Tag Archive for: American Medical Association

Creatine and the Unasked Question

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If you read the article on creatine posted by the AMA, while as short as a sentence or two, the points were valid. Let me elaborate on a couple of the ones I think are most important.

Creatine Builds More than Muscle

The point they were making is that creatine may be beneficial to build muscle in those over 65, but that’s not all. I checked the study on the relationship between creatine intake and memory in persons 66 to 76; while it’s a meta-analysis and those can be potentially biased in the way studies are chosen for inclusion in the analysis, the data showed that memory was improved compared to a younger population.

The question is why? My personal opinion is that creatine may increase the production of energy in nerve cells in the brain, which can help learning and memory. There’s also the possibility that creatine may help increase the fluid content of brain tissue, thus making the cells work more effectively; we do tend to dehydrate more as we get older.

The second important point was that creatine is safe to use for nearly all of us, provided we don’t have chronic kidney conditions. While there have been a few small studies that have shown that even in people with diabetes-related kidney failure, creatine can be safely used, it’s best to work with a physician/specialist if you’re in that category of kidney disease. They can check creatinine levels to make sure kidney function isn’t being harmed. For the rest of us, using 3 to 5 grams of creatine every day seems to increase the benefits of muscle repair and growth with weight training.

The slight water retention and digestive issues mentioned are minor issues that typically resolve themselves when compared to the benefits creatine may generate. Just remind yourself that if your brain is retaining a little water, that’s a good thing!

The Unasked Question

What’s the question no one ever asks in nutrition studies? “How did you feel while you were taking the supplement?” Feelings can vary depending on the supplement: more energy, better sleep, fewer digestive issues, and on and on. I’m not talking about filling out questionnaires or taking tests. We’re all grown up enough to know that you may feel a little worse at first, but it usually goes away with time, so don’t get in a hurry to give up on creatine.

Simply, “How did you feel?” At the end of the day, that’s what’s really important to the person taking the supplement. Too often, because there are no real “hard science” tests for how a person feels, it’s not asked. We simply don’t know everything about how every food, every supplement, and every pharmaceutical impacts every tissue in every organ in the body. Sometimes, it’s just about how you feel day in, day out.

What are you prepared to do today?

        Dr. Chet

References:
1. https://www.ama-assn.org/public-health/prevention-wellness/9-things-patients-should-know-about-taking-creatine
2. Nutr Rev. 2023 Mar 10;81(4):416-427. doi: 10.1093/nutrit/nuac064.

The AMA and Creatine

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After last week, you may be thinking I’m going to talk about another healthcare professional dissing supplements. I’m very pleased to say that’s not correct this time around. You can read the article by clicking here; I wouldn’t recommend listening to the audio version—seems like an AI voice to me.

The first thing that blew me away was the sponsorship: the American Medical Association. I’m not used to the AMA even acknowledging supplements exist except to caution patients to be very cautious using them. Great change.

According to the title, there are nine facts patients should know about creatine. I think the first was the most important: taking creatine in conjunction with a weight training program will increase muscle mass over time. I agree completely. The age range goes from 20 to 80; for people over 40 and facing a continual decline in muscle mass over time, that’s important information to know.

I’ll cover the rest on Saturday, including the question never asked in many studies on dietary supplements.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.ama-assn.org/public-health/prevention-wellness/9-things-patients-should-know-about-taking-creatine

Questionable Comments on Dietary Supplements

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I hope you had a chance to read the article I referred you to on Tuesday; you can still read it by clicking on this link. For the record, I’m not a fan of the AG1 product. In my opinion, supplements should not mix herbals from medicinal plants with vitamins, minerals, and phytochemicals. That aside, there are three main points I alluded to in Tuesday’s Memo so let’s take a look.

Pharmaceuticals vs. Supplements

First, dietary supplements are regulated by the FDA, just not in the same way as pharmaceuticals. Here’s the difference:

  • Medicines have to prove they are safe before they are released for use by the public, but they can claim they will prevent, treat, or cure diseases.
  • Supplements cannot make such claims; they can make only structure-function claims: “This product may help digestive health,” for instance.

This “fact” as the writer proclaimed is the mantra of the American Medical Association and FDA. It seems worse now that they’re producing videos together for the general public. There’s a lot more arguments here, but that’s for another time.

So Much Beta-Carotene

The author brought up the beta-carotene and smoking studies, but I don’t understand why he didn’t question the amount of beta-carotene used in either study. The studies used four to six times the actual intake of beta-carotene at that time. These made these studies suspect because of the extreme use of beta-carotene in the studies. That’s what should be questioned.

Inadequate Nutrition

The proof was poor that he used to suggest that over 75% of the adult population get adequate vitamins and minerals from the food they eat. It was a study based on data collected via food-frequency questionnaire from specific segments of the Hawaiian and Asian populations in the mid 1990s, and I think we all know that those diets differ from the typical diet on the U.S. mainland or Europe. There are data from the 2021-2023 NHANES study available. It’s difficult to compare the data because of the way they were analyzed in the prior study, but a look at the nutrient intake from food looks more like we get 66% of the RDA, at least for some nutrients such as vitamin A, and worse for other nutrients.

Are there more problems? Yes, but that’s enough. This was a rehash of old arguments to say supplements are not necessary. But there’s one question that no one ever asks in any studies. I’ll leave you in suspense until next week when we look at what one physician said about creatine. I think you’ll be surprised.

What are you prepared to do today?

        Dr. Chet

Teaching Doctors About Supplements, But Not Really

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If you haven’t watched the videos that I talked about Tuesday, please take the time to watch them, preferably before you continue reading—I’d like you to form your own opinion about the videos before you get my perspective. I came away with three opinions about the videos, other than they really focused on dietary supplements not being approved by the FDA. Of course, no legitimate healthcare professional or supplement manufacturer ever said they were; consumers may not know that, but I would hope doctors did.

First, the second video discussed potential drug-supplement interactions. There have been few direct studies on those interactions; most are case studies involving the use of herbs such as St. John’s wort and ginkgo biloba that have been published in peer-reviewed journals. What they don’t say is that very few studies have examined drug-drug interactions either. How do they find out about them? Trial and error from reports to the FDA’s adverse effects reporting system.

That addresses my second opinion. There was a strong focus on reporting adverse events from dietary supplements to the FDA. One would think that’s a good thing, but the list of adverse events they listed included every system in the body. I get reporting an allergic reaction, but how would a physician attribute gastrointestinal or cardiovascular issues to a dietary supplement after putting the person on a new medication? It’s just as likely to be due to the medication. Seems to me like an open door to lots of irrelevant reports.

Finally, they spoke about some supplements interacting with blood tests. The only one I’m aware of is excessive biotin intake affecting the troponin test for potential cardiac events. One would expect an extensive list would be provided; the problem is none exists because that’s the only known interaction.

The Bottom Line

There are 13 vitamins. There are dozens of minerals, most found in trace amounts. There are hundreds of herbs, plus nutrients that don’t fall into any of those categories. All can be found in dietary supplements. If I were a physician who spent time watching the videos, I really wouldn’t know more about those nutrients in supplements than I did before I watched. I would have learned only two things:

  • The FDA does not have the authority to approve dietary supplements.
  • If a patient takes dietary supplements, anything bad that happens in the body should be reported as an adverse event.

A lot of red flags were waved when the issues deserved a yellow flag at most. I can think of only one word: sad. With the lack of training and knowledge about supplements among doctors, I think those two organizations could have spent their money better and created videos that would have really helped doctors and their patients.

What are you prepared to do today?

        Dr. Chet

References:
1. https://www.youtube.com/watch?v=GYJYPCJmspE
2. https://www.youtube.com/watch?v=qqyP-vbtlZY

Teaching Doctors About Supplements

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In late May, the Food and Drug Administration (FDA) in partnership with the American Medical Association (AMA) released two short videos to teach physicians about dietary supplements, plus a third aimed at consumers.

The first video spent time defining and explaining what a dietary supplement is, the delivery systems companies use such as tablets,  gummies, bars, etc., and the role the FDA plays in the process. The second video focused on adverse events, how to report them, and a sample conversation between a doctor and patient. I encourage you to watch the videos at the links below.

I think there are two important points of the videos. First, the FDA does not approve dietary supplements in the same way that they approve pharmaceuticals—obviously their main point because it was repeated several times. In exchange for allowing supplements to be introduced quickly, companies do not have to prove safety or effectiveness. However, if they make any health claim, they must report that to the FDA within 30 days of making the claim. Those claims are restrictive; a company can’t say on the bottle or promotional materials “cures heart disease” but can say “contributes to a healthy heart.”

Second, you should always discuss the supplements you take with your physician, especially if you take medications. It can be a pain if you take a lot of supplements, but you must do it because there can be interactions. For example, calcium, whether from food or a supplement, interferes with the absorption of thyroid medications. They should not be taken together (which is tricky because it’s recommended thyroid meds be taken at bedtime when you may be taking a calcium-magnesium supplement to aid sleep).

Those are what I see as the positives of these videos that cover supplement companies and patients; there’s no information about how supplements work or which supplements do what. I’ll cover that aspect of the videos on Saturday. In the meantime, take the time to watch both 10-minute videos.

What are you prepared to do today?

        Dr. Chet

References:
1. https://www.youtube.com/watch?v=GYJYPCJmspE
2. https://www.youtube.com/watch?v=qqyP-vbtlZY

Sugar: New Villain?

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Health by headlines continues, this time, from one of the Journals of the American Medical Association. The headlines revolved around how the sugar industry influenced research and scientific publications in the 1950s through the 1980s. A group of researchers, affiliated with the Philip Lee Institute for Health Policy Studies, examined documents from the Sugar Research Foundation and correspondence between scientists who examined research on the role fat and sugar play in the development of cardiovascular disease. The scientists involved have all died; this was an examination of their papers archived in the universities where they spent their careers as well . . .

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