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Do Supplements Kill?

Nutritional supplements

Supplement Aisle

A study recently published in the Archives of Internal Medicine has concluded that taking multi vitamins and several other supplements was actually associated with an increased risk of mortality (or death).  We’ve seen these studies before and I have several thoughts on them.

First, I do not believe supplements will increase your risk of death.  Supplements are exceptionally safe.  They are so safe, in fact, that they are all sold over-the-counter.  However, supplements are also very effective in helping people with a wide variety of conditions.  With that power can come potential for unwanted side effects.  We must understand that if something has the power to do good it also has the power to do bad.  Let’s break down the study and see how the authors came to the conclusion that they did.

They assessed the use of vitamin and mineral supplements in relation to total mortality in 38,772 older women in the Iowa Women’s Health Study; mean age was 61.6 years at baseline in 1986.  Supplement use was self-reported in 1986, 1997, and 2004.  Their conclusion to the study was as follows:

“In older women, several commonly used dietary vitamin and mineral supplements may be associated with increased total mortality risk; this association is strongest with supplemental iron. In contrast to the findings of many studies, calcium is associated with decreased risk.”

I have several problems with this study. The first is that use of supplements was self-reported.  And the time frame with which they reported was years apart. This is a problem because you are asking people to remember what they are taking.  I do this every day in my practice and many of my patients can’t remember what they’re taking day-to-day and I see them on a monthly basis.

The study also only shows an association, not cause and effect.  This is dangerous because studies like this get huge headlines and inevitably the headlines shout about how dangerous supplements are when, in fact, they are very safe.

To show you just how flimsy an association link in a study may be here is a good example. Say you wanted to study breast cancer and you wanted to look at what is associated with an increased risk of breast cancer. You might conclude that wearing make-up is associated with a much higher rate of breast cancer than not wearing make-up.  You came to this conclusion because you noticed that people who wear make-up get breast cancer at much higher rates that people who do not.  This sounds legitimate of the surface.  Perhaps there is something in the make-up that is carcinogenic.  Or perhaps people who wear make-up are much more likely to get breast cancer than people who do not for another reason. We know that breast cancer is far more common in women and they also happen to wear the most make-up.  An association can easily be shown between people who wear make-up and breast cancer, but it likely not for the right reasons.

Another shortcoming of the study is that the researchers did not know whether the women were taking the supplements for a specific health condition.  People often begin taking supplements because they do not feel well.  They may be experiencing sleep problems, low energy,  head aches or worse.  These symptoms may be signs of deeper problems. We cannot be sure these women did not die from the very condition they were trying to treat and not the supplements.

Thirdly, the increase in mortality was exceptionally small and likely is not clinically significant. What that means is that the results were so minuscule they have almost no observable effect.  It was also noted that the women who used the supplements were almost twice a likely to use hormone replacement therapy (HRT) while going through menopause.  HRT is known to increase the rates of many cancers.

The researchers did take hormone therapy into account in their analysis, along with several other potentially mitigating factors (including age, educational attainment, body mass index, diet, and physical activity).  What I don’t see on this list is prescription drug use.  This must be known for this study to hold any water! Drugs are obtained via prescription for one reason and one reason only – they are dangerous!  They are a leading cause of death in the United States!  If they did not consider drug use then how can they possibly conclude it was the supplements that increased mortality rates?  They can’t!

While I don’t agree with the conclusion of the study, I agree that men and women should seek the advice of someone trained in nutrition and skilled at building a personalized program for each individual.  I never recommend going to the health food store and picking up one of everything and beginning to take them.  As a matter of fact, I rarely recommend multi vitamins.  Not everyone needs more of everything.  Targeted nutrition should be your goal.

Remember, supplements are extremely safe and just because one study concludes that there is an association between supplements and mortality does not mean you should stop taking them, especially if they’ve benefited you.

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Reducing Your Risk of Cancer – 3 things you should include in your diet.

Fresh vegetables are important components of a...

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Did you know that an estimated 1,529,560 people were diagnosed with cancer in 2010? That’s 4,190 new cases per day!

Unfortunately, we have become acutely aware that there are many things in our world that are carcinogenic and inevitably will find more things in the future.  Mutagens come from a variety of places including tobacco smoke and environmental pollutants.  Popular herbicides contain glyphosphate, a compound that depresses the function of important enzymes that are essential for detoxification.  The number one cancer causing mutagen, however, is our diet.  For example, the frying, baking, and roasting of carbohydrate rich foods produces acrylamide, which is a known cancer causing agent in animals.

Everyday we are surrounded by these mutagens that have the potential to cause a genetic mutation within our own cells resulting in a mistake in our genetic code.  According to the New England Journal of Medicine, “Cancer results from the accumulation of mutations in the genes that regulate cellular proliferation.”  As these mutations begin to accumulate the cells can no longer regulate their own production and begin to grow out of control.  They no longer demonstrate the innate ability of apoptosis.  Apoptosis is defined as programmed cellular death.  Healthy cells that develop abnormalities are programmed to destroy themselves when mistakes are made.  Cancer cells, because of excessive mutations, lose this ability and continue to reproduce despite the fact they are causing damage.

The human body has a very unique and effective way of dealing with chemicals that it may come into contact with.  This detoxification system has two phases within which it works.  They are aptly named Phase I and Phase II.  This system is able to detoxify even the most potent of chemicals, including pesticides and other foreign compounds found in the environment.  Although these systems are very complex, we will go over them briefly and broadly.

The molecules produced in Phase I may be even more toxic than the initial chemicals because the molecular groups that are added to them by the body’s detoxification system are very reactive.  This allows these molecules to act as free radicals in the liver.  This is not problematic as long as Phase II is working well. The Phase I molecules are usually quickly converted to harmless molecules for excretion in the urine or bile by Phase II.

At this point you may be asking, “Why do I need to worry about it if Phase II acts so quickly?”  For one, the process is slowed with age and some people metabolize slowly while others metabolize much faster.  This shows the need for nutritional supplementation which maximizes the efforts of Phase I and II and reinforces the idea that we should provide the liver with ample amounts of antioxidants.

So the question remains.  What can you do to help protect yourself from dangerous mutations that may lead to cancer in the future?  Many nutrients have been found to be essential cofactors for the detoxification system, but three have recently been found to directly enhance its activity.

Curcumin

The first is curcumin.  It is a nutrient that is derived from turmeric.  Turmeric has been used for centuries throughout India and Asia for a myriad of different maladies ranging from upset stomach to arthritis.  It has also been shown to reduce total cholesterol and inhibit LDL oxidation.

In a study at India’s Panjab University, researchers found that curcumin inhibited mutagenicity by as much as 80% against mutagens in cooked foods.  Curcumin has also been shown not only to be preventative but also helps reduce the progression of cancer.  Curcumin appears to act by boosting the activity of glutathione S-transferase which is an important Phase II enzyme.

Curcumin has also been shown to be a potent antioxidant.  Antioxidants are important because they scavenge free radicals throughout the system.  Free radicals act on the body on a cellular level producing damage in whatever they come in contact with.

Chlorophyllin

Another potent inhibitor of mutagenicity is chlorophyllin.  This is derived from the green pigment in plants called chlorophyll.  Chlorophyllin is beneficial because it is water soluble and is easily transported in the blood.  It has been shown to inhibit mutations in bacteria when placed in a Petri dish with known mutagens.

Although its precise mechanism of action is unknown, it is thought to act as a powerful antioxidant as well.  In one study, chlorophyllin was shown to promote apoptosis in human colon cancer cells.  This is important because it is thought that the alteration of the process of apoptosis is one mechanism by which cancer continues to reproduce.  Chlorophyllin is has also been shown to be heat stable which is important because it will maintain its powerful properties after ingested.

Broccoli Extract

The third powerful nutrient is broccoli extract.  That’s right. Mom knew more than she thought when she was force feeding you broccoli and cod liver oil!  According to an article in Life Extension magazine, “Broccoli is a plentiful source of glucosinolates, which are converted enzymatically into isothiocyanates. In the body, the isothiocyanates in broccoli boost production of several Phase II detoxification enzymes, enhance antioxidant status, and protect animals against chemically induced cancer.”

A study at Johns Hopkins University showed that broccoli extract significantly reduced incidence, multiplicity, and weight of mammary tumors in rats after exposure to known mutagens.  Its activity is thought to work by enhancing enzymatic activity in Phase II of the detoxification system.

Cancer levels continue to be very high in the United States.  With the never ending influx of new chemicals into our world it is important to protect ourselves with nutrients that have been proven to be beneficial in the prevention of cancer.  Curcumin, chlorophyllin and broccoli extract have been shown to be very effective.  Traditional medicine promotes early detection as a crucial weapon in defeating cancer.  Early detection is of course important, but it is not prevention.  We propose that all of our patients take an active role in their health and prevent serious illness through good nutrition.

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Are we getting enough Vitamin D?

The Institute or Medicine (IOM) says we are.  They say we might even be getting too much.  Their recent report released on November 30th states that most Americans are getting enough vitamin D from their diet and supplementation is unnecessary.  In fact their conclusion to the report states “the committee emphasizes that, with a few exceptions, all North Americans are receiving enough calcium and vitamin D.”  I couldn’t disagree more.

The IOM examined over 1,000 studies and reports to make their conclusions that people need no more than 600IU of vitamin D per day.  They concluded that people are getting enough vitamin D.  However, this blanket statement only applies to one health factor – bone health.

It is my fear that people will see the headlines on the news and assume they are getting enough vitamin D.  The headlines inevitably will read “Americans Getting Enough Vitamin D.”  They will not tell people this refers only to bone health.  Vitamin D does so much more than protect your bones.

The IOM says the evidence, at this point, is insufficient to say that vitamin D has a protective benefit in any other area of health.  Research, however, has shown it improves cancer rates, reduces the incidence of MS, decreases cardiovascular disease rates and many more.

So why the conflict?

Part of the problem is that the IOM based it’s conclusions on what it takes to maintain bone health and since 2000 the research for vitamin D has exploded.  Many studies, published in some of the world’s most respected peer-reviewed journals, have concluded in direct conflict with what the IOM has said.

The IOM has said the studies that were done that drew conclusions on vitamin D’s other health benefits were either poorly designed or were insufficient to conclude vitamin D is good for anything but bone health.  These studies that they dismissed were good enough to be published in many of the best journals in the world.  I guess the IOM does not agree.

Below is a graph of the disease reduction rates by serum levels of vitamin D.  As serum levels rise, the rates of many diseases are reduced.  For example, breast cancer levels are reduced by 30% when vitamin D levels are at 34ng/ml or higher.  The X’s represent reasonable extrapolations based on the research but is beyond existing data.

 

Vitamin D reduces the rates of all of these diseases. It is NOT just for bone health as the IOM has concluded. The references are listed above as well.

The IOM report readily admits that people do not get enough vitamin D by saying:

“While the average total intake of vitamin D is below the median requirement, national surveys show that average blood levels of vitamin D are above the 20 nanograms per milliliter that the IOM committee found to be the level that is needed for good bone health for practically all individuals.”

If you look at the graph above you will see that the research is consistent with that statement.  At 20 ng/ml of serum vitamin D 99% of cases of rickets is prevented.  This is a disease of soft bones in children.  But what about all of the other wonderful, researched benefits of vitamin D? The IOM has seemingly missed the boat.

The graph above would suggest that a level of 60 ng/ml is optimal to protect a person from the diseases listed.  This is a serum level that cannot be obtained by current diets.  A person must supplement to reach this level and the IOM’s recommendation of 600IUs per day obtained from diet is exceptionally low.

I recently tested a patient who was under my care and was taking 4,000IUs per day as I had recommended.  Her serum vitamin D level came back at 18ng/ml.  By any current laboratory’s standard this patient was deficient in vitamin D.  And that’s after taking 4,000IUs per day for 2 months!  How can the IOM say 600IUs is enough for everyone.  It makes absolutely no sense whatsoever.

The IOM’s own report concluded that the average intake is below the median requirement but that blood levels were above the 20ng/ml required for healthy bones according to the quote above in gray.  How could that be possible?  Perhaps the 20ng/ml of serum vitamin D is too low as well.  This would make much more sense.  Instead of making that conclusion the IOM simply concluded that people must somehow be getting enough vitamin D.

I couldn’t disagree more.

The IOM has taken an exceptionally conservative stance on this.  Their stance on this is equivalent to saying that people shouldn’t exercise more than 10 minutes a day because any more than that might lead injury.

I recommend my patients get at least 2,000IUs per day of vitamin D.  I myself take 8,000IUs per day.  The benefits of taking vitamin D far outweigh any perceived “risks” associated with it.  Vitamin D is very safe and I hope this report doesn’t persuade any physicians into thinking it’s not.

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Food is largest source of exposure to BPA

Agua

Image by Daquella manera via Flickr

Bisphenol A, or BPA, is a chemical additive that is used in many things but mainly in plastics and linings of food cans.  Up until a few years ago this was considered a harmless addition to our already high chemical exposure levels.  Then, it was found that exposure to this chemical is linked to serious side effects but you could avoid any consequences by not reusing that Poland Spring bottle, by not overheating your plastics in the microwave or by buying BPA free merchandise.  Now we are finding out that our largest exposure to BPA is our food itself.

BPA has been linked to breast cancer, heart disease, diabetes, male infertility and other health problems.  Recently a U.N. panel concluded that the BPA in the packaging of our foods is actually leaching into the food making our food the number one source of exposure.  This should not be surprising.  One only needs to see the aftermath of the oil spill in the gulf to see that chemicals can get everywhere given the opportunity.

Information is limited on BPA.  It certain amounts it poses threats to fetuses, infants and growing children.  No one is quite sure what it does to adults.  For me, that’s enough.  If you didn’t know if a gun was loaded, would you point it at someone and pull the trigger?  Hopefully not and this is similar.  Just because we don’t know if it’s dangerous and the government is unwilling to take a stand on it just yet, doesn’t mean it shouldn’t be eliminated from our food supply.

This is just another reason to eat an unprocessed, natural diet.  Because this exposure of BPA is coming from foods that are packaged it can be avoided to some degree.  Eat a diet that is high in healthy protein, fats and vegetables and fruits.  Stay away from the packaged food as much as possible. Not only will you avoid BPA but you’ll also get all the great benefits of a healthy diet!

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“I’m destined to get (insert disease here) because my parents did.” – Maybe Not.

The field of genetics has rapidly evolved over the last 15-20 years.  The latest push in genetics is trying to figure out why some people with specific genes express them and why some do not.  For example, a very well-known gene is the “breast cancer” gene called BRCA.  This gene is known to increase the risk of developing breast cancer, but it’s not an absolute.  Just because you have the gene does not mean you are going to get breast cancer.  So why the difference?  Why would one woman with the gene get breast cancer and the next not?

Well some new research on vitamin D may help us find out.  It is clear that vitamin D is a potent genetic regulator.  The reduction in cancer rates and the rates of other diseases drops sharply with adequate vitamin D levels.  Most people, however, do not have adequate levels of vitamin D.

Vitamin D is considered a vitamin, but it’s really a hormone.  It is best obtained from direct sunlight but dietary sources do exist and include fortified milk, eggs and oily fish.  Vitamin D is probably best known for helping people build and maintain strong bones.  While it is essential for that, the story for vitamin D only begins there.

Vitamin D is believed to have a role in controlling genes linked to major diseases such as certain types of cancers, dementia, and autoimmune disorders, new research has found.

“Through large scale studies, we now have a good idea of the genes involved in common complex diseases such as type 1 diabetes, multiple sclerosis and systemic lupus erythematosus,” wrote lead author, Dr. Sreeram Ramagopalan of the Wellcome Trust Centre for Human Genetics at Oxford University.

Scientists from University of Oxford, The London School of Medicine and Dentistry and Simon Fraser University in Canada identified 2,776 gene positions occupied by the vitamin D receptor and 229 genes that changed in response to vitamin D.  That’s right, thousands of genes respond to vitamin D.  To put this in perspective, the human genome has an estimated 23,000 genes.  That means vitamin D has a direct effect on over 12% of our genes. It doesn’t get more important than that!

What I want to stress is that if you are concerned about a part of your family’s health history as it relates to you (and who isn’t) taking vitamin D is good insurance.  It may just offset your genetic potential for disease by controlling your genes and keeping the bad ones turned off and the good ones turned on.

How much should I take?

I always recommend that my patients have their serum vitamin D checked.  It has become a very routine test for physicians to order and just about every person who comes to see me walks out of my office with a lab requisition to check vitamin D.

Taking vitamin D is simple.  Most people, even ones in sunny climates, can benefit from taking vitamin D.  Here in the Northeast I recommend my patients take 4,000-6,000 IUs per day for maintenance.  If we are working to significantly raise serum levels a dose of at least 10,000 IUs per day is necessary.  The point is check your blood levels.  Shoot for a level of between 55 and 65 ng/ml.  Once you reach that level you must maintain it to continue to get all the benefits that vitamin D provides.

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Diet, Exercise can prevent 1/3 of all breast cancer cases

Recently, researchers have concluded that one third of all breast cancer cases in Western countries could be prevented if women ate healthier diets and exercised more.  This is great news for all women and a shift in the thinking of most of modern medicine.  Most of traditional medicine, funded by the pharmaceutical industry, has focused too much on treatment and screening and not enough on actual prevention.  While treatment for breast cancer is extremely important, the best treatment is doing everything you can to avoid it.

When you read most information on breast cancer you will see ‘prevention of breast cancer’ in the same sentence as ‘mammograms’ and ‘self breast exams.’  Mammograms and self breast exams never did anything to prevent breast cancer.  They are great for early detection which is important in the outcome of many cases of breast cancer, but they do nothing to actually prevent it.  True prevention means you never get a disease.  Finding it early in its course obviously means it was not prevented. 

Reseasrchers are finally cathcing up with what people in natural and holistic health have been saying for years.

“What can be achieved with screening has been achieved. We can’t do much more,” Carlo La Vecchia, head of epidemiology at the University of Milan, told The Associated Press. “It’s time to move onto other things.”

Breast cancer is very common in the U.S. unfortunately.  In 2009 there were 190,000 new cases of breast cancer and just over 41,000 deaths.  A women’s overall lifetime chance of developing breast cancer is about 1 in 8.  Obese women are 60% more likely to get breast cancer.  Breast cancer is fueled by estrogen and fatty tissue produces estrogen.  The theory is that women who are overweight produce more estrogen thereby increasing their risk of developing breast cancer. 

Many breast cancer agencies have been careful not to issue guidelines on weight for fear of offending women or causing them to feel responsible for their diagnosis of breast cancer.  That might be the most ridiculous and irresponsible notion I have ever heard.  That’s like the American Heart Association not issuing guidelines on weight because they don’t want you to feel responsible for your heart attack, or the American Heart and Lung Association not telling you to stop smoking because they don’t want you to feel guilty if you get lung cancer.  What the breast cancer associations should be doing is issuing strict guidelines on diet and exercise to empower women.  By issuing these guidelines they would be telling them that they have a choice and can do something to reduce their overall risk!  Yes, breast cancer is a complex disease with many factors to it and diet and exercise won’t stop every case, but why not do everything you can to prevent it? 

Women need to be on diets that are anti-inflammatory.  These are diets that are natually low in carbohydrate and high in healthy fats.  These low glycemic diets will reduce insulin production, reduce fat storage and reduce estrogen production significantly over a woman’s lifetime.  (See our post about the dangers of inflammation and samples of healthy foods.)  Exercises should be varied.  Weight training mixed with cardiovascular training is best.  Weight training maintains lean muscle mass which inhibits fat deposition and cardiovascular training keeps the heart healthy. 

I am not suggesting in any way that if a woman gets breast cancer it’s her fault because she did not exercise.  Quite the contrary actually.  Most health professionals do not treat proactively and have no advice for women on what they should do to protect themselves from various diseases.  They are handcuffed by their education to simply give a pill once a disease becomes diagnosable.  I can’t tell you how many times I have patients come to me who are “waiting to be treated” for a disease that they are on their way to developing, but it hasn’t quite met the requirements just yet.  This is the worst model of medicine, but it is unfortunately the most prevalent.

More and more we are seeing that diet and exercise (big surprise) is the best way to prevent a whole host of diseases.  What needs to happen is that the focus shifts from disease treament to disease prevention.  That is truly the only way that we are going to reduce health costs and improve the health of our country.

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