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Category Archives: Vitamin Pills & Other Supplements

John Oliver Discusses the Supplement Industry

Starting with a look at the Dr. Oz Congressional hearing, John Oliver delivers a good monologue on the problems with dietary supplements and the industry that promotes them.

Just a heads up – there are occasional moments of “naughty language” (a word here and there), so you may not want to play this at work (where you should be hard at work anyway and not watching videos, right?)

Enjoy!

– Hila

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New research on Vitamin D and cancer

In our book and blog, we’ve commented on the numerous health benefits of vitamin D. Many people today are vitamin D deficient, some profoundly. This is due to the fact that very few foods contain significant levels of vitamin D. Humans were meant to obtain it from the sun (the UV rays from sunlight hitting our skin causes a reaction which produces vitamin D). Because many of us aren’t exposed to much sunlight, and even when we’re in the sun, many of us slather on a ton of suntan lotion to prevent skin cancer, the end result is wide spread vitamin D deficiency.

Some consequences of low vitamin D levels

Low vitamin D levels have been linked to many poor health outcomes. Two recent studies add to the growing body of evidence.

The first study, published in Clinical Cancer Research, looked at the link between vitamin D deficiency and prostate cancer. They screened 667 men ages 40-79 at high risk for prostate cancer for vitamin D deficiency. In European men, low vitamin D levels were linked to an over three and a half fold risk of having aggressive prostate cancer. In African Americans, the risk was over four fold. Furthermore, vitamin D deficient African Americans had more than double the risk of being diagnosed with prostate cancer.

The second study, published in the Journal of Clinical Endocrinology and Metabolism, looked at data from 25 studies on over 17,000 people who were diagnosed with breast cancer, colorectal cancer, or lymphoma (a type of blood cancer). Those that had the lowest vitamin D levels at diagnosis had a higher risk of dying from colon cancer and lymphoma, and lower disease-free survival from breast cancer and lymphoma.

Are you vitamin D deficient?

It’s a shame that anyone should be harming their health by having undetected vitamin D deficiency. There’s a simple blood test known as vitamin D OH 25 which can be done by any lab and accurately tests your levels. Aim for a level of 40 (although levels over 30 are probably ok as well). Less than 20 is quite low, and less than 10 is very very low – in fact, many people with very low levels feel tired and achy.

Most adults need about 2000 IU a day of vitamin D3 to maintain adequate levels, although this varies widely depending on one’s sun exposure, diet, and amount of body fat. That’s why it’s better to have it checked. Vitamin D is a fat soluble vitamin which means that it does not get absorbed on an empty stomach or with a light snack. It needs a meal that contains some fat.

The one caveat I have is not to overdo it. High vitamin D levels can cause a lot of problems including kidney damage and kidney stones – so more is definitely not better.

– Tamir

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The dangers of homeopathy

We live in a world of quick fixes. Many of us, due to time constraints and/or laziness, find it hard to work out or to maintain a healthy diet. It’s much easier, and therefore appealing, to be able to take a pill or some other concoction to ward off as well as to treat different diseases.

Unfortunately, to date, there are no such magic pills, liquids, or any other remedies that improve our health in a drastic fashion. Yes, some supplements do have some benefits for some people. For example, many of us, especially in the winter, lack any sun exposure and are therefore deficient in vitamin D. Others who suffer from different medical problems may well benefit from different supplements. However, for the most part, supplements are an utter waste of money and are sometimes potentially dangerous.

A recent study on homeopathy

A recent study from the Australian National Health and Medicine Research Council reviewed all of the available studies done on homeopathic treatments. These studies covered a wide range of different medical and psychiatric conditions, including ear infections, eye disorders, HIV, different musculoskeletal disorders, diarrhea, constipation, vaginal yeast infections, brain injuries, depression, anxiety, dementia, heroin addiction, asthma, respiratory infections, skin disorders, skin infections, and different chronic pain disorders.

Homeopathy is a pseudoscience which theorizes that “like treats like.” Very dilute substances (to the point that there’s no actual substance left in the dilution – only “energy imprints”), which in large doses would produce a symptom, are used to treat diseases causing similar symptoms. It was developed in the late 18th century before the widespread use of sound scientific method, and it makes no sense from a biological point of view.

The results of this very large review of dozens of studies showed – no surprise – practically no benefit to homeopathic treatments for any of the conditions studied. The few studies showing favorable outcomes were very poorly designed and executed.

The bottom line, which I emphasize over and over again, is that there are no short cuts. If you’re currently wasting your money on unproven and potentially dangerous treatments, it’s time to go back to the basics: Exercising, eating a health diet, and not smoking.

Why are homeopathic treatments potentially dangerous? There have been cases of contamination of homeopathic medications with toxic substances. Furthermore, people treating their condition with a homeopathic remedy may neglect or delay seeking proven treatments. Lastly, homeopathy lulls people into a false sense of security; people believe that by taking a few drops of some substance under the tongue, they’ll become healthy. This erroneous view point may lead to people neglecting their diets and not engaging in regular exercise.

– Tamir

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Vitamin E Intake Among People with Alzheimer’s

Preventing or fighting Alzheimer's

Alzheimer’s disease, the most common form of dementia, is a scourge that as of this writing, has no effective cure. The few medicines that are available don’t work that well and often have multiple side effects. Families and caregivers of people with Alzheimer’s who expend a lot of both physical and emotional exertion in taking care of their loved ones are often left frustrated by the lack of effective treatment.

Can Vitamin E Help People Who Have Alzheimer’s?

Recently, a new study shows that vitamin E, a cheap, readily available supplement, has something new to offer. The two year study published in JAMA followed roughly 600 people with mild to moderate Alzheimer’s dementia. The participants were divided into 4 roughly equal sized groups and received either high dose vitamin E (2000 IU daily), memantine (a dementia medication otherwise known by its brand name Namenda), a combination of both vitamin E and memantine, or placebo (a fake pill containing no active ingredients).

People in the vitamin E group experienced an approximately 20% decrease in cognitive decline, which roughly translates into 6 months. No such benefits were seen in the other groups (including the combination group, which, perhaps means that memantine and vitamin E may somehow counteract each other’s effects). Although the results weren’t amazing, in a disease such as Alzheimer’s, in which we don’t have much to offer, it’s quite impressive. Furthermore, high dose vitamin E seemed to be quite safe – no major side effects were noted.

Does This Mean You Should Take Vitamin E to Prevent Alzheimer’s?

For those of you who may be thinking of taking vitamin E to prevent dementia, don’t waste your money. Previous studies have shown that it doesn’t work. Furthermore, vitamin E doses of over 400 IU a day may increase mortality.

The bottom line

The results of this study are very specific to people who currently suffer from mild to moderate Alzheimer’s dementia. If that includes you or a loved one, then consider discussing with your physician the initiation of vitamin E (it isn’t a good idea to start on your own volition – there are some medications and/or medical problems that may make high dose vitamin E unsafe).

For the rest of us, it still comes down to prevention. Smoking cessation, a healthy diet, regular exercise, and taking care of your blood pressure, cholesterol, and blood sugar are still the best (and only) way we have to prevent dementia.

– Tamir

(Image links back to source.)

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Liver failure and dangerous supplements: What’s in the supplements you take?

A recent article in the NY Times highlights the growing problem with unregulated and dangerous supplements. Millions of Americans take supplements for a variety of reasons. The vast majority of the time, these supplements are a waste of money that could be better spent on healthy food and exercise equipment. In other cases, they’re downright dangerous.

What’s really in a supplement?

Unlike medications, which are tightly regulated by the government, supplements have practically no oversight. A couple of months ago I discussed this in a blog post on the dangers of herbal supplements. The lack of regulation means that what’s listed on the label doesn’t necessarily match up to what’s in the supplement. As long as a supplement doesn’t claim to cure or treat any disease, they fall outside of the jurisdiction of the government agencies that regulate medicines. That’s why you’ll see vague claims on the bottles such as “promotes immune system function” or “promotes heart health.”

Furthermore, because you don’t really know what’s in the supplement, it’s hard to know to how to monitor possible adverse effects. For example, if I know that a certain medicine that a person is on may potentially affect their liver or kidneys, I can order routine blood tests to check things out.

Supplement toxicity

Even worse, as the above article points out, many supplements contain dangerous levels of naturally occurring, otherwise healthy substances. For example, green tea contains catechins which may have certain health benefits such as reduction in heart disease. However, many weight loss/fat burner supplements have incredibly large amounts of catechins which can damage the liver.

A recent study showed that 20% of liver damage cases from drugs came from supplements, a number that has risen steadily over the years. A number of those cases have resulted in fatalities and permanent liver damage.

Other supplements have been found to contain traces of medications in them that were, of course, not listed on the bottle (for this would have made the supplement a medicine and thus subject to regulation). Wikipedia has a nice table that lists many of the side effects, as well as drug interactions of many of the common herbal supplements. This is by no means a comprehensive list, and people should always let their doctors know if they do take any supplements, especially if they’re on medication, are pregnant, or have other medical problems.

Does this mean all supplements are bad?

Even though I may seem anti “alternative medicine,” that isn’t so. I do recommend certain supplements for certain people based on scientific studies. For example, vitamin D is good for the bones, Coenzyme Q10 may help with heart failure and may mitigate the muscle aches that some cholesterol medicines cause, and butterbur may help to prevent migraine headaches (although it should be noted that butterbur can be toxic to the liver, and any patient of mine on it has their liver enzymes checked on a regular basis).

The bottom line is that if a natural supplement or vitamin has been shown to be both effective and safe through high quality studies, then I’m all for it. However, if unscrupulous companies are trying to make a quick buck at the expense of people’s health, then I will fight tooth and nail to expose the truth.

– Tamir

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Another nail in the multivitamin coffin

In our book, we discuss how multivitamins are a big waste of money for the vast majority of people, and in some cases may cause harm.

Three new studies published in the Annals of Internal Medicine (here, here, and here), including a large review of studies spanning over 10 years of data in over 300,000 people, found practically no benefit in taking multivitamins and an increased risk of lung cancer in smokers taking supplements containing beta-carotene (a plant form of vitamin A).

There was one study showing a very slight reduction in cancer in men who took a multivitamin, but not in women. Other studies showed harms with certain vitamins (for example one study showed an increased risk of prostate cancer in men supplementing with folic acid, another study showed higher risk of hemorrhagic (bleeding) strokes in those supplementing with vitamin E, yet another showed increased fracture risk in women taking vitamin A supplements).

Vitamin supplements

The bottom line is that if you look at the summation of the data across all of the above studies, you find that there’s no meaningful benefit in taking vitamin supplements in the prevention of heart disease, cancer, or premature death.

The other two studies mentioned above also showed no benefit to vitamin supplementation. One study looked at people over 50 who had suffered a heart attack. Those who were placed on a vitamin supplement fared no better than those who took a placebo “fake” pill. The other study examined men over 65, and showed that those who took a vitamin supplement didn’t show any improved cognitive ability over those who didn’t take the supplement.

Buying into false beliefs about vitamin supplementation

I believe that the biggest problem with vitamins is NOT the waste of money. I’ve personally seen patients in my own practice lulled into a false sense of security because they take their supplements religiously. These same people often have a less than optimal diet. Most rarely if ever exercise. A few smoke cigarettes. Several are obese. Unfortunately, they honestly believe what the salesperson in the vitamin store (often someone with little to no training in nutrition or medicine) tells them that by spending $200 a month on all of these different supplements, they’ll lead a long and healthy life. I guess they’d make no money if they told their customers to start working out or to stop smoking.

If you do take a multivitamin and you’re adamant about continuing to take it, then go ahead (except of course if you’re a smoker, discontinue any supplement containing beta-carotene). However, if you’re eating an awful diet, if you smoke, and/or if you don’t move much, then shift your emphasis towards these lifestyle measures. There’s a wealth of evidence to support decreased death, cancer, heart disease, and other diseases in people with a healthy lifestyle.

Should anyone be taking multivitamins?

Finally, there are unique patient populations that should be taking vitamin supplements due to being at high risk for vitamin deficiencies. These include people suffering from kidney disease, those suffering from Crohn’s disease or other digestive maladies, those who have undergone weight loss surgeries, women who are attempting pregnancy or are pregnant, and people who take certain medicines. If you fall under those categories or were told to supplement for other reasons, then speak with your doctor before stopping any vitamins. Otherwise put out that cigarette, grab an apple, and head to the gym.

– Tamir

(Image links to source: Wikipedia.)

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Beware of Herbal Supplement Dangers

Millions upon millions of people in the U.S. and worldwide use a variety of herbal supplements to prevent and treat a wide range of illnesses, some acute, some chronic. However, there are a variety of herbal supplement dangers you need to be aware of. For example, many herbs haven’t been tested scientifically to show whether or not they’re actually effective or if they’re even safe for long-term use. Furthermore, because the supplement industry as a whole is unregulated, you can never be sure that what you buy and are consuming is really what’s listed on the label.

In fact, a recent study discussed in Science Daily sheds some light on what’s going on. DNA testing was used to determine whether different herbal products actually included what they purported to on the label, and if they were of high quality and free of contamination (all of us have seen the “100% pure” logo on the label of many vitamins and herbs).

The results? 59% of the products contained plant species not listed on the label. Over TWO THIRDS of the products had plant species that were a substitution for the main herb! One third contained various other species which are thought to be fillers or contamination.

Basically, most of the time when you buy herbal pills you’re being ripped off. This is unfortunate, since in some cases, herbs have been shown to help for a variety of ailments. Unlike a whole plant, which can be verified as being the ‘real thing,’ capsules and tablets contain desiccated plant material in which one herb may be indistinguishable from another (this is why the authors of the study used DNA testing).

Lastly, many herbs have serious drug interactions with several commonly used medications including cholesterol meds, antibiotics, heart medications, anesthetics, and chemotherapeutic agents. Even worse, some patients, afraid that their doctor will belittle their use of “alternative medicine” won’t mention that they’re taking such supplements. Common herbs that can have serious interactions include feverfew (used for migraine prophylaxis), black cohosh (used for menopausal symptoms), ginger (used for nausea), St. John’s Wort (used for depression), garlic, ginko biloba (used for memory/concentration), and valerian root (used for anxiety and insomnia).

The bottom line is that unfortunately, it’s a “buyer beware” market for herbal supplements due to the entire industry being unregulated. Furthermore, it’s crucial that you keep the lines of communication open with your physician so that if you are taking herbal supplements, you let them know in order to avoid potentially dangerous drug-herb interactions.

– Tamir

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Further evidence that vitamin supplements are a waste of money

In our book, we detail how – for most healthy people – vitamin supplements are usually a waste of money and may even be harmful in some cases. For example, it’s known that smokers who take beta carotene (the plant form of vitamin A) supplements experience an increased risk of developing lung cancer.

The questionable worth of vitamin supplements

A recent study in JAMA reviewed 78 clinical trials involving close to 300,000 people to assess whether or not the antioxidant vitamins beta carotene, vitamin A, vitamin C, vitamin E, and the mineral selenium helped to decrease mortality. Roughly 30% of the patients had stable chronic diseases such as diabetes or heart disease; the rest of the trials were conducted on healthy participants.

The results were not surprising, given many other recent studies involving the health effects of vitamins. Not only did the antioxidant supplements not decrease mortality, but beta carotene, vitamin E, and high dose vitamin A supplements were actually associated with a slightly higher risk of dying.

Now, to put things in perspective, the increased mortality was nowhere close to what we see with other harmful behaviors such as smoking and lack of exercise; nevertheless, since there’s no benefit in taking these supplements, and some harm, why not save your money and spend it on more productive and useful things such as healthy food, a good pair of sneakers, a bicycle, etc?

The other downside of vitamin supplements that I see as a physician, is that they lull many people into a fall sense of security. People think that taking their multivitamin will somehow ward off the damage done to their bodies through not exercising, eating a poor diet, and in many cases, smoking.

The bottom line is that there are no short cuts. If you want to stay healthy, you have to exercise, follow a healthy diet, and quit smoking. There isn’t a magic pill out there that will replace these three pillars of healthy living.

– Tamir

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Omega 3 Supplements and Prostate Cancer

Generally speaking, including sources of omega 3 fats in one’s diet (usually in the form of fatty fish), has been shown to have health benefits, especially when it comes to heart health. This has led to the wide use of omega 3 supplements, which are even used at high doses in the treatment of elevated blood fats (a condition known as hypertriglyceridemia).

One big problem is highlighted in a recent study published in the Journal of the National Cancer Institute confirming research from 2 years ago linking blood levels of omega 3 fats with a significantly higher risk of developing prostate cancer. Even more worrisome was that the risk of the developing aggressive prostate cancers (the ones that are more likely to kill a person) increased by 71% in those who had the highest blood levels of omega 3.

Researchers are at this time baffled by the results due to the fact that omega 3 fats are known to have anti-inflammatory properties, and chronic inflammation is thought to play a role in the development of several cancers, as well as heart disease and many autoimmune disorders.

Paradoxically, those with the highest levels of omega 6 fatty acids (thought to promote inflammation), had a modest reduction of almost 25% in the risk of developing prostate cancer.

What does this mean for us? Unfortunately, it may be too early to understand the full picture. The way the study was designed didn’t per se prove causation (i.e. we cannot say that omega 3 fats cause prostate cancer). However, due to the fact that this is the second study to show such a link, if you’re male, it may be prudent to avoid taking omega 3 supplements unless advised by your physician or nutritionist for a specific purpose. Including fatty fish in your diet is probably a good idea (the concentration of omega 3 in men in the highest group seemed to be higher than the amount an average person would consume through diet alone, implying that many were perhaps taking supplements).

Omega 3 supplements and prostate cancer

Furthermore, for virtually every other condition, omega 3 fats seem to be beneficial. The more important thing than the actual amount of omega 3 fat that one consumes is the ratio of omega 3 to 6 in one’s diet. An ideal ratio is around 2-4 parts of omega 6 to one part omega 3. Unfortunately, due the ubiquitous use of cheap vegetable oils and products derived from them (e.g. mayonnaise), the ratio in most Western diets may exceed 20 or even 30 parts omega 6 to one part omega 3. To add insult to injury, smoking may worsen the pro-inflammatory properties of omega 6 fats.

If you want to maintain a healthy fat ratio in your diet without having to increase your risk of developing prostate cancer through overindulgence in omega 3 supplements, simply reduce the amount of omega 6 in your diet by eliminating or drastically reducing your consumption of vegetable oils, mayonnaise, salad dressings, etc. Stick to monounsaturated fats which don’t upset the omega 6 to 3 ratio and have their own health benefits. These include nuts, olive oil, and avocados.

– Tamir

(Images links to source.)

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Co-enzyme Q10 and heart failure

Let me preface this post by stating that I have no financial connection to any manufacturer or distributor of Co-enzyme Q10 – this post is intended purely for the benefit of the reader.

In our book, we discuss several different nutritional supplements and vitamins that are commonly used. One supplement that I intentionally left out was co-enzyme Q10 (CoQ10). At the time the book was published, there were no high-quality studies to support its use. However, it seems that things have changed.

CoQ10

CoQ10 is a natural substance found in our cells which helps in the cell’s energy production. In nature, it’s found in organ meats and oils. CoQ10 has been touted as having many different health benefits; however, much of this is based on very weak evidence.

It is known that CoQ10 can help with muscle pain induced by statins (the most common and efficacious group of cholesterol medicines). It may also have a role to play in the prevention of migraine headaches in those who suffer frequent bouts; in addition, small studies have shown a possible benefit in lowering blood pressure.

Recently, results of the Q-Symbio trial show that CoQ10 may have amazing benefits in those who suffer from heart failure – a condition in which the heart can’t effectively pump blood. Risk factors for heart failure include heart disease, untreated high blood pressure, excessive alcohol use, and, of course, smoking. Due to advances in the treatment of heart failure, including more widespread use of effective medications, as well as implantable devices which can shock the heart if it stops beating or help it to beat at a normal pace if it slows down too much, the life expectancy of those who suffer from heart failure has improved. Nevertheless, mortality is still much higher for those who suffer from heart failure than in age-matched people in the general population.

The Q-Symbio trial basically showed that in those with pre-existing heart failure who were given 100 mg of CoQ10 three times a day over a 2 year period, risk of dying, as well as other adverse outcomes such as being hospitalized, needing a heart transplant or mechanical support for the heart was reduced by nearly a half! This is a remarkable reduction – on par with some of the very best medications and therapies that we have. Furthermore, there were no real side effects.

What does this mean for us? It’s a bit too early to tell 100% if CoQ10 should be used by everyone with heart failure. In general, results of a trial need to be replicated in other trials in order to evaluate whether or not the evidence is indeed real. HOWEVER, I think that due to the safe nature of CoQ10, it is reasonable for any of you who have heart failure to discuss supplementation with your cardiologists.

Furthermore, for those who suffer from chronic migraine headaches, it’s a reasonable supplement to try, along with magnesium and riboflavin (aka vitamin B2); it certainly has a more favorable side effect profile then many of the other medicines used, which include blood pressure medicines, seizure medicines, and anti-depressants.

Finally, in those of you who regularly take statins for heart problems or for cholesterol reduction (e.g. Lipitor (atorvastatin), Zocor (simvastatin) Crestor (rosuvastatin) Pravachol (pravastatin)), it’s a reasonable supplement to take, especially if you have muscle aches (which you should mention to your physician) or if you regularly exercise.

– Tamir

(Image – with CoQ10 on top – links back to its source.)

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