small effect, but it is not zero – as the headlines suggested.

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

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

Garbage-In, Garbage-Out

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Apples and Oranges

Because the authors included a wide variety of clinical studies, they were able to state that “Increases in bone mineral density were similar in trials of calcium monotherapy [calcium by itself] versus co-administered calcium and vitamin D…and in trials where baseline dietary calcium intake was <800 [clearly insufficient] versus >800 [probably sufficient] mg/day.”

This could be considered a strength of their meta-analysis, but they are only valid comparisons if other important features of the studies being compared were uniform – i.e. they were comparing apples to apples.

But what if they were comparing apples and oranges?

For example, we know that vitamin D is required for efficient calcium utilization. When the authors compared studies having a baseline calcium intake of <800 mg/day with studies having a baseline calcium intake of >800 mg/day, they did not even check to see whether use of vitamin D was evenly distributed between the two groups.

If most of the studies with a baseline calcium intake of <800 mg/day did not include vitamin D with their calcium supplements, the authors would be comparing apples and oranges. The comparison would be invalid.

Similarly, we also know that if calcium intake at baseline is adequate, adding more calcium is unlikely to increase bone density significantly. When the authors compared studies with and without vitamin D, they did not even check to see whether baseline calcium intake was evenly distributed between the two groups.

If the participants in most of the studies utilizing supplements providing both calcium and vitamin D were already consuming sufficient calcium at baseline, they would be comparing apples to oranges. Again, the comparison would be invalid.

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

The Bottom Line

A recent study has reported that the RDA recommendation of 1,000 – 1,200 mg/day of calcium for people over 50 provides only a minimal increase in bone density (0.7-1.8%) over the first year or two. This translates into a very small (5-10%) decrease in risk of bone fractures.

It did not matter whether the calcium came from dietary sources or from supplementation. The authors concluded that adding extra calcium to the diet, whether from food or supplements, was not a very efficient way to increase bone density and prevent fractures.

This study suffers from some serious flaws. It is a meta-analysis of previous clinical trials looking at the effects of calcium on bone density. Meta-analyses can be very strong studies because they average the effects of many individual studies. However, meta-analyses can also suffer from the “garbage-in, garbage-out” phenomenon.

Simply put, the quality of the meta-analysis is only as good as the studies that go into it. In this case the meta-analysis included many clinical studies that were done 10, 20, 30 and even 40 years ago. Based on what we now know about bone metabolism, the design of many of those early studies was clearly inadequate (details are given in the article).

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

__________________________________________________________________________________________________

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

Do NAD Levels Decrease With Age?

August 4, 2026 by Dr. Steve Chaney

Why Do We Care About NAD Levels?

Author: Dr. Stephen Chaney

We have heard for years that NAD decreases as we age and supplements like NMN that increase NAD levels may be beneficial because they:

Increase cellular energy production which can reduce fatigue and improve stamina.

Activate sirtuins (your anti-aging genes) which, among other things, enhance DNA repair and reduce cellular stress.

Enhance energy metabolism in the brain. Studies are currently ongoing to evaluate its effectiveness in combating neurodegenerative conditions like Alzheimer’s and Parkinson’s diseases.

Enhance energy production in muscle which could improve physical performance and exercise capacity in older adults.

Regulate your circadian rhythms which could improve sleep quality and reduce systemic inflammation.

But what if none of this were true? A recent study has reported that blood levels of NAD don’t decline with age (MM Tretowicz et al, Nature Metabolism, 8: 1282-1290, 2026).

The headlines from social media influencers and bloggers, and even the New York Times, are saying things like:

“The idea that NAD levels decrease as we age is a myth”

“Supplements that raise NAD levels are a waste of money”

You are probably confused by the headlines. You are wondering, “What is true and what is a myth?” To answer that question, I need to evaluate the study behind the headlines.

But first it’s time for the professor’s favorite topic, Metabolism 101. It’s time to ask, “Why do we care about NAD levels?”

Why Do We Care About NAD Levels”

Let’s start by looking at the structures of NMN and NAD, so you can envision their relationship.

In the upper left corner, you see the structure of NMN, the abbreviation for nicotinamide mononucleotide. It contains nicotinamide (a form of vitamin B3), the 5-carbon sugar ribose, and a phosphate.

In the lower left corner, you see the structure of adenine mononucleotide, consisting of adenine, ribose, and phosphate. However, the better-known name for that structure is adenosine monophosphate, or AMP. If you add two phosphates to that molecule, you have ADP. If you add three phosphates to that molecule, you have ATP, which is the energy currency of the cell.

If you join nicotinamide mononucleotide and adenine mononucleotide together, you get nicotinamide adenine dinucleotide or NAD, which is the structure on the right.

With that behind us, let’s get back to the original question, “Why do we care about NAD levels?” Below I have put together a simplistic, conceptual diagram to explain the importance of NAD.

Simply put, the foods we eat are primarily composed of carbon, hydrogen, and oxygen, with an occasional nitrogen or sulfur thrown in for good measure. As the foods we eat are broken down in our cells…

The carbons and oxygens are converted to CO₂, which we exhale.

The hydrogens are transferred to NAD to produce NADH.

In an oxygen environment hydrogen, or more properly the electrons it possesses, are “high energy”.

When NADH enters our mitochondria, it encounters a biochemical pathway called the electron transport chain.

NADH transfers its hydrogen to the oxygen we breathe in to produce H₂O, or water.

It transfers its electrons to the electron transport chain where they provide the energy to convert ADP to ATP, which is the energy currency of the cell.

NAD does have a sister molecule called FAD which plays a similar role. As you can see from the simplistic diagram above, they are essential for energy (ATP) production in our cells. By feeding electrons into the electron transport chain, they are responsible for 90% of the energy our bodies need to survive and thrive. With that in mind, you can begin to appreciate why a decrease in the levels of either one of these molecules is concerning.

On a personal note, my thesis advisor at UCLA, Dr. Paul Boyer, received the Nobel Prize for deciphering the complex mechanism by which the electron transport chain uses electrons to generate ATP.

Do NAD Levels Decrease With Age?

So, now it is time to peak behind the curtain. It’s time to look at the study behind the headlines.

The researchers obtained blood samples from seven small clinical studies that looked at the variation in blood NAD levels with age. They used a very high precision method for measuring blood levels of NAD and applied it to the blood samples obtained from each study.

[Note: This is important because some of the variability in blood NAD levels between studies could have been due to variations in the way blood NAD levels were measured.]

They reported that:

Whole-blood NAD levels remained remarkably stable with age. This is different from the generally accepted paradigm.

Whole-blood NAD levels were not influenced by lifestyle.

- Elite athletes had blood NAD levels comparable to sedentary controls.

- Exercise had little effect on blood NAD levels.

- Diet had little effect on blood NAD levels.

Whole-blood NAD levels increased with NMN supplementation. This confirms previous studies.

They concluded:

“Our results challenge the utility of blood NAD levels as a biomarker of ageing or lifestyle factors.”

That conclusion is significantly different from the headlines you may have seen. The headlines suggest that the whole NAD hypothesis is a myth. This study is just saying that measuring blood NAD levels is easy, but it may not be the best way to gauge the effect of age or lifestyle on NAD stores.

But before I discuss that further, I should point out that this study has some glaring flaws. Let me share what the critics of this study are saying about it.

What Are The Critics Saying?

Here are the top four criticisms that other experts have raised about this study:

“Lack of Red Blood Cell Normalization: The study did not adjust NAD measurements for red blood cell (RBC) count, hematocrit, or hemoglobin—values that normally decrease with age and tend to be lower in women than in men.”

Why Is This Important? The authors of this study measured whole blood NAD levels. Red blood cells typically make up 40-45% of total blood volume. Red blood cells lack mitochondria, so they don’t need as much NAD as energy-intensive tissues. However, white blood cells do have mitochondria and do need higher levels of NAD.

As the percentage of red blood cells decrease with age, the percentage of white blood cells increases. This leaves open the possibility that a decrease in NAD levels in white cells might be offset by an increase in the number of white cells in the same volume of blood.

What do other studies show? Studies that normalize whole blood measurements for the red blood cell count generally show a decrease in blood levels of NAD with age.

One Step Forward, Two Steps Back. The scientists who designed the study should be commended for using the same, high-precision method to measure NAD levels in blood samples from different studies. However, neglecting to normalize for red blood cell count is a fatal flaw that may invalidate their study.

“Insufficient Sample Size: The study pooled several smaller observational studies and clinical trials rather than drawing from a single large cohort—an approach that introduces heterogeneity and limits the ability to detect modest but real biological effects.”

My Perspective: This is what I call the Garbage-in, Garbage-out principle that invalidates many well-intentioned meta-analysis studies.

“Pre-Analytical Variability Across Cohorts: The study combined blood samples from seven studies collected under different conditions, introducing potential variability from factors such as collection tubes, processing delays, storage temperature, and freeze-thaw handling—all of which can substantially influence NAD measurements. The variation between studies in this meta-analysis was approximately 10-15 nmol/mL—while the age-related decrease they were looking for was only around 1.5 nmol/mL. When technical variation is nearly ten times the size of the biological signal, it is very difficult to draw confident conclusions.”

My Perspective: Another example of Garbage-in, Garbage-out.

“Measurements Were Done In The Wrong Tissue: The critical distinction that is easily lost in most coverage is that the study measured NAD in whole blood—not in the organs and tissues where age-related NAD biology may be most relevant. Whole blood is a complex matrix dominated by red blood cells and circulating immune cells. It may tell us relatively little about NAD status in energy-intensive tissues like the brain, skeletal muscle, skin, liver, or kidney—the compartments where the scientific case for age-related NAD decline is mostly built.”

“Concluding from stable whole blood NAD levels that NAD does not decline with aging anywhere in the body is the scientific equivalent of measuring the temperature outside your front door and concluding it must be the same temperature in every room of your house.”

What Do Other Studies Show? Previous studies have shown an age-related NAD decline in skin, brain, skeletal muscle, and liver.

My Perspective: Even if this study, despite many flaws, is correct in concluding that blood NAD levels do not decline with age, that finding is irrelevant. In essence, that is what the authors were saying when they concluded, “Our results challenge the utility of blood NAD levels as a biomarker of ageing or lifestyle factors.”

So, ignore what you may be hearing from social media, your favorite health blogger, or other sources. Anything beyond saying that a recent study showed that blood may not be the best place to measure the effect of aging on NAD levels is pure fiction.

And don’t forget that the study also confirmed that NMN supplementation was effective at increasing NAD levels.

The Bottom Line

You may have seen headlines saying things like:

“The idea that NAD levels decrease as we age is a myth”

“Supplements that raise NAD levels are a waste of money”

When we peak behind the curtain and look at the study behind the headlines, we discover the study came to two conclusions:

It confirmed that NMN supplements were effective at increasing NAD levels in our blood.

It concluded that blood NAD levels may not be useful biomarkers of aging or lifestyle factors.

Neither of these conclusions look anything like the headlines you may have seen.

Experts who have reviewed that study have concluded that:

It is highly flawed.

Even if blood levels of NAD do not decrease with age, that is irrelevant because NAD levels have been shown to decrease with age in energy-intensive tissues like brain, muscle, skin, liver, and kidney.

As one of the experts put it, “Concluding from stable whole blood NAD levels that NAD does not decline with aging anywhere in the body is the scientific equivalent of measuring the temperature outside your front door and concluding it must be the same temperature in every room of your house.”

For more details on the study and what critics are saying about it, read the article above.

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

___________________________________________________________________________

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

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

_____________________________________________________________________

About The Author

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

Are All Food Additives Bad-Part2?

July 28, 2026 by Dr. Steve Chaney

The Bad and The Ugly

Author: Dr. Stephen Chaney

Are All Food Additives Bad-Part2?

I get a lot of questions about food ingredient labels. That’s because in today’s social media world everyone is an “expert” wanting to be heard. Couple that with the fact that old news is boring, and we have a problem. To keep their followers engaged these “experts” must keep coming up with new information that is novel and scary. It doesn’t need to be true – just novel and scary.

Last week I talked about “good” food additives, which I defined as food additives that are on the social media “naughty lists” but are actually OK for most people most of the time. I would be the ﬁrst to admit the using the word “good” as a descriptor for food additives is a bit of a misnomer.

Of course, the word “good” should really be reserved for organic fresh fruits and vegetables along with other whole, unprocessed foods. The problem is that most of us don’t eat enough of those foods, so we need to know which ingredients in the processed foods and food supplements we eat are OK.

This week I will cover food additives that are “bad” for some of us, and food additives that are bad for most of us – These are the ones I call “ugly”.

Food Additives – The Bad

The term “bad” for the food additives is also a bit of a misnomer. In some cases, these are food ingredients that some people should avoid but are perfectly OK for others. In other cases, the type of food determines whether the additive is OK or should be avoided. However, these are nuances that seem to escape the average internet social media influencer.

Sodium Nitrate and Nitrite: This is a perfect example of a food ingredient that can be “bad” in certain foods and “good” in others. Brieﬂy:

When sodium nitrate and/or sodium nitrite are added to processed meats, they can combine with the amino acids from the meat in the intestine to form cancer-causing nitrosamines. As you might suspect, this is not a good

On the other hand, when sodium nitrate or sodium nitrite are found in fruits and vegetables or combined with natural antioxidants such as vitamin C in food supplements, they are converted to nitric oxide, which improves arterial health and can lower blood pressure.

Sugar & High Fructose Corn Syrup: As I have described in earlier issues of “Health Tips From The Professor”, there are no sugar villains and there are no sugar heroes. The problems associated with sugars of all types in the American diet are related to the amount of sugar in our diet (too much) and the kinds of foods they are found in. In summary:

When sugars are consumed as a part of foods that are rich in ﬁber and/or protein they have much less of an eﬀect on blood sugar levels (a lower glycemic index) than when they are consumed in sodas, juices and highly processed That’s important because the bad health consequences of sugars are primarily caused by foods that lead to high blood sugar levels.

Consequently, we should focus on the glycemic index (the eﬀect on blood sugar levels) of the foods we eat rather than obsessing about the amount or kinds of sugar on the label.

MSG: MSG, or monosodium glutamate, is a particularly interesting case. MSG is the sodium salt of the amino acid glutamate. Glutamate is found in every protein in our body and in every protein we eat. However, glutamate is also a neurotransmitter. That poses a problem for some people:

When MSG is used as a ﬂavor enhancer in foods with a low protein content, the glutamate is very rapidly taken up by the brain and can overstimulate some neurons.

- For most people this is no problem, but a small number of people experience what used to be called “Chinese Restaurant Syndrome” due to the large amounts of MSG used in some Chinese foods.

- The common symptoms associated with “Chinese Restaurant Syndrome” are headache, sweating, skin ﬂushing, nausea & fatigue. Allergic reactions to MSG can even be life threatening in some individuals.

Because of that, MSG is no longer widely used as a ﬂavor enhancer, and most restaurants either no longer use it or provide warning labels so sensitive individuals can avoid foods containing MSG.

However, now the internet bloggers are warning you to avoid foods containing hydrolyzed or enzymatically digested vegetable protein and sodium caseinate because they contain MSG. That is utter nonsense.

Glutamate is one of the 20 amino acids found in every protein we eat. As that protein is digested in our intestine, monosodium glutamate (MSG) is released. Hydrolyzed vegetable protein and sodium caseinate are simply pre-digested They contain no more MSG than we would have produced if we digested them ourselves.

Monosodium glutamate (MSG) formed during the digestion of a complete protein is no more dangerous than any of the other amino acids released during digestion of that protein. That is because when all the amino acids are in the blood at the same time, they compete with glutamate for uptake into the brain. This slows the entry of glutamate into the brain and prevents overstimulation of neurons.

The bottom line is that MSG as a ﬂavor enhancer is harmless for most people, but problematic for some. MSG as a component of hydrolyzed vegetable protein or sodium caseinate is harmless for everyone because it is in balance with the other naturally occurring amino acids.

Salt (Sodium): I could, and probably should, write a whole article on sodium intake. Suﬃce it to say that:

1) most of us consume too much sodium,

2) most of that sodium is hidden in the foods we eat rather than added at the table.

3) some people are more sensitive to the bad eﬀects of sodium than others.

As a rule, most of us should consume only limited amounts of high sodium foods and be careful with our saltshaker (Try using herbs for flavoring rather than sodium). However, we need to be aware that some of us are more sensitive to sodium than others.

Food Additives – The Ugly

Finally, there are some food ingredients that most experts (except for those in the food industry) agree should be avoided. The Environmental Working Group ie respected for their careful evaluation of foods and food ingredients that are good for us and those that should be avoided. So I have listed their “Dirty Dozen” – The food additives most likely to cause major health harms, increased risk of cancer, and/or developmental harm and hormone disruption.

1) Potassium Bromate. Potassium bromate is a possible human carcinogen added to flour used in packaged baked goods

2) Propyl Paraben. Propyl paraben is a preservative used in pastries and some tortillas. It causes developmental and reproductive harm.

3) BHA. Butylated hydroxyanisole, better known as BHA, is a preservative used in cured meats and other foods. Multiple sources have identified it as a possible human carcinogen.

4) BHT. Butylated hydroxytoluene, also called BHT, is a preservative found in cereals and other foods. It’s a chemical cousin of BHA and is a possible human carcinogen.

5) Titanium Dioxide. Titanium dioxide is a color additive used mostly in candy. It may damage DNA.

6) Artiﬁcial Colors. Synthetic food dye can be found in many types of food and beverages. It can affect development and cause behavioral difficulties in children. There are seven dyes that are especially concerning: Red 3, Red 40, Yellow 5, Yellow 6, Blue 1, Blue 2 and Green 3.

7) Aspartame. Aspartame is an artificial sweetener that can affect the hormones that regulate metabolism and have a negative effect on weight control. It has also been linked to heart disease and increased risk of cancer.

8) ADA. Azodicarbonamide, or ADA, is used as a dough conditioner and strengthener, as well as a bleaching agent in breads and pastries. ADA has been linked to an increased risk of cancer. It may also cause liver and kidney injury and affect the blood and the nervous and respiratory systems.

9) Propyl Gallate. Propyl gallate is a preservative used in vegetable oil, meat products and chewing gum, among other products. It may cause hormone disruption and has been linked to an increased risk of asthma, hyperactivity and even cancer.

10) TBHQ. TBHQ is a preservative that prevents oxidation. Also known as tertiary butylhydroquinone, it is typically added to packaged foods like crackers, potato chips and baked goods containing oil. Many animal studies have associated TBHQ with immune dysfunction, including potential impairment of the body’s ability to regulate inflammation and fight infections and cancer.

11) Sucralose. Sucralose is an artificial sweetener that is about 600 times sweeter than sugar. Non-sugar sweeteners like sucralose may increase risk of Type 2 diabetes, cardiovascular disease and mortality in adults, as well as preterm birth.

12) Sodium Nitrate. Sodium nitrite is an additive used to preserve meat. When added to processed foods, nitrites are associated with an increased risk of cancer. [As I noted above sodium nitrate is actually good for us when found naturally in plant foods or paired with antioxidants in food supplements.]

The Bottom Line

Last week I listed some “good” food additives, which I define as food additives that are on the social media “naughty lists” but are actually OK for most people most of the time.

This week I have discussed the bad and the ugly food additives.

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

___________________________________________________________________________

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

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

_____________________________________________________________________

About The Author

Are All Food Additives Bad-Part1?

July 21, 2026 by Dr. Steve Chaney

Are Any Food Additives “Good” For You?

Author: Dr. Stephen Chaney

Are All Food Additives Bad-Part1?

In the last two issues of “Health Tips From The Professor” I have debunked myths about the dangers of erythritol and sorbitol – alcohol sugars that are widely used in supplements and processed foods. Perhaps it’s time to take a broader look at food additives and separate myths from facts.

The warnings about which food additives to avoid are a perfect example. A few years ago, it was simple to know which ingredients to avoid. If you avoided foods with sugar, reﬁned ﬂour, trans fats and all the artiﬁcial stuﬀ, you were OK. However, in recent years the list of ingredients to avoid keeps getting longer and longer.

It has reached the point where it is getting hard to ﬁnd a food product or food supplement that doesn’t have any of the additives on the “naughty list”. You may even be wondering if there is anything besides organic fresh fruits and vegetables that you can eat. How did we get to this point?

The answer is obvious. All the social media “experts” needed something new to warn us about, so they took molehills and turned them into mountains. They took food additives that might cause a few problems for a limited number of people and characterized them as ingredients that were dangerous for everyone. Their posts were picked up and repeated by other “experts” and soon everyone thought they had to be true. The warnings about food ingredients became “nutrition myths”.

It is time for a myth buster to come along and help you sort through all the ingredient warnings so that you know which ones are true and which are myths. Let me be your guide.

I began my “research” by Googling “Food Ingredients to Avoid” to see what was on the internet. After a bit of “research” I came up with 25 of the most frequently mentioned “dangerous” food ingredients and have divided them into 3 categories. I call them “The Good, The Bad and the Ugly”.

Are Any Food Additives “Good” For You?

Let me start by identifying the “good ones” – those are food additives that are on the social media “naughty lists” but are actually OK for most people most of the time. I would be the ﬁrst to admit the using the word “good” as a descriptor for food additives is a bit of a misnomer.

The word “good” should really be reserved for organic fresh fruits and vegetables along with other whole, unprocessed foods. Of course, the problem is that most of us don’t eat enough of those foods, so we need to know which ingredients in the processed foods and food supplements we eat are OK.

The list of food additives that are perfectly OK for most of us would be a long one, so let me just mention a few that have inadvertently slipped onto the social media “naughty lists” that you may have seen.

I have discussed GMO foods and ingredients derived from GMO crops, soy foods and soy-derived food additives, and canola oil in previous editions of “health Tips From the Professor”. So, I won’t discuss them here. If you want more information on those topics, just go to https://chaneyhealth.com/healthtips/ and put the appropriate term in the search box

Carrageenan

Carrageenan comes from seaweed and red algae. It has been used in food for thousands of years because of its gelling properties. In the supplement world, it is used to improve consistency and the disintegration of tablets.

There is a lot to like about carrageenan. It is natural, organic and non-GMO. Why then has it become an internet villain in the food ingredient world? The problem is that most of the internet “experts” who are vilifying carrageenan are not distinguishing between carrageenan and its breakdown product poligeenan. Here are the facts:

In some animal studies poligeenan at very high doses has been shown to cause diarrhea, hemorrhaging & ulcerations of the colon and even colon Not all animal studies agree, but this does raise the possibility that high doses of poligeenan might cause the same eﬀects in humans.

Food grade carrageenan contains <5% poligeenan and does not raise the same concerns.

Food grade carrageenan does not cause gastrointestinal problems in most animal studies. Nor has it been shown to cause cancer in any animal study.

The FDA, USDA and WHO have reviewed all available studies and have concluded that food grade carrageenan is safe.

The International Agency for Research on Cancer (IARC) has concluded that carrageenan does not cause cancer.

Caramel coloring is another example. I won’t go into detail here, but the situation is like that for carrageenan. It is a minor impurity of caramel coloring that is the concern. However, caramel coloring itself should not be a concern for products made by any reputable manufacturer that employs rigorous quality control tests on their ingredients.

Maltodextrin

Food sources of complex carbohydrates, isolated on white.

Maltodextrin is a natural food ingredient made from enzymatically digesting starchy foods. It is used as a stabilizer and thickener in foods. It is also combined with glucose and fructose in sports drinks to provide sustained energy.

Myth #1: Social media is ﬁlled with claims that maltodextrin causes gastrointestinal problems or that it is unsafe. There is very little evidence to back that up, and we need to consider those claims in light of the fact that we produce lots of maltodextrin in our intestines every day as we digest the starches in our diet.

Myth #2: “Maltodextrin is just another sugar. It is just another way for food manufacturers to hide the total amount of sugar in their products.” Maltodextrin is actually less sweet than most sugars. As described above, it is primarily added to foods for reasons other than to impart sweetness.

Myth #3: “Maltodextrin is GMO.” It’s true that most maltodextrin in the US comes from GMO corn. However, as I pointed out in my article on GMO foods, the genetic modifications are found only in the DNA and protein. Maltodextrin is a highly puriﬁed food ingredient that contains neither DNA nor protein. That means there are no health concerns associated with maltodextrin, only possible environmental concerns about the pesticides and herbicides used with GMO corn.

Carmine (Also Known As Cochineal)

I ﬁnd this one truly amusing. Social media posts breathlessly proclaim: “Did you know that the red dye used in your favorite food comes from ground up insects?”

Of course, the statement is factually correct. Carmine is a red food dye extracted and puriﬁed from a tropical beetle. However, the implication the statement suggests is completely misleading.

This is a highly puriﬁed ingredient. It contains no insect parts. In fact, you are far more likely to ﬁnd insect parts in your breakfast cereal or piece of toast. The FDA allows up to 350 insect fragments, 5 rodent hairs, and 2 rodent poop pellets in every cup of ﬂour. Enjoy your breakfast cereal and toast!

Carmine dye is natural, organic, and non-GMO. It is much safer than the Red #2 or Red #40 it replaces. What’s not to like?

Are the alarmists worried that the beetles will become an endangered species or are they concerned about the suﬀering of the beetles who give up their lives to produce carmine dye?

The Bottom Line

A few years ago, it was simple to know which ingredients to avoid. If you avoided foods with sugar, reﬁned ﬂour, trans fats and all the artiﬁcial stuﬀ, you were OK. However, in recent years the list of ingredients to avoid keeps getting longer and longer.

It has reached the point where it is getting hard to ﬁnd a food product or food supplement that doesn’t have any of the additives on the “naughty list”. How did we get to this point?

The answer is obvious. Social media “experts” always need something new to warn us about, so they can engage their followers. Their posts were picked up and repeated by other “experts” and soon everyone thought they had to be true. Their warnings about food ingredients became “food myths”.

It is time for a myth buster to come along and help you sort through all the ingredient warnings so that you know which ones are true and which are myths.

This week I started with the “good” additives, which I define as food additives that are on the social media “naughty lists” but are actually OK for most people most of the time.

The list of food additives that are perfectly OK for most of us would be a long one, so I have just mentioned a few that have inadvertently slipped onto the social media “naughty lists” that you may have seen.

Next week I will discuss the bad and the ugly food additives. Stay tuned.

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

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

___________________________________________________________________________

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

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

______________________________________________________________________

About The Author

Is Sorbitol Dangerous?

July 14, 2026 by Dr. Steve Chaney

Should You Avoid Foods Containing Sorbitol?

Author: Dr. Stephen Chaney

Sorbitol is in the news. And the news doesn’t seem to be good. Social media influencers are telling you:

Sorbitol can cause gastrointestinal distress (cramping, bloating, cramping, and diarrhea).

Sorbitol can cause heart attacks and strokes.

Sorbitol can cause liver disease.

They are telling you to scan every label and avoid anything with sorbitol in it. Should you listen to them, or are they promoting food myths to get more followers and clicks?

After all, sorbitol is found in lots of healthy foods such as peaches, pears, apples, nectarines, apricots, cherries, sweet corn, white cabbage, and eggplant. Should you give up those as well?

And our body produces sorbitol from other sugars, so we always have some sorbitol circulating through our bloodstream.

In short, sorbitol is not a foreign substance. It’s not an artificial sweetener. Our body knows how to handle it safely.

But every food myth starts with a kernel of truth. So, let me discuss each of these claims and separate the kernel of truth from the myth.

Can Sorbitol Cause Gastrointestinal Distress?

This claim is true, but:

It is true for every sugar alcohol.
It is a matter of dose.
It is also true for the sugar alcohols found in healthy foods.

Let’s examine those last two points in more detail.

For most people, the small amount of sugar alcohols found in the foods they eat cause no problem. It’s only when they consume large amounts that they experience gastrointestinal distress. [Note: I said most people. If you have Irritable Bowel Syndrome (IBS) or Small Intestinal Bacterial Overgrowth (SIBO), you may be sensitive to even small amounts of sugar alcohols – and many other things.]

And the gastrointestinal effects of large amounts of sugar alcohols are not limited to processed foods. They can also be associated with consumption of healthy foods. Let me share my personal experiences, and you can see if you have had similar experiences.

Years ago, I had a strawberry patch and several fig bushes. At the height of their seasons, it was tempting to eat lots of strawberries and lots of figs. After all, why let those delicious fruits go to waste?

I quickly discovered that 8-10 strawberries on my breakfast cereal was a treat, but 30 strawberries at a sitting was a BIG problem. Similarly, 2-3 figs for dessert were the perfect ending to a meal, but 10 figs at a time was a BIG problem.

The take-home lesson was clear. Small amounts of sorbitol and other sugar alcohols in healthy foods and supplements are no problem. Our body knows how to handle them. But large amounts of sorbitol and other sugar alcohols can cause gastrointestinal distress. And it doesn’t matter if those large amounts come from healthy foods or unhealthy processed foods.

Can Sorbitol Cause Heart Attacks And Strokes?

Human heart attack time bomb as a symbol of urgent health problems due to poor cholesterol levels and bad diet eating fatty greasy junk food.

This claim is mostly false. In the first place, the study on which this claim is based was done with erythritol, not sorbitol. More importantly, the study was deeply flawed.

I have described the flaws in a recent issue of “Health Tips From the Professor”.

In addition to its many flaws the study only found an association between erythritol and heart disease at very high intakes of erythritol. Specifically:

There was no association between erythritol and heart disease at low to moderate intakes of erythritol. As with sorbitol, erythritol is found in many healthy foods and our bodies know how to handle the amount of erythritol found in healthy foods and supplements.

The association between erythritol and heart disease was only seen at intakes of 30 grams/day or above. The only way you could get that much erythritol daily would be to consume a diet with lots of erythritol-sweetened highly processed foods. And we already know a diet of highly processed foods is associated with an increased risk of heart attack and stroke.

After reviewing the study and analyzing its flaws, I concluded,” Clearly, it doesn’t matter what sweetener we are talking about. Large intake of any natural sweetener in the context of a diet rich in highly processed foods appears to have an adverse effect on our health. And we don’t know whether these adverse health effects are caused by the sweetener or some other components of the highly processed foods.

If you want to improve your health, the best solution is to decrease your intake of highly processed foods. That will automatically reduce your intake of sweeteners and other unhealthy components of highly processed foods and increase your intake of healthy components from the whole foods you will be eating instead”

Many other experts have come to a similar conclusion after reviewing that study.

However, that hasn’t kept social media influencers from warning you to read labels and avoid everything with sorbitol in it because it increases your risk of heart attack and stroke. And, unfortunately, some respectable web sites have repeated that claim without examining the study behind the claim.

Can Sorbitol Increase The Risk Of Liver Disease?

This claim is also mostly false. The study behind this claim was done in zebrafish, not humans. And the zebrafish were put on antibiotics that wiped out their intestinal bacteria. Under these conditions, when the zebrafish were fed glucose, they developed fatty liver disease.

I realize that description of the experimental protocol has probably left you confused. So, let me walk you through the metabolic rationale for the study.

In zebrafish, like in humans, a small amount of dietary glucose is converted to sorbitol by intestinal mucosal cells.

In zebrafish and humans, the small amount of sorbitol produced in the intestine is degraded by intestinal bacteria. No harm, no foul.

However, when the intestinal bacteria are wiped out, sorbitol accumulates and is absorbed into the bloodstream. Simply put, this was way to create very high blood levels of sorbitol in zebrafish.

Zebrafish and humans are both able to metabolize small amounts of sorbitol. But when the blood levels of sorbitol are high enough, the normal metabolic pathways are overwhelmed.

Under these conditions, sorbitol goes to the liver where it is converted to fructose.

Previous studies have shown that excess fructose in the liver can cause fatty liver disease.

The authors of this study concluded, “These results indicate that sorbitol is derived from glucose in the zebrafish intestine, implicate gut microbiota [gut bacteria] in protecting against sorbitol-induced steatosis [abnormal accumulation of fat], and suggest that dietary sorbitol, which is used as a sugar substitute, may increase the risk of developing steatotic liver disease [fatty liver disease].”

This is the message you have probably seen from social media influencers and some websites. Of course, they consider “fatty liver disease” to be too complicated, so their warnings are usually that sorbitol can cause liver disease or liver “danger”.

It sounds scary, but this claim ignores the flaws in this study. In the first place, the study was conducted with zebrafish with no intestinal bacteria. We don’t know whether this is true for humans under normal conditions. And if it is true, it required high blood levels of sorbitol which can only be attained in humans by eating lots of highly processed sorbitol-sweetened foods.

And to put this in proper perspective we also need to investigate the link between fructose and fatty liver disease, as I have done in previous issues of “Health Tips From the Professor”.

Fructose or “fruit sugar” is, as the name suggests, found in almost all fruits.

Fructose in fruits is present in small amounts and is encased with fiber, so it is absorbed slowly.

Our bodies are designed to handle the fructose found in fruits. It is slowly converted to glucose, avoiding the blood sugar spikes associated with sucrose (table sugar) and glucose consumption.

Fructose in highly processed foods is present in much larger amounts with no fiber to slow its absorption into the bloodstream.

Under these conditions, our normal metabolic pathways for dealing with dietary fructose are overwhelmed. Fructose accumulates in the liver, where it is converted to fat.

If we consume highly processed fructose-containing foods long enough, we develop fatty liver disease.

Is this starting to sound familiar? In short, fructose, erythritol, sorbitol, and other sugar alcohols are not a problem in the small doses found in supplements and healthy foods. They only become a problem when we consume lots of processed foods that use them as sweeteners.

Is Sorbitol Dangerous?

The short answer is, “No”. You can ignore the dire warnings about the dangers of sorbitol. They are food myths! You don’t need to become a label reader and avoid every supplement and food with sorbitol on the label.

Here is the truth about sorbitol:

#1: It can cause gastrointestinal distress (cramping, bloating, cramping, and diarrhea) if you eat too much sorbitol-containing foods at one time. Other studies suggest that this occurs for most people at doses of 10-15 grams of sorbitol. This can occur with excess consumption of both healthy foods and processed foods that are high in sorbitol.

And most of us figure out pretty quickly which foods are a problem for us. That doesn’t require label reading. It just requires paying attention to our symptoms.

#2: The claims about increased risk of heart disease and liver disease are mostly false.

The claim that sorbitol increases the risk of heart disease was based on a study with erythritol, not sorbitol, and the study was highly flawed.

The claim that sorbitol increases the risk of liver disease was done with zebrafish, not humans.

If those studies tell us anything, it is that health issues associated with sorbitol consumption only occur at high doses which can only be achieved by eating lots of sorbitol-sweetened highly processed foods.

There is no evidence of health issues associated with the small amounts of sorbitol found in some supplements and healthy foods. Our bodies are designed to handle small amounts of sorbitol because they occur naturally in a healthy diet containing fruits and vegetables.

I suppose you could read the labels of processed foods and avoid the ones containing sorbitol. However, there are lots of health concerns with highly processed foods. Sorbitol is the least of the concerns.

A better choice would be to avoid highly processed foods. You don’t need to read their labels to know they are bad for you.

The Bottom Line

We are constantly bombarded with new food ingredients we need to avoid. Social media influencers are telling us to scan food and supplement labels, so we know which ones we shouldn’t eat.

The latest warnings are about sorbitol, a sugar alcohol that occurs naturally in healthy foods and is also added to processed foods. We are being told that:

Sorbitol can cause gastrointestinal distress (cramping, bloating, cramping, and diarrhea).

Sorbitol can cause heart attacks and strokes.

Sorbitol can cause liver disease.

are telling you to scan every label and avoid anything with sorbitol in it. Should you listen to them, or are they promoting food myths to get more followers and clicks?

Here is the truth about sorbitol:

The claim that high levels of sorbitol can cause gastrointestinal distress are mostly true, but they are equally true for healthy foods and processed foods that are high in sorbitol.

And most of us figure out pretty quickly which foods are a problem for us. That doesn’t require label reading. It just requires paying attention to our symptoms.

The claims that sorbitol increases our risk heart and liver disease are mostly false. They are based on flawed studies that were not done with sorbitol in humans.

- If those studies tell us anything, it is that health issues associated with sorbitol consumption only occur at high doses which can only be achieved by eating lots of sorbitol-sweetened highly processed foods.

- There is no evidence of health issues associated with the small amounts of sorbitol found in some supplements and healthy foods. Our bodies are designed to handle small amounts of sorbitol because they occur naturally in a healthy diet containing fruits and vegetables.

A better choice would be to avoid highly processed foods. You don’t need to read their labels to know they are bad for you.

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.

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

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

______________________________________________________________________

About The Author

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

The Erythritol Myth

July 7, 2026 by Dr. Steve Chaney

Who Should Be Concerned About Erythritol Intake?

Author: Dr. Stephen Chaney

Everyone is searching for the perfect sweetener. And if you were in the marketing department of Big Food Inc, the perfect sweetener would be defined as:

Natural, meaning that it is found in fruits, vegetables, or other plant foods.

Low in calories. Of course, a perfect sweetener would have zero calories because it is not metabolized in our bodies.

Low glycemic, meaning that it would have a minimal effect on blood sugar levels. Once again, a perfect sweetener would have zero effect on blood sugar levels.

Safe, meaning that it has no adverse effects on our health.

Sugar alcohols appear to meet all these criteria, so they have become the sweetener of choice for lots of highly processed foods. This is especially true for the sugar alcohol, erythritol, since it is currently the least expensive of the sugar alcohols.

So, a recent study (M Witowski et al, Nature Medicine) suggesting that erythritol might increase the risk of heart disease was quite surprising.

This is the first study to suggest a link between erythritol and heart disease, and it was a flawed study (I will discuss the flaws below).

Reputable scientists don’t put much credence in a weak first study like this one. We generally consider the conclusions of a first study like this one to be an unproven hypothesis at this point.

But we are cautious. There will be many follow-up, better designed studies, to test this hypothesis. Once these studies have been published, the scientific community will look at all the evidence and either issue a warning or conclude that there is no reason for concern.

But that doesn’t stop the Dr. Strangeloves of the world from warning you of the “dangers” of erythritol and telling you to avoid it at all costs.

For that reason, I felt it was appropriate to address this issue. I will:

Describe the study and its flaws.

Put the study into the broader perspective of what we know about sweeteners.

Identify the two population groups who should be most concerned about erythritol.

How Was The Study Done And What Did It Show?

This study can be divided into three parts.

#1: An Association Between Erythritol Blood Levels And Heart Disease.

There were three separate experiments included in this section of the study. In each experiment patients were recruited after visiting cardiac clinics for diagnostic procedures. The average age of these patients was 67 and 45% of them already had experienced a non-fatal heart attack prior to the study. In other words, these were all older patients with pre-existing heart disease who were at high risk of heart attack or stroke in the near future.

The first study was a metabolomic study. In simple terms this means that high-tech equipment and computing were used to measure hundreds of metabolites in the blood of the patients and, in this case, correlate each of them with the occurrence of heart attacks and strokes over the next three years.

This experiment identified 16 sugar alcohols and related metabolites in the blood of these patients that were associated with an increased risk of heart attack and stroke. (I will discuss the significance of this observation in more detail later.)

Because erythritol was among the top 6 compounds in terms of association with increased heart attack and stroke risk, and erythritol is the most commonly used sugar alcohol in processed foods, the next two studies focused on the association between blood levels of erythritol and heart attack/stroke risk. Their results were predictable.

High blood levels of erythritol were associated with an increased risk of heart attack and stroke over the next three years.

Flaws In This Portion Of The Study:

As the authors of the study pointed out, these studies were done with older patients with pre-existing heart disease who were at high risk of heart attack or stroke. They acknowledged that it is not known whether these associations exist with younger, healthier patients.

As the authors also pointed out, these are associations. They do not prove cause and effect. In particular, the studies did not measure the diet, exercise habits, and other lifestyle factors of these patients that may have contributed to their increased risk of heart attack and stroke.

When you look closely at the data, it is clear that the association is only seen at the highest blood levels of erythritol. Specifically, the blood levels of erythritol in these patients were divided into quartiles. The risk of heart attack and stroke in the first three quartiles (low to moderate blood levels of erythritol) were identical to the control. However, the fourth quartile (highest blood levels of erythritol) was associated with a dramatically increased risk of heart attack and stroke. That raises three important questions:

- “How much erythritol were patients in the fourth quartile consuming?”

- - The authors did not look at dietary intake of erythritol but did note a previous study estimated that Americans consume up to 30 grams of erythritol a day.

- 30 grams of erythritol a day is a huge amount of erythritol. Where does that erythritol come from?

- - Much of it comes from erythritol-containing highly processed foods like zero calorie sugar substitutes (either erythritol alone or erythritol mixed with artificial sweeteners to improve the taste); reduced- and low-calorie carbonated and non-carbonated beverages; hard candy and cough drops, cookies, cakes, pastries, and bars; puddings and pie fillings; soft candies; syrups and toppings; ready to eat cereals; fruit novelty snacks; and frozen desserts.

- - But it is also found in foods you might not suspect, such as plant-based “milk” substitutes; chocolate and flavored milks; barbecue and tomato sauce, fruit-based smoothies, the syrup used in canned fruits, yoghurt; low calorie salad dressings; and even salty snacks.

- - In other words, the only way anyone can consume 30 grams of erythritol in a day is to consume large quantities of erythritol-containing highly processed foods (I will discuss the significance of this observation later).

- “What else was different about patients in the fourth quartile?”

- - When you look carefully at the data, the patients in the fourth quartile were significantly older, with a higher incidence of diabetes, pre-existing coronary artery disease, previous non-fatal heart attacks, congestive heart failure, and greater triglycerides – all of which significantly increase their risk of heart attack and stroke.

#2: Mechanistic Studies:

Next the authors did in vitro and animal studies looking at the effect of high levels of erythritol on blood clotting.

These studies showed that high levels of erythritol promoted blood clotting both in vitro and in mice. The authors concluded that these studies provided a plausible mechanism for a link between high erythritol blood levels and increased risk of heart attack and stroke.

Flaws In This Portion Of The Study:

Other critics have pointed out that the assays used were not accurate models of blood clotting in humans. This particular critique is beyond my expertise, so I won’t comment further. However:

- As someone who was involved in cancer drug development for over 30 years, I know that in vitro and animal models are poor indicators of how things work in humans.

- And as a biochemist, I have two concerns:

- - The authors provided no mechanistic rationale for why erythritol would enhance blood clotting.

- - The authors made no effort to show that the effect of erythritol was unique. Would high levels of other sugar alcohols or other naturally occurring sugars have the same effect on blood clotting in their assays? We don’t know.

#3: Blood Levels Of Erythritol After Oral Intake.

Finally, the authors gave subjects 30 grams of erythritol and measured blood levels over the next several days.

This experiment showed that very high blood levels of erythritol were attained and maintained for at least two days before gradually decreasing to baseline. The authors concluded this experiment showed that it was feasible to attain and maintain high blood levels of erythritol for several days following a single ingestion of 30 grams of erythritol.

Flaws In This Portion Of The Study:

I have already pointed out that 30 grams per day is a huge amount of erythritol. Furthermore, erythritol from foods in the diet will come from a variety of foods, many of which will contain components (fiber etc.) that slow the absorption of erythritol.

In contrast, the subjects in this experiment were given 300 ml of liquid containing 30 grams of erythritol and told to drink it in two minutes!

In other words, these subjects were consuming 30 grams of erythritol in 2 minutes rather than 24 hours, and they were consuming it in the most easily absorbable form. For a study like this, that makes the effective dose orders of magnitude greater than the amount of erythritol that anyone consumes from their diet over a 24-hour period. The study design was completely unrealistic.

The Erythritol Myth

As described above, this is the first study to suggest an association between erythritol and heart disease, and it was a highly flawed study.

It is also important to know that erythritol is not an artificial sweetener. It is found naturally in healthy foods like grapes, peaches, pears, watermelons, and mushrooms. It is also found in some fermented foods like cheese, soy sauce, beer, sake, and wine.

It is also a byproduct of normal human metabolism, so we always have some of it circulating in our bloodstream. Our body knows how to handle low to moderate intakes of erythritol in small amounts.

However, to help you really understand what this study means, I need to put it into the context of other studies. I will do this in story form (You will find more details about these studies in my book “Slaying The Food Myths”.

First, let’s look at highly processed food consumption:

Multiple recent studies have shown that high consumption of highly processed food is associated with increased risk of obesity, diabetes, heart disease, and premature death. We don’t know what it is about highly processed food consumption that is responsible for the increased risk, but it is unlikely to be just one thing.

As I pointed out above, the only way to achieve the high blood levels of erythritol associated with increased heart disease risk is to consume large quantities of erythritol-containing highly processed foods.

Next, let’s follow the history of sweeteners in highly processed foods.

When I was a young man, sucrose (table sugar) was added to most highly processed foods. Sucrose is found naturally in many fruits and vegetables. Small to moderate intake of sucrose in unprocessed and minimally processed foods posed no problem. However, large intakes of sugar in highly processed foods were found to increase the risk of obesity, diabetes, heart disease, and premature death.

At that point, sucrose became a “sugar villain”, and Big Food, Inc substituted fructose and high fructose corn syrup (a mixture of fructose and glucose) for sugar in their highly processed foods. As with sucrose, fructose is found naturally in many foods, and small to moderate intakes of fructose and high fructose corn syrup posed no health risks. However, large intakes of fructose and high fructose corn syrup in highly processed foods were found to increase the risk of obesity, diabetes, heart disease, and premature death.

Fructose and high fructose corn syrup then became the sugar villains. And because high fructose corn syrup is chemically and biologically indistinguishable from natural sugars like honey, date sugar, coconut sugar, it is likely that high intakes of these sugars in highly processed foods would cause the same problem.

So Big Food, Inc started relying on artificial sweeteners in their highly processed foods. But guess what? Recent studies have suggested that artificial sweeteners in highly processed foods are associated with obesity, diabetes, and heart disease.

That has caused Big Food, Inc to rely more on sugar alcohols in their highly processed foods, particularly erythritol because it is the least expensive of the sugar alcohols. Now the current study comes along and suggests that high intake of erythritol in highly processed foods may increase the risk of heart disease.

If this hypothesis is confirmed by better designed studies, it is not clear what Big Food, Inc will do next. The metabolomic study described above showed that high blood levels of several other sugar alcohols are associated with an increased risk of heart disease.

Hopefully, you are starting to see a pattern here. It’s time to ask the question, “Is it the sweetener, or is it the food?”

Clearly, it doesn’t matter what sweetener we are talking about. Large intake of any natural sweetener in the context of a diet rich in highly processed foods appears to have an adverse effect on our health. And we don’t know whether these adverse health effects are caused by large amounts of a sweetener that is perfectly healthy in smaller amounts or some other component of the highly processed foods.

Who Should Be Concerned About Erythritol Intake?

The authors of this study identified two groups who should be most concerned about erythritol consumption – diabetics and adherents of the keto diet.

Diabetics are at high risk because they are told to consume non-caloric sweeteners instead of sugars, and they are not told to avoid highly processed foods. Consequently, they consume much higher amounts of non-caloric sweeteners than the average American.

I must admit that I didn’t foresee keto adherents as a group who would consume lots of erythritol. However, it appears that keto enthusiasts love their sweets as much as the rest of us, and the sweetener of choice for keto-friendly sweets is The authors said that a single serving of keto ice cream contains 30 grams of erythritol. I can hardly imagine how much erythritol they must be getting in their diet.

And, once again, the best advice for both groups is to simply decrease the amount of highly processed food in their diet.

The Bottom Line

Erythritol is not an artificial sweetener. It is found naturally in healthy foods like grapes, peaches, pears, watermelons, and mushrooms. It is also found in some fermented foods like cheese, soy sauce, beer, sake, and wine.

It is also a byproduct of normal human metabolism, so we always have some of it circulating in our bloodstream. Our body knows how to handle erythritol in small amounts.

That is why it was a surprise when a recent study claimed that high intake of erythritol is associated with an increased risk of heart attack and stroke. The Dr. Strangeloves of the world are already starting to tell you that erythritol is deadly and you should avoid it at all costs. But reputable scientists are saying, “Not so fast”.

This is the first study to suggest an association between erythritol and heart disease, and it was a highly flawed study.

In fact, the study showed that low to moderate intakes of erythritol had no effect on heart disease risk. It was only the highest intake of erythritol that was associated with increased risk of heart disease. And given the distribution of erythritol in the American diet, the only way someone could take in that much erythritol is to consume large amounts of erythritol-sweetened highly processed foods.

A brief review of the literature on sweeteners reveals that this is a common pattern for every natural sweetener tested. Low to moderate intake of these sweeteners has no adverse health effects. However, high intake of every sweetener tested in the context of a highly processed food diet is associated with an increased risk of obesity, diabetes, heart disease, and premature death.

That raises the question, “Is it the sweetener, or is it the food?”

Clearly, it doesn’t matter what sweetener we are talking about. Large intake of any natural sweetener in the context of a diet rich in highly processed foods is likely to have an adverse effect on our health. And we don’t know whether these adverse health effects are caused by the sweetener or some other component of a highly processed food diet.

For more details on the study and information about which foods are likely to contain erythritol and the population groups who should be most concerned about erythritol 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.

________________________________________________________________________

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