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Dietary supplements and scams

Friday, February 11th, 2011

and it isn't cheap

When I was at Langley AFB in th early 1970s, we had an opportunity to take a field trip to the Cayce Institute. Edgar Cayce was a supposed psychic who lived from 1877 to 1945. I came away from that trip with a healthy dose of scepticism, not so much about Mr. Cayce himself, whose work I never saw, but of those who inherited his mantle,

That scepticism has served me well over the years and today led to a prolonged web search on the supposed benefits of acia berries as a dietary modality and supplement. It started with a news article I found that claimed a Channel 10 employee had lost 25 pounds in 4 weeks on the "Optimal Acai" program.

I began tracing the story and found a number of websites that were pertinent: WebMD said acai berries are claimed by marketeers to be an "elite superfood with anti-aging and weight loss properties." They did note that the berry, which comes from a palm tree found in Central and South America, has lots of antioxidant capacity, even more than other berries (cranberry, raspberry, blueberry). It contains chemicals that are in the flavinoid and anthocyanin family, the latter being found in red wine for example.

But as to the claimed health benefits of this particular berry, who knows. Thus far there are no studies that show it's better than other similar fruits.

MedlinePlus, the National Library of Medicine's consumer information source, notes the acai berry has antioxidants, but says there is insufficient evidence thus far to show its effectiveness.

So how did the acai berry craze start? In November of 2004 a dermatologist, Dr. Nichoas Perricone, appeared on the Oprah show. Subsequently a post on oprah.com touted his so-called superfoods, especially acai. The comment that struck me was "harvested in the rain forests of Brazil, acai tastes like a vibrant blend of berries and chocolate."

Well that sounds yummy, but who is Dr. Perricone and what's the data? And why do I connect this back to Edgar Cayce?

Dr. Perricone is a dermatologist who writes on weight loss and anti-aging. He's also an Adjunct Professor of Medicine at Michigan State's medical school. One of his books, The Perricone Promise, tells of neuropeptides and their role in aging and focuses on a particular diet. A three-month supply of a neuropeptide-based serum that his own company sells costs $570.

Subsequently there have been scams with emails sent off linking to supposed news reports on the acai berry diet; one was to a website New7health.com which had an identical claim as the supposed website I saw today (reporter lost 25 pounds in 4 weeks). This was exposed as bogus in March 2010 and led me to reread the supposed Channel 10 health news article.

Part of the promise beside rapid weight loss is to eliminate bad toxins built up over many years and remove sludge from the walls of the colon. Now I was back at the Cayce Institute with a basic part of their program being so-called "High Colonics," enemas to lose weight.

I won't believe any of this kind of spiel until The NLM and other reputable medical organizations report controlled, double-blind, peer-reviewed, evidence-based studies.

Posted in Dieting, Governmental Efforts, medically-oriented background info, supplements, tricks and gimmicks | 4 Comments »

Focus on Vitamin B-12 again

Tuesday, January 18th, 2011

high-dose B-12

I've been reading a number of articles about Vitamin B-12 lately. One convinced me we should be taking a higher dose at our age. In young people B-12 deficiency is rare; that's not true for the elderly where some have estimated up to 15% may be lacking in this essential nutrient. What I hadn't fully realized is the omeprazole (Prilosec) I take chronically could potentially also block absorption of B-12.

B-12 deficiency, when severe, causes macrocytic anemia, low red blood cell counts with the cells themselves being larger than normal. That's the flip side of iron-deficiency anemia where the cells are smaller than usual. But there are a host of other issues attributed to B-12 deficiency: depression, dementia, confusion, appetite loss, balance problems. All those have many other causes, of course.

We had been taking a multivitamin for seniors, but added high-dose B-12, (1500 mcg/day. Like the rest of the B vitamins, B-12 is water soluble and if one takes "too much' it can be excreted in urine. That's not true for fat-soluble vitamins like Vitamin D where the potential for overdose is worth thinking about (although there is ongoing debate as to how much Vitamin D we should be getting; see my last post). Our senior vitamin mixture has 25 mcg of B-12 or about 4 times the recommended daily (RDV) value for young healthy adults, but I don't care if I take more than that since I'm about to turn 70 and take that proton pump blocker omeprazole.

beef liver

Today the Wall Street Journal in its Health and Wellness section had an article about B-12 deficiency. It is more likely to be seen in people who don't eat meat or dairy products (beef liver has 48 mcg/slice which is 800% of the RDV). Several chronic bowel diseases  (e.g., celiac disease) can lower its absorption.

The Institute of Medicine recommends that anyone in their 50s or older get most of their intake of this essential vitamin from supplements or, alternatively from so-called "fortified" cereals. When I looked at the NIH's lists of foods that contain larger amounts of B-12, I was somewhat surprised to see at least eight cereals listed.

There is a blood test for B-12 with normal levels of 200-800 picograms per milliliter  cited as the normal range. But my own doc just said my level was superb, ~1,000 pcg/ml in January of 2009. There are now B-12 nasal sprays and some people with severe deficiency have to get B-12 shots, but she talked to a hospital pharmacist who said, just tell me to take my Prilosec at a different time of the day than my B-12.

So if you are 70+ or have a chronic bowel disease or are a vegan, you may want to ask your physician about a B-12 level.

Posted in medically-oriented background info, supplements, Vitamins and Minerals | No Comments »

When even the experts disagree

Friday, January 14th, 2011

A good source of calcium

I saw two interesting articles this week that made me pause and chuckle a bit. One came from the American College of Physicians' publication, "ACPInternist:" the other from medscape.com as A "Best Evidence Review," and compared and contrasted recent US and Canadian authoritative recommendations." The topics were calcium intake/supplements and Vitamin D optimal dosage and the suggestions varied considerably.. I doubt it's because Canada is further north, but that thought crossed my mind.

So let's talk about calcium first.

In July 2010 an article appeared in the British Medical Journal which made many physicians change their recommendations on calcium supplements. There was nearly 1/3 more heart attacks in a group of patients taking calcium pills as opposed to another group who weren't. At a later revelation at an American medical society meeting, the same group of research scientists showed a data from the Woman's Health Initiative (WHI) that also found a heart risk from calcium supplements, this time both in heart attacks and calcification of coronary arteries.

We quit taking our calcium pills, but continued to drink and eat milk and milk products.

Now other medical researchers have cast doubts on the significance of the data saying the overall WHI statistics showed what is a small heart risk at most. There's still a debate as to whether calcium supplements do or do not decrease hip fractures (a major problem, especially in older women).

Then the Institute of Medicine report issued in November as a joint US-Canadian dictum said most Americans, except possibly for teenage girls and some of the elderly, get enough Vitamin D and calcium without using any supplements and that the major risk of too much calcium intake was really kidney stones. There was a specific caveat that postmenopausal women taking supplements may be getting too much calcium.

High-dose Vitamin D

Now the January 5th, 2011 Medscape review looked at Vitamin D recommendations in Canada versus those in the United States. Both came from authoritative sources: The Osteoporosis Canada study concluded that many of us are low in Vitamin D and that more is good, mostly in promoting bone health, but possibly in colon cancer prevention and also in decreasing older adult falls. They suggest taking larger doses than the US Institute of Medicine does.

SO...how do I parse these varying studies and what do we plan to do. First, we will continue to get our calcium from food sources, mostly milk, soy milk (with its added calcium), cheese and yogurt. Secondly we'll continue to take a larger dose of Vitamin D in pill form, but perhaps slightly less than we are now, and I may get a little more sun exposure.

One comment in the Medscape article was a "young white person needs approximately 4 minutes of direct exposure to sunlight on the arms and legs to generate approximately 1,000 IU of vitamin D3." There's debate as to using sunscreen or not with a small, but randomized Australian study showing a similar increase in blood levels of Vitamin D, measured as 25-hydroxyvitamin D3 (25-OH-D) whether actual sunscreen was used or a placebo sunscreen. Notice, please, that nobody is suggesting prolonged or facial sun exposure.

Sun and Clouds

I may try some arm and leg skin exposure to sunlight; my wife who has had one skin lesion removed won't. We'll continue taking Vitamin D and she needs a follow-up blood level test as her first one was low. We're now on 5,000 IU per day and that may be too much; the Canadian study suggests 800 to 2,000 IU per day; the US recommendations, while lower (800 IU per day for those 71 and older; we're just shy of that), say risks from too much Vitamin D don't increase until doses are over 4,000 IU per day.

Confusing, isn't it; I suggest you ask your own personal physician as to what you should be doing and also ask them if they've seen the most recent recommendations.

Posted in Governmental Efforts, medically-oriented background info, supplements | No Comments »

Caveat Emptor

Friday, January 7th, 2011

An article that got me thinking and Googling

Remember when phlogiston was the answer? Well maybe not; that was a long time ago, but ideas in science and medicine come and go.

Two things reminded me of that in the last few days. I usually try to keep up with developments in those areas of medicine that I have a direct or even peripheral interest in. I read the abstracts in the Annals of Internal Medicine and decide which articles make sense to read in full. I look through the bi-monthly Journal Club appended to Annals and do the same.

Then I find suggestions in the two papers and several magazines I read and hunt down the original articles on which they are based.

Some of that is personal; we each take several prescription meds plus a senior vitamin, a large-dose B12 pill, vitamin C, fish oil capsules and vitamin D each day and our supplements have varied over the years as new articles come out.

But even as a medically-trained (now retired for 12+ years) individual, there are times when I find a sudden switch  in the conventional thinking to be jarring.

Two of those happened in the past week.

I was about to write a blog post on Omega-6 to Omega-3 ratios in our diet and give my take on what our optimum ratio should be. American diets have had a ratio well over that in many countries; some advise altering that from the current/recent 15:1 or even 40+:1 to 2:1 or 1:1.

Then my wife, aware of my interest in the area, showed me an article that led me to contacting a senior Harvard professor. Dr. Frank Sacks works in the Department of Nutrition in the Harvard School of Public Health and has chaired, co-chaired or been the principal investigator on a number of well-known, multi-center studies.

He was kind enough to respond to me email and sent me two of his publications, one from the journal "Circulation 2009; 119; 902-907 and the other from The Journal of Clinical Endocrinology and Metabolism 91(2): 309-400.  Bottom line: he feels both Omega-6s and Omega-3s are good polyunsaturated fatty acids (PUFAs) and that ratios make no sense. I'm still digesting his articles and may comment on them later.

Then a friend gave me an article from The Atlantic. It had the intriguing title I pasted in above. I read the lay publication and then Googled the man written about.

Dr. John Ioannidis is a Professor of Medicine at a Greek university, Adjunct Professor at Tufts (where he did his fellowship after graduating from Harvard) and Director of the Preventive Medicine Research Center at Stanford.

Nearly ten years ago he began a project in Greek hospitals that eventually led him to state as much as 90% of the research articles published in medical journals have one or more critical flaws. This isn't limited to medicine, of course. Similar work, termed meat-resaerch, has been done in a variety of scientific fields, with the same conclusions.

Yet a late 2007 blog post by a surgeon/scientist comments 1). to paraphrase Churchill's famous bon mote on democracy, medicine's use of randomized clinical trials and peer-review is the worst way to find the best new treatments, except for all other ways. Whether "evidence-based" reviews have improved the system remains to be seen.

Statistical analysis, as done in a commentary on Ioannnidis's work, can explain why even a quarter of the very best studies can yield incorrect results.

Yet medicine moves on, discarding treatments found to be ineffective or harmful.

In the meantime, I'll not try the latest and "best"..at least not most of the time.

Posted in Food Additives, Healthy eating, medically-oriented background info, supplements | No Comments »

Omega-3s to the rescue or not?

Monday, December 20th, 2010

A while back (actually in March 2010) I accompanied my wife on a trip to Phoenix where she was going to attend an Integrative Mental Health Conference with Dr Andrew Weil as the co-director. One of the sessions she attended was on new methods for treating depression.

Among the alternative medicine approaches to this major issue, said to be the world's fourth leading cause of morbidity and death, is the use of Omega-3 supplements. The notes from the conference intrigued me, especially since we were already taking fish oil.

fish in the raw

So we've both dug into the literature and talked to others about fish oil and omega 3s. I just watched a video on the National Library of Medicine's MedlinePlus site and printed off articles from that website, Science Daily and the University of Maryland Medical Center and read portions of a book, The Omega-3 Connection published in 2001 by a Harvard researcher.

So here's my take on Omega 3s.

They are helpful in lowering triglyceride levels, likely effective for preventing heart attacks and possibly are effective for a host of other conditions, including depression.

You can get them from oily fish, but eating large amounts of fish may expose you to mercury, dioxin and PCBs; the NIH feels it's well worth the risk to eat fish, at least moderately. If you do eat fish several times a week, bake or broil them, don't fry them or eat so-called fish sandwiches.

Fish oil supplements appear to help a number of conditions, although the evidence seems mixed. I think the real benefit likely comes from taking a moderate dose of fish oil, using a good brand and keeping the bottle in the dark and probably in the freezer.

fish-oil capsules

The use of high-dose fish oil should be restricted to people who are under the care of an experienced physician. We take two capsules a day and some of the research results I read about would require 12 or more capsules.

High doses of fish oil can reduce your ability for blood clotting and therefore increase the risk of strokes and other bleeding problems. I'd avoid it if I were on blood-thinners (e.g., Coumadin) or high-dose aspirin.

When it comes to depression (and I'm talking about so-called unipolar depression, not bipolar (severe mood swings, what used to be called manic-depressive disorder), a number of studies seem to show the EPA fatty acid in fish oil works, not the DHA.

If you're on an anti-depressive medication, taking a small amount of fish oil may help potentiate the drug's effect. Again, using large amounts of fish oil without any medication could be effective, but must be restricted to Rxs from an experienced physician.

And, fish oil may also potentiate the efects of anti-hypertensive meds. So if you're on one and start taking fish oil capsules, have your blood pressure checked several times.

But, having read as much as I have on fish oil, I'm certainly going to keep taking it. When taken in low doses, the MedlinePlus website says "it's likely safe for most people." And my bet is it can help a lot of us.

Posted in medically-oriented background info, supplements | No Comments »

Vitamins in general

Tuesday, November 23rd, 2010

Vitamins for seniors

I've written several posts on calcium intake and, in reviewing them for the book I'm working on, noted I had mentioned, but not detailed, my thoughts about vitamin D. So I've been researching source material on the subject and wanted to bring you up to date on my take on the new recommendations for how much we should be getting.

Let's begin with vitamins in general. A reasonable starting definition of  a vitamin is an organic compound that is required in tiny amounts and can't be synthesized by the body. So until the 1930s, when vitamin C was first made by chemical means, all our vitamins came from our diet.

Vitamins are divided into water-soluble and fat-soluble varieties. The former include vitamin C and the B vitamins, B1, 2, 3, 5, 6, 7, 9, and 12; the latter include vitamins A, D, E and K. Various others have been proposed and later found to be capable of synthesis by humans, thus accounting for the missing letters and numbers.

Water-soluble vitamins are not well-stored by the body and must be regularly replenished. Vitamin C, for instance, in studies conducted on conscientious objectors in Britain during WW II and in Iowa on prisoners in the 1960s, is depleted in a few weeks to as long as six to eight months depending on the degree of "pre-loading". The British Navy started giving lime juice to its sailors in 1795 to prevent them from developing scurvy on long voyages.

On the other hand excess intake of these is less likely to have toxic effects.

Fat-soluble vitamins are stored in the liver and various fatty tissues, need not to be taken quite as regularly  and conversely are more likely to be toxic when taken in excess.

Those are, of course, sweeping general statements.

So let's go back to how we get our vitamins and a few controversies. The famous chemist and two-time Nobel pre winner Linus Pauling, proposed in 1970 that taking larger doses of vitamin C could reduce the incidence of the common cold. He later expanded his claims to include mega-dose vitamin C as beneficial for a variety of ailments, including cancer.

A large series of well-designed and double-blind studies disproved the former claim and the Mayo Clinic conducted three controlled studies from 1979 to 1985 that showed patients with advanced cancer who were given 10,000 milligrams of vitamin C a day had no improvement when compared to pateints given a placebo.

So we take 500 milligrams of vitamin C a day. Can you get enough of the 13 vitamins from your diet? Sure if you work at it. Does the requirement for various vitamins change with age? I think the answer if clearly yes and, for instance, we're now taking a large dose of B12 daily as recent data suggests seniors may malabsorb this crucial vitamin.

And B12 is water soluble, so if I take a little bit more than I need I'm not going to worry about it.

But then there are the fat-soluble vitamins and I'll write more about them and especially about vitamin D in my next post.

Posted in Food Additives, medically-oriented background info, supplements | 1 Comment »

Calcium supplements, heart attacks and statistics

Tuesday, October 26th, 2010

After I looked through the November issue of the Harvard Heart Letter I decided to revisit the calcium supplement issue I wrote about several months ago.

Harvard researchers published an article in Annals of Internal Medicine in March of this year. They did a meta-analysis of 17 studies that examined results from calcium supplementation, or vitamin D supplementation, or both, with an emphasis on cardiovascular disease (CVD). A meta-analysis statistically combines the results of several studies that address a shared research hypotheses.

A friend gave me Tom Siegfried's article on statistical significance from the March 27, 2010 edition of Science News. It's title is "Odds are, it's Wrong." What it basically said was our way of deciding if a conclusion is valid is flawed much of the time. We really often need to examine the results of several studies and then see if the studies were actually designed to look at the general population.

We also need to examine at the level of confidence in the results. The standard we most often use is a p value of 0,05; that translates as one possibility in twenty that a result happened by chance. Is that good enough? I'd be very comfortable if the possibility was one in ten thousand, but one in twenty? A later comment in the same journal added casuality, e.g, Although 100% of people who die of stomach cancer drank milk as kids, that doesn't mean milk causes stomach cancer.

So let's go back to the Harvard paper and see how it applies to you and me. The Harvard folk started with 1,484 possible articles and came up with only17 that met their criteria. They wanted to limit their included research projects to prospective controlled studies in adults. They excluded, among others, review articles, letters to the editor, papers where there was no control group, retrospective studies or studies in children.

So far, so good. But when I drilled down into the remaining articles, many were done on dialysis patients, not a general population. Some were projects were only vitamin D was taken, some where just calcium was given, some where both were supplemented.

In terms of the general population they only found one study where just vitamin D was taken by the participants.  Even that one was flawed; it didn't include sufficient information on sun exposure or duration of vitamin D supplementation. It did conclude that postmenopausal women (34,486 of them), not only didn't increase their CVD risk by taking vitamin D; they likely decreased it. Other studies I've ready recently aren't as sure of the cardiovascular benefits of vitamin D.

We really do need vitamin D; it helps us absorb calcium and has other roles including maintaining healthy bones.  The NIH says most healthy adults can safely take vitamin D in doses up to 2,000 IU/day, The Harvard Heart Letter said 800 to 1,000 IU/day.  Sun exposure is the other place we get it, 10 to 15 minutes a day without sunscreen is enough.

The New Zealand article, published in the British Medical Journal in August 2010, said there was a 30% increase in cardiovascular events in people taking calcium supplements. But...the increase in heart attack frequency was one person in 200. Additionally their study excluded anyone also taking vitamin D; that makes less sense to me. The only study reviewed by the Harvard researchers that looked at combined calcium and vitamin D supplements showed no increase in CVD risk.

So I'm still not taking calcium tablets, but I am drinking skim milk (low-fat is another choice if you hate skim milk) and eating some non-fat yogurt daily. And I'm taking vitamin D.

Posted in medically-oriented background info, supplements | 6 Comments »

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