Chelation Therapy: Too Soon to Judge

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The results of the study on chelation therapy in subjects with diabetes showed a reduction in cardiovascular incidents during the follow-up time. No single event dominated, ranging from heart attack to stroke to death, but overall there were fewer incidents. Subjects who did not have diabetes did not experience a benefit in v incidents during the same follow-up time.

That led the researchers to speculate why. They couldn’t come up with any specific reason other than the chelation must involve a mechanism that was not yet identified. They carefully suggested that while the results were positive, this study could only suggest that larger clinical trials were necessary and the findings do not constitute enough evidence to be recommended as a treatment.


Should You Do It?

Here a few more things to consider:

  • The cost: each session costs $90 to $150 and there should be at least 30-40 of them. Add office visits and the total price could be around $5,000; none of it is covered by insurance.
  • All the subjects continued to use their typical medications for diabetes, cholesterol, and blood pressure. This was not replacing traditional treatments, it was in addition to the treatments.
  • The investment of time was significant at three-plus hours once a week or on whatever schedule the patient and doctor agree upon.


The Bottom Line

This study demonstrated a small cardiovascular benefit to the patients, reducing the risk of a cardiovascular event from 35% to 25%. In my opinion, the results are too small to justify the cost of money or time.

I know people who swear by chelation therapy, and I’m happy it worked for them, but there’s too much we don’t know. Nobody tracks what is actually changed in the body during chelation. Where do the heavy metals go? What if someone doesn’t process metals the same way to eliminate them? At this point, there are more questions than answers.

Here’s an idea. Spend the money on more vegetables and fruit for your diet. Invest the three hours per week in additional exercise. Both of those things will give you a better return on your investment than chelation therapy.

Eat less. Eat better. Move more.

What are you prepared to do today?

Dr. Chet

 

Reference: Circ Cardiovasc Qual Outcomes. 2014;7:15-24

 

Update on Chelation Therapy

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One of the questions asked during Tuesday’s Conference Call was about chelation therapy for helping with memory. I didn’t find any research to support that outcome, but a couple of studies have been published on chelation therapy with cardiovascular disease (CVD). One paper was from the Trial to Assess Chelation Therapy or TACT study.

Chelation therapy is used to eliminate heavy metals with the goal of reducing the metals that can be toxic to the body. While it’s been used for decades, the research hasn’t demonstrated a clear benefit.

For the TACT trial, researchers recruited over 1,700 subjects. In this paper, they used a sub-group of subjects from the original study who had diagnosed diabetes and had a heart attack more than six months before the study began. Half the diabetic subjects received chelation with EDTA (ethylene diamine tetraacetic acid) as well as some vitamins and minerals. The other half were infused with just saline solution. All subjects were given low doses of vitamins and minerals.

Subjects were infused once per week for 30 weeks and then biweekly and bimonthly until 40 sessions were completed. Each chelation session lasted three hours. With the investment of time, did the chelation therapy result in fewer cardiovascular events over the next five years? We’ll see on Saturday.

What are you prepared to do today?

Dr. Chet

 

Reference: https://doi.org/10.1161/CIRCOUTCOMES.113.000663

 

Let’s Go!

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Riley, my pretend grandson, is learning to talk; he’s taking his time about it, but he’s got a few things down pat. Paula says he’s the only child she’s ever known who used verbs before he used nouns, and his favorite verb is go.

Whenever he hears anything that sounds like “shoes,” he perks up and asks, “Shoes?” If I tell him, “Go get your shoes,” he’s off like a rocket to find them. Then he brings them to me and wants me to put them on him. As soon as I do, he runs to the front door and starts saying, “Let’s go!”

RileysWalk2I’ll admit there are times I’m not crazy about going out in 85-degree muggy weather, but I can’t look into those big blue eyes and say no. So off we go! I’m teaching him boundaries because he wants to go everywhere and get there fast; he’d barely learned to walk when he started running. He’s learning stop and if he doesn’t, he has to hold my hand. But it’s a joy to see a toddler, or anyone really, who wants to move so much.

Whether you’re a parent or a grandparent, getting kids to move early in life is important. But you have to be able to keep up with them, and that means you have to be fit as well. Do you really want to say Daddy or Grandma is too tired? Of course that will happen sometimes, but it should be rare. By the way, going with them counts as exercise for you, too.

That means you have to take care of you first. If you do, when you hear, “Let’s go!” you’ll be ready to go.

What are you prepared to do today?

Dr. Chet

 

Maybe They Won’t Notice

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Last Friday, we had a small tornado touch down in our area. The wind and lightning were so bad, they woke me up at 3 a.m. I looked out the deck window and the rain was horizontal from the North. My front door window, covered by five feet of roof, was getting pummeled by rain. That has never happened.

In the morning, I checked to see the damage. The plants that are normally spilling over the front of the large containers were blown up over the plants standing in the back like an apron over Grandma’s head. The wind blew so hard, the lounge folded over—and it’s cast aluminum! I walked the yard and everything seemed to be fine. Nothing blown over. There were uprooted trees in the neighborhood that Paula and I noticed as she took me to the airport. We escaped. Or so we thought.

We never looked up in the back yard. Ever see the commercial where an older sibling takes the hair-trimming shears and cuts a path down the center of his little brother’s head? That’s what our locust tree looks like; a big branch in the center broke. How we didn’t notice that for three days is beyond me.

What’s the relation to our health? We don’t check our bodies enough. Where did that freckle come from? But it isn’t a freckle. I’m really out of shape! Except that shortness of breath isn’t really happening because you’re out of shape.

We’ve got to pay attention to our bodies, folks. They’re speaking to us all the time. Stop ignoring what they tell you and get things checked out; better to deal with it earlier rather than when it’s a serious problem. You don’t need a tornado to hit your life.

What are you prepared to do today?

Dr. Chet

 

Should You Get the Shingles Vaccination?

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I think everyone over 60 should get the shingles vaccination, and the older you are, the more important it is. You’re going to get a lot of opinions on this one, so here’s how I arrived at this recommendation.

Remember, one out of three or 33% of those over 60 will get shingles. The shingles vaccine is effective only 51% of the time. If the vaccine is effective half the time, that lowers your chances by half so your odds are only about 17% that you’ll get shingles. But that isn’t the reason I would recommend it.

The reason is because of the postherpetic neuralgia (PHN) that some people develop. Shingles is bad but PHN is worse; I’ve heard excruciating stories from people, mostly due to the region that was affected. You cannot predict where it will occur and the rash and pain is debilitating. Here’s the important point: the shingles vaccination will lower the risk of getting PHN by 67%. That lowers the risk of getting PHN to less than 10%. Those are odds I like.

It’s not known what increases your risk of shingles. The best predictor is family history: if your parents or siblings have had shingles, the probability is greater that you’ll get it. And that makes the vaccination an even better bet.

I have no family history of shingles, but I got the shingles vaccine about a year ago. I’m neither an advocate for nor against vaccinations. I look at the science and determine the odds; I don’t always get the flu vaccine. In this case, because I intend to live a long time and the odds of getting shingles increases with age, I decided it was the right decision. Yes, it’s an expensive vaccination, but check your coverage; Paula just discovered she can get it for about half price through her prescription plan and with her sensitive redhead skin, she’s not taking any chances.

It’s your body. Only you can decide what’s right for you. For more information, check out the link below.

What are you prepared to do today?

Dr. Chet

 

Reference: http://bit.ly/2sNdd1r

 

What Causes Shingles?

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“What’s your opinion on getting the shingles vaccination? It’s expensive and my insurance doesn’t cover it. Is it worth it?”

A little background first. Shingles is a viral infection. One million people will get shingles this year, and one out of three people 60 and older will get shingles in their lifetime. It’s caused by the same virus that causes chicken pox; if you’ve had chicken pox, you’ve still got the virus lying dormant in your body. It hides in your nerve cells until for some unknown reason, it begins to multiply and cause the pain and blisters of shingles.

The virus manifests itself with burning and pain, even before a rash breaks out. Generally speaking, it lasts two to three weeks and goes away by itself. While it’s inconvenient, it’s not life threatening; itching and burning can be treated. However, what is much more serious is when shingles turns into postherpetic neuralgia. The pain and inflammation can last for weeks, even months, and sometimes years. It can be debilitating. We don’t know what makes some cases serious while others clear up on their own.

That brings us back to the vaccination—and I’ll cover that on Saturday.

What are you prepared to do today?

Dr. Chet
Reference: https://www.cdc.gov/vaccines/vpd/shingles/public/index.html

 

Why I’ll Keep Using Coconut Oil

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The research that the authors of the American Heart Association Presidential Advisory on Dietary Fats and Cardiovascular Disease, specifically on coconut oil, seems to be in conflict. The authors suggested coconut oil is bad for us, but the research studies they used didn’t really seem to confirm that conclusion. What gives?

The criteria that the Advisory’s panel used were limited in scope. There’s no evidence that the regular use of coconut oil contributes to CVD, even in cultures that regularly use coconut oil. They used a part-equals-whole logic. As they reported, there were significant increases in LDL-cholesterol when subjects increased coconut oil in their diet in the studies they cited. Because a high LDL-cholesterol level contributes to CVD, therefore coconut oil must contribute to CVD. That’s why the Panel does not recommend its use.

I understand what they said. The data they used supported their conclusion. However, they used a very narrow use of the data on coconut oil to support their recommendation.

They are correct when they state that coconut oil is high in saturated fat; in fact, it has the highest percentage of saturated fat of all fats and oils including lard and butter. But it also has a very high percentage of short- and medium-chain saturated fatty acids as opposed to longer chain fatty acids. The advantage is that short- and medium-chain fatty acids can by-pass the liver and be used directly to produce energy in most organs of the body, which makes coconut oil an option for getting energy quickly.

Let’s examine the statement that LDL cholesterol increased when subjects were taking coconut oil (1). In one study, LDL rose from 166 to 171 mg/dl in men and 155 to 156 in women (2). In another study, LDL rose from 118 to 128 mg/dl in a study of men and women (3). These were studies that lasted six weeks and five weeks respectively. There’s no evidence it would continue to rise had the subjects continued to use coconut oil. An increase of 3–6% in LDL-cholesterol wasn’t translated into a risk for CVD. Statistically significant? Yes. Meaningful in the real world? No.

The panel did not recommend coconut oil because it has saturated fat and has no other health benefits, but that point is debatable. Research on other benefits of coconut oil is really just beginning. Too many health gurus are overstating the benefits, especially when it comes to Alzheimer’s disease, and that creates the hype and most likely, the reason the Panel singled out coconut oil to examine more closely.

 

The Bottom Line

The Panel suggested we keep fat intake to no more than 30% of dietary intake; of that, only 10% should be saturated fat. They recommend that we substitute poly-unsaturated and mono-unsaturated fats and oils for saturated fat. That’s not really controversial and it’s a good idea.

What they did not say was that we couldn’t use coconut oil as one of our sources of saturated fat. If we eat 2,000 calories per day, that would mean up to 200 calories per day can come from saturated fat; that’s about two tablespoons per day, and that seems to be a reasonable source of saturated fat consistent with their recommendation.

Here’s the real bottom line: if you’re going to use a sat fat as a source of immediate energy, coconut oil is a healthier choice than lard or butter. And that’s why I use coconut oil; I don’t use a lot, but it works for me and makes sense to me as a scientist.

My recommendations never change. Eat less. Eat better. Move more. And in my opinion, using coconut oil is eating better.

What are you prepared to do today?

Dr. Chet

 

Reference:
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

 

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