Thursday, June 28, 2012

Dr. Oz, Green Coffee Extract, and Dietary Supplement Beliefs

In September 2011, John Cloud, a writer for Time Magazine, published an article about his own experience with dietary supplements titled: "Why Most Dietary Supplements Aren’t Worth the Money." Using himself as the subject of his home-based experiment, he took 3,000 pills over a 5 month period to see what effect it would have on his health. Checking his blood at the beginning and end of the the trial period revealed that the "lab rat experiment," as he referred to it, changed nothing except for his weight.

As a result of consuming some twenty pills a day, which he thought must provide some protective health benefits, he rationalized that he had a license to eat poorly, and as a result, gained 15 pounds.  Obviously, this one man study is not extrapolatable, but it is a curiosity.  What effect would these same pills have on the health of others?  The comments posted online in response to Mr. Cloud's article were generally negative. Most responders railed at how he basically proved nothing and failed to recognize the true value of taking supplements.

You may remember my blog on March 18, titled A New Religion Is Sweeping America. I called this religion Supplementum, and it referred to the unshakeable belief that many people hold that the dietary supplements they take are what is keeping them healthy. They have a fervent religious faith in these pills that rivals any other possible religious belief. They often refer to the studies that prove that their supplements are the right ones. By refer, I mean state that there are such studies, but of course, can't produce them.

Everyday, I try to read studies and articles from reliable, and sometimes not so reliable sources about dietary supplements. Often, there are comments associated with such articles, and as with the John Cloud article, the comments almost always vigorously defend the use of supplements based on purported studies. However, I can't usually find such studies (most don't exist!?).  More importantly, when I do, the studies are usually worthless.

For example, Dr. Oz recently promoted Green Coffee Extract as an effective weight loss supplement. It has become a rage on the internet as the next great weight loss product. Oz did so based on quoting a recent study. I believe I found the study to which he was referring. The study involved sixteen people and was performed in Bangalore, India (with some involvement from the chemistry and psychology departments at the University of Scranton).  I found discrepancies in the study and emailed specific questions to the author in India. He actually responded to write that he will be in touch again. I am still waiting.

However, the author of the study made passing reference that upon follow-up (time period not given) to the study, the subjects who had lost weight had kept it off. This doesn't make much scientific sense as the effects should wear off after the study is done. It was also presented as a double-blind randomized control study, but was in fact, a cross-sectional study, which means that all study subjects both received the product (in two different doses) and the placebo at one point, which means that they all lost weight when they took the highest amount and apparently kept it off, regardless of what they received first.  At least a third received the full dose first, and another third received the half dose first.

Ignoring the fact that a 16 person study is essentially nonsensical for scientific validity, other aspects of the study also were illogical. The argument for the green coffee extract is that it prevents absorption of glucose thereby reducing calorie intake thereby resulting in weight loss. By description, it works actively to prevent such absorption. It should work as an active ingredient similar to the short-term effects of drinking coffee.

Again, this makes no sense because if they received the product first, and kept off the weight, what effect did the placebo even have? The study also states that the study subjects may have figured out when they got the placebo and when they got the coffee extract. Not quite a blind study then, huh? Finally, there was no actual description of what the subjects ate during the study.  I think everyone can agree that would make a huge difference on weight gain or loss.

Today, a patient of mine that regularly corresponds with me responded to my advice for her to take a vacation from her daily supplements. She is a true believer in supplements. Her response was that she does for a month whenever she goes for blood work and when she stopped it one time, the pressure in her eyes increased so much she needed surgery from which she is still recovering. Pressure in the eyes is referred to as Glaucoma, and based on my research there is no body of good evidence that any supplements have any effect on this medical condition. (There are studies that show some benefit with macular degeneration, another eye condition, but that's a subject for another day. I also recently heard a leading ophthalmologist trained at the University of Pennsylvania state the same conclusion.)

Nevertheless, she believes wholeheartedly that stopping the supplements caused the increase in pressure. Of course, I can't know for certain that it didn't, but I suspect that it was happenstance because if it happened once, it should have happened every time, and again, there is no science to support her assertion.

As my wellness and preventive medicine practice grows, I often encourage patients to take these supplement holidays and I will tell you that the feedback has been nothing less than euphoric. The blood-work I perform after a month of supplement holiday, just as with John Cloud, generally show no difference. Why?  Because most of what my patients were taking is treated by the body as excess and is excreted away.  (The old joke is that people who take costly dietary supplements have the most expensive urine.)

Interestingly, people who stop the supplements report that they have more energy than they have had in a long time. This is a subjective report and I also don't put much faith in it.  My thinking, albeit not fully confirmed, is that most supplements usually have little to no short-term effect, despite the subjective reports, and mostly negative or also little to no long term effects.  

My biggest concern is for those patients that have become so psychologically dependent on these pills that they have been taking for so long that they are truly afraid to stop them. I really feel for these patients and pray that they ultimately don't do themselves any real long term harm. In the interim, I am delighted to report that the number of patients who wisely are stopping these wasteful and potentially harmful pills continues to grow with no appreciable difference noted in their health or blood-work.

If you are taking such pills, please allow me to prove to you that you also probably don't need most of what you are taking under any circumstances and definitely less so if you make some tweaks to your diet.  As the cartoon above humorously depicts (this was proved in actual study conducted by Cornell University), marketing can be very persuasive. Don't let the supplement marketers and their TV pitchmen have their way with you.  I'm not sure they really have your best interests at heart.


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