Tag Archive for: supplements

Food Is Better Than Supplements, But …

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Getting your nutrients from food by eating a healthy diet is the most desirable way of getting vitamins, minerals, and phytonutrients. Period. If we could all do it, no question that’s the best way. But you and I don’t live in some fantasy world. We’re busy. We don’t always have enough time to shop and cook healthy meals. Dietary supplements have helped fill the nutrition gap.

What should we think about this latest research? Should we stop taking supplements, especially calcium? Before I give you my opinion, I want to tell you that I emailed the corresponding author of the paper, a brilliant woman and a talented researcher. I had two questions about the study. She answered me the same evening—Saturday night before Easter. That I got such quick reply was remarkable; I’m still waiting for answers from other researchers I contacted months ago.

The first question I asked was a basic one: what was the mortality rate of the subjects in the study compared with the national cancer mortality rate? The national mortality rate is 156 deaths per 100,000 people per year. That works out to 1.6 people per 1,000. The rate in the study was about 3 people per 1,000. She replied that the study results are not directly comparable for complicated reasons.

But here’s something that can be directly compared. A 62% increase in cancer mortality would be transferable to national statistics because that’s the idea: to generalize to the entire population. A 62% increase means that 2.5 people per 1,000 would die from cancer in a given year instead of 1.6. When applied to the entire population that could be a lot of people, but it applies only to those who took over 1,000 mg of calcium per day.

The other question I asked was whether they had data on how long the people were taking the supplements; NHANES asked about the 30 days prior and recorded the prior 24 hours. How long were they taking the supplements? Weeks? Months? Years? Decades? That might have made some difference. The data were collected in the questionnaires used for two of the cycles that I examined, but that data was not used in the analysis.


The Bottom Line

I think we should eat the best diet we can. I also think we should use quality dietary supplements to complement our diet. This study was an exercise in statistics more than nutrition. It can tell us the statistical outcomes of the people in the study, but it can’t really be used to tell us anything about what we should do as individuals.

Not every person who took a higher amount of calcium died from cancer. On top of that, if supplementation did have a significant negative impact on our health, it stands to reason there would have been more negative results than just for calcium. Because the research questions were fitted to the available data, there’s just too much we don’t know about factors that can influence the results.

Another good question the study didn’t ask is why people were taking calcium. For instance, a woman with osteoporosis may take calcium for better bone health. Did those women have fewer broken bones with supplementation? If so, that might be worth any higher risk that exists. As with any nutritional intervention, it’s important to weigh the pros and cons. If you’re concerned, talk to your healthcare professional about what you should do; they know you and your health status and can help you make the right choices.

Supplement confusion is a good reason to get a copy of my new CD Supplementing Your Diet. Check out why at drchet.com.

What are you prepared to do today?

        Dr. Chet

Reference: Ann Intern Med. doi:10.7326/M18-2478.

Food vs. Supplements: A Closer Look

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There’s no question National Health and Nutrition Examination Survey (NHANES) has done the best job of collecting data on nutritional intake in large-scale studies. I’ve applauded it in the past, and I’m not going to change now just because there’s an NHANES-based paper that critiques the use of supplements. NHANES data were used by one of the co-authors of the current research paper we’re examining; in that study, they demonstrated regular use of a multivitamin-multimineral can compensate for deficiencies in our diet.

What could explain the same data showing potential benefits and hazards of supplements? Two reasons in my opinion. First, the research questions were not part of the original study; that’s supported by the fact that the lead author would have been six or seven years old when data collection began.

Imagine you apply for a loan. You’d give the bank all kinds of financial data: your total earnings, where you work, what you owe, and so on. Then imagine that researchers take all that very accurate data and estimate your hourly wage. They could be right on the money or way off, because they don’t know how many hours you worked; that wasn’t one of the questions. It’s the same with the data in this study; the researchers can make a great guess from the data they have, but the question they’re trying to answer wasn’t one of the original questions asked so their guess may be very far from correct. That happens often in these retrospective studies.

Second, the bulk of the researchers were experts in statistics and epidemiology. The statistical analysis accounted for 11 factors to numerically make the data comparable. We can’t really know what that does to modify the data instead of collecting data on actual variables.

Still worried? I’ll finish this up on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: Ann Intern Med. doi:10.7326/M18-2478.

Food vs. Supplements

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Last week, the health headlines blared that nutrients from foods were better than nutrients from supplements—specifically that excess calcium from supplements was associated with an increased risk of dying from cancer. That will get your attention if you take supplemental calcium, especially if you’re taking calcium because your physician told you to take it because you have osteopenia or osteoporosis. Let’s take a closer look at this study published in the Annals of Internal Medicine.

Researchers examined data collected for the National Health and Nutrition Examination Survey (NHANES) on food intake and supplement use. NHANES data are now collected every two years, so they selected six consecutive cycles and tracked the all-cause mortality from subjects in those data. They found that in over 30,000 adults over 20 years of age tracked for six years, there were 3,613 deaths with 805 from cancer.

The researchers then examined the food intake and supplement use of the subjects from the prior 30 days of data collection with mortality data. That’s where they discovered that in the subjects who died from cancer, there was a 62% greater risk if they took more than 1,000 mg of supplemental calcium per day. The overall conclusion was that nutrients from foods are better than nutrients from supplements; in addition, some supplements may be hazardous.

Should you start chucking out your calcium supplements? We’ll take a closer look at this study the rest of this week.

What are you prepared to do today?

        Dr. Chet

Reference: Ann Intern Med. doi:10.7326/M18-2478.

Supplementing Your Diet

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Last week, a study was published that concluded that nutrients from food are better than nutrients from supplements. Does that mean you can throw out the supplements and just eat more? Short answer: no.

Did you ever notice that one week some vitamin is good for you and the next it’s supposed to be bad for you? Why is that? One reason is the way nutrition research is done.

One of the most popular audios I’ve ever made was Supplements Made Simple, so now I’ve updated all the tracks and included a section about the problems with nutrition research.

Introducing Supplementing Your Diet—Why, What, and Who. This CD examines the issues related to dietary supplements in the 21st century. The first question is simply why do we need them? Can’t we get enough nutrients from the food we eat? I’ll address that question from a variety of perspectives, including those based on your physiology and biochemistry.

What about the research that says supplements aren’t necessary and are a waste of money? As I said, I’ll tackle that issue head on with three specific reasons too much research on supplements is flawed and yields misleading conclusions.

If you do need to supplement your diet, where do you begin? I’ll explain the four supplements everyone should take and the reasons why.

Finally, how do you decide which company to buy supplements from? I’ll give you five characteristics that distinguish a high-quality manufacturer. That will help you choose the company whose supplements are best for you. This audio cuts through the forest of obstacles to help you see things clearly so you can make an informed decision on how to supplement your diet.

All this information is just $9.95 plus shipping and handling.

And if you’re in the supplement business, this audio will answer your potential clients’ questions about the basics. If you want to grow your supplement business, I’ve included special pricing on five copies of this CD so you can loan them to clients to help them make their decisions. You can point them to my online bio to show them why they can rely on my explanations.

Enjoy this holiday weekend, and I’ll be back Tuesday.

What are you prepared to do today?

        Dr. Chet

Quality Manufacturing: Own It

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The most important trait of a quality manufacturer of dietary supplements is to own as much of the process as possible: farms to grow plants, laboratories to test all components of the supplements, scientists to base formulations on the latest research, manufacturing facilities for the products, and elements of the distribution process. As I said, no company can process every nutrient that may go into a supplement but the more they control, the better the oversight.

The problem will always be the lack of control. As control decreases, the probability of tainted supplements increases. Anyone, and I really mean anyone with the money, can put together a formula for supplements and find a manufacturer that will make it. The ingredients can be organic and natural or they can be the cheapest available. That person can also find a warehouse to store it and another company to distribute it, especially in these days of Internet shopping. Anyone can start selling his own formulations for supplements within a week to a month.

Lack of ownership isn’t necessarily a bad thing; we can’t begin with the premise that everyone is out to cheat everyone by cutting corners. But while someone might be an excellent nutritionist with a great idea for a supplement of some sort, they’re not necessarily an expert in the entire process of manufacturing. That could result in problems with the finished product that were unseen due to a lack of expertise.

In this week’s Memos, I’ve covered a simple way to assess the manufacturers of supplements. The only thing you have to do is ask the right questions before you buy. That protects you and your family.

What are you prepared to do today?

Dr. Chet

 

Quality Manufacturing: Independent Testing

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Let’s continue our look at how quality manufacturers could prevent tainted products. In-house testing is important, but all work should be verified by an independent testing company. There are several labs that perform such services such as NSF and USP. There are three important services they can perform:

  1. Inspect the facility to make sure the manufacturing process complies with FDA Guidelines for dietary supplements known as Good Manufacturing Practices.
  2. Verify the quantities of nutrients in the products listed on the product labels.
  3. Check for the presence of contaminants of all types.

It seems simple enough. Why don’t all manufacturers use independent testing companies? One of the reasons is cost: it’s not inexpensive, and it also must be continuous. But the trademark of a quality manufacturer is independent testing of the manufacturing facilities and dietary supplements they make.

We’ll finish this up on Saturday with one of the most important traits of a quality manufacturer.

What are you prepared to do today?

Dr. Chet

 

Quality Manufacturing: Establish Rules

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Last week’s Memos were about supplements that were tainted with pharmaceuticals. What can manufacturers do to insure their products are not tainted? Mistakes can always happen, but what can be done to get those errors as close to zero as possible? That’s what we’ll cover this week.

Let’s begin with this premise: no manufacturer of dietary supplements grows every plant they use or makes every vitamin in their supplements. There’s nothing wrong with that because the growth and production of supplements is so complex. However, there are two things that a manufacturer can require from their vendors.

First, that they follow specific guidelines in the growth of plants: what type of seeds, what type of organic herbicides, how the plants must be harvested, and on and on. Following guidelines would also be required of outside companies who make vitamins and process minerals.

Second, all vendors’ products would be tested for contaminants upon arrival before any final products are made. If they do not meet the guidelines, the shipment is rejected.

Monitoring the quality of ingredients is the first step in making sure a dietary supplement contains untainted ingredients. I’ll cover another in Thursday’s Memo.

What are you prepared to do today?

Dr. Chet

 

Tainted Supplements: Buyer Beware

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There was a big problem with the papers that were published in JAMA and the resultant media headlines: the authors and commentator lumped the tainted products into a single category of dietary supplements and categorized these questionable manufacturers and their tainted products with all manufacturers of dietary supplements. That was simply wrong, and people in health news know better. There will always be unscrupulous companies out to make a quick buck and laughing all the way to the bank.

Some of the tainted products are still on the market today. Most are available only online, and their websites contain no information about the company who makes them or how they were made. They might simply be the same product sold under different names; there’s no way to tell.

The everyone-in-the-pool approach used by the authors reflects an underlying belief that the FDA should give approval to every dietary supplement. There are healthcare professionals who don’t like supplements of any kind. With this kind of news, they make the leap that all supplements are equal, and thus all require more restrictive oversight to stem the tide of tainted supplements. That’s just foolish. Quality manufacturers that want to continue to be in business follow the rules set out by the FDA for dietary supplements. Fly-by-night companies won’t, no matter what the laws say.

Buyer Beware

The articles do raise an important concern: how do you know whether the products you’re buying are made by a reputable manufacturer or not? After all, you’re going to be putting them in your body. Do your homework, just as you might do with any other consumable product. Check out the company online to the extent you can. The more information you can find, the better. If there’s not much info, consider that a red flag.

But how do you know what to look for? I’ll cover that in next week’s Memos, so make sure you don’t miss them.

What are you prepared to do today?

Dr. Chet

 

References:
1. JAMA Network Open. doi:10.1001/jamanetworkopen.2018.3337.
2. JAMA Network Open. doi:10.1001/jamanetworkopen.2018.3329.
3. FDA Database: http://bit.ly/2Pyq0B3

 

Which Products Were Tainted?

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The logical concern is this: what products were on the list of supplements that made up all those headlines? There were over 700 products on the FDA list of tainted products, so I think there’s a better way to ask the question: what were the categories of products?

1. Sexual performance was the overwhelming leader.
2. Weight loss was second.
3. Muscle building also made the list.

The problem with the sexual performance products was that they contained actual Viagra, Cialis, or one of the other medications used for erectile dysfunction. The weight loss products contained a pharmaceutical that has been taken off the market because of side effects. Most of the problematic muscle-building products contained anabolic steroids. When people take these types of medications pitched as dietary supplements without knowing what’s in the product, the potential for unexpected consequences is substantial and could threaten their health.

I reviewed the entire list of supplements on the FDA list and found no products—not one—offered by a reputable company. No multivitamins. No antioxidants. No herbals such as echinacea.

Here’s the bottom line: these were not dietary supplements, they were pharmaceuticals that skirted the FDA regulations for pharmaceutical and over-the-counter drugs and the FTC rules for honesty in advertising. But that’s not what the paper’s authors and the commentator said. We’ll finish this on Saturday.

What are you prepared to do today?

Dr. Chet

 

References:
1. JAMA Network Open. doi:10.1001/jamanetworkopen.2018.3337.
2. JAMA Network Open. doi:10.1001/jamanetworkopen.2018.3329.
3. FDA Database: http://bit.ly/2Pyq0B3

 

Tainted-Supplement Headlines

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I’d like you to read these three headlines, stop, and identify the first thought that comes to your mind:

“Hundreds of Supplements Are Tainted With Hidden Pharmaceutical Drugs”

“Hidden Drugs and Danger Lurk in Over-the-Counter Supplements, Study Finds”

“Supplements Often Tainted by Hidden Drugs”

No matter what supplements you’re taking, the thought “I wonder what’s really in my supplements?” must have passed through your mind, even just for a second. I know my readers were thinking that. Should you be concerned? Will that multivitamin or B complex you’re taking contain something dangerous?

That’s the takeaway from these headlines about a paper published in the JAMA Network Open journal (1). The article had a corresponding commentary criticizing the FDA for dereliction of duty in not seeing that these products were removed from the marketplace. (2).

There are some important lessons here and this is the first one: while numerous publications called this a study, it was not. A few scientists reviewed the FDA website that listed tainted products marketed as dietary supplements; the FDA had sent warning letters to the manufacturers to stop selling the products. The authors grouped them by category of product type and then spent eight pages talking about them. According to the paper, they did nothing else—no other investigation or analysis.

The type of products that made the tainted products list wasn’t surprising if you closely follow health news. I’ll tell you what they are on Thursday.

What are you prepared to do today?

Dr. Chet

 

References:
1. JAMA Network Open. doi:10.1001/jamanetworkopen.2018.3337.
2. JAMA Network Open. doi:10.1001/jamanetworkopen.2018.3329.
3. FDA Database: http://bit.ly/2Pyq0B3