Sunday, April 6, 2014

Monkeying Around With Longevity

The search to extend human longevity spans the ages. More recently, scientists have repeatedly shown that restricting the intake of calories while continuing to supply essential nutrients extends the lifespan of flies and yeast by as much as 40 percent. An additional research vector that captured much attention were animal studies with rodents that suggested similar benefits from caloric restriction. 

Although positive results were not seen with all strains of rodents, some rodents were shown to live significantly longer when their calories were limited.  As with all animal studies, scientists wanted to know if these benefits extended to more complex creatures that more closely resemble humans--such as primates--better known as monkeys.

When the National Institute of Aging (NIA) completed their studies with monkeys in 2012, the NIA's conclusion was that that caloric restriction made no difference. This hardly put the controversy to bed, but it did seem to dampen some enthusiasm for this approach to extending human longevity.

This past week, a new study from the University of Wisconsin stirs up new hope for reconsidering this strategy. Over 25 years, Wisconsin researchers studying rhesus monkeys, considered by some the best proxies for humans, found a significant reduction in mortality and in age-associated diseases among those monkeys fed calorie-restricted diets. The study, begun at the University of Wisconsin-Madison in 1989, is one of two ongoing, long-term U.S. efforts to examine the effects of a reduced-calorie diet on nonhuman primates.

The study of 76 rhesus monkeys, reported Monday in Nature Communications, was performed at the Wisconsin National Primate Research Center in Madison. When the monkeys were 7 to 14 years of age, they began eating a diet reduced in calories by 30 percent. The comparison monkeys, or the control group, which ate as much as they wanted, had an increased risk of disease 2.9 times that of the calorie-restricted group, and a threefold increased risk of death.

So which study is correct?  According to the Wisconsin researchers the reason for the discrepant results is that the NIA monkeys that were in the control group versus the intervention group were actually already on calorie restricted diets and that's why no difference was found in longevity between the two groups. Also, the NIA monkeys were consistently slimmer (and presumably healthier) that the Wisconsin monkeys, who were allowed to eat what they wanted. (I guess even monkeys, particularly captive ones, overeat when enabled to do so.) The NIA was apparently more careful with all their monkeys to limit their food intake regardless of the study.

How did the Wisconsin researchers reach this conclusion? Through their own experience in monkey research, and by reference to an online database recording the weight of thousands of research monkeys, the Wisconsin researchers concluded that the NIA controls were actually on caloric restriction as well. “At all the time points that have been published by NIA, their control monkeys weigh less than ours, and in most cases, significantly so” stated Ricki Colman, a senior scientist at the Wisconsin Primate Center, who presently co-leads the project.

More importantly, the NIA control group monkeys were also found to live longer on average that most other monkeys, and the Wisconsin researchers theorized that this was due to even a small reduction of calories. The big conclusion was that it seems that the small caloric restriction in the NIA control animals had its own benefits, suggesting that a reduction of as little as 10 percent could meaningfully retard aging.

As these studies were very expensive to conduct and will therefore not be repeated any time soon, the question remains do primates benefit from calorie restriction as long as they get all essential nutrients? The Wisconsin study would suggest that for rhesus monkeys, the answer is yes.

So what does that mean for us humans?

According to the Wisconsin researchers, they were“not studying [caloric restriction]...so people can go out and do it, but [rather] to delve into the underlying causes of age-related disease susceptibility...It’s a research tool, not a lifestyle recommendation."

Although the helpful mechanism of why caloric restriction may be beneficial has not been fully identified, it is believed to have something to do with the "reprogramming of the metabolism. In all species where it has been shown to delay aging and the diseases of aging, [calories restriction]... affects the regulation of energy and the ability of cells and the organism to respond to changes in the environment as they age.”

One of the first break-downs in metabolism results in diabetes, which can be seen as “an inability to properly respond to nutrients.” Diabetes damages a whole range of human capabilities including the functioning of muscle, fat and blood vessels. "The Wisconsin scientists began to see diabetes among the control animals while they were still in the prime of life, within six months after beginning their study. The contrast with the restricted animals could not have been more dramatic" Colman said. “Until two years ago, we did not have evidence of diabetes in any caloric-restriction animal, but we had a significant number of diabetes, or pre-diabetes, metabolic syndrome, in the control animals.”

Although it is generally accepted that very few people can tolerate a 30 percent reduction in calories, the study does merit consideration.  Primarily because “the basic biology of caloric restriction in rodents, worms, flies and yeast seems to carry over to primates," it appears worthwhile to identify the underlying mechanism for this result in order to better understand the potential benefit to human primates who are genetically so closely related to rhesus monkeys.

The bottom line here is that as long as they all get their essential nutrients it would appear across multiple species, from simple worms to far more complex primates, that eating less is better than eating more. It's not a large stretch to extend that logic to homo sapiens. Accordingly, even cutting back on 10% of your calories may have a huge effect on your longevity--adding years of healthy living to your life.  And that's not something to monkey around with.


Wednesday, April 2, 2014

If Money Grew On Trees...


Many parents like me have often expressed to their children that "money doesn't grow on trees." The point of this admonishment is obvious: money is not something one comes by naturally; rather, making money requires time and effort.

I've been thinking a lot about this old adage lately. What if money did grow on trees? Would that make money any less valuable or difficult to come by? Is there any relationship between money growing on trees and your health?

In the back of my house, I have two fruits trees: a grapefruit tree and a lemon tree. Both were planted by our gardener about seven years ago. The first tree has never so much as produced a single grapefruit. The other tree sprang a few lemons its first year and since then has meagerly grown an annual--wait for it--solo lemon. The problem is obvious. Neither the gardener nor I have properly nourished (trees like humans can't function properly without adequate nutrition) the soil around the trees to enable the trees to effectively grow fruits. True, the trees get a fair amount of rain and more than adequate sunshine.  But if even one component of what is needed to grow fruits is missing--you get no fruits.

Now let's imagine that money was like a fruit that grew on trees.  In order to harvest such money, effort would have to be expended to ensure that the tree was properly taken care of. First, the tree would need to be in the proper climate to grow.  It would need sufficient water and nutrients in its soil. Also, during a certain season (did you think it grew year round?--fruits don't), when the money was sufficiently ripe, it would need to be harvested. This would require physical work. If you let the money just fall to the ground, animals would grab it. If you didn't want to do the work or didn't know what to do, you would have to hire a gardener. That costs money as well.

On the other side of my house there is a loquat tree. (For the curious, the loquat is a species of flowering plant in the family Rosaceae, native to south-central China. It is a large evergreen shrub or small tree that grows yellow fruit.) The loquat is one of my wife's favorite fruits and for good reason. It is truly succulent.  Each year we try to take down as many loquats as possible. However, many are beyond our reach and many of those within reach are grabbed by unknown others (they just disappear). By the end of the season, animals have also joined in the feast by consuming those that fall to the ground. We could hire someone to pick the higher branches of the tree for us, but we calculated that it would be less expensive to simply go to a store and buy the loquats.

Also, if we had a money tree, it would need to be protected against infection. For example, a palm tree near my house recently died. It apparently died because of benign neglect. We recognized something was wrong two years ago when we called in the experts. One told us it was a fungal infection. Two others said it was malnourished. I believed the second two--it was less expensive to go that route than pay thousands for a fungal treatment. So I begged my gardener to feed it. He claimed he did and yet the other day, I noticed it was dead.  My gardener's response: an infection killed the tree and he is not responsible for infections. Ouch. Then without permission, he cut it down.  (Time for a new gardener?)

Now let's imagine if my recently departed palm tree was a money tree.  That's easy to imagine because it was.  This was a beautiful palm tree that I had paid a lot of money to have planted (and would have to pay even more to a new gardener now to replace). It also had great value to me aesthetically as it sat prominently in front of my house.  Despite its value, it still bit the dust. I had tried to do right by it, but let it down. My tree was gone; my money (tree) was lost.

One last fruit tree story.  A neighbor has an avocado (actually a fruit) and mango tree. Each year when the fruits are ripe for picking, she barters the fruits for things she needs. In other words, they have real financial value, similar to a farmer harvesting his own fruit trees for sale.

By the way, it would obviously make a big difference what denomination of money my tree would grow. If it was a mere $1, then a harvest of one hundred would yield an annual $100. That would definitely not justify the cost of growing the money. At $5, it would be $500.  Even at $100, it would only yield $10,000 if they were all harvestable.  But at that value, you would definitely need to employ very effective and costly security measures to keep others away so your expenses would further increase.  Obviously, the higher the denomination the better, but under $100 would still require a lot of trees with plenty of land (which can be expensive) to support them to make a good living.

So when I summed up the costs of successfully maintaining a fruit tree, let alone assuring that it gave a bountiful harvest each annual season, one thing was perfectly clear to me. Fruit trees are money trees and so money does grow on trees.

So the next time you hear or read that money doesn't grow on trees, perhaps you will remember the stories of my fruit and palm trees and realize that it really does. Parents would be wise to teach their children that even if money did grow on trees (which arguably it does), in order to fully realize its value would take much time, effort, and not the least of, money.  The lesson here is regardless if money does or does not grow on trees, in order to make money you have to invest (no pun intended) your time, effort, and even money in doing so.

The same can be said for your health and wellbeing. Like a healthy tree full of fruits, your body requires nurturing and conscious effort to stay healthy.  My palm tree met a premature death. My fruit trees don't live up to their potential. Try not to let the same happen to you by recognizing the value of planting the seeds of a healthy life and harvesting the fruits of your labors...(puns obviously intended.)

Otherwise, you may never live to realize the full bloom of your life.


Thursday, March 20, 2014

Are Statins Really Your Best Solution? Please Consider the Alternative

About two years ago, I wrote a blog titled, Selenium, Statins and Super Fish Oils, Oh My (here is the link: http://mdprevent.blogspot.com/2012/03/selenium-statins-and-super-fish-oils-oh.html). In that blog, I described what I consider the growing enchantment between the medical community and the use of statins. It's kept growing since then.

Back in November 2013, the the American Heart Association and the American College of Cardiology issued new guidelines regarding who should take a statin. This week a new study calculated that based on these guidelines, an additional 13 million Americans should be taking a statin, bringing the total to over 56 million users, representing over one out of six Americans. It is estimated that about one-quarter of U.S. adults age 45 and older already take such drugs

Even though the FDA issued a warning two years ago that statins may raise the risk for diabetes by 9%, a subsequent study that compared the increased risk for diabetes versus the benefits of statins, concluded that the benefits won. The study found that only among those who already had the highest risk for diabetes was the risk greatest for developing diabetes from statin use.  (That's kind of funny in a very sad way as those at greatest risk of developing type two diabetes are the same as those with increased risk factors for having a heart attack such as elevated blood sugar, and obesity.) In addition, although other side effects, like liver dysfunction and leg cramping, and in more severe cases, muscle necrosis has been reported with statin use, these side effects are generally dismissed as irrelevant when compared to the 'great' benefits associated with taking statins.

So what are those great benefits? The primary endpoint is preventing a heart attack.  According to the recent study, it was calculated that if an additional 13 million people took stains, there could be 475,000 fewer heart events.  Wow, that's almost a half million fewer people suffering a life threatening event.  So that's a good thing, right?  It's really not that clear to me.

If you calculate what percent of people taking the statin would presumably (I say presumably, because it is not proven) benefit, it comes out to about 3%.  That means that 97% or over an additional twelve and a half million people would have taken the stain for no benefit, but still possibly suffered some side effect(s) along the way, such side effects estimated at higher than 3% than those deriving benefit to as high as 20% side effects among users by some reports.

To be fair, I had this discussion multiple times with my recently deceased brother, the cardiologist, who felt that if 100 people took a stain with 99 of those people deriving no benefit, but one life being spared a heart attack, than the use for all 100 was justified. How can one argue against saving a life if no real harm (let's just say that muscle necrosis and liver damage, because they are relatively infrequent don't count) is done to the others?

I'll tell you how.  People taking statins to reduce cholesterol and now based on the new guidelines, to reduce inflammation, are subject to a "licensing effect" bestowed upon them by their statin use. Before I address this "licensing effect," first let's consider some other relevant points.  Heart attacks still occur even among statin users so it's no absolute panacea.  Second, a number of heart attacks are delayed or prevented among statin users by other physician actions such as the placing of stents and bypass surgery. In almost all cases of high cholesterol and inflammation, other than familial hypercholesteremia, a genetic disorder that runs in families that results in high cholesterol levels, the overwhelming majority of people's cholesterol and vascular inflammation is under the influence of diet and lifestyle and statins buy some relatively short period of time, at best a few years,  of reprieve.

In other words, if a person taking a statin continues to consume foods and live a lifestyle that is conducive to having a heart attack, the effects of the statin are by and large mostly neutralized and nearly twice as many statin users will have a heart attack than will not. 

Unfortunately, it appears that many statin users feel like they have a "license" to keep eating all the artery clogging and inflammatory foods they want, live as sedentary life as they can comfortably endure, and not take any responsibility for what happens inside their body because they are comforted by the knowledge that they are under the care of a physician who prescribed a statin for them.

(Let's ignore for a moment that there are other major reasons we die such as cancer and strokes that are also affected by our lifestyle choices.  True, you may say, death is inevitable today so does it really matter how you go?  That's a personal preference, but I vote for avoiding such a fate and letting heaven wait for as long as possible.)

The question then remains, do we really want to have a vast majority of Americans taking pills, absolved of any personal responsibility, instead of confronting the difficult lifestyle choices that will have a far more profound affect on their overall health?

Now some reading this post may argue that most Americans are either unwilling or incapable to make the changes necessary to preserve good health and therefore pills like statins are a viable alternative.  It is difficult, albeit painful, to argue with this logic.  Nevertheless, I write to inform people taking statins that they would ultimately be better off making tough lifestyle changes than placing their bets solely on pills as such pills are not the best answer for most of you. 

No one should discontinue their use of a stain based on this post. If my words, however, resonate with you, please consider speaking with your physician and discussing how you may discontinue your statin by making some changes to your lifestyle and diet that may make such pills irrelevant and superfluous. 

Choices really do have consequences when it comes to good health.  It's your health. It's your life. Take control.

Friday, March 14, 2014

Vitamin D and Breast Cancer: Are they married or just acquaintances?

With recent headlines like Vitamin D Enhances Breast Cancer Survival, a woman could hardly be faulted for running out and stacking up on Vitamin D pills.  The meta-analysis study (a compilation of studies) upon which this headline and similar ones are based, was published in Anticancer Research and showed that the higher the Vitamin D level at the time of diagnosis, the better the prognosis. On the surface, this would suggest a cause and effect relationship.  To the untrained eye, one might conclude that raising Vitamin D levels has some type of anti-cancer effect.

However, the evidence to date would suggest that this is not the case. First, even in this study, even women with very high levels of Vitamin D were still diagnosed with breast cancer.  The higher levels of vitamin D simply meant average longer survival. So what do I think is going on?

I believe, and a recent study, which I will discuss in a moment, supports my tentative conclusion, that this is a matter of correlation between vitamin D levels and one's state of health..  As correlation does not imply causation, raising vitamin D levels artificially high with Vitamin D supplements will neither prevent cancer, as the first study clearly showed, nor improve its prognosis. Why?

In a study published in the Lancet, the British medical journal, titled,  The effect of Vitamin D supplementation on skeletal, vascular, or cancer outcomes: a trial sequential meta analysis, the researchers compiled a representative group of Vitamin D studies and divided them into two groups. The first group included studies such as the breast cancer study above that showed consistently that higher levels of vitamin D correlated well with better health and disease outcomes. The second group of studies were double.blind randomized controlled studies that showed that Vitamin D supplementation versus placebo had little effect on overall health.

The authors of this study proffered what they believe to be the plausible explanation for the inconsistencies between the two groups of studies.  They tentatively concluded that raising Vitamin D levels above a certain threshold of adequacy doesn't prevent disease; rather, disease lowers Vitamin D levels.  as applied to the breast cancer study, this means that the women with the highest level of Vitamin D at the time of breast cancer diagnosis were healthier than those with lower Vitamin D levels and therefore had a better prognosis.  The worse the breast cancer, the unhealthier the patient, the lower the Vitamin D level, the poorer the prognosis.

As with all studies, one can reach no conclusive decisions from either of these studies. They merely add to our knowledge. My take-away from these studies is that Vitamin D is essential to human health and having levels above 20 mcg is essential and some say above 30 mcg. is ideal. 

The best way to get your Vitamin D remains 15 minutes of daily sun exposure to your torso/extremities. Alternatively, consuming food products with high concentration of Vitamin D like unsweetened Almond Milk and wild Alaskan Salmon are second, with Vitamin D pills coming in third. If you are taking pills because you absolutely can't do the first two then the recommended daily allowance (RDA) if you are below age 70 is 600 iu. and above age 70 it's 800 iu. That's not a typo. By the way, RDAs were developed to cover 97% of the population's needs. 

Supplementing with levels above these numbers has not been shown to have any benefit so save your money.  Again, this is what the current preponderance of evidence shows.  I'll let you know if something changes. Some large population studies are underway with expected publication in 2016 and 2017 so stay tuned.

Wednesday, February 26, 2014

Is Faith In Dietary Supplements A New Religion?


In 2012, the Pew Forum of Religion and Public Life published survey results that concluded that "the number of Americans who do not identify with any religion continues to grow at a rapid pace. One-fifth of the U.S. public – and a third of adults under 30 – are religiously unaffiliated today, the highest percentages ever in Pew Research Center polling. In the last five years alone, the unaffiliated have increased from just over 15% to just under 20% of all U.S. adults." Around the same time, the Centers for Disease Control and Prevention (CDC) reported that dietary supplement use had markedly increased with more than one half of the U.S. population currently taking some form of dietary supplement.

What's going on? Is there any relationship between Americans' growing dissociation with religion and their expanding use of dietary supplements? I think so. It appears they are trading one religion for another.

I proffer that there is a new religion in America and it is called Supplementiasm, which is a steadfast belief in the health benefits of consuming dietary supplements.  I believe that Supplementiasm is the fastest growing U.S. religion based on the CDC's estimates, in addition to dietary supplement industry reports that now claim as high as 80%, of all Americans as followers, having grown some twenty fold in the past 15+ years alone.

Like other religions, Supplementiasm has steadfast disciples who vigorously defend its tenets and detractors who question its very legitimacy. It's more extreme disciples will ridicule and attack anyone who challenges its omnipotence and veracity.  When three recent studies published in The Annals of Internal Medicine concluded that "limited evidence supports any benefit from vitamin and mineral supplementation for the prevention of cancer or cardiovascular disease," including an editorial titled, Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements, the faithful of Supplementiasm took the offensive.

Not surprisingly, Steve Mister, President of the Council for Responsible Nutrition, the main trade association for the dietary supplement industry, went on record by stating that "we reviewed the literature and came to the opposite decision" as his organization found the studies to show that multivitamins now "had the potential for additional benefits." That response was mild when compared to other pundits that labeled the Annals' conclusions "bunk right off the bat," "garbage in garbage out" and "highly premature and unscientific." The rhetoric on the internet got so heated that it nearly dared comparison to the controversy surrounding the cartoon depictions of Islam's revered founder several years back. Challenges to religion and faith always stir emotions.

As with most of the major religions, Supplementiasm offers its devout many places of worship from small health food storefronts on the internet to corporate retail megastores and many venues in between. Supplementiasm also has it religious leaders like Doctors Mehmet Oz and Andrew Weil, who spread its gospel with almost missionary zeal. In response to the Annals controversy, the Dr. Oz Show devoted two segments during different episodes to reaffirming Dr. Oz's personal faith in multivitamins, going so far as to declare that he and other members of his family takes them at home. Of course, with Walgreen's Pharmacies, significant sellers of dietary supplements, and Schiff Vitamins, manufacturers of the same, listed as "Trusted Partners" on his show, it was not surprising that Oz came to their defense. In fact, many in the supplement industry credit Oz's regular pronouncements for their growing popularity.

Another common factor among major religions is the splintering of groups. For example, Christians, have Catholics, Baptists, Protestants, etc. Jews have Orthodox, Conservative, Reform, etc. and Muslims, have Sunnis and Shiites.  Similarly with Supplementiasm, one can find segmentation among the highest devotees to dietary supplements, with membership in various sects such as Vegans, Vegetarians, Juicers, Calorie Restrictors, etc.

While Supplementiasm may have it's devout followers, I do not count myself among them. In fact, you could label my beliefs as agnostic, as I am full of doubts and questions.  You see I've been down this path before. As I was raised in a Jewish religious household, was schooled through college in religion-affiliated institutions, and grew up expected to have taken the leap of faith in embracing my religion's core belief system, I understand what it means to make religion part of one's life. I also appreciate that the absence of or ability to appreciate the available evidence that supports religious belief does not always represent evidence of absence.

In addition, my mother was an early devotee of dietary supplements as she zealously read Prevention Magazine as early as the 1960s. Based on her early readings, she had me eating chicken and calf liver as often as I can remember.  Every breakfast throughout elementary school consisted of a mixed bowl of cottage cheese, fresh squeezed orange juice, fresh ground apple sauce, and wheat germ. (Yes, it tasted like you think.) I ate it every day. For lunch, to make sure I got enough protein, she woke early to make fresh fried chicken cutlets.  (I must admit I appreciated her daily effort and they tasted quite good, unlike the breakfast bowl.)

For a number of years, her imposed routine including daily spoonfuls of cod liver oil. In later years, her preachings included carrots for beta-carotene, multivitamins and fish oil pills. Even in my 40s, she was pounding the pulpit in favor of folate, a B vitamin. Don't get me wrong. My mother is a smart lady who wanted what was best for her family. But her reacting to the latest "science" was misguided.  I also don't think that Prevention Magazine meant any harm. It was only reporting on the latest studies. I'm not sure my mother could have ever imagined how fast such teachings would eventually spread and how much of it was wrong and potentially harmful, with calf-liver being a prime example. My mother, a religious woman, just wanted to believe in something better. It was as if we belonged to another religion.

So given my religious inclinations, one might think that I would have a penchant for Supplementiasm. Well, I did until about three years ago. In 2011, I opened a primary care and preventive medicine practice and one of my first actions was to purchase five thousand dollars’ worth of dietary supplements for sale to patients. My initial list of dozens of products was whittled down to about thirty products, including calcium, Vitamin D, melatonin, fish oil, alpha-lipoic acid, etc. as initial research indicated they were the most reliable products to offer. Then I started intensively reading the scientific literature by securing a paid subscription to the Natural Standard database of dietary supplements and herbs and reviewing the clinical literature, and as I read more, the more my faith waned. I developed a decided bias against the bulk of dietary supplements.

After reading over 30,000 studies and abstracts found on the government's website of published clinical literature called Pubmed and other online databases, one thing was clear. Dietary supplements were not the panacea their manufacturers claimed they were. In many cases, they were a waste of money, and at times even posed a real harm.  Based on my collected data, I created a lecture titled Why Dietary Supplements Are Usually a Waste of Money and May Be Harmful that I gave dozens of times to thousands of people across Southeast Florida. I even made TV and radio appearances to spread the message.  I began to engage with Supplementiasm adherents and the old adage of not discussing religion and politics with strangers immediately came to mind.  It felt like I was insulting their G-d, while all I was asking for was the evidence they were relying upon.  These disciples included licensed and practicing physicians hawking products.  My words often made no impact as far as I could tell and when pressed to produce their Bible equivalent, they were consistently unable to do so.

So at this point, you may think me atheistic about Supplementiasm, but that would not be true. I continue to search for the truth and to try and differentiate between the science and pseudo-science. I am not prepared to reject dietary supplements completely out of hand (as I do believe in certain supplements like Vitamin D and calcium in certain cases; though, I always prefer food over pills for nutrition) but my concerns are many and growing. Based on my accumulated knowledge, I feel very few Americans should be taking any dietary supplements, including multivitamins, and most thought leaders, in the dietetics and medical fields agree with me.

However, like any true theologians, the disciples of Supplēmentum hold steadfast in their beliefs and cannot be easily dissuaded.  An anecdote bears proof. The supplements I purchased for my practice came from a company I came across at a medical conference that seemed reputable. When I decided to no longer include supplements in the practice, it meant no further purchases from the company and this displeased their representative.  In response, their representative asked if they could check my blood to see if I have any vitamin deficiencies because they are sure everyone does.  Wow, I thought.  The representative had really drunk the kool-aid. By the way, my blood tests were normal.  Another company had me test my antioxidant levels on their patented scanner, which many revere as one of the sacraments of Supplēmentiasm. The scanner scored me in the highest echelons of carotenoids, an antioxidant whose measured levels are thought to be indicative of total antioxidant activity in the human body.  I scored extremely high despite my lack of supplementation; rather, because, I eat several servings of fruits and vegetables every day. It was a waste of a test. But that's not even what disturbed me. The representative, when confronted with the result, argued that I was the exception.

An even bigger concern is the degree of sacrosanct belief that so many, sellers and consumers of such products (I suspect she's a user), harbor about supplementation. For million of years, men and women and their predecessors lived off the land and somehow that no long suffices. The supplement marketers propagate stories about soil depletion creating nutrient poor fruits and vegetables. My review of over a 100 studies of nutrient depleted soil showed that in 100% of the cases, the produce failed to grow properly and were not edible. Yes, soil may be depleted, but the studies show that fruits and vegetables that actually grow and make it to our hands still have plenty of nutrition.

Furthermore, despite the fact that not a single valid human study has ever demonstrated an extension of a single day of human life from supplementation in the absence of deficiency, nearly $30 billion was spent last year on these products. My own experience with attempts to talk some patients off of taking supplements got the nastiest looks imaginable. Sometimes successful, some patients would return to tell me how much better they felt having stopped the pills. I would tell them that that what they were experiencing was a placebo effect because the supplements had no effect on them while they were taking them.  For those who wouldn’t stop, it was clear that they were believers that their products were sacrosanct. They believe despite the absence of any tangible evidence; their beliefs are as strong as any religious faith.

However, my greatest concern is that this growing dependence on dietary supplements increasingly may strip people of any responsibility for their lifestyle choices. Pop a pill or two or twenty and you are all set. Nothing to worry about. This is a very dangerous thought process.

I am respectful of all religions. However, I must confess that I wish this Supplēmentiasm, with over 55,000 products now on sale, would be exposed for the chicanery that it mostly represents. While there are many wonderful attributes to religion, and to religious belief and practice, the facts remain that religious extremists have been responsible for many destructive and irresponsible actions over the centuries. Let's hope that Supplēmentiasm's leaders do not yet prove to do the most harm.

As to the supplements I bought for my practice, I gave a few for free to a handful of patients that I thought would benefit, gave the more scientifically supported pills to a nearby homeless shelter, and discarded the rest. I had learned an expensive lesson, but my religious sensibilities to do the right thing were well served. I await the day when the disciples of Supplementiasm come to the same conclusion, but I have little faith that day will come soon.

This parody is not meant to insult any religion or any person of religious faith. It is provided for thought and discussion purposes only.

Friday, February 14, 2014

Dr. Oz's Claims on Turmeric: Does He Just Make Things Up?

On an episode of the Dr. Oz Show this week, Oz claimed that a new study was recently released that showed that Turmeric, an Indian spice, is useful in the treatment of irritable bowel syndrome. He recommended a dosage of 500 mg.

Is There Such A Human Study?
After searching for such a recent (last few years) study, I couldn't find any. In fact, a study by the title of Curcumin (Turmeric) in the Treatment of Irritable Bowel Syndrome: A Randomized-Controlled Trial (CuTIBS) was initiated in 2007, completed in 2009, and updated in 2011, but the results were never published. (see: http://clinicaltrials.gov/ct2/show/results/NCT00779493). Since that time, pubmed.com, the database of clinical studies, does not identify any other such studies. Unpublished results usually mean worthless results. 

A pilot study done ten years ago in 2004, contained no control group that was given a placebo for comparison purposes. (See: http://www.ncbi.nlm.nih.gov/pubmed/15673996?dopt=Abstract) Instead of a control group, it had two study groups, with one group taking one pill and the other group taking two pills. Both groups showed some improvement of IBS symptoms. However, it's important to remember that a study for IBS showed that a group that was told it was being given a placebo still showed improvement with IBS.  Either way, non-blinded, non-randomized studies are of little clinical value.  They definitely don't rise to the level of deserving national pronouncements.

Is Turmeric Really That Helpful?

What is interesting about Turmeric is that it is a plant that is consumed mostly as an ingredient of local ethnic foods, primarily by natives of India, particularly in Southeast India, where it grows.   It is claimed to have ant-cancer, anti-inflammatory, anti-dementia, anti-infectious, and anti-oxidant properties. With all these health benefits, one would expect that natives of Southeast India would have longer life expectancies.  One would be very wrong and disappointed as India has one of the lowest rates of life expectancy anywhere in the world. (See:


Harms of Turmeric

Faithful readers of this blog may remember a few years back my writing about the recommendation I received from Michael Roizen, a partner with Dr. Oz on several books, who highly recommended that I consume turmeric for its multiple health benefits, including dementia prevention. (Here's an excerpt from that blog almost three years ago: 

"Dr. Roizen told me that turmeric prevents Alzheimer's and is good for brain health. Based on Dr. Roizen's suggestion that day (and my hearing him repeat the same advice a few days later on the Retirement  Living TV channel), I naively purchased turmeric and began to add it regularly to my food.

Unfortunately, the highly staining substance turned my teeth bright yellow.  After this disconcerting turn of events, I began intensively researching turmeric and discovered two disturbing facts. First, tumeric has little validated science to support its use for the indications Dr. Roizen asserted. Second, I discovered that in the absence of a black pepper called piperine, turmeric is very poorly absorbed by normal ingestion and so adding it to my food was an effort in futility, except if turning my teeth yellow was my endgame. (By the way, I had to go to a dentist to get rid of the stain.)"

It was that incident, by the way, that really started me on the path of trying to verify positive statements made about any dietary supplement.

Final (For Now) Word on Turmeric

As an aside, I am not against turmeric, or its derivative curcumin, as an ingredient in meals.  There is just no real good proof that it has a very positive effect on any major human health factor. According to naturalstandard.com, it doesn't get higher than a grade of C, for inconclusive evidence, for any clinical indication.

So once again, Dr. Oz recommends a product that lacks the scientific support he claims. He even goes so far as to give a specific untested dosage of 500 mg. 

Did he just make it up? You know the answer.