Tag Archive for: supplements

Yes, Supplements Matter

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The study that was published in the Journal of American Academy of Cardiology created several issues that go beyond the headlines of supplements being of no benefit. Let’s first take a look at the published results of the study.

The researchers found that most supplements such as multivitamins, vitamin D, calcium, and vitamin C do not have a significant effect on cardiovascular disease or overall mortality. On the other hand, folic acid had a significant beneficial effect on reducing stroke and overall CVD, and B-complex, a vitamin with a variety of B vitamins in it, also helped reduce the incidence of stroke. However, the study showed antioxidants had a negative effect on all cause mortality as did niacin. Whether beneficial or not, the results, while statistically significant, were not clinically significant.

The researchers stated that they expected beneficial effects on the reduction of cardiovascular disease and overall mortality. The fact that they did not find those benefits resulted in the headlines that supplements don’t matter.

Here are just three of the issues with the study. They included studies with different nutrients as well as studies that didn’t have the same amount of nutrients. The RCTs included in the analysis did not have the exact same amounts of any given nutrient in the supplement; three of the studies on antioxidants and cancer mortality had different amounts of beta-carotene and vitamin E. Another way of putting it was they not only were comparing apples to oranges, but they also compared three oranges to a dozen apples.

Another issue was adherence to the study rules. The subjects did not necessarily take all the supplements they were given, and compliance varied between the studies. Positive or negative effects could be determined by whether subjects took all of their supplements or took them only when they remembered or felt like taking them. The adherence to supplement use varied by study.

Here’s one more issue. Every RCT used supplements as a potential treatment for a disease—in this case, diseases related to the heart and the death rate from heart disease or other diseases. It’s the treatment model used by physicians: the pill, whether pharmaceutical or supplement, must reduce the incidence of or cure the disease. While desirable, that’s not what nutrition is all about.

The Bottom Line

While we would like to see research results that prove that we can live longer or better by taking supplements, that isn’t really the point in my opinion. We take supplements to fill the gaps in our diet. As the researchers point out, if everyone ate more plant-based foods, we could meet the minimal amounts of nutrients our bodies needs. That hasn’t happened in the 30 years I’ve looking at this issue, and I don’t see it changing any time soon.

Taking vitamin and mineral supplements serves as nutritional insurance to support your body’s processes and to make sure you don’t open the door for deficiency diseases; supplements are more like shotguns than rifles. Supplements do matter and I’m going to continue to take mine every day.

There are so many issues with this research paper—much too long for this Memo—that I recorded a Straight Talk on Health about them. If you’re a Member or Insider, you can listen to Research Update on Supplements any time. If you’re not, now is a good time to join.

What are you prepared to do today?

Dr. Chet

 

References: Jenkins, D.J.A. et al. J Am Coll Cardiol. 2018;71(22):2570–84.

 

Supplements: Helpful or Harmful?

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About a week ago when a press release about a study published in the Journal of American Academy of Cardiology stated that vitamins and minerals don’t seem to help the health of those people who use them; they should stick to getting nutrients from the food they eat. As you can imagine, I got questions from many readers.

For those of us who use dietary supplements, have we been wasting our money? Or maybe as part of the study showed, we’re doing ourselves harm? Don’t throw out your supplements just yet.

The study was a meta-analysis that examined randomized controlled trials (RCT) since the U.S. Preventive Services Task Force (USPSTF) Recommendations for Dietary Supplements was published in 2012. They examined RCTs that used multivitamins, vitamins and minerals, and antioxidants to determine their affect on health variables related to cardiovascular disease and overall mortality.

Was the study done well? Yes and no. They included RCTs that examined the use of specific supplements and health outcomes. The problem is that they didn’t examine the quality of the supplements used in those studies. That’s a significant problem but not the only one. More on this Saturday. Until then, regardless of the headlines, take your supplements if you know why you’re taking them.

What are you prepared to do today?

Dr. Chet

 

References: Jenkins, D.J.A. et al. J Am Coll Cardiol. 2018;71(22):2570–84.

 

Why Nutrition Is a Process

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A celebrity doctor who specializes in cancer treatment said something that caught my attention, and it goes to this question: why are some people cured by specific treatments while others don’t respond at all? In his opinion, it’s because the cancer creates a new system in the body that competes with the other systems.

The new system may be different in each body once the cancer is established, which could mean that everyone really requires an individual approach. A systems approach would be necessary only if the cancer gets too established; early diagnosis can use treatments that work in most people. Late diagnosis means the cancer has established a system with strengths and weaknesses that are unknown. But the systems approach isn’t limited to cancer.

What’s a Systems Approach?

A systems approach is simply this: we attempt to reach a goal by looking at the interactive nature and interdependence of all the factors in an entity.

Here’s an analogy: you flip the switch for the light in your kitchen, but the light doesn’t go on. What could be wrong? The light won’t work if:

  • Your bulb is burned out
  • Your circuit breaker needs to be reset
  • An electrical outlet somewhere has a tripped GFCI
  • Your switch has gone bad
  • A wire is loose in your light fixture
  • The power is out to your whole house

Turning on a light is easy—my grandson Riley is very good at it and he’s not even three. But if it’s not working, you have to look at each element of the system to find the problem and get the kitchen light back on.

How Vitamin D is Part of Your Bone Health System

While osteoporosis or weight gain doesn’t create a new system like cancer does, there are numerous steps in both processes. On top of that, if we’ve been on the path to bone loss or weight gain, there may be changes in normal metabolism that have to be overcome.

Let me explain using vitamin D for bone health. Whether we make vitamin D in our skin, get it from food, or take it in supplement form, it has to be processed by the liver to become the active form to promote bone growth. If there’s a defect in getting the raw vitamin D from food or a supplement into the bloodstream and on to the liver, not enough vitamin D would be made into the active form. Or there may be a defect in the processing of the raw vitamin D once it gets to the liver. Or there may a defect in the receptor for the active vitamin D on the target tissue. I could go on and on about where issues could occur, but I hope you get the point. Right now, we have no idea where the issue might be for the use of vitamin D in an individual just as we don’t know where the weak point of a cancer system might be and thus where we should attack.

Do we quit? No. We simply use a systems approach—we look at every step necessary to reach our goal and what we can do at each step. We begin with taking vitamin D for a specific period of time. We then get re-tested, most likely a bone density scan. If there’s growth, great. If there’s not, then we either add more D or add calcium or switch to a different form of calcium. Then retest. If that doesn’t work we can add vitamin C or glucosamine, both critical to the manufacture of connective tissue. There are other factors such as smoking and exercise that also impact bone growth. We systematically add new variables or add more of some that we’re already doing. Might this take a long time? Yes. Would we have to pay attention? Yes. But is it a natural approach to complicated conditions? Again, yes. No matter what the condition, if you’re going to try to deal with it nutritionally, that’s the approach you’ll have to take. You have to find what works for you.

The Bottom Line on Vitamin D

The systems approach goes a long way to explain why some people benefitted from vitamin D and calcium to prevent fractures and others did not. The only fact the meta-analysis study proves is that vitamin D and calcium supplementation don’t work for everyone. The key is to move on to the next approach; it may be different supplements or it may even be a medication. More options must be tried until a solution is found for each individual.

Over time, I’m going to continue to explore this concept of a systems approach to nutrition. I have no idea where it will lead, but it’s worth spending more time thinking and researching it.

What are you prepared to do today?

Dr. Chet

 

Reference: JAMA. 2017;318(24):2466-2482. doi:10.1001/jama.2017.19344.

 

You Actually Have to Take the Supplements

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The authors of the study on calcium and vitamin D supplementation as they relate to fractures were all orthopedic surgeons, as stated in the paper. They had no known training in nutrition. Maybe not statistics either.

When you perform a meta-analysis, each research study included is given a weight in the form of a percentage, which indicates how much it contributed to the outcome. Not all studies should contribute equally; that helps to eliminate the bias of a tremendous benefit in a very small study versus a large study with no benefit. They didn’t seem to read something in three studies that contributed close to 90% of the analysis (2-4): the authors of those papers said that the reduction in fractures did occur, or at least bone was restored, when the subjects took over 80% of the doses of calcium and vitamin D they were supposed to take. The problem: average compliance was around 50%.

What these surgeons could have done was tease out the data on those subjects who were compliant and analyzed that data. What they might have had were results that demonstrated that in order to get a benefit, subjects had to take the supplements regularly. That would have been meaningful. Instead, inexperience or ignorance left us with headlines but little else.

Still, there are some questions that were raised in my mind and I’ll cover them on Saturday. But one thing won’t change: if you’re going to take supplements of any kind, you’ve got to actually take them if you want a benefit.

What are you prepared to do today?

Dr. Chet

 

References:
1. JAMA. 2017;318(24):2466-2482. doi:10.1001/jama.2017.19344.
2. Lancet. 2005;365(9471): 1621-1628.
3. Arch Intern Med. 2006;166(8):869-875.
4. Am J Med. 2006;119(9):777-785.

 

Are Vitamin D and Calcium Still Worth Taking?

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Maybe you recently read a headline that went something like this: “Vitamin D and Calcium Do Not Prevent Fractures.” Many headlines were much worse. Over this past weekend I read the research paper published in JAMA. Is it real? Should you not bother taking your calcium and vitamin D to protect your bones? No—keep taking them. But it does give me an opportunity to talk about some of the issues surrounding these types of papers as well as the complexity of nutrition for our health. That’s our topic this week.

The study was a meta-analysis of studies that examined the relationship between the risk of fractures in elderly populations and supplementation with calcium, vitamin D, and both supplements together. After a rigorous database search, 33 randomized controlled trials were included in the meta-analysis. Some studies lasted several months, and some lasted several years. The amounts of calcium and vitamin D in the supplements varied in every study. After analysis, the researchers determined that neither calcium nor vitamin D nor the combination of both reduced the rate of fractures when compared to placebo. That led to their conclusions.

This was a mess as you probably guessed with differing quantities and lengths of the trials. What bothered me most was that if they really understood nutrition as well as the results of the studies they included, they could have done something special. I’ll cover that on Thursday.

What are you prepared to do today?

Dr. Chet

 

Reference: JAMA. 2017;318(24):2466-2482. doi:10.1001/jama.2017.19344.

 

Interaction Between Food and Blood Thinners

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Blood thinners are the second most common medication that can interact with food and supplements. Blood thinners such as warfarin are used to prevent blood clots in people with atrial fibrillation, artificial heart valves, and deep vein thrombosis.

When a blood thinner is prescribed, people are given a list of foods and supplements to avoid. Top of the list is vitamin K and foods that contain vitamin K such as green leafy vegetables. Herbs such as garlic and ginkgo, supplements that contain vitamin E, coenzyme Q10, and omega-3 fatty acids are also discouraged because they may make the blood thinner. The goal is to optimize the international normalized ratio (INR), a measure of clotting ability. It isn’t that those types of patients have blood that coagulates more than normal; the theory is that keeping vitamin K from interfering with the blood thinner will reduce the probability of clots.

The problem: the recommendations are not supported by definitive research; it’s more a matter of playing it safe based on the theory of what the nutrients will do rather than actually based on science. In a recent review article, the authors concluded: “Restriction of dietary vitamin K intake does not seem to be a valid strategy to improve anticoagulation quality with vitamin K antagonists. It would be, perhaps, more relevant to maintain stable dietary habits, avoiding wide changes in the intake of vitamin K.” I absolutely agree.

What do you do? First, decide what diet you want to eat and supplements you want to take and stick to it. Second, work with your physician to adjust the blood thinner to get the dosage just right to keep your INR within range. Third, if you can’t get it normalized, there may be other factors as yet unknown that are affecting clotting. You’ll have to stick to the common recommendations, science-based or not.

Last chance to become an Insider and listen to tonight’s free conference call and get your health questions answered. You can learn more and join at this link.

What are you prepared to do today?

Dr. Chet

 

Reference: Medicine (Baltimore). 2016 Mar;95(10):e2895.

 

CO2 and Plant Nutrients: Proceed with Caution

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The Memos this week have examined a potential problem with the nutrient content of the plants we eat due to increasing CO2 levels. What does the research show? Part of the problem that Dr. Loladze had was that no one was doing much research on the issue of CO2 and nutrient content. That’s going to change based on some of the research that has been published.
 

Mineral Content Has Decreased

In a study published in 2004, researchers examined the nutrient content—13 nutrients and water—of 43 garden crops as reported by the U.S. Department of Agriculture in 1950 and 1999 (1). They reported declines in six nutrients: protein, calcium, iron, phosphorus, riboflavin, and vitamin C. The reductions ranged from 6% for protein to 38% for riboflavin. The researchers concluded that the decline could be explained by changes in the types of cultivated plants. Okay. If we’re now planting crops that have lower nutrient content, maybe they’ve been selected for size or appearance or the ability to be transported long distances. Do we think that’s okay?

In a study published in 2014, researchers used a creative approach to test the affect of increased CO2 on grains and legumes (2). They mimicked the predicted CO2 levels expected in the middle of this century in grains and legumes grown under field conditions. They set up an outdoor system that allowed more CO2 to be released on the plants. They found that grains and legumes had decreased levels of zinc and iron and grains had lower levels of protein.

Dr. Loladze also published an article on mineral loss in plants. He examined every research paper that examined atmospheric CO2 on plants that we eat as well as trees and grasses. Remember that he is a mathematician; he used some very sophisticated techniques that are beyond me. However, to put it simply, the better the study was designed, the more the plants showed a decline in mineral content, averaging about 8% (3).
 

Far From Complete

The research in this area is really just beginning; scientists are just becoming aware of this nutrient decline. Perhaps that will attract research dollars. Dr. Loladze was never able to get significant funding for his work. Still, he persevered.

Here are two issues that I’d like explained or examined. First, why would an increase in carbohydrate content affect the mineral and protein content? If the minerals are in the soil, it would seem they would end up in the plant. That was never explained very well.

Another issue they raised was the protein content of goldenrod pollen. The researchers were able to examine it over the decades because samples are saved at the Smithsonian Institution. The protein content of goldenrod pollen has decreased by a third over the decades. They suggested that was important to bees; they need the pollen for the hive to survive. Is the lack of nutrients contributing to the collapse of bee colonies? Obviously, more specific research needs to be done before we really know the implications, if any. It’s going to be years until there’s enough research to make definitive statements about this.
 

Proceed with Caution

There is still every reason to eat your vegetables, fruits, and whole grains, even if the vitamin, mineral, and protein contents have declined somewhat—if anything, this a reason to eat even more to make sure you get your phytonutrients. Water and fiber are two more good reasons.

This also reinforces the need to do one more thing: take a multivitamin-multimineral that contains plant concentrates every day. If the nutrient content of plants is declining, that’s an excellent way to prevent nutrient deficits in your own body. It’s the simplest way to proceed with caution until the science catches up.

What are you prepared to do today?

Dr. Chet

 

References:
1. J Am Coll Nutr. 2004 Dec;23(6):669-82.
2. Nature 510, 139–142. doi:10.1038/nature13179.
3. Loladze. eLife 2014;3:e02245. DOI: 10.7554/eLife.02245

 

The Ignorant Vegan

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Before you write me an indignant email, remember this: the definition of ignorant is lacking awareness or uneducated. While being a vegan is a great way to eat, it can also be done poorly and thus can create health issues over time if vegans haven’t bothered to educate themselves. The issue is the foods people choose to include in their vegan diet.

Start with white: pasta, rice, bread, potatoes. Those are all vegan choices and can be prepared with some excellent recipes. The problem is the same as it would be for anyone, vegan or not: too many starches lead to an exaggerated insulin response. Calories still count: those extra calories can be converted to fat and actually increase cholesterol levels. You don’t get to overeat just because you’re vegan.

 

Nutrient Deficiencies

The problem doesn’t end there. Focusing on starches can limit the amino acids necessary to make complete proteins, at least in enough quantities to keep the body healthy. Isoleucine, leucine, and lysine are all deficient in those white starchy foods. The white foods have to be balanced with legumes which have high amounts of those amino acids.

Another potential issue can be iron. Because vegans do not eat seafood or meat, they can become iron deficient over time—and I’m talking six months or more. Yes, green vegetables such as spinach and kale do have iron, but a person has to be diligent in knowing the sources so they get those vegetables every day or at least several times per weak. In addition, soy products, sometimes a staple of a vegan diet, can interfere with iron absorption.

Last is vitamin B12. It’s sparse in plant-based products so unless you eat brewer’s yeast or the English staple marmite, vegans must take a B12 supplement.

 

Learning to Be a Vegan

Being a vegan is a healthy approach to improving your health but you have to be informed. It takes work for a while, until it becomes second nature. The one thing you can’t afford to be is an ignorant vegan. It can be dangerous to your health—the last thing you want.

Next week, I’m going to review the movie “What the Health” so make sure you see it this weekend. We’re going to answer the one question posed by the movie: does the science show that a vegan diet is the only path to optimal health?

What are you prepared to do today?

Dr. Chet

 

What Do Vegans Eat?

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The simplest way to describe a vegan diet is that it includes everything—except any food that comes from animals. If it comes from a plant, you can eat it. That includes all vegetables, all fruits, all grains, all legumes, and all nuts.

Peanut butter and jelly? Yes, if the bread is vegan. Baked sweet potato with brown sugar? Yep. A glass of wine or beer? Absolutely. Vegan pasta with marinara sauce? Ditto, but don’t add the Parmesan. I could go on and on, but you can see that it’s more than just salads and raw vegetables. And yes, you should eat plenty of those as well.

What should you eliminate? Meat from any animal; fish is also off limits. Fat from any animal. Anything cooked in or containing animal fats. Those biscuits you love? They’re made with lard, which comes from beef. The butter that goes on those biscuits? Nope, it comes from milk. Your favorite cake? No, it’s made with eggs. How about Jell-O; certainly Jell-O has to be okay! Not that either. It contains gelatin which comes from an animal. You can still eat those deep-fried foods as long as the oil is all vegetable.

The animal sourcing can extend to supplements as well. Gelcaps and capsules are made from animal or fish gelatin, although there are good vegan choices today. But don’t skip the supplements; they’re important because one nutrient that’s not easily accessible from plants is vitamin B12.

Just as there are vegan supplements, there are vegan versions of almost any food you can think of: eggs, milk, cheese, bread, burgers, even steak. I don’t know how good they taste, but they exist.

Seems pretty straightforward, doesn’t it? I’ll tell you how people can get it wrong on Saturday. Don’t forget to catch the documentary “What the Health” so you can follow along my review of the movie next week.

What are you prepared to do today?

Dr. Chet

 

Power Up with Vitamin B12

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The final supplement I’ll cover this week is vitamin B12, sometimes called the energy vitamin. Many vitamins are involved with energy production, but a lack of B12 can certainly cause problems with energy and other issues.

Vitamin B12 is also known as cobalamin and if you’re wondering, yes, this vitamin does include the mineral cobalt. There are two primary functions of B12 in the body. The first is to help reduce the chemical homocysteine to methionine while helping folate be converted into a usable form in the same reaction. Without enough B12, homocysteine increases inflammation in the body . . .

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