I am honored to have won the 2018 Obesity Medicine Association Dr. Hal Seim Scholarship Fund Award! I had a wonderful time at the Obesity Medicine Association Summit in Washington DC. Looking forward to utilizing the tools that I've learned to help improve the health of my future patients.
Recently a new study₁ "Supplemental Vitamins and Minerals for CVD Prevention and Treatment" was published in the Journal of the American College of Cardiology regarding the effect of vitamin and mineral supplementation on cardiovascular disease outcomes and all-cause mortality. Since its release, it has gotten a plethora of attention across a multitude of news channels with headlines claiming "Study: Vitamin Supplements Don’t Provide Health Benefits"₂ to "Scientists studying vitamin supplements warn that they’re a huge waste of money."₃ While this study is certainly valid and deserves attention, I believe that the takeaway message is getting skewed and taken out of proper context and misleading the public.
I would like to take a moment to provide my personal opinion regarding this new study and some important points that we should consider when interpreting its conclusion. The generalized consensus from the study is that vitamin and mineral supplements seemed to provide no benefits in preventing cardiovascular disease or early death.
1. I can agree with the general concept that popping a simple multivitamin or basic dose of a supplement will not magically extend your lifespan and prevent cardiovascular disease. Supplements are certainly advertised and marketed to a very high extent and often touted as a fix for many issues and consumers often spend more money on them than is necessary.
2. Food should be the primary source of our nutrients and the priority of a healthy lifestyle. A wholesome diet rich in fruits and veggies will provide most, if not all of the micronutrients necessary for optimal health and prevention of any nutrient deficiencies. They also provide nutrients that we often cannot get from a pill alone including polyphenols and fiber.
3. Numerous studies have found that diets such as the Mediterranean Diet have significantly reduced the risk of cardiovascular disease and all-cause mortality.₄,₅,₆
4. In addition to a healthy diet, exercise is paramount for optimal well-being and is the closest you can get to consuming a "panacea miracle pill." Exercise has been proven time and time again to reduce all-cause and cardiovascular-related death, diabetes mellitus, cancer, osteoporosis, cognitive decline, and much more.₇ Exercise and proper nutrition are like two wheels on a bicycle: you need both working in order to progress forward.
With all that said, I do feel as though this new study is getting misinterpreted and falsely portraying that all supplements are useless and a complete waste of money.
1. This study was a meta-analysis comparing a variety of studies on specific supplements (folic acid, B-vitamins, multivitamins, vitamins C, D, β-carotene, calcium, selenium, antioxidant mixtures and niacin) and looking at their effects on cardiovascular disease outcomes and all-cause mortality. It did NOT state that all of these supplements are useless for any purpose. Headlines that are extrapolating the results of this study and proclaiming that all supplements are a waste of money are incorrectly interpreting this study. Each vitamin and mineral has specific roles in the body and may positively benefit individuals who are deficient or have a specific health condition. Just because a vitamin does not improve heart health or length of life, does not mean that it has no beneficial impacts on another aspect of health or quality of life.
2. Each person is unique and has specific vitamin and nutritional needs based on their diet, lifestyle, genetics, and more. We need to have a personalized approach to nutrition and supplements and understand that certain individuals have a greater need and benefit from certain supplements. Meta-analyses are great at providing a high sample size analysis of a large number of studies to help us see overall trends and effects. But we must remember that within each individual study, there is a wide range of outcomes, with some subjects noting a negligible effect or possibly negative effect due to a supplement, but others experiencing a highly beneficial impact. Also, the authors of the study are allowed to pick and choose the studies to include in the meta-analysis, thereby introducing the potential for bias.
3. There are many vitamin and mineral deficiencies in the US. This has been well-documented in a variety of studies. Here is a chart which displays the Prevalence of inadequacy (% of population below Estimated Average Requirement - EAR) for “underconsumed nutrients” identified in 2015–2020 Dietary Guidelines for Americans from food only and food + multi-vitamin/multi-mineral supplements (MVMS) among adults age 19 years and older reporting taking a MVMS. NHANES 2009–2012.₈
As you can see, there is a high level of deficiency of many nutrients in our population. You can also see from this study, that supplementation of a multi-vitamin/multi-mineral supplement significantly decreased the percentage of people with a deficiency.
Here are some other deficiencies and their subsequent reduction thanks to supplementation:₈
There are clearly many nutritional deficiencies which were vastly improved with a basic multivitamin. The argument can be made that a proper diet would not have these deficiencies, but unfortunately the average person's diet is subpar and therefore may be deficient in one or more vitamins or minerals. Adding in an affordable multivitamin to "fill in the gaps" seems like a perfectly reasonable idea. Sure, it may or may not improve their life expectancy or CVD risk, but it may reduce one of the many well-documented ill effects of having a vitamin or mineral deficiency.
4. "Adequate" ≠ Optimal
All too often, a blood test indicating that a value is within the "reference range" or a vitamin/mineral meets the RDA (Recommended Dietary Allowance), then that is optimal. This is incorrect. We must look beyond the reference ranges and RDA and determine what is truly optimal. ₉
A good example is Vitamin D. A value of <20 ng/ml is considered "deficient" according to the Institute of Medicine.₁₀ Often, test results in the 20s and 30s are considered fine and no supplement is recommended. A value of 21 may not be "deficient," but it is far from optimal. There is a dose dependent relationship and higher serum 25-hydroxyvitamin D [25(OH)D] concentrations have been associated with a lower risk of multiple cancer types across a range of 25(OH)D concentrations. ₁₁,₁₂
5. Another important takeaway from this is that the dosages used in supplement studies are often low. A study comparing the effects of 400iu of Vitamin D3 may very well have much less of a positive impact in comparison to 5000iu. We cannot state that a particular supplement is useless when a study is not using optimal dosing. Of course "optimal" may very well vary from supplement to supplement and also from person to person so once again, an individualized approach must be taken and ideally blood tests can confirm that the serum level is rising to the appropriate value.
6. We cannot discredit the hundreds of thousands of studies which have found an immense number of different benefits due to many different supplements. Every day, many new studies are released which find positive outcomes due to supplementation of different vitamins, minerals, and herbs. A simple search on PubMed or Medical News Today or ErgoLog of a particular supplement will show research articles which have documented the power of different supplements. I encourage you to also visit Examine.com which provides an unbiased source of supplement information including a summary of effects of supplements and their level of evidence based on documented clinical studies.
In conclusion, I hope my post helps to provide a different look at supplements and understand their role in our health. I do not discredit the findings of the "Supplemental Vitamins and Minerals for CVD Prevention and Treatment" study and agree with its advice to focus on healthy dietary patterns and increased consumption of fruits and veggies. I just wanted to provide a rebuttal to the generalized news spreading the idea that all supplements are useless. I believe that proper nutrition and exercise are the cornerstones of a healthy lifestyle and supplements are only a complementary component of an optimal health plan and should be customized to each individual's needs.
- Joe Zucchi
1. Jenkins DJA, Spence JD, et al. Supplemental Vitamins and Minerals for CVD Prevention and Treatment. JACC: Journal of the American College of Cardiology. http://www.onlinejacc.org/content/71/22/2570. Published May 28, 2018. Accessed May 31, 2018.
2. Study: Vitamin Supplements Don't Provide Health Benefits. U.S. News & World Report. https://www.usnews.com/news/health-care-news/articles/2018-05-29/study-vitamin-supplements-dont-provide-health-benefits. Accessed May 31, 2018.
3. Wehner M. Scientists studying vitamin supplements warn that they're a huge waste of money. BGR. http://bgr.com/2018/05/29/do-vitamins-work-supplement-effectiveness-health/. Published May 29, 2018. Accessed May 31, 2018.
4. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet | NEJM. New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMoa1200303. Accessed May 31, 2018.
5. Bo S, Ponzo V, et al. Predictive role of the Mediterranean diet on mortality in individuals at low cardiovascular risk: a 12-year follow-up population-based cohort study. PubMed. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4830057/. Published 2016. Accessed May 31, 2018.
6. Knoops KT, de LC. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. PubMed. https://www.ncbi.nlm.nih.gov/pubmed/15383513. Published September 22, 2004. Accessed May 31, 2018.
7. Warburton DER, Nicol CW, Bredin SSD. Health benefits of physical activity: the evidence. PubMed. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1402378/. Published March 14, 2006. Accessed May 31, 2018.
8. Blumberg J, Frei B, Fulgoni V, Weaver C, Zeisel S. Impact of Frequency of Multi-Vitamin/Multi-Mineral Supplement Intake on Nutritional Adequacy and Nutrient Deficiencies in U.S. Adults. MDPI. http://www.mdpi.com/2072-6643/9/8/849/htm. Published August 9, 2017. Accessed May 31, 2018.
9. Functional Medicine Methods And Ideas. Integrated Healthcare Solutions. http://www.drcafferyintegrativehealth.com/functional-medicine-methods-and-ideas/. Accessed May 31, 2018.
10. Tello M. Vitamin D: What's the "right" level? Harvard Health Blog. https://www.health.harvard.edu/blog/vitamin-d-whats-right-level-2016121910893. Published October 3, 2017. Accessed May 31, 2018.www.health.harvard.edu/blog/vitamin-d-whats-right-level-2016121910893
11. McDonnell SL, Baggerly C, French CB, et al. Serum 25-Hydroxyvitamin D Concentrations ≥40 ng/ml Are Associated with >65% Lower Cancer Risk: Pooled Analysis of Randomized Trial and Prospective Cohort Study. PLOS Medicine. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0152441. Accessed May 31, 2018.
12. Disease Incidence Prevention Chart. GrassrootsHealth. https://grassrootshealth.net/document/disease-incidence-prevention-chart-in-ngml/. Accessed May 31, 2018.
This is a delicious, protein packed recipe that is great for when you're rushed and need a wholesome meal or snack that is quick and easy to make.
1. Rolled Oats
2. Whey Protein Powder
3. Greek Yogurt
4. Frozen Berries
5. Creme cookies or nuts
The beauty of the recipe is that it can be easily adjusted according to your tastes and available ingredients. You can try a variety of different protein powder flavors, different flavors of greek yogurt, and different frozen berries. You can also use graham cracker or nuts instead of the cookies for an alternative added crunch! You can also adjust the portion size according to your caloric needs.
1. Mix the water and oatmeal and cook according to your preference.
2. Add a scoop of whey protein, cup of greek yogurt, frozen berries, and crushed cookie or nuts.
3. Mix and enjoy!
Here are the macros according to my recipe:
We’ve all heard it before: “Always use full range of motion.” We know it’s the right thing to do when weight lifting, but have we ever stopped and asked ourselves if we are enforcing it? Sure, we may think we’re using full range of motion with each exercise, but I want you to be honest with yourself and re-evaluate your form the next time you’re training in the gym. It’s easy to judge someone doing quarter reps when squatting and think to ourselves “I have much better form than that,” but “better” may not be good enough. Many of us may, in fact, be lifting with solid form, but I encourage you to test your boundaries and explore the potential benefits of increasing your range of motion during each exercise. Over the past month, I have done just that, and have already noticed the benefits.
Before I highlight some of the advantages, I would like to make a disclaimer that we all have different anatomical structures and joint mobility limitations so just do the best that you can and be sure to start with lighter weights to avoid injuries.
Advantages of Full ROM (Range of Motion)
- Increased strength and hypertrophy were also found in the full ROM group in a different study analyzing upper limb muscular development using barbell preacher curls.
- Fat loss even improved in a longer range of motion training group compared to shorter range of motion.
Overall, the benefits speak for themselves, both from an anecdotal observation as well as a scientific evidence perspective. Next time you’re training, be cognizant of your range of motion and consider adjusting the weight to truly allow yourself to maximize range of motion. In turn, you will maximize muscle growth, strength, and flexibility.
Take a look at the back of your supplements. Do you see a list filled with proprietary blends consisting of a multitude of ingredients, including artificial flavors, sweeteners, food dyes, preservatives, and fillers? It might be time to rethink about what you're actually putting into your body. As the world of fitness supplements has grown exponentially, so too has the amount of "junk" that has been additionally added in. Each day more and more research unveils the benefits to many of the supplements we take such as creatine, citrulline, beta-alanine, BCAAs, whey protein, etc. But we often don't realize that we tend to be taking in much more than just those ingredients in our pre-workouts and post-workout shakes.
Just recently we heard about the potential carcinogenic effects of sucralose (aka Splenda) and the CSPI (Center for Science in the Public Interest) downgraded it's rating for sucralose from "Caution" to "Avoid."
See here for more info: http://www.cspinet.org/new/201602081.html
While occasional servings of sucralose are most likely safe, we may overlook the actual dosage of sucralose in some of the top preworkouts on the market. See this video from Kris Gethin for more info:
Since labels often don't list the actual dosage of inactive ingredients, we have no idea how much of these artificial sweeteners and colorings are in our supplements.
As if one sweetener wasn't enough, most brands tend to add another sweetener as well, such as Acesulfame-Potassium. This also has been categorized as "Avoid" by CSPI:
Beyond the sweeteners, many brands tend to value marketing gimmicks over your health and well-being and color their supplements with artificial food dyes such as Yellow 5, Yellow 6, and Red 40. These ingredients have been found to pose risks such as hyperactivity in children as well as a potential risk of cancer (like Red 3) and allergic reactions. See here for more info:
When we consider the fact that we often drink down our preworkouts in less than 10 seconds prior to heading to the gym, is it really necessary to be adding such high doses of sweeteners and colors? Especially considering we take these products day after day, in addition to other workout supplements such as BCAAs or post workout drinks which also contain another high dose of artificial sweeteners.
Being aware of all of the ingredients in your workout supplements allows you to make informed decisions about your health. It may be wise to consider opting for supplements that naturally sweeten their products with stevia and use natural food colorings such as beet root. Or, consider purchasing unflavored supplements with which you can rest assured that the contents are actually the active ingredients and not just fillers and flavorings.
I'm proud to support Do Vitamins and their wonderful line of supplements.
Wonder Whey Organic Whey Protein
I encourage you to look at all of their supplements and rest assured knowing that all of the ingredients are stated on the label with their dosages and there are no other fillers. Each supplement is crafted with scientifically proven effective ingredients and has the certifications to prove the quality and purity. Your health should be a top priority so choose good nutrition and supplement wisely. And follow the matra of Do Vitamins:
Purity and performance; no pollutants.™
What if I were to tell you that over the weekend I had ravioli, popcorn, cookies, smoothies, crackers, dip, chocolate chip cookie dough bars, muffins, chocolate pudding, ice cream, chicken parmesan, and more and enjoyed it without feeling guilty AND actually felt as though I still stayed on track in terms of my nutrition?
Am I crazy?
No - it's all possible to fit those foods into your life if you pick the right products and keep things in moderation. Those foods would all be typically classified as "dirty" or "unhealthy" but I'm posting this as an example that foods aren't inherently "good" or "bad" and that trying to "eat clean" 24/7 is not necessary or ideal.
Now yes, it is true that the above foods are typically very high in calories and it would be hard to fit them into your daily macronutrient goals, but I'm here to show you that if you shop right, you can buy much healthier varieties of the same foods and stay on track.
Below I will compare the nutrition of my food choices vs. an alternative popular version:
It's pretty clear to see the vast amount of differences between the food choices in terms of their nutrition values. I hope this helps to highlight the point that if you put some effort into food planning and choices, you can still eat foods that are enjoyable and stay on track with your nutrition plan. And while this post is meant to serve as an example of how to incorporate delicious foods and snacks into a lifestyle, I also want to point out that my weekend also included "healthy" food options such as chicken, veggies, fruits, protein shakes, etc. I also went out for dinner and ordered Chicken Parmesan with angel hair pasta, but only had half my portion and a side salad so I could take home the rest. This saves 50% of the calories. And I also fit in a quick workout as well over the weekend.
With the right preparation, you too can find the perfect balance and be able to enjoy your food choices and continue progressing toward your health and fitness goals.
I hope everyone had a Merry Christmas and best wishes for a Happy New Year! With 2016 right around the corner, many people across the world will be planning their New Year's Resolutions, and losing weight or getting in shape is at the top of list in terms of popularity. Unfortunately, studies show that, by Jan. 10, most Americans have already given up and only 8% of people actually achieve their New Year's Resolutions. Here are a few tips to help you stick to your resolutions and achieve the results you desire.
Set Both Long Term and Short Term Goals
Envision what you want to achieve and write your goals down or make it into something visible and tangible so you will be reminded of your goals each day. Whether it's a reminder you'll read each morning or a note that you'll come across throughout the day, keep the goal fresh in your mind and work towards achieving it each day. Additionally, remember to set smaller, short term goals to help you stay accountable and continue progressing.
Rome wasn't built in a day. And most likely, you didn't gain the weight overnight so don't expect to lose it overnight either. While 7 day fasts and 14 diets are all the rave, they do more harm than good. Fast and rapid weight loss oftens leads to primarily water and muscle loss, which will do more harm to your metabolic capacity in the long run. And typically, once you return to your old habits, you'll regain the weight and then some. Any diet which you cannot sustain in the long run is not worth starting in the first place. Successful weight loss is about making lifestyle changes, both physically and nutritionally, as well as psychologically so that you can lose the weight and keep it off. These changes need to be adjustments that you can adhere to today, tomorrow, next week, and next year. Losing weight is one step, but weight loss maintenance over the long term is a true accomplishment.
Focus on the Process, Not Just the Goals
While it's easy to talk about what we want to achieve, we must take action. Aim to take steps each and every day to help get you closer to your goals. Whether it's substituting one soda per day with a glass of water, or committing to exercising 3x per week for 30 minutes, every step counts. Success is the sum of small efforts, repeated day in and day out. We don't have to be perfect and we shouldn't expect the process to be easy. But strive to do your best each day because consistency is the true key of success.
Let your friends and family know what you're trying to accomplish and how they can assist you on your journey. They can help keep you accountable and stay on track. Also having a workout buddy to motivate you and expect to meet you at the gym certain times during the week can be a great tool, especially on days that your mind is tempting you with excuses to skip the workout. Staying motivated is vital for success and while extrinsic motivational factors may be the primary fuel source at the beginning, they can become intrinsic motivational factors over time. See my previous post regarding exercise and motivation here.
Be Patient and Proud of Yourself
The best things in life take time, hard work, and consistent effort to achieve so be patient and believe in yourself. Anything is possible! It will require commitment, dedication, time, will power, and sacrifices. There will be temptations and times when you fall down. But failure isn't falling down. Failure comes from refusing to get back up. You can make it happen if you set your mind to it and I promise you that the results will be well worth it. Each day, wake up with determination and a goal. If you achieve it, you'll go to bed with satisfaction at night.
Get a Plan and Stay Accountable
Even if you have the proper mindset, you still need the game plan for success. And while there's no substitute for hard work, it's also important to strive to work smarter as well. There are millions of diets and fitness plans out there, but for it to be truly successful, it must be customized for the individual. Everyone is different so a "cookie-cutter" diet plan will never be optimal. A customized program should be based on many factors, including one's body composition, lifestyle habits, current and previous diets, likes/dislikes, workout equipment, preferences, and goals. Along with the proper plan, motivation and accountability is vital. Will power can fade so having the support and guidance to pick you up when you fall and keep you progressing along the path is essential. And when the right plan is combined with consistent progression, then resolutions and goals will indeed come true.
If you're ready to take the first step towards your goals today with a customized online personal training plan, click here.
- Joe Zucchi
The latest episode of Weight Loss, Fitness, & Your Health is now available for viewing! In this episode, Dr. Piotrowski and I discuss tips for avoiding holiday weight gain. I hope you find it informative and helpful in the coming months! Feel free to comment here or ask any questions in regards to the video.