Coconut Oil Research vs. the AHA

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For this memo, I’ll print conclusions from the papers cited in the American Heart Association Presidential Advisory on Dietary Fats and Cardiovascular Disease and then print what the authors wrote about the research studies they used to assess coconut oil (1). I’ll confess, it’s hard to understand how they reached some of these conclusions.

The study:
The findings suggest that, in certain circumstances, coconut oil might be a useful alternative to butter and hydrogenated vegetable fats (2).

AHA:
“A carefully controlled experiment compared the effects of coconut oil, butter, and safflower oil supplying polyunsaturated linoleic acid. Both butter and coconut oil raised LDL cholesterol compared with safflower oil, butter more than coconut oil.”


The study:
In conclusion, the results of this study indicated that it may be premature to judge SFA-rich diets as contributing to CVD risk solely on the basis of their SFA (saturated fatty acid) content.

AHA:
“Another carefully controlled experiment found that coconut oil significantly increased LDL cholesterol compared with olive oil (3).”


The study:
There was no evidence that coconut oil acted consistently different from other saturated fats in terms of its effects on blood lipids and lipoproteins.

AHA:
“A recent systematic review found seven controlled trials, including the two just mentioned, that compared coconut oil with monounsaturated or polyunsaturated oils. Coconut oil raised LDL cholesterol in all seven of these trials, significantly in six of them.”

The Advisory’s conclusion: “Because coconut oil increases LDL cholesterol, a cause of CVD, and has no known offsetting favorable effects, we advise against the use of coconut oil.”

Significantly. That’s a meaningful word in statistics but how about in the real world? I’ll finish this up in Saturday’s memo.

What are you prepared to do today?

Dr. Chet

 

References:
1. Circulation. 2017;135:00–00. DOI: 10.1161/CIR.0000000000000510
2. J Lipid Res. 1995;36:1787–1795.
3. Am J Clin Nutr. 2011;94:1451–1457
4. Nutr Rev. 2016;74:267–280.

 

Coconut Oil: Healthy or Not?

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The headlines screamed “Coconut Oil is Alarmingly High in Saturated Fats!” News post after news post talked about how Americans have been sold a bill of goods on the health benefits of coconut oil. Now the American Heart Association says it’s harmful. They published a Presidential Advisory on Dietary Fats and Cardiovascular Disease, a review paper to examine one issue: does saturated fat contribute to cardiovascular disease? They state that both the public and healthcare professionals are confused over this issue. The reasons are complex but primarily due to recent research publications that questioned the role saturated fat plays in the development of CVD.

The paper is 19 pages long with six pages of references. I’m not going to cover the entire paper because for the most part, there’s nothing new in what they’ve said. I’m only going to address a single issue: coconut oil. They begin the section by citing a New York Times survey that looked at which foods nutritionists consider healthy and what a group of registered voters consider healthy; nutritionists say coconut oil is not healthy while the public believes it is. The authors speculate that this is the result of the marketing of coconut oil in the popular press. Evidently they don’t spend much time on the Internet, because that’s where the bulk of claims for coconut oil are made.

I’m a fan of coconut oil for one primary reason (other than the fact that I love coconut): it contains short- and medium-chain fatty acids that can by-pass the liver and be used as energy for most organs. Is it still a saturated fat? Absolutely. Does it cause an increase in your risk of CVD? I’ll review their research on Thursday.

What are you prepared to do today?

Dr. Chet

 

Reference: Circulation. 2017;135:00–00. DOI: 10.1161/CIR.0000000000000510

 

The Big Fried-Potato Question

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During the eight-year study, only 236 of the 4,400 subjects died; fewer than 30 per year. We don’t know what caused their deaths; one would expect it to be heart attacks and strokes but that data was not examined. The researchers adjusted the analysis for a number of variables including age, but it would have been more valuable to know whether fried-potato consumption was related to early mortality. That would give us more of an indication that there really was an increased mortality from eating french fries three days a week.


The Big Question

The big question is simply this: why are researchers from Italy examining the relationship between potato intake and mortality in a study about osteoarthritis? On the surface, it doesn’t make any sense. There was no overall strategy outlined in the reasoning for the study.

One reason they did it is because it’s open-access data: anyone can examine the data and use it for any type of analysis. All I had to do was register and I could download all the data related to any of their questionnaires including the FFQ. I’m not going to analyze the data, but I could.

The study was designed to examine osteoarthritis (OA) and the variables that are important to its prevention and treatment: “The purpose of this study is to examine people who have knee OA or are at high risk for knee OA; information will be used to better understand how to prevent and treat knee OA.” No mention of looking at potato intake and mortality.

The problem is that the authors of the study did not design the variables to examine; they had to use what was already in the study. The questions might have been different if they begin with a study to examine their research question: does potato intake affect mortality in North America? Here’s an example. The authors did not include data from potato chips in their analysis. To be fair, they couldn’t because all snacks were lumped together: potato chips, corn chips, pretzels, and other snack food. If you were starting from scratch, you would definitely include separate questions on the types of snack foods. But this is the type of problem that occurs when you don’t design the study; you take whatever is there, and maybe it works and maybe it doesn’t.


The Bottom Line

What can we gain from this research paper? Not much—it’s mostly meaningless in the real world. But we can do this: be realistic in how we prepare foods and what fast foods we choose to eat. Deep-fried foods can be a part of your diet; just make them a small, infrequent part of it. Every food can be a part of your diet as long as you control the amount and how often you eat it. Eat less. Eat better. Move more.

What are you prepared to do today?

Dr. Chet

 

Reference: Am J Clin Nutr doi: 10.3945/ajcn.117.154872

 

The Data Must Make Sense

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The data has to make sense before you do any type of statistical analysis; that’s why I always look at the mean and standard deviations. Let me explain what I found that seemed a little off in the Fried Potato Study.

The authors divided the data into quintiles based on potato consumption from less then once per month to greater than three days per week. The researchers reported 19 variables from age to calorie intake to the percentages of various diagnosed diseases in each quintile of potato intake.

I focused on the caloric intake and the Body Mass Index in each category of potato intake. As potato intake increased, the caloric intake increased 600 calories per day—from 1,150 calories per day to 1,750 calories per day. Keep in mind there are 3,600 calories in a pound, so that’s over a pound a week. In every quintile, as the potato intake increased, so did the caloric intake. That could make sense although we don’t know if the additional calories all came from potatoes.

What didn’t make sense was that the BMI for each quintile was about the same: 28.5. That makes no sense at all. If the calories increased, the BMI had to increase for each quintile. It did not. Physical activity could not explain it because those in the highest caloric intake were less active than those with the lowest potato intake. It would be wonderful if calories didn’t add up and we could eat all we want without gaining a pound. I’m sad to say it doesn’t work that way.

While the study leaves that question unanswered and many more, it still isn’t the single biggest question of all. Can you guess what it is—even without reading the study?

What are you prepared to do today?

Dr. Chet

 

Reference: Am J Clin Nutr doi: 10.3945/ajcn.117.154872

 

Fried Potatoes: Hazardous to Your Health

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The headline said: “Eating fried potatoes linked to higher risk of death.” My philosophy is that we can eat anything as long as we eat them in moderation, and I like French fries once in a while. My scientific curiosity tells me that I need to check this out. Let’s take a look at the study.

Researchers from Italy used data from the Osteoarthritis Initiative (OAI) to assess the relationship between potato intake and mortality. This is a multicenter study that recruited over 4,400 subjects from four medical centers in the North America. The eight-year study followed subjects who have osteoarthritis of the knee or are at high risk for developing it.

At the beginning of the study, data were collected on dietary intake using a Food Frequency Questionnaire. The dietary data were used to examine the relationship between potato intake and mortality rate. Non-fried potatoes were not related to increased mortality, but there was an increased risk of death for those subjects who ate fried potatoes. The risk was highest if someone ate fried potatoes more than three days per week.

Those are the results. But I have several questions of my own. I’ll cover that the rest of the week including the big question. Don’t forget: tomorrow night is the Fibromyalgia webinar; there’s still time to register.

What are you prepared to do today?

Dr. Chet

 

Reference: Am J Clin Nutr doi: 10.3945/ajcn.117.154872

 

How to Reduce Disease-Related Pain

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The first two memos on pain were relatively easy: joints and nerves. From that point forward, it can get very challenging: Lyme disease, irritable bowel syndrome, shingles—the list of diseases that lead to pain could go on and on. To complicate matters, with the concern over opioid addiction, many people in pain don’t want to even try those medications. What do you do?

The key is to work with your physician and specialists to develop a strategy for pain relief. That will vary by disease. A medication that benefits the nerves for shingles pain may be helped by NSAIDS or other pain relievers, but NSAIDS may not be beneficial for someone with IBS; the absorption of the pain reliever may cause more bowel pain.


Two Strategies to Help

There are two things you can try that may directly or indirectly help with pain. The first is to reduce inflammation and as I mentioned on Tuesday, the supplements that may help are omega-3s, turmeric, and glucosamine. They can help reduce inflammation in more than joints.

The second would be to strengthen the immune system. Lyme disease is bacterial, shingles is a virus, and IBS is an attack on the lining of the intestines. While strengthening the immune system is not directly involved, it may assist the body in dealing with the cause and reduce the pain. To me, that means using probiotics, antioxidants such as vitamin C and E, and using herbs such as echinacea and garlic. As I said, it may not directly affect pain but may indirectly help the body cope with the condition.


The Bottom Line

The two strategies won’t work for every disease. Every form of cancer can result in different pain. Some diseases such as type 2 diabetes can impact the extremities and eyes in ways that require professional guidance. But in general, strengthening the immune system may help over the long term. That also means increasing the intake of vegetables and fruit and getting some exercise within the limitations of the condition. That’s a topic for another time.

What are you prepared to do today?

Dr. Chet

 

How to Reduce Nerve Pain

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Do you ever have pain that shoots down your leg? How about your hands getting numb or painful? Ever get a headache because you’ve clenched your neck muscles so tight due to stress? More than likely, you’re experiencing some form of pain caused by a firing nerve, and these three examples are the ones I’m asked about most often.

It’s always important to get an examination and diagnosis of the potential cause of the pain. If it’s mechanical, that’s one thing. If it’s neural, your approach will be slightly different. The cause of the pain may be a completely different location than where you feel the pain. In the first example, the probable cause is an impingement of the sciatic nerve somewhere; it could be in the spine where the nerve exits the spinal cord or it could be in the pelvic girdle. The second is the classic symptom of carpal tunnel syndrome; the nerves in the neck and shoulder are the primary cause even though the resulting pain is in the wrist and hands.

The critical part of dealing with nerve pain is to try to relieve the pressure on the nerve. Physical therapy and possibly massage that stretches and strengthens the appropriate joints are critical, but they must be done consistently. For some, pain relievers other than non-steroidal anti-inflammatories may be beneficial. Supplements that may help would be high-DHA omega-3s, gingko biloba, and magnesium. If you pushed me to say what’s the best approach, I would say take whatever you can to relieve the pain so you can do the physical therapy. Use the supplements for a longer term solution.

One more type of pain to look at Saturday.

What are you prepared to do today?

Dr. Chet

 

How to Reduce Mechanical Pain

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Every morning, the process of getting my body moving is challenging. My back is stiff and my knee is tender, on the border of painful. The longer I’m up, the better I move. After about 30 minutes, I can get my workout. It takes my knee 10 minutes to warm-up once I start running.

I’m going to talk about pain this week—specifically, three types of pain and what may help. Today it’s mechanical pain. Remember the time you slipped and twisted your knee? Wrenched your shoulder when you picked up something you thought was a lot lighter? Broke your ankle skiing? Those are the types of injuries that can lead to mechanical changes that can result in pain; the injury heals but the tendons, ligaments, and cartilage are not quite the same. It can lead to pain, even many years later. That’s what happened to my right knee.

What can you do about it? Strengthen the supporting tissues to the extent you can. I went to a physical therapist, got an evaluation, was assigned some exercises and I do them regularly. It has strengthened the muscles that directly and indirectly impact the knee. While it’s still tender when I wake up, the swelling is gone and I can run if I choose. To me, that’s the most important thing. But I also take a timed release non-steroidal anti-inflammatory in the morning and use omega-3s, turmeric, and glucosamine twice a day. That works for me. You may need more pain relievers or you may need none.

That’s how you can deal with mechanically-induced pain. On to nerve-induced pain on Thursday and disease-related pain on Saturday.

What are you prepared to do today?

Dr. Chet

 

The Bottom Line on Weight Loss Supplements

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In the weight loss supplement debate, who is correct: proponents or opponents? Are any weight loss supplements beneficial? The answer is complicated.

The opponents of weight loss supplements have the bulk of research on their side for two primary reasons. Weight loss studies using dietary supplements have a lack of consistency in the form of the supplement used, the combination of nutrients in the supplements, and the methodology. That can include everything from the amount of the key ingredient being examined to the number of subjects in the study. The second reason is that some studies examining weight loss supplements on humans don’t control for confounding variables such as age, menopausal status, gender, and type of diet and exercise used to lose weight.

That doesn’t mean that opponents of weight loss supplements have evidence on their side—just the lack of consistent evidence. The problem is a lack of research that demonstrates a significant and permanent impact on body weight. In addition, some weight loss supplements may have potentially negative side effects, so the opponents have the advantage.

Another reason for the opponents’ advantage is the overselling of weight loss benefits based on marginal research. Remember what I began these memos with: “The fat will melt away!” I wish that were true, but there’s no supplement that directly does that. Even if we go back to a banned weight loss supplement, ephedra, it didn’t burn fat. It helped control appetite and may have increased metabolism slightly. There are no safe dietary supplements that do that to any significant degree. Small studies in rodents or even test-tube studies show the potential benefit of many types of herbs, but there are few human trials.

The problem for those selling weight loss supplements is that the type of research that would satisfy the opponents will never be done—it simply costs too much money. While the weight loss supplement industry is a multi-billion dollar industry in total, no single product comes close to generating that kind of revenue. With the type of clinical trials necessary to satisfy critics, there would be no profitability, especially when any other company could put out a competing product with the same ingredient in a different dose and say it’s just as good.

Bleak picture? It depends on how you look at it. Let me give you my perspective.

 

My Take on Weight Loss Supplements

I’ve spent a considerable amount of time checking out weight loss supplements. Is the research perfect? No. But if a nutrient or herb has at least some positive outcome helping people lose weight, I’m fine with that. If it’s mostly theory and animal research with poor human trials, I let it go until they prove something. With that in mind, I think there are some supplements that have consistently shown a benefit in helping people lose weight. The reason they work is not always what is purported to be the reason. The results will be different for different users based on their genetics, their microbiome, and their environment.

So here goes. In my opinion, the weight loss supplements that have shown the most benefit helping people lose weight when they eat less and move more are:

  • Chromium picolinate
  • Garcinia cambogia
  • Conjugated linoleic acid (CLA)
  • Green tea extract

Why do I think these will help? For one reason: they give people an edge in their effort. They positively affect carbohydrate and lipid metabolism, may help increase overall metabolism, and help control hunger. They will never help people lose weight without diet and exercise, but they will give those who are trying an edge in their efforts. To me, that’s worth the cost. That’s why I use most of them myself.

The opponents of weight loss supplements offer nothing other than an opinion. To me, that may be intellectually correct but it’s morally corrupt. With 70% of the population overweight, we don’t need naysayers and obstructionists. We need alternatives that work.

What are you prepared to do today?

Dr. Chet

 

Weight Loss Supplements: Pro vs. Con

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The proponents and opponents of weight loss supplements both cite research to support their opinions. For the opponents, the claim is that there’s a lack of adequate research that supports the benefits of weight loss supplements, and the research that has been done is marginal. The proponents often overstate the benefits of studies that have been done on some weight loss supplements. What gives?

In my opinion, there are several problems. The first problem is attempting to apply the randomized, placebo-controlled trial used in pharmaceutical studies. Trials haven’t included enough subject groups or anywhere near enough subjects per group. The obvious answer is to use people who want to lose weight as subjects: put them on a diet and exercise program while you give half the supplement and the other half the placebo. Reasonable but not good enough. There should be at least four more control groups: normal-weight people with the supplement or placebo, and overweight people who take the supplement or the placebo without a diet and exercise program. Without doing that, no one really knows how much the supplement helps.

The second is not including enough variables. Weight loss and fat loss are obvious and are always included. Some include blood indicators: hormones such as ghrelin, leptin, and cortisol. Too often they don’t do measures of hunger and satiety with simple 0-10 scales. For the guy who criticizes the Food Frequency Questionnaire as much as I do, do I really think a simple hunger scale could be important? I do. For one thing, I think it would be a good predictor of whether people will stick with the study, and by extension, with the program in real life.

The final problem is the expectation of the researchers. I believe that researchers on both sides go in with an expectation of success or failure. They’re supposed to begin a study anticipating both outcomes equally, but I think there’s an inherent investigator bias; they’re just people, after all.

Given the problems, and believe me, this list could include at least a dozen more problems, are all weight loss supplements suspect? No, and I’ll give you my list of real contenders on Saturday.

What are you prepared to do today?

Dr. Chet