Tuesday, July 2, 2013

Two Doctors' Opposing Views On Supplements: You Be The Judge

The following is an exchange that recently took place between Dr. Randy Baker, a self-proclaimed holistic doctor, whose claim to fame is that he was once the doctor of Jerry Garcia of The Grateful Dead rock band, and myself.  This exchange took place on a website called HealthTap. In respnse to the question below, Dr. Baker offered advice. I initially questioned his advice and you can read for yourself what followed.
 
Dr. Baker commented:
Diet & supplements
7.0 isn't terrible. Many docs would add drugs but diet, supps. & exercise can often reverse diabetes. The most impressive method I've seen is a raw vegan diet as advised by Gabriel Cousens MD- see his book There Is A Cure for Diabetes & http://www.naturalnews.com/028341_diabetes_living_foods.html Also http://spectrum.diabetesjournals.org/content/22/4/206.full Consider consulting a holistic doc.



Dr. Steven Charlap commented:
Skip the supplements and focus on a low glycemic, low fat diet combined with 45 minutes per day of moderate intensity physical activity (difficult to sing) to reverse the diabetes. a1c of 7 merits concern and requires immediate attention to prevent progression.

Dr. Randy S. Baker commented:
Dr. Cherlap, I am not sure why you advise "skip the supplements" when the review cited in my answer, from a mainstream journal published by the American Diabetes Association, cites sound research showing significant reductions in A1C in those taking a combination of chromium and biotin, and in those taking fenugreek, gymnena sylvestre, milk thistle or chia. Aloe alone reduces fasting glucose from an average of 250 to 142. These supplements are extremely safe and highly effective and when combined with a low-glycemic diet and exercise are likely to give significantly better results than diet and exercise alone.

Dr. Steven Charlap commented:
Simply put, because none of these supplements are needed to minimize the ravages, slow the progression or reverse type two diabetes if a diabetic is eating a healthy diet and exercising properly. In fact, and i hope you agree,diet and exercise are the most important approach for diabetics Getting people to rely on pills when natural solutions exist is just plain misdirected.

Dr. Steven Charlap commented:
By the way Dr. Baker, do you read the studies you cite? In the Diabetes Journal article it clearly states "The American Diabetes Association's official position is that there is inconclusive evidence demonstrating the benefit of chromium supplementation?"E nough said? Besides one can get chromium from food so why get it in a pill?

Dr. Steven Charlap commented:
Stop pushing supplements.

Dr. Randy S. Baker commented:
Dr. Cherlap, I could not agree more that diet and exercise are essential foundations of diabetes care and there is no substitute for them. The bulk of my original answer above was advising Dr. Cousen's diet, which has very impressive results. However, many diabetics still have elevated sugars despite a healthy diet and exercise. The supplements I have mentioned are "natural solutions," herbs like cinnamon, aloe, and milk thistle, the trace mineral chromium, the vitamin biotin and the food chia seeds. My intention is not to get people to "rely on pills" but to use every safe and effective tool available to improve and enhance health.

Dr. Steven Charlap commented:
Dr. Baker, My concern with your answer is that even though these compounds may come from nature, there are no conclusive studies regarding their proper dosing, their interaction with other drugs, their long term side effects, etc. Not everything in nature is safe, e.g. poison mushrooms and berries, and natural products that have a medicinal effect must be used with the same caution as a prescribed drug . Also, many of these products are accompanied by chemicals used to package, prepare, and dispense them that potentially carry their own risk factors. The real issue is you would never advise a patient you haven't met to take a specific prescription in such a forum; yet, you don't hesitate to tell them to take various supplements in combination without knowing their medical histories, other medications, etc. Again, just because something is natural doesn't make it safe and if it works as you suggest, then it's the equivalent of a prescribed drug that must be used cautiously and monitored.. Sugar cane, the foxglove plant, red yeast rice, white willow bark are all natural but their extracts at various doses can be quite harmful. Please stop the dangerous practice of recommending specific supplements to patients you don't know.

Dr. Steven Charlap commented:
By the way, studies have shown the advantages of a pesco-vegetarian diet over a raw vegan diet, so Dr. Cousins approach may not be the healthiest. Are you a fan of fish oil in a pill or wild Alaskan salmon?

Dr. Randy S. Baker commented:
Dr. Cherlap, I appreciate your comments and agree with much of what you have to say. I could not agree more that just because something is natural does not mean it is safe. If you look at the original answer above I did not recommend any specific supplements for the patient, just referenced a review from a mainstream journal demonstrating the efficacy of a variety of supplements for diabetes along with advice to consult a holistic MD with expertise in such supplements. And yes, some of these supplements can have side effects and interactions with pharmaceuticals (though the patient who asked the question does not appear to be taking pharmaceuticals). One of the reason I feel it is reasonable to mention specific supplements in my answer here is that so few doctors know about these and I want patients to be aware of these options. One area where we disagree is the safety of over-the-counter nutraceuticals compared to prescription pharmaceuticals. While there are safety concerns with both, over 100,000 Americans die each year from the side-effects of properly-prescribed pharmaceuticals, and in recent years ZERO deaths have been reported from nutraceuticals. Are there probably a few people who's death was related to nutraceuticals but this was not recognized?- quite possibly yes. Are the hazards of nutraceuticals as a class anywhere near the hazards of pharmaceuticals? Not even close! Still, I do agree these substances should be used wisely and optimally under the guidance of a physician who is knowledgeable in such matters and it is unfortunate that most doctors receive virtually no education in these matters. I also share your concern about the safety of the additives/fillers/binders in drugs and supplements. That is one of the reasons I advise people work with a knowledgeable physician, for guidance in choosing the best quality supplements. As for Dr. Cousens, the only condition for which I recommend trying a raw vegan diet is diabetes, as he has gotten such impressive results. In general I am quite skeptical about the wisdom of a totally raw diet for most people and personally follow a primarily pesco-vegetarian diet myself. And I advise the raw vegan diet for diabetics only temporarily, feeling it is wise to go to more balanced diet after better control is obtained. Like you, I agree that it is always best to get nutrients from our diet when possible and wild Alaskan salmon is my favorite source of omega 3's, but for those who don't like fish (or can't afford it), purified fish oil pills (or liquid) is an acceptable option, though many (but not all) people can get adequate Omega 3's from flax or hempseed oil. Again. I appreciate your feedback. HealthTap is an interesting forum not just because of our opportunity to help the patients here but because of the opportunity to see the perspective of our fellow physicians and have discussions like this one!

Dr. Steven Charlap commented:
Dr. Baker, I am always concerned when doctors quote the 100,000 figure of American deaths by prescription meds, first because it is represents an extrapolated estimate that has never even come close to being proven as true and second, and much more importantly if were true, it represents just .00002 (.0002%) of the 4.02 billion annual prescriptions that Americans received in 2011. In other words, for every 10,000annual prescriptions there may be one purported related death, which may or may not have been caused by the prescription and even if the prescribed was, the cause, the drug may have caused the death because it was the wrong prescription for the diagnosed medical problem and the patient therefore died because he or she was improperly treated, and not because of a side effect of the drug. As for deaths related to supplements, as you know, as there typically no records kept in any formal manner of supplement usage, it has proved very difficult to link deaths to supplements usage unless the death happened quickly. if the supplement contributed to the death over time,there would be no easy way to link them together. It took a good study to show the link between beta-carotene supplements and increased cancer risk. Smarter people than me have shown real dangerous links between many supplements and increased mortality. Forgive me if I say it would be disingenuous to state that any specific supplement is useful when the prevailing scientific evidence is inconclusive for that supplement. Chromium for diabetes is a perfect example. While I appreciate that reasonable people can disagree, the credible science continues to support very limited use of supplements in general. Even if doctors are over-prescribing prescription medications and some of these medications create serious adverse events, it is not a justification to advise patients about whom you know little to nothing about their medical histories to take supplements instead. Please stop giving such advice in this forum and limit it to your private practice where it is prudent to do so.

Dr. Randy S. Baker commented:
Dr. Cherlap, the 100,000 figure is on the FDA website. Quoting the FDA's own website: "Why Learn about Adverse Drug Reactions (ADR)? Institute of Medicine, National Academy Press, 2000 Lazarou J et al. JAMA 1998;279(15):1200–1205 Gurwitz JH et al. Am J Med 2000;109(2):87–94 Over 2 MILLION serious ADRs yearly 100,000 DEATHS yearly ADRs 4th leading cause of death ahead of pulmonary disease, diabetes, AIDS, pneumonia, accidents and automobile deaths" Again. all of the above is claimed by the FDA- see http://www.fda.gov/Drugs/DevelopmentApprovalProcess/DevelopmentResources/DrugInteractionsLabeling/ucm114848.htm As for my advising the people who ask questions here, the whole reason they ask questions is to learn about treatment options. If a diabetic asks what they can do to improve control, I will of course discuss diet, exercise and pharmaceuticals but feel I would be remiss not to mention over-the-counter nutraceuticals that are widely considered safe and proven effective in studies published in mainstream journals. I commonly discuss the potential hazards, side effects and interactions of supplements on HealthTap and do not see them as a panacea. I would expect people trying supplements to do so under proper medical supervision. If you disapprove of this then we will just have to agree to disagree on this topic.

Dr. Steven Charlap commented:
Dr. Baker, Here are the actual citations for the 100,00 figure: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6026a1.htm http://www.iom.edu/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf

As you, and anyone else reading our comments, can read, the 100,000 number is an estimate and it includes many pain meds such as oxycodone as the cause of death, which is often an overdose. In response to your comment, "I would be remiss not to mention over-the-counter nutraceuticals that are widely considered safe and proven effective in studies published in mainstream journals. I commonly discuss the potential hazards, side effects and interactions of supplements..." When you say "widely considered," by whom? Other physicians? That is a blatantly false statement and you know it. Also, many of the journals, particularly the ortho-molecular journals, which commonly support supplements, are not widely respected by the physician community. Most physicians disdain supplements and for good reason, the least of which is their love for pharmaceuticals. As to your statement that you commonly discuss side effects, I saw no such discussion in regards to your diabetes recommendations. As you said, we can agree to disagree and let the facts speak for themselves.

3 comments:

  1. He seems to have never walked into a supplement aisle: Looking at chromium alone, there is concern over longterm supplementation with Chromium picolinate (linked to kidney failure and liver damage). Quite irresponsible coming from a doc on a forum.

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    1. Most doctors, by their nature and training, want to help others. Some have a savior complex that requires them to always offer a solution, even when a good one is not known. When prescription medications are either not indicated, useless, or have intolerable side effects, supplements offer such doctors another solution to recommend even if the science is sketchy. I don't think Dr. Baker is a bad guy; I think he is misguided, especially about his generally pro-marijuana views. That's my $.02.

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