Yes, Supplements Matter

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The study that was published in the Journal of American Academy of Cardiology created several issues that go beyond the headlines of supplements being of no benefit. Let’s first take a look at the published results of the study.

The researchers found that most supplements such as multivitamins, vitamin D, calcium, and vitamin C do not have a significant effect on cardiovascular disease or overall mortality. On the other hand, folic acid had a significant beneficial effect on reducing stroke and overall CVD, and B-complex, a vitamin with a variety of B vitamins in it, also helped reduce the incidence of stroke. However, the study showed antioxidants had a negative effect on all cause mortality as did niacin. Whether beneficial or not, the results, while statistically significant, were not clinically significant.

The researchers stated that they expected beneficial effects on the reduction of cardiovascular disease and overall mortality. The fact that they did not find those benefits resulted in the headlines that supplements don’t matter.

Here are just three of the issues with the study. They included studies with different nutrients as well as studies that didn’t have the same amount of nutrients. The RCTs included in the analysis did not have the exact same amounts of any given nutrient in the supplement; three of the studies on antioxidants and cancer mortality had different amounts of beta-carotene and vitamin E. Another way of putting it was they not only were comparing apples to oranges, but they also compared three oranges to a dozen apples.

Another issue was adherence to the study rules. The subjects did not necessarily take all the supplements they were given, and compliance varied between the studies. Positive or negative effects could be determined by whether subjects took all of their supplements or took them only when they remembered or felt like taking them. The adherence to supplement use varied by study.

Here’s one more issue. Every RCT used supplements as a potential treatment for a disease—in this case, diseases related to the heart and the death rate from heart disease or other diseases. It’s the treatment model used by physicians: the pill, whether pharmaceutical or supplement, must reduce the incidence of or cure the disease. While desirable, that’s not what nutrition is all about.

The Bottom Line

While we would like to see research results that prove that we can live longer or better by taking supplements, that isn’t really the point in my opinion. We take supplements to fill the gaps in our diet. As the researchers point out, if everyone ate more plant-based foods, we could meet the minimal amounts of nutrients our bodies needs. That hasn’t happened in the 30 years I’ve looking at this issue, and I don’t see it changing any time soon.

Taking vitamin and mineral supplements serves as nutritional insurance to support your body’s processes and to make sure you don’t open the door for deficiency diseases; supplements are more like shotguns than rifles. Supplements do matter and I’m going to continue to take mine every day.

There are so many issues with this research paper—much too long for this Memo—that I recorded a Straight Talk on Health about them. If you’re a Member or Insider, you can listen to Research Update on Supplements any time. If you’re not, now is a good time to join.

What are you prepared to do today?

Dr. Chet

 

References: Jenkins, D.J.A. et al. J Am Coll Cardiol. 2018;71(22):2570–84.

 

Supplements: Helpful or Harmful?

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About a week ago when a press release about a study published in the Journal of American Academy of Cardiology stated that vitamins and minerals don’t seem to help the health of those people who use them; they should stick to getting nutrients from the food they eat. As you can imagine, I got questions from many readers.

For those of us who use dietary supplements, have we been wasting our money? Or maybe as part of the study showed, we’re doing ourselves harm? Don’t throw out your supplements just yet.

The study was a meta-analysis that examined randomized controlled trials (RCT) since the U.S. Preventive Services Task Force (USPSTF) Recommendations for Dietary Supplements was published in 2012. They examined RCTs that used multivitamins, vitamins and minerals, and antioxidants to determine their affect on health variables related to cardiovascular disease and overall mortality.

Was the study done well? Yes and no. They included RCTs that examined the use of specific supplements and health outcomes. The problem is that they didn’t examine the quality of the supplements used in those studies. That’s a significant problem but not the only one. More on this Saturday. Until then, regardless of the headlines, take your supplements if you know why you’re taking them.

What are you prepared to do today?

Dr. Chet

 

References: Jenkins, D.J.A. et al. J Am Coll Cardiol. 2018;71(22):2570–84.

 

Update on Prostate Cancer Treatment

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The treatment of prostate cancer has been changing over the past few years. For most men with prostate cancer, wait and see has become the norm. It all depends on age, the location, and the aggressiveness of the cancer. The more aggressive types of cancer, located close to the outer capsule of the prostate, typically required radiation treatment. The question has been the best time to begin that treatment. A recent study provided some insight.

Researchers selected 1,566 consecutive men who had a prostatectomy in various medical centers. Based on a scoring system that ranked the severity, location, and other factors, they either received immediate radiation therapy or they were monitored until the cancer returned and then given salvation radiation therapy. The immediate-radiation patients experienced reduced biochemical recurrence (as assessed by PSA), they had lower rates of the cancer spreading, and the death rate was lower when compared with salvation therapy. In this case, the more aggressive treatment for men with aggressive prostate cancer produced better outcomes.

The Prostate Health webinar will be available for a few more weeks. If you’re concerned about the health of your prostate or what to do for benign prostatic hypertrophy or prostate cancer, you absolutely have to watch this webinar. If you want to know what questions to ask your physician, this webinar is a must see. Order it today.

What are you prepared to do today?

Dr. Chet

 

References: JAMA Oncol. 2018;4(5):e175230. doi:10.1001/jamaoncol.2017.5230.

 

Life Expectancy Is More Than Living Longer

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What’s more important to you: living longer or living better with the years you have? Think about it as you read this Memo and I’ll come back to that later.

The Upside of the Study

There were three important lifestyle variables that clearly stood out (1). The more exercise you get, the better off you are. Of those who got perfect 5s, they averaged over an hour per day of exercise. Second, the lower the BMI, the better; researchers didn’t track who might have lost weight over the years to get in the lowest BMI category, but it’s clear that carrying fewer pounds helps.

Finally, the Alternate Healthy Eating Index (AHEI) is a score of the quality of the diet, not the quantity. The highest quintile was below 60 out of 100 possible points. That means you don’t have to eat perfectly; just eat your vegetables and fruit and fewer refined carbohydrates and sugars, and you’ll see benefits.

The Downside of the Study

The subjects were overwhelmingly white and they were nurses and doctors for the most part. Whether that translates to other races and professions, we just don’t know.

The biggest issue for me is the Food Frequency Questionnaire used in the original studies as well as the AHEI scores. Trying to remember what you’ve eaten in so many categories over a year never made sense to me; there’s just too much potential for error. There were also differences in AHEI scores between the Nurses Study (all women) and the Health Professionals Follow-Up Study (all men). The men had an AHEI of 59 while the women in the nurses study had an AHEI of 37.5 in the groups assigned a 5. That makes no sense to me. I know the FFQ were slightly different, but the way the data are extracted to arrive at the AHEI score should have accounted for that. Are men so much better with the quality of their diet? Not buying it.

Supplements

Here’s something I found interesting. The use of a baby aspirin went up as the overall scores went up. In contrast, multivitamin use went up as the overall scores went down. To me, that means that healthcare professionals in all professions know that taking a baby aspirin is good for you. It also means that the poorer the diet, the more people try to compensate with supplements. The goal should be to complement a good diet with a multi, not try to make up for a poor one.

Amount of Time Living with Disease

I asked you a question at the beginning of this memo: what’s more important to you: living longer or living better? Right now, the average number of years spent living with some form of disease is almost 12 years (2). Not every condition is as debilitating as others, but would you rather live longer no matter what your health is or would you rather live well right up to the day you check out? Only you can answer that one. The study didn’t examine quality of life so we don’t know how the subjects did.

Here’s my guess: I would wager that the more healthy lifestyle variables you can add to your life, the longer and better you will live. Eat less. Eat better. Move more. It all starts with those six words.

What are you prepared to do today?

Dr. Chet

 

References:
1. https://doi.org/10.1161/CIRCULATIONAHA.117.032047.
2. https://ourworldindata.org/life-expectancy.

 

How Much Does a Healthier Life Increase Life Expectancy?

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This week is about life expectancy and the results of a recent study on how to possibly extend it. Looking at lifestyle’s impact on mortality, here are the criteria researchers applied (1).

  • Smoking: never smoked
  • BMI: 18.5–24.9
  • Exercise: at least 30 minutes daily of moderate to vigorous physical activity which included brisk walking
  • Healthy diet: high diet quality score (upper 40%) of the Alternate Healthy Eating Index
  • Moderate daily alcohol intake: one drink or less for women, two or less for men

Individuals were given one point for each factor if they complied, 0 if they did not, so every person had a score between 0 and 5. The researchers then calculated predicted life expectancy for each score.

Here’s what they determined. Comparing those who had perfect 5s on their lifestyle score with those who had 0, women who were 50 years old were projected to live an average of 43 more years while men were projected to live another 37 years. For the subjects who scored 0 on the lifestyle score, the women were projected to live another 29 years while the men had another 25.5 years. That’s an additional 14 and 12 years respectively.

This was not all in or all out; the higher the lifestyle score, the longer someone was projected to live. I think it’s important to know that you don’t have to do it all at once. No matter what your current age, one significant change may help you live longer.

On Saturday I’ll wrap up this look at lifestyle and life expectancy.

What are you prepared to do today?

Dr. Chet

 

Reference: https://doi.org/10.1161/CIRCULATIONAHA.117.032047.

 

U.S. Life Expectancy Is Down—Again

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Life expectancy is the average time a person might live; a baby born in 2017 will be expected to live 78.6 years according to the U.S. Centers for Disease Control. That’s a long time, but it could be better. After reaching a high in 2015, U.S. life expectancy decreased in 2017 (1). It was only a tenth of a year, just over a month, but it’s the second year in a row life expectancy in the U.S. decreased.

Where do other major countries stand on life expectancy? Japan still leads the world at 85 years (2). Other notable countries are Australia and Italy at 82.3 and Sweden at 82.1. Our neighbors to the north in Canada are at 81.9 years, tied with France and Norway. The lowest quartile is mostly African countries; click the second reference below to find where other countries rank. Where does the U.S. rank? In the mid-40s. Seems like we should be higher, doesn’t it?

Researchers decided to examine how lifestyle could impact life expectancy. They used data from the Nurses Health Study and the Health Professionals Follow-up Study with a combined subject pool of over 120,000 men and women who’ve been followed since the 1980s. They then calculated a health score for each subject, examined who died and what they died from over the past 30 or so years, and examined how health habits related to mortality. We’ll check out the results in Thursday’s Memo.

What are you prepared to do today?

Dr. Chet

 

References:
1. https://www.cdc.gov/nchs/data/databriefs/db293.pdf.
2. http://bit.ly/2sl8TcH
3. https://doi.org/10.1161/CIRCULATIONAHA.117.032047.

 

Is Make-Up Sleep Good for You?

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The first summer holiday is upon us and I have some good news: if you burn the candle on both ends during the week, you may be able to make up for it by sleeping a little extra on weekends. Based on a Swedish study of over 40,000 subjects tracked over 13 years, consistently getting fewer than five hours of sleep per night was associated with higher mortality. But when subjects were able to get extra sleep on weekends, that risk was cancelled.

My philosophy is that we’re going to be dead a long time, so if you must get less sleep during the week to accomplish all you want, so be it. I’ve often told people who’ve asked that as long as you can turn off the alarm and sleep in at least one day a week, that can help. Now there’s some science to back up what I’ve said for years. True, it’s just an observational study and sleep certainly varies by individual, but make-up sleep may be what you need to keep going through the week.

Enjoy the long weekend, and do yourself a favor: get some extra sleep. It may be just the thing you need for your health.

What are you prepared to do today?

Dr. Chet

 

Reference: J Sleep Res. DOI: 10.1111/jsr.12712.

Losing Weight with the Maduro Diet

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“Diets don’t work!” is a mantra of just about every health expert who doesn’t have a diet to sell. “I’ve tried eating less, and even counted every calorie, and I still can’t lose weight!” is something I’ve heard for the 30 years I’ve been doing what I do. Both statements are false.

Before you start your response or unsubscribe, read the rest. There’s a food crisis in Venezuela brought on by the government. I’m not talking about the merit of political systems, but the effect is a continuing lack of food for years now. It’s been referred to as the Maduro diet, named after the president of the country. As a result, the citizens have continued to lose weight. Some accounts have it as an average of 17 pounds in 2016 and another 24 pounds in 2017; I can’t verify the precise numbers. Hyperinflation also contributes to the food shortage; currently it’s 18,000%. One woman held up a plantain and said it cost as much as she’d paid for her house several years before. Some stores don’t count money, they weigh it. Let that sink in.

When people eat fewer calories than they need, they lose weight. The difference is that we’re fortunate that it’s a choice in the U.S., Canada, Australia, and most of Europe. It’s not optional in Venezuela. There’s simply not enough food and therefore, as a nation, they’re all losing weight.

Look at pictures of the populace in North Korea and you’ll see the same effect. In both countries, the leaders look very well fed, to put it politely. I have to think that makes hungry citizens even more resentful.

If you were not given a choice in the quantity of food you could eat per day, no matter where those calories come from, you would lose weight. Period. But most of us are fortunate to be able to make a series of food choices all day long, and that makes it extremely complicated. Still, it’s your body. It’s your choice. Choose wisely today and every day.

What are you prepared to do today?

Dr. Chet

 

Health Headline: Diet and Hearing Loss

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Researchers examined nutrition data collected between 1991 and 2013 in the second Nurses Health Study to examine whether adherence to a healthier diet reduced the risk of hearing loss. They developed a scoring system for three dietary approaches: the Alternate Mediterranean Diet (AMED), the Dietary Approaches to Stop Hypertension (DASH), and the Alternative Healthy Eating Index-2010 (AHEI-2010). They also gave the subjects a hearing health questionnaire to ascertain hearing loss in 2009 and 2013. The researchers divided the diet scores into quintiles and examined the trend across increasing adherence to each of the three diets as determined by the scoring system.

Researchers reported that as the adherence to each diet increased, hearing loss decreased. Those subjects who adhered to their diet best reduced their hearing loss by as much as 30%.

Headline worthy? A split decision. I’m in favor of any reason for nurses or anyone else to eat a healthier diet with more vegetables and fruit.

Why not headline worthy? The first issue was use of the food frequency questionnaire, which relies on recall for the number of typical servings of over 150 items during the past year. Yes, you read that right; the questionnaire asks, for example, how many times you had chicken in the last year and how big was the serving. Maybe you could answer questions like that accurately, but I couldn’t. And as the old axiom about data goes: garbage in, garbage out.

Second, it used a poorly validated self-report of hearing loss from fewer than 700 subjects in just two studies. That’s good enough for a pilot study, but not good enough to make a recommendation.

Third was that when examining the median values for scores in the highest quintile across all three diet assessments, adherence was no better than 67% and as low as 50%. That means 33–50% of the time, the subjects ate foods that were not part of each diet. What made up the other half to a third? Maybe that was the secret to success.

So while these are promising results, they simply point the way to a bigger, better study to see if a better diet makes a significant difference in reducing hearing loss. However, if fear of hearing loss will motivate you to eat healthier, that’s a good outcome. But if I suspected hearing loss to be in my future, I’d take other steps in addition to eating better.

The Bottom Line

That’s my look at last week’s health headlines and the science behind them. In every case, the science did not merit the conclusions. The rush to publicize results gets headlines, but really? That’s all it does.

We can say that they provide interesting results that need further study. Even without complete info, you could take positive steps such as eating better to perhaps help avoid the conditions studied—you’ve got nothing to lose by eating more fruits and veggies.

What are you prepared to do today?

Dr. Chet

 

Reference: The Journal of Nutrition, nxy058, https://doi.org/10.1093/jn/nxy058.

 

Health Headline: Ketogenic Diet and Type 1 Diabetes

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Researchers wanted to examine the blood sugar control of type 1 diabetics who use a very low carbohydrate, high-protein, moderate fat ketogenic diet. The diet was developed by Dr. Richard Bernstein, himself a type 1 diabetic. They used a unique study design: they requested volunteers from a Facebook group of children and adults who adhere to the Bernstein Diet. Over 300 volunteers completed an online survey about their diagnosis and diet. The diagnosis of type 1 diabetes was confirmed from medical records from a follow-up survey of medical staff.

This was a rigid ketogenic diet with no more than 30 grams of carbohydrate allowed per day. The average intake was 36 grams carbohydrate per day. The better the control of carbohydrate intake, the better the HbA1c score, with a mean of 5.7%. Remember, these were type 1 diabetics; there are many type 2 diabetics who don’t control their HbA1c that well. I think this study illustrated the potential of nutrition in affecting a disease system. One interesting aside was the healthcare professionals treating the patients seemed indifferent to the dietary approach regardless of the results.

Headline worthy? Yes, in context. Close to half the subjects did not provide access to medical personnel so the researchers relied on the initial subject surveys for information. They also had no access to any dietary records to confirm the diet. Still this was a unique way to use social media to gather information. The study has to be confirmed using traditional research design to assess the variables. But this approach examined people who live this diet on their own or with their children. That can provide insights that might be missed if the study were conceived by a group of research professionals discussing the question around a table.

What are you prepared to do today?

Dr. Chet

 

Reference: Pediatrics. 2018. doi: 10.1542/peds.2017-3349.