Will Processed Meat Kill You?

May 5, 2026 by Dr. Steve Chaney

What Is The Truth About Meat?

Author: Dr. Stephen Chaney

Vegans will tell you that any meat is bad for you. Keto enthusiasts haven’t found a meat they don’t like. To them grains and most fruits and vegetables are the problem.

But what about those of us who aren’t at either extreme? Which meat, if any, should be part of a healthy diet? And how much of them should we eat?

For years the paradigm had been clear:

Fish was best, especially fish rich in omega-3s. They were good for your heart and your brain. And some studies suggested that high intake of omega-3-rich fish might help you live longer.

Poultry and other white meats were neutral.

Red meat was probably bad for you. It was high in saturated fat and cholesterol, and some studies linked it to an increased risk of heart disease. Plus, the International Agency for Research on Cancer (IARC), an agency of the WHO, listed it as a probable carcinogen. [Note: Recent studies have questioned concerns about red meat. I will discuss this below.]

Processed meats were considered a “no-no” The IARC listed processed meat as a definite carcinogen for humans based on studies linking it to colon, stomach, lung, and pancreatic cancers. It is also linked to an increased risk of heart disease.

However, most of these studies were done in the United States. And our diet is very different from that of many other countries.

That’s why a recent study (R Iqbal et al, American Journal of Clinical Nutrition, 114:1049-1058, 2021) caught my eye. The study was designed to measure the association between unprocessed red meat & poultry and processed meat intake with the risk both mortality and major cardiovascular disease with cancer as a secondary end point. And the study used data from 21 countries around the world except the United States.

How Was This Study Done?

The authors used data from the Prospective Urban Rural Epidemiology (PURE) study. The study is a large-scale (164,007 individuals), prospective (meaning it follows the individuals over time rather than taking measurements from them at a single time) study. The individuals in the study were aged 35-70 years and were followed for an average of 9.5 years.

The individuals came from 21 low-, middle-, and high-income countries.

The low-income countries included Bangladesh, India, Pakistan, Tanzania, and Zimbabwe.

The middle-income countries included Argentina, Brazil, Chile, China, Columbia, Iran, Poland, South Africa, and Turkey.

The high-income countries included Canada, Saudi Arabia, Sweden, and the United Arab Emirates. [Note: The United States was not included in the study.]

At the beginning of the study and at 3, 6, and 9 years the following data were collected from everyone enrolled in the study.

Demographic information (age, sex, location, education, wealth index, and smoking status).
Lifestyle information (diet and physical activity).
Health history.
Medication use.
Cardiovascular events and mortality.

Will Processed Meat Kill You?

The authors compared high intake of processed meats (5 ounces per week, the equivalent of two sausages/week) with zero intake of processed meats. They reported that high intake of processed meats increased the risk of:

Mortality by 51%.
Major cardiovascular disease by 46%.
Non-cardiovascular mortality by 50%
Cancer by 84%.
Heart attack by 62%.
Stroke by 56%.

Furthermore, even as little as 1.5 ounces of processed meat per week significantly increased the risk of mortality.

For red meat and poultry, the authors compared high intake (9 ounces per week) with low intake (2 ounces per week). For both red meat and poultry they did not find any association between high weekly intake and any of the health outcomes.

[I would note however, that many Americans consume 4 ounces of chicken or an 8-ounce steak at dinner – that’s one meal on one day. The corresponding weekly intake would be 28 ounces of chicken or 56 ounces of red meat. That’s significantly higher than the highest weekly intake used in this study.]

The authors concluded, “We observed no significant association between the consumption of unprocessed red meat and poultry intake and health outcomes. And higher intake of processed meat was associated with higher risks of mortality and cardiovascular disease. These findings may indicate that limiting the intake of processed meat should be encouraged.”

In my opinion, there are so many studies linking the consumption of processed meat with heart disease, cancer, and premature death that the last sentence of their conclusion should have said, “These findings unambiguously confirm that limiting the intake of processed meats should be encouraged.”

What Is The Truth About Meat?

Red Meat:

Yes, there is a lot of confusion about red meat. Many studies, like this one, find no adverse health effects associated with red meat consumption. That has led many experts to conclude that the dangers of red meat have been greatly exaggerated.

I think we should dig a little deeper. Most of the studies showing that red meat consumption increases the risk of heart disease, cancer, and mortality have been done in this country. So, perhaps we should be asking what is different about red meat consumption in our country.

There are several factors to consider:

Cooking Methods: The authors of this article pointed out that we often grill our meat at high temperatures which causes the formation of cancer-causing chemicals, while many of the countries in the PURE database stew their red meat at much lower temperatures.

Diet Context: As I have explained in a previous article of Health Tips From the Professor, fruits, vegetables, and whole grains are the antidotes to the cancer-causing chemicals formed when we cook red meat. And they bind to cholesterol in the intestine and flush it out of the body. Finally, they dilute the saturated fat in red meat with polyunsaturated fats, which helps create a healthier balance of fats.

In this country we often pair our steaks with French fries or a baked potato loaded with butter and sour cream. However, in low- and middle-income countries red meat is an expensive luxury and is often used as a garnish to dishes containing lots of vegetables and whole grains.

Amount Consumed: As a mentioned above, the amount of red meat most Americans consume in a week far exceeds the highest weekly intake of red meat in this study. The highest weekly consumption of red meat in this study is more consistent with using red meat as a garnish than as a main course.

Poultry:

For poultry, there is no confusion. Studies done in this country also find no association between poultry consumption and cardiovascular disease, cancer, or mortality. That may be due to a healthier fat profile and the ways in which poultry is usually cooked.

Processed Meat:

For processed meat, there is also no confusion. Virtually every published study from across the world agrees that it increases the risk of cancer, heart disease, and premature death. And the effect is not trivial. This study suggests that just 2 sausages a week is enough to increase your risk of premature death by 50%! So, the answer to the question, “Will processed meat kill you?” appears to be, “Yes”.

The authors of this article pointed out that the saturated fat and cholesterol in processed meat and red meat were very similar. They didn’t mention it, but the cooking techniques are also similar. So, neither of these explain why processed meat is so bad for us.

However, the amounts of preservatives and food additives in processed and unprocessed meats differ greatly. Based on this, the authors of the study and many other experts postulate that it is the preservatives and food additives that are responsible for the health risks of processed meats.

What Does this Mean For You?

This study agrees with many other studies showing that processed meats are bad for us. The authors recommend limiting your intake of processed meats.

However, their data show that as little as two strips of bacon, one hot dog, or half a large sausage per week significantly increases your risk of heart disease, cancer, and premature death. Based on that, my advice would be to avoid processed meats as much as possible.

As I described above, most experts feel that it is the preservatives and food additives that are responsible for the health risks associated with processed meats.

Some studies suggest that nitrates in processed meats may be the main culprit. Based on that belief, some food companies are offering nitrate-free processed meats as a healthier option.

However, there still may be some additives in nitrate-free processed meats (read the label carefully), and we have no clinical studies showing that the nitrate-free processed meats in the marketplace are good for us.

Red meat is more confusing. This study and others suggest it poses no health hazards. And many experts are telling you that the warnings about consuming red meat were overblown. They are telling you that red meat is good for you.

However, some studies suggest that red meat increases your risk of heart disease, cancer and premature death. When you examine the data behind the studies, I think that better advice would be that red meat can be good for you or bad for you depending on three factors:

Portion size: We should think of red meat as a garnish rather than a main course – 3-4 ounces is a healthy portion size. 8-12 ounces may be too much.
Cooking method: Many of the bad things associated with red meat are the result of high temperature cooking, especially over a flame or on a grill. Choose low temperature cooking methods whenever possible.
Diet context: Whole fruits, vegetables and whole grains are the antidotes to all the bad things associated with red meat. 3-4 ounces of red meat in a vegetable stir fry or green salad is likely to be much better for you than an 8-ounce steak with French fries.

Also, red meat already has more than enough saturated fat and cholesterol. Adding foods or sauces high in fat and cholesterol may overload the body’s ability to safely process them. But adding vegetables or vegetable oils helps to restore a better balance between good and bad fats.

Finally, this and other studies agree that white meat is healthy. My only advice is:

Avoid white meat that has been fried (especially by fast food restaurants that only change their oil every 20,000 miles) or cooked with fatty sauces.
Think of the whole diet rather than just the protein source. White meat will be the healthiest as part of a whole food, primarily plant-based diet.

The Bottom Line

A recent study reported that eating as 5 ounces of processed foods per week increases your risk of heart disease, cancer, and premature death by 50%. That is equivalent to two sausages per week!) The authors of the study recommended that you limit your intake of processed meats.

However, the study showed that even as little as 1.5 ounces (2 strips of bacon, one hot dog, or half of a large sausage) per week significantly increases your risk of all three. Based on that data, my recommendation is to consider avoiding processed meat altogether.

The study reported that unprocessed red and white meat are not associated with increased health risks. I put those findings into the context of other published studies on the topic. I discuss my recommendations for unprocessed red and white meat in the article above.

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

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

____________________________________________________________________________

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

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

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

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

_____________________________________________________________________

About The Author

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

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

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

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

For the past 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.

Does Magnesium Protect Your Heart?

October 25, 2022 by Dr. Steve Chaney

Do You Need A Magnesium Supplement?

Author: Dr. Stephen Chaney

Getting an adequate amount magnesium from our diet should not be a problem. Magnesium is found in a wide variety of foods with the best sources being legumes (beans), nuts, seeds, whole grains, green leafy vegetables, and dairy foods.

The problem is:

None of these foods contain enough magnesium by themselves to provide the RDA (420 mg/day for men and 320 mg/day for women) for magnesium. We need to consume a variety of these foods every day – something most Americans aren’t doing.

These foods are decent sources of magnesium only in their unprocessed form. And most Americans consume more highly processed foods than whole, unprocessed foods.

Two to three servings of dairy provide a decent amount of magnesium, but many Americans are cutting back on dairy. And plant-based dairy substitutes often provide much less magnesium than the dairy food they replace.

Finally, green leafy vegetables (iceberg lettuce doesn’t count) don’t make it into the American menu as often as they should.

As a result, recent studies find that at least 50% of Americans are not getting enough magnesium in their diet. In fact, the average magnesium intake in this country is 268 mg/day for men and 234 mg/day for women. And the figures are not very different in other developed countries.

Does it matter? Recent studies have shown that an adequate intake of dietary magnesium is associated with lower risks of cardiovascular diseases (CVD) and all-cause mortality. This may be because of the of role of magnesium in supporting heart muscle contraction, normal heart rhythm, and blood pressure regulation. Adequate magnesium intake is also associated with lower risk of type 2 diabetes.

But what if you have already had a heart attack? Is it too late for magnesium to make a difference? A recent study (I Evers et al, Frontiers in Cardiovascular Medicine, August 12, 2022) was designed to answer this question.

The authors examined the effect of magnesium intake on cardiovascular disease (CVD) mortality, all-cause mortality, and coronary heart disease (CHD) mortality in patients who had experienced a recent heart attack.

[Note: CHD is defined as heart disease due to clogged coronary arteries, such as a heart attack. CVD includes CHD plus diseases caused by other clogged blood vessels, such as strokes and peripheral artery disease].

How Was The Study Done?

The authors used data from a previous study that had enrolled 4,365 Dutch patients aged 60-80 (average age = 69) who had experienced a heart attack within approximately 4 years prior to enrollment and followed them for an average of 12.4 years. All patients were receiving standard post-heart attack drug therapy.

The characteristics of the patients enrolled in the study were as follows:

Male 79%, female 21%
Average magnesium intake = 302 mg/day
Percent magnesium deficient: 72% of men and 67% of women
Percent taking magnesium supplements = 5.4%
Percent on drugs to lower blood pressure = 90%
Percent on statins = 86%
Percent on diuretics = 24%

Upon entry into the study the patients were asked to fill out a 203-item food frequency questionnaire reflecting their dietary intake over the past month. Trained dietitians reviewed the questionnaires and phoned the participants to clarify any unclear or missing items. The questionnaires were linked to the 2006 Dutch Food Composition Database to calculate magnesium intake and other aspects of their diets.

The patients were divided into 3 groups based on their energy adjusted magnesium intakes and those in the highest third (>322 mg/day) were compared to those in the lowest third (<238 mg/day) with respect to cardiovascular disease (CVD), all-cause mortality, and coronary heart disease (CHD) mortality.

The comparisons were statically adjusted for fiber intake (most magnesium-rich foods are also high fiber foods), diuretic use (diuretics reduce magnesium levels in the blood), age, sex, smoking, alcohol use, physical activity, obesity, education level, caloric intake, calcium, vitamin D, sodium from foods, potassium, heme iron, vitamin C, beta-carotenoids, polyunsaturated fatty acids, saturated fatty acids, overall diet quality based on the Dutch Dietary Guidelines, systolic blood pressure, kidney function, and diabetes. In other words, the data were adjusted for every conceivable variable that could have influenced the outcome.

Does Magnesium Protect Your Heart?

When those with the highest magnesium intake (>322 mg/day) were compared to those with the lowest intake (<283 mg/day):

Cardiovascular disease (CVD) mortality was reduced by 28%.

All-cause mortality was reduced by 22%.

Coronary heart disease (CHD) mortality was reduced by 16%, but that reduction was not statistically significant.

They then looked at the effect of some variables that might affect CVD risk on the results.

Diabetes, kidney function, iron intake, smoking, alcohol use, blood pressure, most dietary components and overall diet quality had no effect on the results.

The results were also not affected when patients using a magnesium supplement were excluded from the analysis. This suggests the effect of magnesium from diet and supplementation is similar.

However, diuretic use had a significant effect on the results.

- For patients using diuretics, high magnesium intake versus low magnesium intake reduced CVD mortality by 45%.

How Much Magnesium Do You Need?

You may have noticed that the difference between the highest magnesium intake group and the lowest intake group was, on average, only 39 mg/day. So, the authors also used a statistical approach that utilized data from each individual patient to produce a graph of magnesium intake versus risk of CVD, total, and CHD mortality. For all 3 end points the graphs showed an inverse, linear relationship between magnesium and mortality.

From this, the authors were able to calculate the effect of each 100mg/day increase in magnesium intake on mortality risk. Each 100mg/day of added magnesium reduced the risk of:

CVD mortality by 38%.

All-cause mortality by 30%.

CHD mortality by 33%, and these results were borderline significant.

The inverse relationship between magnesium intake was observed at intakes ranging from around 200 mg/day to around 450 mg/day, which represented the range of dietary magnesium intake in this Dutch population group.

This study did not define an upper limit to the beneficial effect of magnesium intake because the graphs had not plateaued at 450 mg/day, suggesting that higher magnesium intakes might give even better results.

The authors concluded, “We observed a strong, linear inverse association of dietary magnesium with CVD and all-cause mortality after a heart attack, which was most pronounced in patients who used diuretics. Our findings emphasize the importance of an adequate magnesium intake in CVD patients, on top of cardiovascular drug treatment.”

I might add that this is the first study to look at the effect of magnesium on long-term survival after a heart attack.

Do You Need A Magnesium Supplement?

As I said earlier, the best dietary sources of magnesium are beans, nuts, seeds, whole grains, green leafy vegetables, and dairy foods. And:

None of these foods contain enough magnesium by themselves to provide the RDA (420 mg/day for men and 320 mg/day for women) for magnesium.

These foods are decent sources of magnesium only in their unprocessed form.

When unprocessed, each of these foods provides 20 to 60 mg of magnesium per serving. If we use an average value of 40 mg/serving, you would need in the range of 8-10 servings/day of these foods in their unprocessed form to meet the RDA for magnesium.

You could get a more accurate estimate of the magnesium content of your diet using the “Magnesium Content of Selected Foods” table from the NIH Factsheet on Magnesium.

Now you are ready to ask yourself two questions:

Does my current diet provide the RDA for magnesium?

2. If not, am I willing to make the dietary changes needed to increase my magnesium levels to RDA levels?

If your answer to both questions is no, you should probably consider a magnesium supplement. A supplement providing around 200 mg of magnesium should bring all but the worst diets up to the recommended magnesium intake.

The current study did not define an upper limit for the beneficial effect of magnesium on survival after a heart attack but suggested that intakes above 450 mg/day might be optimal.

I do not recommend megadoses of magnesium, but intakes from diet and supplementation that slightly exceed the RDA appear to be safe. In their Magnesium Factsheet, the NIH states, “Too much magnesium…does not pose a health risk in healthy individuals because the kidneys eliminate excess amounts in the urine.”

The only concern is that magnesium from supplements is absorbed much more rapidly than magnesium from foods, and this can cause gas, bloating, and diarrhea in some individuals. For this reason, I recommend a sustained release magnesium supplement, so the magnesium is absorbed more slowly.

Finally, we should not consider magnesium as a magic bullet. The current study statistically eliminated every known variable that might affect survival after a heart attack, so it could estimate the beneficial effects of magnesium alone.

However, survival after a heart attack will likely be much greater if diet, exercise, and body mass are also optimized.

The Bottom Line

Recent studies have shown that an adequate intake of dietary magnesium is associated with lower risks of cardiovascular diseases (CVD) and all-cause mortality.

But what if you have already had a heart attack? Is it too late for magnesium to make a difference? A recent study of heart attack patients in Holland was designed to answer this question.

When heart attack patients with the highest magnesium intake (>322 mg/day) were compared to those with the lowest intake (<283 mg/day):

Cardiovascular disease (CVD) mortality was reduced by 28%.

All-cause mortality was reduced by 22%.

Coronary heart disease (CHD) mortality was reduced by 16%, but that reduction was not statistically significant.

The authors went on to look at the inverse linear relationship between magnesium intake and mortality risk. They found that each 100mg/day of added magnesium reduced the risk of:

CVD mortality by 38%.

All-cause mortality by 30%.

CHD mortality by 33%, and these results were borderline significant.

The authors concluded, “We observed a strong, linear inverse association of dietary magnesium with CVD and all-cause mortality after a heart attack…Our findings emphasize the importance of an adequate magnesium intake in CVD patients…”

I might add that this is the first study to look at the effect of magnesium on long-term survival of patients who have suffered a heart attack.

For more details on this study and my discussion of whether you might benefit from a magnesium supplement, 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.

Do Calcium Supplements Increase Deaths From Heart Valve Disease?

June 14, 2022 by Dr. Steve Chaney

What Did This Study Get Wrong?

Author: Dr. Stephen Chaney

“Killer calcium” is back. Once again, we are seeing headlines saying that calcium supplementation increases our risk of dying from heart disease. If you have seen these headlines, you are probably confused.

After all, there have been three major clinical studies looking at the effect of calcium supplementation on heart disease risk. These studies followed close to 100,000 Americans for 10-20 years. And none of the studies found any increase in the risk of developing or dying from heart disease for people taking calcium supplements. For more information on this topic, see an article from “Health Tips From the Professor”.

You are probably wondering, “What is going on? I thought this issue was settled”.

In the first place, this study did not look at heart disease in general, but on a very specific form of heart valve disease called aortic stenosis. Aortic stenosis is a narrowing of the heart valve leading to the aorta. And it is often associated with calcification of the heart valve.

The cause of aortic stenosis is complex, but it is associated with:

Chronic inflammation.
High cholesterol levels.
Tobacco use.
Dysregulation of calcium metabolism caused by things like elevated parathyroid levels and end-stage kidney disease.
Elevated blood levels of calcium and/or vitamin D.

Because of the role of calcium and vitamin D in aortic stenosis, the current study (N Kassis et al, Heart, Epub ahead of print, 1-9, 2022) was designed to ask whether calcium and vitamin D supplementation influenced the risk of dying from aortic stenosis.

How Was This Study Done?

The Cleveland Clinic scanned their Echocardiography Database for patients aged 60 years or more who had been diagnosed with mild to moderate aortic stenosis. 2,657 patients met these criteria (average age = 74, 58% men) and were followed for an average of 59 months in their database.

In terms of calcium and vitamin D supplementation:

49% did not supplement.

12.5% supplemented with vitamin D (dose not defined).

38.5% supplemented with calcium (500 – 2,000 mg/day) ± vitamin D.

The study looked at the correlation between vitamin D supplementation and calcium supplementation with:

Aortic valve replacement surgery.

All-cause mortality* with and without aortic valve replacement surgery.

Cardiovascular mortality* with and without aortic valve replacement surgery.

*Note: Since all the patients had aortic stenosis at the beginning of the study, both all-cause and cardiovascular mortality were primarily due to aortic stenosis.

Do Calcium Supplements Increase Deaths From Heart Valve Disease?

Before I describe the results of the study, there are two things you need to know:

Vitamin D supplementation did not have a significant effect on any outcome studied, so I will not mention vitamin D in the rest of this article.

In the calcium supplementing group, there were only a few people taking calcium supplements without vitamin D. However, their outcomes were the same as for people taking calcium + vitamin D supplements. Therefore, the authors discussed their results in terms of calcium supplementation, not calcium + vitamin D supplementation. I will do the same.

With those two things in mind, here is what the study found.

With respect to the need for aortic valve replacement surgery:

Calcium supplementation increased the need for surgery by 50%.

With respect to all-cause mortality:

Calcium supplementation increased the risk of death by 31%. When you divided the results into patients who did and did not have aortic valve replacement surgery within the 59-month follow-up of this study:

- Those who received aortic valve replacement surgery did not have a statistically significant increase in risk of death.

- Those who did not receive aortic valve replacement surgery had a 38% increased risk of death.

With respect to cardiovascular mortality:

Calcium supplementation doubled the risk of death. When you divided the results into patients who did and did not have aortic valve replacement surgery within the 59-month follow-up of this study:

- Those who received aortic valve replacement surgery did not have a statistically significant increase in risk of death.

- Those who did not receive aortic valve replacement surgery had a 205% increased risk of death.

The authors concluded, “Supplemental calcium … is associated with lower survival and greater AVR [aortic valve replacement surgery] in elderly patients with mild to moderate AV [aortic stenosis].”

What Did This Study Get Wrong?

Let me start by looking at the limitations of this study.

#1: This is a single study. It is a well-designed study, but it is only one study. And, as the authors acknowledge, previous studies have come down on both sides of this issue. Until we have more well-designed studies that come to the same conclusion, we cannot be confident this study is correct.

#2: The results of this study could have been significantly influenced by confounding variables.

For example:

End-stage kidney disease is associated with a dysregulation of calcium metabolism that can lead to aortic valve calcification. Patients in the calcium supplementation group had a 2-fold higher incidence of chronic kidney disease and a 10-fold higher incidence of kidney dialysis.

There were also significant differences in several diseases and drugs that influence the risk of developing aortic stenosis between the groups.

In the words of the authors, “Given the degree of clinical differences between the groups, there was a risk of residual confounding that may have impacted our findings; we attempted to mitigate this with our statistical model.”

However, as Mark Twain is quoted as saying, “There are lies. There are damn lies. And then there are statistics.”

That is a humorous way of saying we should not put too much faith in statistical manipulations of the data.

#3: They did not measure parathyroid levels. That is a serious omission because elevated parathyroid levels are a major driver of the type of dysfunctional calcium metabolism that could lead to calcification of the aortic valve.

#4: Serum calcium and vitamin D levels were slightly lower in the calcium supplementation group. This is unexpected because aortic stenosis is usually associated with higher serum calcium and vitamin D levels.

The authors speculated this might be due to transient increases in serum calcium levels following supplementation. This is possible for some calcium supplements, but not others.

Specifically, some calcium supplements are marketed on how quickly they get into the bloodstream. But those same supplements often do not provide all the nutrients needed for bone formation. There is always the possibility that excess calcium not used for bone formation might be deposited where we do not want it (such as in the aortic valve).

What Did This Study Get Right?

#1: It was a larger, longer lasting study than previous studies on the effect of calcium supplementation on aortic stenosis. Even though it has limitations, we shouldn’t discount it. It might just be correct.

#2: It doesn’t necessarily conflict with the earlier studies showing that calcium supplementation doesn’t increase cardiovascular disease risk. That’s because the design of these studies is very different.

The health of the people studied was very different.

- The earlier studies started with healthy adults and asked whether calcium supplementation increased their risk of developing cardiovascular disease.

- This study started with people who already had a form of cardiovascular disease associated with abnormal calcium metabolism and asked whether calcium supplementation increased their risk of dying from the disease.

The age of the people studied was very different.

- The earlier studies started with middle-aged adults and followed them for 10-20 years

- This study started with people in their mid-70’s and followed them for almost 6 years.

The type of cardiovascular disease studied was different.

- The earlier studies included all types of cardiovascular disease.

- This study focused on a very minor type of cardiovascular disease, aortic stenosis. Aortic stenosis accounts for about 10% of all cardiovascular disease 17% of cardiovascular deaths. There may not have been enough deaths from aortic stenosis in the previous studies to have had a statistically significant effect on the results.

Given all these differences, the results of this study may not be incompatible with the results of previous studies

What Does This Study Mean For You?

There are three important takeaways from this and previous studies:

1) For most Americans calcium supplementation does not increase the risk of cardiovascular disease. That has been shown in three major clinical studies.

2) However, if you have been diagnosed with aortic stenosis, calcium supplementation may increase your risk of needing heart valve replacement or of dying from the disease. This study is not definitive, but I would advise caution.

You may wish to discuss with your doctor how to best balance:

- The need for calcium supplementation to prevent osteoporosis…

- With the need to limit calcium supplementation to prevent adverse outcomes from your aortic stenosis.

3) Finally, the authors did not discuss a very significant observation from this study, namely that heart valve replacement reduced the risk of dying from aortic stenosis in people taking calcium supplements.

Aortic valve replacement is the only proven treatment for aortic stenosis. If your doctor recommends aortic valve replacement, you should consider it.

The Bottom Line

A recent study looked at the effect of calcium supplementation for people with aortic stenosis, a rare form of heart disease.

The study found:

Calcium supplementation increased the need for aortic valve replacement surgery by 50%.

Calcium supplementation increased the risk of all-cause mortality* by 31%. When you divided the results into patients who did and did not have aortic valve replacement surgery during the study:

- Those who received aortic valve replacement surgery did not have a statistically significant increase in risk of death.

Calcium supplementation doubled the risk of cardiovascular mortality*. When you divided the results into patients who did and did not have aortic valve replacement surgery within the 59-month follow-up of this study:

- Those who received aortic valve replacement surgery did not have a statistically significant increase in risk of death.

*Note: Since all the patients enrolled in this study had aortic stenosis at the beginning of the study, these deaths were primarily due to aortic stenosis.

There are three important takeaways from this and previous studies:

1) For most Americans calcium supplementation does not increase the risk of cardiovascular disease. That has been shown in three major clinical studies.

You may wish to discuss with your doctor how to best balance:

- The need for calcium supplementation to prevent osteoporosis…

- With the need to limit calcium supplementation to prevent adverse outcomes from your aortic stenosis.

Aortic valve replacement is the only proven treatment for aortic stenosis. If your doctor recommends aortic valve replacement, you should consider it.

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.

Does Sugar Cause Heart Disease?

June 17, 2014 by Dr. Steve Chaney

Is Sugar No Longer Your Best Friend?

Author: Dr. Stephen Chaney

Sugar has gotten a lot of bad press in recent years. You’ve probably already heard that high sugar intake is associated with inflammation, obesity and diabetes. As if that weren’t bad enough, the latest headlines proclaim that added sugar may also increase our risk of fatal heart disease. Are those headlines true? And if they are true, what should you do about it?

Sugar Basics – The Truth About Sugar

There are three facts about sugar that almost every expert agrees with:

The sugars that occur naturally in foods like fruits and vegetables are generally not a problem unless you are a diabetic. It is the added sugars in our diet that we should be concerned with.

The amount of added sugars in the American diet has increased dramatically since the founding of this country. Based on data from the US Department of Commerce and the USDA, the amount of added sugar in the American diet has gone from 6.3 pounds/year in 1822 to over 100 pounds/year in 2000. Put another way, we have gone from consuming the amount of sugar in a 12 oz soda every 5 days in 1822 to every 7 hours in 2000.

The lion’s share of that added sugar is coming from sodas and similar sugary beverages. The amounts are: sodas and other sugar-sweetened beverages (37.1%), grain-based desserts (13.7%), fruit drinks (8.9%), dairy desserts (6.1%) and candy (5.8%).

Beyond that there is little agreement among experts. When I was a young man the sugar “villains” were glucose and sucrose. Then it was sugar alcohols. Today it is high-fructose corn syrup and maltodextrin. Tomorrow it will be something else.

In reality there are no sugar heroes and no sugar villains. The harmful effects of added sugars are based almost entirely on:

The amount of added sugars in the diet…and…

The type of foods those added sugars are found in.

For more information, watch my video “The Truth About Sugar”.

Does Sugar Cause Heart Disease?

The study behind the headlines (Yang et al, JAMA Internal Medicine, 174: 516-524, 2014) followed 11,733 participants in the 3^rd National Health And Nutrition Examination Survey (NHANES III) for an average of 14.6 years. (NHANES studies are designed to represent a cross section of the adult US population). Sugar intake was based on the average of two dietary surveys for most of the participants, and cardiovascular deaths were determined from the NHANES III Linked Mortality Files.

The average intake of added sugar in the American population was around 16% of total calories (compared to around 1% of total calories in 1822). For comparison purposes, the authors divided the population into three groups based on added sugar consumption:

Those consuming less than 10% of calories from added sugar (28.6% of the population).

Those consuming between 10% and 25% of calories from added sugars (46.4% of the population).

Those consuming more than 25% of calories from added sugars (25.0% of the population).

When the groups with the 10-25% and >25% of calories from added sugars were compared to the <10% group with respect to cardiovascular deaths, the results were pretty striking.

The group consuming 10-25% of calories from added sugars had a 30% increased risk of dying from heart disease

And the group consuming >25% of calories from added sugars had a 275% increased risk of dying from heart disease!

This association between added sugar consumption and risk of cardiovascular death was independent of age, sex, race/ethnicity, educational attainment, physical activity, HEI score (a measure of overall diet quality and BMI (a measure of obesity).

The Strengths And Weaknesses of This Study

Strengths:

This was a particularly large, well designed study.

This study is consistent with a number of early studies suggesting that added sugar intake increases the risk of cardiovascular death. See, for example “Can Soft Drinks Cause Heart Disease?”

Weaknesses:

The main weakness of this study is that it measures associations only. It does not prove cause and effect.

Should You Switch To Diet Sodas?

You may be thinking that you should switch to diet sodas – and perhaps artificially sweetened snacks and desserts as well. It only makes sense that if sugar is the problem, artificial sweeteners must be the answer. Wrong! The latest research suggests that diet sodas may be just as bad as the sugar-sweetened sodas.

I have already shared one study with you that linked consumption of diet sodas with increased risk of heart disease (see “Can Soft Drinks Cause Heart Disease?”). The link between diet sodas and heart disease has now been supported by another major clinical study reported by Dr. Ankur Vyas from University of Iowa, March 30, 2014 at the American College of Cardiology’s 63^rd Annual Scientific Session.

This study followed 60,000 women with an average age of 62.8 years who were enrolled in the Woman’s Health Initiative Observational Study for 9 years. They reported that compared to women who never or rarely drank diet sodas, those who consumed two or more diet sodas/day were:

30% more likely to suffer heart attacks and strokes…and…

50% more likely to die from cardiovascular disease.

What Can You Drink?

By now you are probably asking yourself: “If regular sodas, diet sodas, other sugary and diet beverages, and even most fruit juices are out, what else can I drink? Is there anything left?”

It’s not quite as daunting as it seems at first. It may take some time to re-educate your taste buds, but your health is worth it. Here are some healthy alternatives:

My #1 recommendation is always water. If you crave some flavor, add lemon, mint, or your favorite fruits. Herbal teas are another flavorful, healthy choice.

If you crave caffeine, go for green tea, regular tea or coffee – without sweeteners, of course.

If you crave the carbonation, start with unsweetened mineral water or seltzer and add you favorite flavorings.

The Bottom Line:

1) The evidence is getting stronger every day that too much added sugar in our diet is linked to increased risk of death from cardiovascular disease. If you are consuming >25% of calories from added sugars the increased risk is almost 3-fold!

2) The evidence from this study suggests that it would be prudent to keep added sugars below 10% of calories. For most Americans this represents around 200 calories/day from added sugars. That compares with the World Health Organization’s recommendation that added sugars be <10% of calories, the Institute of Medicine’s recommendation that added sugars be <25% of calories, and the American Heart Association’s recommendation that added sugars be <100 calories for women and <150 calories for men.

3) There are no sugar heroes and villains. The amount of added sugar in the diet is much more important than the kind of sugar. The food that the sugar is found in is also very important, with sodas and similar sugar-sweetened beverages being the worst offenders (See my video “The Truth About Sugar” for more information).

4) Artificial sweeteners are not the solution. A recent study with postmenopausal women suggests that consumption of as few as two diet sodas a day increases the risk of heart attacks and strokes by 30% and cardiovascular death by 50%.

5) Don’t despair. You won’t have to go thirsty. There are lots of healthy alternatives available (see 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.

Does An Apple A Day Keep Statins Away?

February 4, 2014 by Dr. Steve Chaney

The Latest On Diet And Heart Health

Author: Dr. Stephen Chaney

In a previous “Health Tips From the Professor” I talked about how difficult it has been to prove that statins significantly reduce the risk of heart attack or cardiovascular deaths in a low risk population group. Now let’s look at the other side of the coin – lifestyle change –and ask how effective lifestyle change is at reducing the risk of cardiovascular disease.

You’ve all heard the saying “An apple a day keeps the doctor away”. It dates back to Victorian England. It was the public health message of the day – much simpler and more concise than our current food guide plate.

A prominent British doctor and his research team recently decided to see how accurate that saying really was. But they took their study one step further. They compared the effectiveness of an apple a day versus a statin a day at reducing the risk of cardiovascular deaths (Briggs et al, British Medical Journal, 3013;347:f7267 doi: 10.1136/bmj.f7267).

The results of that comparison may surprise you.

Does An Apple A Day Keep Statins Away?

They used the data from the Cholesterol Treatment Trialist meta-analysis to estimate the effectiveness of statin drugs at reducing cardiovascular deaths. They used the data from the PRIME comparative risk assessment model to estimate the effectiveness of apple a day at reducing cardiovascular deaths.

They asked what would happen if each of them were the primary intervention for the entire British population over 50 who were not currently taking statin drugs (17.6 million people).

They assumed a 70% compliance rate for both interventions. In simple terms that means they assumed that 70% of the population would actually do what their doctors told them. (Patients must be more compliant in England than in the US).

The results were interesting. They estimated that:

Giving a statin drug each day to 17.6 million people would reduce the number of cardiovascular deaths by 9,400.

Giving an apple each day to the same 17.6 million people would reduce the number of cardiovascular deaths by 8,500 (not significantly different).

But when they looked at side effects and cost the two interventions were significantly different.

Giving a statin drug each day to 17.6 million people would also cause some significant side effects. The authors estimated that it would lead to:

1,200 excess cases of severe muscle pain and weakness
200 excess cases of rhabdomyolysis (muscle breakdown, which can lead to irreversible kidney failure)
12,300 excess cases of diabetes

On the other hand, there are no known side effects to an apple a day.

The statin intervention would cost an estimated $295 million. In the case of apples, you would presumably be substituting a more healthy food for a less healthy food so there would be little or no net cost.

And the 70% compliance rate is probably wildly optimistic. Some experts have estimated that up to 50% of patients discontinue their statin medications within the first year because of side effects or cost.

Is There A Scientific Basis For Those Estimates?

Of course, we all know that the “apple a day…” saying was never meant to be taken literally. It was just a simple way of saying that a good diet will reduce the risk of disease.

It turns out that there was another major study on the effect of dietary fiber on reducing the risk of cardiovascular disease in the very same issue (Threapleton et al, British Medical Journal, 2013;347:f6879 doi: 10.1136/bmj.f6879). It was a meta-analysis that combined the data from 22 previously published studies.

This study showed:

For every 7 g/day increase in dietary fiber the risk of both heart attacks and cardiovascular disease decreases by 9% (7 grams of dietary fiber could come from one serving of whole grains plus one serving of beans or lentils or from two servings of fruits or vegetables).

For every 4g/day of fruit fiber (equivalent to one apple) the risk of heart attacks decreases by 8% and the risk of cardiovascular disease decreases by 4%.

The numbers are similar for every 4 g/day of vegetable fiber.

Another recent study showed that consumption of 75 g/day of dried apple (equivalent to two apples a day) lowered total cholesterol by 13% and LDL-cholesterol by 24% in post-menopausal women (Chai et al, J. Acad Nutr Diet, 112: 1158-1168, 2012). That’s comparable to the cholesterol reduction achieved with statin drugs.

The Bottom Line

If you have not previously had a heart attack and are at relatively low risk, something as simple as adding an apple a day (in place of less healthy foods) may just as effective as statin drugs at reducing your risk of cardiovascular death without the side effects and cost of the drugs.

This is not really new information. For years both the American Heart Association and the National Institutes of Health have recommended that Therapeutic Lifestyle Changes (weight loss, healthy diet and exercise) should be tried BEFORE drug treatment to reduce the risk of heart disease.

So if you want to avoid statins, tell your doctor that you are willing to make the needed lifestyle changes to reduce your risk of heart disease and stick with it. Lifestyle changes are hard, but clinical studies clearly show they can often be just as effective as drug therapy, without the cost and side effects.

Don’t misunderstand me. I’m not advocating avoiding statin drugs if they are absolutely necessary. If you have had a heart attack or are at high risk of heart disease, it is clear that statins can save lives. Even here I would recommend talking with your physician about incorporating therapeutic lifestyle change into your regimen. It may allow them to minimize the dose, and therefore the side effects, of the statin drugs.

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.