Tag Archives: New England Journal of Medicine

The Knock On Niacin – Big Pharma At It Again

Two new reports recently came out that said niacin, vitamin B3, is not effective for the prevention of heart disease or stroke. And, in fact, it might be dangerous. The studies also concluded that it might be so dangerous is shouldn’t be recommended at all. This is not an uncommon response when nutrients are studied, especially ones that reduce the market share for billion dollar statin medications.

Two studies recently published in the New England Journal of Medicine found that while niacin does reduce triglycerides, raise “good” (HDL) cholesterol, and reduce “bad” (LDL) cholesterol, it did not reduce the risk of heart attack or stroke.

Big PharmaI have several problems with the new information that’s been plastered all over the media recently about the recent studies:

Problem #1:

While two studies were performed, the largest of the two was funded by Merck Pharmaceuticals. It had over 25,000 participants while the other study, funded by the NIH, had just over 3,000 people. Merck clearly has an interest in driving down the sales of niacin as it would likely increase the sales of their cholesterol lowering drugs Zocor and Zetia. As an added note, niacin sales have tripled since 2002. Wouldn’t it be a perfect time to get a study that shows it’s dangerous or ineffective?

Problem #2:

These published trials do not reflect the clinical experience of doctors around the country who’ve been recommending niacin for decades. Research and a doctor’s clinical observations are often different. Which one do you believe?

Problem #3:

These trials focused on high-risk patients, almost all of whom were already taking statins and had low LDL levels. Would you see more benefit in clinical trials if these patients had different lipid profiles, or in those who did not already have heart disease? The populations they studied were already being treated intensively. It’s unlikely they were going to benefit by just one more treatment (niacin in this case).  As a matter of fact, in the Merck funded study they clearly state they cannot say whether niacin might be beneficial for patients at even higher risk of having a heart attack or stroke or those with higher LDL levels.

Problem #4:

Statins are particularly ineffective with potentially serious side effects, yet we don’t see reports on the news telling us to stay away from them. This is likely the powerful pull Big Pharma has on media and medicine. A full 98% of people who take statins see no benefit. Zero percent avoid death by taking a statin and only 1.6% avoid a survivable heart attack, and 0.4% are helped by preventing a stroke. Compare that to the side effects where 2% develop diabetes and 10% develop muscle damage as a result of taking that statin and the numbers don’t add up.

I think the real lesson of these studies (both on niacin and ones published on statins) is that inflammation, not necessarily the cholesterol itself, is the problem. If you address those factors, you will live a long, cardiovascular disease-free life.

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‘What’ you eat is more important than ‘How Much.’

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Finally a large-scale study has concluded what I have been telling patients for years! What you eat is more important than how much of it you eat.  A calorie is not a calorie!

If you ask many classically trained dietitians about maintaining a healthy weight they will regurgitate the same old rhetoric they always have – “as long as you don’t eat more calories than you expend you won’t gain weight,” and “there are no bad foods, just bad amounts of food.”

The above statements have never made sense to me.  I remember taking ‘advanced biology’ in high school.  (There was nothing really ‘advanced’ about it. It was just the second of two courses, the first being ‘basic’ biology.)  In this class I remember learning about physiology and how the body responded differently to different types of food.  Some foods caused the release of insulin while others caused little or no release of this hormone.  The job of this hormone? It basically tells the body to store fat.  From that information I concluded that what you ate had to make a difference in your weight.

As I progressed through my eduction in college (as a biology major) and then on to chiropractic school where I truly received advanced training, my view did not change – the quality of food that I ate had to make a difference on maintaining my weight.  It could not possibly be as simple as calorie-in/calorie-out.

Yet when you read information online or from other mainstream media outlets you will hear just the opposite. “Eat whatever you want, just be sure it’s in moderation.” Or “It doesn’t matter what kind of food you eat as long as it’s low calorie.”

A new study of just over 120,000 people finally has come up with a conclusion that makes more sense.  Hopefully the American Dietetic Association will take notice.  Individually there are some very good dietitians out there, but the American Dietetic Association is making people sicker and sicker with their stance on many aspects of health in my opinion.

The researchers analyzed data on three separate studies over a 20-year period, tracking the long-term effects of different foods and lifestyle changes on more than 120,000 men and women. Adults in the study gained an average of 3.35 pounds every four years, for a total average weight gain of almost 17 pounds.

Regular consumption of potato chips, French fries and sugared beverages were most to blame for slow and steady weight gain. However, people who ate yogurt, fruits, vegetables, nuts and whole grains either lost weight or gained the least.

Now, I will be the first person to tell you that weight is not the be-all, end-all of health markers.  It’s a good one, but there are plenty of thin people in this world who are very unhealthy.  Also, I generally do not recommend grains be a big part of anyone’s diet.  In small amounts they are ok, but they contribute to inflammation which can be problematic for many reasons.

The other foods in this study – yogurt, fruits, vegetables and nuts – are free foods! Eat them as much as you want.  I routinely encourage people to eat these foods as much as possible.

Interestingly, nuts are a high calorie food yet they performed very well in helping people lose or maintain their weight.  If it truly was about calorie-in/calorie-out then nuts should have performed poorly.  It just goes to show you it isn’t about the calories that we’re putting in, it’s about the quality of those calories.

As much as I’d like to say it’s only about the quality of our food that matters, I cannot.  The amount matters to a certain extent.  If you are regularly consuming 7,000 calories per day you will gain weight.  That type of excess cannot be combated with ‘good’ foods.  However, to get that kind of extra calorie one would have to consume huge amounts of the ‘bad’ foods like fast food, doughnuts, etc.  Those clearly are not quality foods in the first place.

Dr. Dariush Mozaffarian of the Harvard School of Public Health and Brigham and Women’s Hospital is the author of the study that appears in the New England Journal of Medicine.  He says the calorie-in/calorie-out theory is incorrect “because different foods have a different effect on the body. ‘You can’t just say a calorie is a calorie. It doesn’t address your feelings of fullness, your blood glucose levels, your blood insulin levels and the other biological responses in your body.”

I could not agree more and this has been my point to other ‘experts’ on nutrition when we debate the calorie-in/calorie-out theory.

Let me pose this scenario to you –

Two people are going to embark on an experiment.  They are going to eat identical calorie diets for the next year.  One person is going to eat 2,000 calories per day in potato chips and the other is going to eat 2,000 calories per day in chicken and vegetables.  Who will be healthier and have the most optimal weight at the end of our experiment?  Intuitively we would say the person eating the chicken and vegetables would be and I believe this is correct.

There have been many short-term studies that have concluded healthy diets only need to focus on calorie content.  The quality of the food was not important for maintaining weight.  Finally a study has looked long-term and concluded that the quality of your food is important. Make sure your choices are good choices.  If you focus on the quality of your food you will maintain your weight more effectively than counting those calories.

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

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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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