Sunday, September 30, 2012

Don't Get Caught Up In The Gluten Free Or Wheat Belly Mania

The book, Wheat Belly, is a perfect example of why I often say, Caveat Lector, 'let the reader beware.'  It is yet another example of a writer, in this case a physician, selectively picking and choosing facts, and sometimes even distorting the truth to push a particular agenda, in this case the benefits of a gluten-free diet. However, to say that the book is nonsensical would also be unfair. The reality is that some people have problems with gluten, a protein composite found in wheat, barley, rye and triticale (a wheat/rye hybrid).

The general argument often raised against gluten is that it is a protein that triggers an immune or allergic response. Pundits recommend avoiding it because they claim all wheat has been genetically modified and our bodies are not well equipped to process the new increased chromosome varieties. (By the way, the more ancient grains like Kamut, have not been altered.)

About 1% of the population suffers from a disease called Celiac-Sprue which is an auto-immune disease and about another 2% or so (some say as many as 15%, but I'm not buying it) are gluten sensitive. Gluten sensitivity has been implicated in a wide variety of abdominal symptoms including bloating, discomfort, cramps, pain, and diarrhea, as well as a number of non-abdominal symptoms including headaches and migraines, lethargy and tiredness, attention-deficit disorder and hyperactivity, schizophrenia, muscular disturbances as well as bone and joint pain.

The point of today's blog is not to exhaustively review the state of the science related to gluten and its health consequences. Rather, I hope to point out that everything you've ever heard about gluten and the problems it causes based on statistics probably doesn't apply to YOU.  97% (some claim as low as 85%) of the population does not seem to have any problems with gluten despite the recent hoopla. If you are among the unlucky 3% (or15% by some exaggerated accounts), then you should avoid it.

How do you know if it is a problem for you? First, if you don't have any of the problems mentioned above, gluten is not a problem for you. If you have such symptoms, simple blood tests can detect if gluten is causing celiac disease or if you have a wheat allergy. If both these tests are normal, but you have these problems, gluten may still be the culprit. Eliminating gluten products for three weeks and watching if symptoms disappear is a great way to check. I suggest restarting the gluten products in moderation after three weeks to see if symptoms return.

You may ask why bother and not just eliminate gluten? According to Peter H.R. Green, MD, director of the Celiac Disease Center at Columbia University, "For people with celiac disease, a gluten-free diet is essential. But for others, "unless people are very careful, a gluten-free diet can lack vitamins, minerals, and fiber." The facts are that although gluten itself doesn’t appear to offer unique nutritional benefits, the whole grains that one would need to stop consuming to avoid gluten are a rich source of fiber and contain an array of vitamins and minerals, including B vitamins and iron. Whole grain foods should be considered part of a healthy diet which lowers the risk of heart disease, type-2 diabetes, and some forms of cancer.

So most people have no problem with gluten and shouldn't avoid it and some people do and have to eliminate it from their diets. The best way to figure it out is with a knowledgeable primary care physician or gastroenterologist. Don't self-diagnose and unnecessarily deprive yourself of healthy whole grains. There is no reason to single out gluten as a food to eliminate without good cause. 

But I'm not done yet. But what really gets me is that gluten has taken on a hyperbolic, almost mythical status.

The author of Wheat Belly, in an interview published in Natural Awakenings, describes his almost miraculous transformation when he abandoned gluten. He states how while eating gluten his triglycerides were very high, he was diabetic, and had high blood pressure and excess weight around his middle, but when he stopped everything went to normal including his developing increased focus and attention. I'm calling him out that it wasn't the elimination of gluten that gave him these results even if he's telling the truth and it actually happened. Why? Gluten is a protein, not a carbohydrate. Eliminating a protein such as gluten shouldn't provide all these benefits. Also, the author advocates for increased consumption of other proteins mostly derived from animals that eat gluten in large quantities. Finally, my personal experience is just the opposite. I consume gluten every day for breakfast and lunch. Instead of cutting out gluten from my diet, I eliminated or restrict a host of other foods.

I severely limit my meat and chicken consumption, limit starchy vegetables such as potatoes and corn, eat no pasta, cakes, cookies, ice cream or other milk products (I'm lactose intolerant), or any processed foods other than non-preservative, non-sugar added breakfast cereals (with kamut and other whole grains) and freezer section breads (with sprouted grain and spelt).

I also markedly increased my consumption of wild fish, such as salmon and cod, to at least 4 times a week, added unlimited fruits (and by unlimited I mean at least ten portions a day) and vegetables, and a fair share of nuts, seeds and beans (including lentils and chickpeas as chummus).

My verifiable results including dropping my cholesterol from 290 to 160 without a statin, shedding about 25 pounds, decreasing my blood sugar from pre-diabetic to normal, eliminating my irritable bowel syndrome and reflux, and markedly decreasing my osteoarthritis in my left hip. I can't tell you what exactly did the trick other than sharing exactly what happened and telling you that my diet INCLUDES gluten. I know that what works for me or anyone else for that matter may not work for others and it is ridiculous for people to suggest otherwise.

So if you haven't read Wheat Belly, save your money and forget it. If a friend tells you how great they feel on a gluten-free diet, be happy for your friend, but realize that it may have no bearing to you and it may also be a self-described placebo effect.

If you have the symptoms described above, don't ignore them and have them checked out. You may actually be part of the small minority that have a gluten problem and there is no reason to suffer needlessly.

Either way, maintain a healthy level of skepticism about things that sound miraculous or like quick fixes. Gluten seems to fit that bill for most people. To belabor the point, Caveat Lector.

The best thing you can do to live a healthy life is to stay informed, but share any concerns with a doctor you trust. Find one that invests the time to really know you, is willing to discuss your issues, and patiently explains decisions. Think like a doctor, but act like a patient.

Sunday, September 23, 2012

If It Doesn't Make Sense...

I often like to say that "If it doesn't make sense, it doesn't make sense." Now this may not strike you as the most pithy of sayings, but I find it to be astoundingly profound for its accuracy.  Basically, it means that if you hear something that doesn't make sense, then it usually means you didn't hear it right or it isn't true. This has been a long-standing belief of mine since high school. A few anecdotes may explain why.

When I was in high school, Jeff, a close friend of mine often did well on tests.  I thought like me that he didn't really study so he did well because he was simply smarter than me and absorbed the material in class better than I did.  I was convinced of this until one day when I was at his home the night before a history examination.  While I watched the Yankees play ball, he repeatedly snuck away for some reason. Finally, I followed him only to discover that he was studying the history book for the upcoming test. I realized then that in general, one can't do well for a test unless one prepares. This may have been obvious to others, but it took this incident for this reality to resonate with me. (What can I tell you, I was a slow starter.)

When my children would tell me that their friends were doing well on tests without studying, I would often respond that I was sure this was not true. Inevitably they would discover the truth. When I built my national health care practice, my fervent belief in things needing to make sense saved me from making many mistakes.  Whenever I heard something that didn't make sense, rather than reacting to the information, I would first search out the facts. Inevitably, they either told a different story or there was more information that offered clarity to the situation.

In my current medical practice, the constant search for things to make sense continues to serve me well. Two recent incidents are excellent cases in point. The first involves a patient who said he lost 35 pounds by limiting his salt intake and consuming a lower fat diet.  While there are mechanisms to explain how both of these may contribute to some weight loss, in and of themselves, they are not sufficient enough factors to result in major weight loss.  Why? Low fat diets often result in greater consumption of high carbohydrate foods that are major weight gain culprits.  Although the patient insisted that switching from dark chicken to white chicken were among the major changes he made to lose weight, I knew that it didn't make sense, and upon further questioning, it became readily apparent that simultaneously with decreasing the fat and salt content of his food, he had likewise decreased his carbohydrate intake. Now it made sense.

Another recent situation involves a patient who admits to being an alcoholic. She asked me innocently enough why she was suffering from the ravages of alcoholism (multiple abnormal blood results) while those around her that drank with equal aplomb seemed to be spared from such consequences.  I assured her that this was simply not the case. Looking at her, you would not expect her to have anemia, blood in the urine, abnormal liver function tests, very high cholesterol, inflammation of the esophagus, etc. It is only because she admits her problem and sought the care of a doctor that her issues were identified. My rule that things make sense guides me in telling her that her friends will also suffer, if they aren't already, the consequences of alcoholism sooner or later.

I have numerous other examples that I won't bore you with the details. The bottom line is we live in a world where most things make sense (except maybe liposuction) even if we don't agree with them. One of the most sensible things is that taking care of your health yields great benefits under almost any circumstances. Yet, book after book gets published and people pay good money to hear the same advice over and over again. On the surface, this would seem nonsensical. Why don't people get it?  It seems to be simple enough. Avoid processed foods and eat mostly unprocessed foods. Yet, so many people are overweight and suffer from poor food choices. It's a huge problem and may seem like it doesn't make sense.

The problem is it actually makes sense. We know sugar and trans-fats are bad for us, sometimes even vowing to avoid them, yet the moment someone puts a piece of creamy 'Midnight Dark Chocolate Belgium Chocolate Cake' in front of us we throw caution to the wind and disavow any previous resolutions.

It actually makes sense because the lure of such a treat overpowers even the best of us. For some, it's not chocolate cake but ice cream, hot dogs, french fries, movie theater popcorn, pizza, pasta, etc. The list is endless and each of us knows our poison -- the devilish food we can't resist. So what's a reasonable person to do in a world that forever tempts us to corrupt healthy eating?

The answer is planning. If you have unhealthy food at home, expect that you will eat it. If you go hungry to a restaurant and do not know what's on the menu in advance, expect to choose poorly. If you go to a friend's house and haven't explained to your friend what you are trying to accomplish with your eating, expect things to go awry.


If you plan out as many meals as possible in advance, then you are more likely to eat the right foods. If you eat some nuts before going out to a restaurant for dinner and check the menu on-line before the meal so you can pre-select your choice, you will be less likely to eat the bread and butter and choose the unhealthier fare off the menu. If you go grocery shopping when you are not starved and avoid impulse purchases along the aisles, you are more likely to choose wisely.

Willpower will fail you.  In an interesting study in which two groups were asked to eat foods at different rates, the group that ate slower were surveyed to be less hungry two hours later. However, when both groups were shown delicious deserts shortly thereafter, they ate the deserts in similar quantities. The researchers explained that our bodies' natural appetite stimulants allow us to eat favorite foods even when we are not hungry. 

Eating healthy takes effort and planning. It's not simple, but it's usually the only thing that works. It also makes sense. So the next time you hear something that doesn't make sense, remember that what you are hearing may be wrong or you may be hearing it wrong.

Wednesday, September 19, 2012

Super Immunity - Not!

When I hear the word "Super," my thoughts race back to my childhood and my dalliance with  Superman, the DC Comics superhero from the planet Krypton who gains super powers from exposure to our sun. We all know the old rephrase that he's "able to leap tall buildings in a single bound, faster than a speeding bullet, more powerful than a locomotive." We also all know that he's a fictional character and such powers simply do not exist. Yet, like my older brothers, I could not get enough of the comic books and TV shows featuring the super fellow and other super heroes.  Everyone loves the idea of something super.

During my residency, the word "super" took on new meaning. Whenever I needed a lab result right away, I would write that I needed it STAT. However, I found that since every resident would write STAT on every blood work request, the lab began to dismiss the qualification. It then became necessary to write "SUPER STAT" to try to differentiate my request from the others. Soon, all my fellow residents were equally connoting "SUPER STAT" on each request and that too lost significance. It then became a game of how many "SUPERs" you could add before STAT. It wasn't uncommon to see "SUPER SUPER SUPER SUPER SUPER SUPER STAT" on a lab slip. The lab techs, I am sure, got a good chuckle, from our efforts of one-upmanship.

Today, "super" seems to have a new affixation. People love to attach it to all sorts of concepts related to health and nutrition. Case in point is a new book just featured on The Dr. Oz Show (yes, he's back for a new season) titled Super Immunity by Dr. Joel Fuhrman. In general, I think Fuhrman is a highly reputable doctor who fully understands the value of healthy eating. Notwithstanding, I have to take exception to his, or anyone's, concept of super-immunity or super foods or super anything for that matter. The reason is that I can find no evidence whatsoever to support the concept of super immunity or super foods. From my perspective, a food is either health promoting or it is not. It either supports a healthy immune system or it does not. You get the drift.  I don't know about you, but I don't want my body to do anything but function properly and that includes my immune system. In fact, I love wild Salmon, but I would never call it a super food (because it's not--it's just a healthy source of protein, fatty acids, etc.).

You may think this is a question of semantics, but I think there is much more at stake here. Dr. Fuhrman would be the first to tell you that eating properly is not a question of adding healthy foods to your diet; rather, it is a matter of building a foundation of healthy foods. Yet, when you suggest to the public any suggestions of quick fixes, eg. super foods, you run the risk of people thinking that they can balance unhealthy foods with such super-foods. This is how people are confused into believing the popular adage that eating healthy means "eating in moderation." Bad foods will often neutralize the benefits of healthy foods, super or otherwise.  Moderation simply doesn't apply to certain foods like trans-fats, sucrose, high fructose corn syrup, etc.

A writer, speaker, or doctor must choose his or her words carefully as to not mislead the reader, listener, or patient. I know this from first-hand experience. Through my lecturing, I have learned the importance of choosing the right words so as to not lead listeners to wrong or invalid conclusions. For example, I can't make a general statement that medications are bad (although not a fan of many due to indiscriminate use, many medications serve useful purposes) for fear that someone may stop all their medications inappropriately. I know because this has happened. Nevertheless, I heard Dr. Fuhrman make such a statement on the Oz show. I also can't say that a little bit of neurosis about one's health can contribute to longevity because someone may take that as a reason to start obsessing about every facet of their health. I know that because unfortunately that also happened.

Some doctors may feel it is appropriate to take liberties with superlatives like "Super" to grab attention with the good intention to deliver important information. (Isn't the road to hell  paved with good intentions?) I feel it strains credibility and undermines the ultimate message.  Let's leave "Super" to Superheroes and let's stick to science instead of science-fiction when it comes to dispensing health advice. Otherwise, it won't be long before you see a book with the title SUPER SUPER SUPER SUPER SUPER IMMUNITY trying to grab your attention.

Thursday, September 13, 2012

Want The Truth?

In a scene in the play and movie of the same title, A Few Good Men, written by Aaron Sorkin, there is the following scene involving the interrogation on the witness stand of a Colonel Jessep, played by Jack Nicholson in the movie, by a Lieutenant Kaffee, played by Tom Cruise in the same movie.

It goes like this:

Witness Jessep: You want answers?
Lawyer Kaffee: I think I'm entitled to them.
Witness Jessep: You want answers?
Lawyer Kaffee: I want the truth!
Witness Jessep: You can't handle the truth!

That line is considered one of the most notable movie lines of all times.  However, for me, it poses a much larger question. Do people always want the truth?

We know that in social situations, the truth may be best avoided. For example, if your friend just got a awful haircut or your spouse gained some weight, when asked, should you always be honest? Some may argue that one should always tell the truth, but I think we can mostly agree that a white lie such as expressing approval of someone's new clothing (that they are currently wearing and which you wouldn't be caught dead in) may be the right thing to do on the spot. Later on, may be a different story.

Nevertheless, when people come to a doctor they should always expect and always receive the most honest answer the doctor can provide. Quite frankly, it really doesn't matter if they can handle the truth, they are legally obligated to it and should expect no less. And by truth, I mean all the facts.

That's the way I feel about the preponderance of information disseminated by mass media to the unwary public. The media may believe that it is more important to create an emotional response than to give you the actual facts. A reporter who interviewed Dr. Oz conveyed to me that this was his belief. He thinks he should nudge people in the right direction rather than give them the facts. You may agree, but I am vehemently opposed.

Why? Since opening MDPrevent in 2010, I have encountered hundreds of patients who were not explained all of their previous blood results. Every time I see an old blood laboratory result, I query patients if the doctor who ordered the test ever discussed all the listed abnormalities. Unfortunately, most of the time the answer is no.

The most commonly ignored laboratory findings appear to be pre-diabetes and early signs of anemia.  The doctors are so busy turning off the red light (the reason the patient came to see them for in the first place) that they are essentially ignoring the yellow lights at risk of turning red.  When I ask other doctors why this is the case, I get the expected answer. There simply isn't enough time to address problems that haven't yet happened.

To that I say phooey!  Medicare and other insurances pays doctors more for the more time they spend with you. The doctor's first obligation is to the patient in front of him or her. If they need more time than scheduled, they should schedule another appointment. But there is no excuse not to review all your findings and discuss ways to avert greater problems.  An ounce of prevention may be worth a lot more than a pound of cure--it may be worth your overall health and life.

If you have had blood work in the past two years and there were any abnormalities (numbers out of range) noted on the results, I urge you to ask your doctor to explain what the results mean and if they indicate a potential longer-term problem. Such discussions are necessary. Trust a doctor when I tell you it is best to be aware of everything (not to obsess or get neurotic) even if action is unnecessary and imprudent.

From my perspective, an educated consumer is the best patient. You may sometimes have trouble handling the truth, but you are entitled to it, the truth and nothing but the whole truth, from your doctor.

Wednesday, September 12, 2012

Is Red Meat Intrinsically Bad?

One of the most common questions I am asked by my patients is if red meat is bad for them. The answer to this question could fill a book, but I will try to give a more concise and succinct answer here.

I will not address the moral issues associated with eating red meat; rather, I will only focus on the health consequences.

Here's what I have gleaned from my research.  From an evolutionary perspective, man's becoming a carnivore is what allowed the human brain to develop into its current form. Apparently, the addition of animal protein to early man's diet allowed the brain to further develop and evolve to its superiority in the animal kingdom.  At one point in evolution when meat became scarce, allegedly the human brain also degenerated. When the animal population regained its numbers and meat became more readily available, the brain regained its stature. Therefore, the immediate answer to the question above is that meat is not intrinsically unhealthy.

However, there is no question that the meat that was eaten by our ancestors is not the same meat we eat today and most likely not the same quantities. Today's meat is mass produced by feeding cows all sorts of additives such as hormones, antibiotics, corn feed, etc.  According to T. Colin Campbell, PhD, in his controversial book, The China Study, bovine (cow) meat and its byproducts such as milk and cheese are the root cause of most cancers and autoimmune diseases in the world.  (As an aside, every person I have met in my life who told me they had been diagnosed with Multiple Sclerosis (MS), a degenerative nerve disease, had a history of taking animal derived amino acid supplements and using protein powder products to build muscle. This is not a scientifically valid sample, but one hell of a coincidence. Of note, Campbell claims that MS is one of the consequences of using animal derived protein.)

The other problem with meat is the quantities we consume. Our forebearers had to hunt for their meat and so it was not as readily available as being on a supermarket shelf. It also had less saturated fat because the animals were leaner and more active than the pasture dwelling, sedentary, fattened cows from which we derive most of our meat today. 

The other problem with meat is how it is prepared. Processed meats like salami, bologna, pastrami, etc. have always been notoriously unhealthy because of added nitrites, a known carcinogen.

Furthermore, according to a new study involving more than 2,000 men performed by the University of Southern California and the Cancer Prevention Institute of California, pan-frying red meat may increase man's risk for prostate cancer by up to 40 percent.

"We found that men who ate more than 1.5 servings of pan-fried red meat per week increased their risk of advanced prostate cancer by 30 percent," study leader Mariana Stern, associate professor of preventive medicine at the Keck School of Medicine at USC, said in a university news release. "In addition, men who ate more than 2.5 servings of red meat cooked at high temperatures were 40 percent more likely to have advanced prostate cancer."

Hamburgers, an American favorite, in particular, were linked to an increased risk of prostate cancer, the study found. If people knew how most hamburger meat is prepared and processed here in the U.S., including the nature of fillers added, they would probably never eat a hamburger again. I know I've stopped eating hamburger's based on two videos I saw, one that dealt with the cardiovascular effects of the hamburger in regards to clotting arteries and another that demonstrated what is typically added to them such as other parts of the cow that should be discarded.

The reason for the increased rate of prostate cancer demonstrated by the USC study is not known and may have to do with the formation of DNA-damaging carcinogens -- known as heterocyclic amines -- during the cooking process.

So what's the bottom line?

In my study of longevity and the cultures that seem to enjoy the highest rates, one thing is certain. If they eat any meat at all, it is always as a side dish.

For the record, I am not a vegan and I have no plan anytime soon to become one. First, because as you know I am wild about wild salmon. Vegans don't eat any meat, fish, chicken or otherwise. Second, vegans need to supplement with Vitamin B12, which tells me that it's not natural for us to be vegans if we need a pill made in a plant to maintain our health. Third, because I'm not convinced that a bite here or there of some unprocessed red meat is the poison that some people would have you believe it is.  Fourth, most of the time I come across it when invited to a meal and I don't want to insult my hosts. Having a strong social network is more important to my overall good health and longevity that sticking to an uncompromising position on red meat.

For those looking for yet another reason to minimize red meat and/or have an ecological focus, scientists have calculated that reducing red meat consumption would decrease global warning. So if you've been keeping score, there are a lot more reasons to limit your red meat consumption than maintain it.

In conclusion, I don't think that the red meat we generally have available to us is too healthy from both a heart-wise and overall health perspective (and don't forget ecological). So if you insist on eating red meat, I suggest you think of it as a side dish.

Sunday, September 9, 2012

Can You Trust Dr. David Williams?

My patients often share with me the myriad health newsletters to which they subscribe. Recently a patient gave me a newsletter written by Dr. David Williams. My first question before reading the newsletter was what kind of doctor is Dr. Williams? The patient responded I'm sure he's an MD. In fact, Dr. Williams is a chiropractor.  Now don't get me wrong. I have nothing against chiropractors as I've used them myself for strained backs and shoulders. Also, I have no problem with anyone writing about nutrition as long as they stick to scientifically validated facts.

However, I do have two major pet peeves. People who distort information, and people who try to confuse you with information so they can sell you something. The newsletter I was asked to read concerned the lost value of eating an entire chicken and all parts of animals (not at one sitting) because otherwise you don't get the gelatin contained in bone marrow, etc. The premise was, as is often the premise in such rubbish, is that the more recent trends not to eat the chitins (pig intestine), pancreas, etc. has led to diabetes, heart disease, obesity, etc. and if you eat them, all those problems may disappear.

The newsletter starts innocently enough like they all do with a pseudo-scientific explanation of the importance of gelatin to our health. But like most of these non-credible newsletters it veers off to the fantastic when it makes unsubstantiated health claims. Of course, the moment that starts I become suspicious if there's a sales pitch coming up. To Dr. William's credit, there was no pitch for selling his own gelatin, but there was reference to another commercial product, which I could not find for sale on his website. Nevertheless, Dr. Williams's website lists many products for sale of questionable value including the now highly disputed resveratrol (due to research improprieties).

The bottom line on Dr. Williams is that he has an actual degree and a license. He is more trustworthy than those PhDs from non-accredited schools that I've been writing about in previous blogs. Notwithstanding, when Dr. Williams makes preposterous claims about the all curative health benefits of a substance like gelatin, he throws his credibility into seriously questionable territory and by doing so undermines any good he may otherwise be capable of doing.

Facts and science matter and we have enough bad information already out there. We don't need more articles that tell us this may help us and this may hurt us.  It only adds to the confusion. I feel if you don't have something of value to say, stay quiet. As the old saying goes, "Better to keep your mouth closed and be thought a fool than open it and remove all doubt."

Friday, September 7, 2012

Ginkgo Biloba: Another Supplement Bites The Dust--Almost

One of the biggest fears among seniors is the development of dementia, particularly Alzheimer's, which comprises about 60% of dementia cases.  According to currently available statistics, about 1 out of 7 seniors over 65 develops dementia, as do about 3 out of 8 above 85.

Nevertheless, the moment many seniors experience any memory problems, the first thing they worry about is if they are developing dementia. On this point, I turn to my favorite quote source Mark Twain, who once wrote and I paraphrase, "I have spent most of my time worrying about things that never happened."  Clearly in most cases, dementia begins with memory problems, but not every memory problem is dementia, and forgetting something once in a while is not necessarily a sign of dementia. I write this not to discourage proper follow-up of increasing or sudden onset of significant memory problems, but to caution sanity when your mind doesn't seem to work as well as it once did and you forget a thing or two. There are many reasons one may forget something, the simplest being distraction and the most complicated being more than dementia.

Nevertheless, the business of helping people deal with memory issues is thriving.  There are books, games, programs, specialized exercise equipment, medical foods, and of course supplements that promise improvement in memory if you just use them. One of the foremost among them is Ginkgo Biloba. Skipping over the detailed specifics of its origins, it is best summarized as an extract of trees that typically grow in China. This extract has been purported to be used by the Chinese for centuries and studied extensively. Nevertheless, there is quite a bit of debate regarding its effectiveness in treating memory problems and preventing Alzheimer's.  European studies have shown more benefits than American studies for memory help.

One of the biggest problems with many medical studies is that they are paid for by the manufacturer of the product who controls what gets data released and this often creates a conflict of interest for the researcher. Therefore, one hardly ever sees a negative study paid for by the manufacturer.  Imagine my surprise and delight to learn about a new study about ginkgo biloba that was paid for by Ipsen, the producer of ginkgo biloba extract that had negative findings. And by negative, I mean the product did not do what the researchers had hoped it would do--stop the progression of Alzheimer's.

Here are the results of the study copied verbatim from the study itself:


Between March, 2002, and November, 2004, we enrolled and randomly allocated 2854 participants, of whom 1406 received at least one dose of ginkgo biloba extract and 1414 received at least one dose of placebo. By 5 years, 61 participants in the ginkgo group had been diagnosed with probable Alzheimer's disease (1·2 cases per 100 person-years) compared with 73 participants in the placebo group (1·4 cases per 100 person-years; hazard ratio [HR] 0·84, 95% CI 0·60—1·18; p=0·306), but the risk was not proportional over time. Incidence of adverse events was much the same between groups. 76 participants in the ginkgo group died compared with 82 participants in the placebo group (0·94, 0·69—1·28; p=0·68). 65 participants in the ginkgo group had a stroke compared with 60 participants in the placebo group (risk ratio 1·12, 95% CI 0·77—1·63; p=0·57). Incidence of other haemorrhagic or cardiovascular events also did not differ between groups.


Long-term use of standardized ginkgo biloba extract in this trial did not reduce the risk of progression to Alzheimer's disease compared with placebo.

This study performed by Bruno Vellas, MD, of Hopital Casselardit in Toulouse, France, and colleagues was reported in The Lancet Neurology.
According to the researchers, "Ginkgo has been used in some countries by patients with cognitive disorders, and its plausible mechanisms of action for brain benefits include antioxidant effects and potential inhibition of caspase-3 activation and amyloid-beta aggregation."

Quoting, furthermore, the researchers noted, "Yet several studies -- including the Ginkgo Evaluation of Memory trial reported in 2008 -- haven't been able to demonstrate that the plant extract can prevent dementia. Indeed, the entire field of prevention of Alzheimer's disease is lacking, with little effects seen for various therapies including hormone replacement therapy, NSAIDs, vitamins, and cholinesterase inhibitors."

According to a Columbia University professor, this was a well constructed, if imperfect study. What makes it most noteworthy is that it was paid for by the manufacturer and did not get the desired results. That makes this study more reliable in my mind.

So there you have it. Another staple of the supplement industry bites the dust, at least as far as for Alzheimer's prevention value. It may still have some value in short term memory help, but that's a topic for another day.

Tuesday, September 4, 2012

Vitamin D Blood Tests May Be Unreliable--Particularly In Overweight People

As the Vitamin D debate rages on, it seems that practically every day a new related study emerges.

Vitamin D, the reigning health topic du jour, has been linked to cancer, diabetes, obesity, the autism spectrum, unhealthy aging, and a myriad of other health issues--basically everything. (the more illnesses it is linked to, the more pills marketers can sell).

There are many dubious pundits claiming that there is an epidemic of vitamin D deficiency, with some proclaiming that as many as 75% of all people are deficient, and therefore, everyone should be supplementing with Vitamin D tablets, particularly those who get little sun exposure and the elderly.

I don't agree with the statistics regarding the number of people with deficiency because I think the blood tests don't tell the whole story, and a recent study involving obese and non-obese people makes me think I am right. Notice the emphasis on think, not know. (By the way, another recent study revealed that two out of three of the main pieces of equipment used by blood labs to measure Vitamin D often report artificially low numbers.)

Before I get to the main study, here's what everybody seems to agree on in regards to Vitamin D:

1. Vitamin D is a group of fat soluble substance most call a vitamin. (There is some disagreement if it's really a vitamin as the body can produce it on its own, unlike all other vitamins which must be derived from external sources. However, Vitamin D is often called the "sunshine vitamin" because the body can produce it from cholesterol after your skin is exposed to sun.)

2. Human beings can consume two forms of Vitamin D: cholecalciferol (vitamin D3) or ergocalciferol (vitamin D2). The liver apparently converts Vitamin D to calcidiol and the kidney converts some of it to the active form called calcitriol. Blood tests measure only calcidiol.

3. Vitamin D deficiency can cause osteomalacia (rickets in children), a disease related to softening of the bones due to problems with bone mineralization.

4. There is more vitamin D stored in fat or adipose tissue than typically circulates in the blood. That makes sense because it is fat-soluble. (There is some disagreement if they are positively or negatively correlated, eg. whether they increase and decrease together.) What is known for sure is that generally the more fat you have, the more Vitamin D is stored in such fat.

5. Routine Vitamin D blood tests only measure circulating Vitamin D (calcidiol) and not fat stored Vitamin D. (There are ways, such as liquid chromatography, to measure fat-stored vitamin D, but they are not part of normal testing.)

6. Obese people have lower levels of circulating and higher levels of fat-stored Vitamin D than non-obese people.  Basically, the more fat you have, the more of your Vitamin D is stored in it and the less you have circulating and easily measurable. (This could explain why some scientists claim there is more Vitamin D deficiency today than ever before. It could be a result of an increasing weight among Americans with 2 out of 3 now deemed overweight and 36% purported to be obese.)

7. Vitamin D blood levels increase with weight loss. (It is not clear what happens to the total amount of fat-stored Vitamin D with weight loss, but presumably it decreases.)

8. Wild fish such as salmon are still a great source of Vitamin D.

Here are the questions whose answers have less agreement, if not outright disagreement.

1. What levels of blood circulating Vitamin D define deficiency and inadequacy?

2. Can the body tap into fat-stored Vitamin D when needed?

3. Why do vitamin D blood levels increase with weight loss?

4. Why do obese people have lower levels of circulating blood Vitamin D?

5. When and how much supplementation is necessary and appropriate for different levels of deficiency or inadequacy.

6. In the absence of deficiency or inadequacy, does extra Vitamin D offer any special protection against cancer, diabetes, heart disease, diabetes, etc.?

The recent study about Vitamin D, I referenced above, showed that in comparing obese young men to normal weight young men, the obese young men when exposed to tanning radiation akin to sun exposure actually seemed to produce 57% less Vitamin D than the non-overweight young men exposed to the same radiation. The results suggest that the obese get less Vitamin D from sun exposure that the non-obese. 

The authors of the study contend that the reason for this result is that the fat or adipose tissue in the obese men may absorb the additional Vitamin D produced.  The authors also put forth the supposition that obese people have less Vitamin D to start with because they spend less time in the sun.

This study triggered an exhaustive research effort by me to better understand the science of how vitamin D moves in and out of fat storage. More specifically, I wondered if one has a high level of Vitamin D in fat storage and a low level in blood circulation, would the Vitamin D come out of storage before a clinically evident deficiency develops. In other words, can you depend on your fat-stored Vitamin D to play a helpful role and prevent deficiency? If your fat-stored vitamin D provides the body with necessary Vitamin D, then we can dispense with all the blood tests for circulating Vitamin D because they would be unreliable indicators of deficiency and inadequacy.

The study, among others, seemed to suggest that the more obese you are, the more of your Vitamin D would go into fat storage and therefore there would be less in blood circulation. This means that the more obese you are, the more Vitamin D deficient you would be on blood measurement. If this would be a true deficency, one would expect to see cases of osteomalcia among the morbidly obese.

Guess what? After reviewing every published study available on pubmed, it was startling that there was not a single case or study reported that demonstrated bone related problems with rising obesity. In fact, it doesn't even seem to lead to osteoporosis, another bone related disease, and in fact, scientists have long believed that obesity protects against osteoporosis.  (Some recent studies out of China that differentiate between obesity based on body mass index versus actual body fat composition suggest that obesity based on high fat composition may not be preventive of osteoporosis.)

Furthermore, the only studies linking osteomalacia to obesity involve obese patients who undergo a surgical procedure to lose weight called the jejunal-ileal bypass. This procedure can sometimes lead to malabsorption, a condition in which the body can't absorb certain nutrients, in which case all kinds of problems and deficiencies become more likely.

This knowledge raises a serious question regarding the validity of the widely used Vitamin D blood test. If the test does not correlate to clinical symptoms, of what value is the test?  When the test shows a low level, is it because it is actually absent throughout the body or because much of it is stored in the fat, thereby undetectable by the blood test?

Although the study postulated, and other studies have also shown, that Vitamin D levels increase with weight loss, allegedly due to more outside exercise and therefore more sun exposure, I offer an alternative theory.  I say theory because I can't support what I suspect is the case because I couldn't find a single study that has considered this issue. Like all theories, it needs to be tested.

I postulate that as body fat shrinks, stored Vitamin D is released into circulation. What I don't know if having more blood circulating versus fat-stored Vitamin D actually makes a health difference? The answer to this question is imperative to know definitively before we compel so many people, particularly the overweight and obese to unnecessarily supplement with Vitamin D for the sole purpose of increasing circulating levels of Vitamin D.

Until the role of fat-stored Vitamin D is elucidated, I think most of the rest of the studies on Vitamin D will be essentially meaningless because you aren't measuring all the Vitamin D in the body.

For example, another study showed that there is an increased incidence of developing metabolic syndrome and a larger waist circumference after five years in patients with low blood Vitamin D.

My questions, which this study did not fully answer, are did they really have low total body Vitamin D or was it low in the blood because most of it was stored in fat. Also, did the low Vitamin D levels put them at greater risk because they were already overweight and/or pre-diabetic or because they had low sun exposure and poor dietary intake?  Finally, does low Vitamin D cause problems or indicate they already exist?

Perhaps it is not the Vitamin D blood level that matters but the presence of excess fat? Perhaps it is the excess Vitamin D that is stored in the fat that is causing the problems? We must know more about the role and activity of the fat-stored Vitamin D to answer these questions.

Maybe Vitamin D is a proxy for something else. It won't be the first time in medicine that we discovered that something was not what we thought it was. For example, we thought ulcers were caused by stress and it turned out to be mostly bacteria infections. We thought homocysteine controlled heart disease and it turned out to be only a bio-marker. We thought taking beta-carotene would prevent cancer, but it turned out that to be just the opposite. We thought statins were great for us...wait, many, but fewer still think that but maybe that will change some day as well.

From my perspective, I will no longer be recommending, in the absence of symptoms, Vitamin D supplementation for levels above 25 in overweight and obese patients. I will however, continue to strongly recommend (and offer extensive support to) overweight people to help them lose weight, not only for the sake of increasing their Vitamin D levels, but also for all the other health benefits such weight loss confers.

Also, for those without history of skin cancer, I continue to advocate for at least 15 minutes per day of sun exposure to extremities or belly, as long as reddening of the skin is avoided. Based on my current knowledge, this appears to beat supplementation almost every time, even in the elderly.

Vitamin D is obviously a complicated issue that begs for real clarity. Major studies are underway which may offer some real answers.  However, if they don't consider the role of fat-stored Vitamin D, they may actually be of little value. Let's hope for the some good answers and in the interim, try to stay healthy the old fashioned way- get up, get out, and move around.  Of course, watch what you eat because it is still the single most important determinant of health.

Monday, September 3, 2012

Can You Trust Andrew Saul?

Mark Twain once wrote, "Don't take advice from a health book. You could die from a misprint."

Although Twain passed about 102 years ago, I think that advice was prescient and equally applies today to health books, newsletters, websites, blogs (including mine), etc. This isn't the first time you've heard this warning from me and you should be pretty confident it won't be the last.

My compunction against such marketing-driven news sources is that I find most of them consistently misleading and most importantly derived from suspect sources of authority. For the fifth time in as many months, I have come across yet another self-proclaimed expert in nutrition with a no less than dubious PhD from yet another mail order program.

In this case, it's Andrew Saul whose PhD, as he describes on his website,, hails from a "non-traditional PhD program," from the non-accredited, degree mill called Greenwich University. His degree in Ethology, which is the scientific study of animal behavior, apparently makes him an expert comfortable telling people to "Doctor Yourself" and "Fire Your Doctor," two of his book titles.

I was asked to consider the writings of Saul based on his apparent success as a prolific author and proponent of dietary supplements. The little I have read so far leads me to best describe his writing as gibberish, not worthy of further contemplation. Nevertheless, I promised an associate I would read in entirety Saul's book "Doctor Yourself," and I will report my conclusions upon completion.

What I find most dismaying is that the real PhDs in nutrition seem to do a poorer job of making their writings well known. It seems the higher the quality of the authorship, the more difficult for the writing to gain widespread circulation. Perhaps the truth simply isn't that interesting?

BTW, I picked up the Mark Twain quote above from Saul's website (and confirmed its accuracy independently).  I guess his website is good for something after all.

I apologize for the negative tone of this blog, but someone needs to bring this type of information to light and there are very few others doing so.

The problem is, as Twain once also eloquently wrote, "A lie can travel halfway around the world while the truth is still putting on its shoes."

Caveat Lector!