Vitamin D Takes A Hit

Faithful readers of this blog (May 18 and August 29) have read my railings against Vitamin D for some time now. It never made sense to me that so many Americans were deemed to be Vitamin D deficient nor did it make much sense that as people got heavier that their blood test for Vitamin D would report lower levels although they wouldn't develop any deficiency symptoms. I even raised the question if it was possible that fat stored Vitamin D (fat soluble) is available to the body when needed.  While this question remains unanswered, the question of what defines a Vitamin D deficiency just got a new answer and I think it makes sense.

The Institute of Medicine (IOM) just revised the guidelines for what defines a Vitamin D deficiency.

First, a little about the IOM.  The Institute of Medicine (IOM) is an independent, nonprofit organization that

works outside of government to provide unbiased and authoritative advice to decision makers and the public. 

Established in 1970, the IOM is the health arm of the National Academy of Sciences, which was chartered under President Abraham Lincoln in 1863. Nearly 150 years later, the National Academy of Sciences has expanded into what is collectively known as the National Academies, which comprises the National Academy of Sciences, the National Academy of Engineering, the National Research Council, and the IOM.

Under the new IOM guidelines, you are considered to have adequate Vitamin D levels if your level is above 20 ng/mL. The previous level was 30 ng/mL. In one fell swoop, the IOM has essentially removed almost all Americans from the category of being Vitamin D deficient. 

You will no doubt hear push-back from those quarters that make money peddling Vitamin D and related advice, but you should essentially ignore them. The IOM is trustworthy.

So if you didn't have enough reasons yet to push aside your multivitamins and Vitamin D supplements, perhaps this one will do the trick for you.

For the umpteenth time, eat whole foods including a wide variety of vegetables, fruits, beans, nuts, seeds, whole grains and Wild Salmon and you will consume all the vitamins, minerals, antioxidants and all the other health promoting nutrients you need for a healthy mind and body. Get 15-30 minutes of sun each day (earlier or later in the day and avoid reddening) and Vitamin D is also well covered. (You also get it from Wild Salmon.)

The key to a healthy life is to eat healthy every day.

Do Multivitamins Prevent Cancer? Part 2

The media is having a field day with the recent study titled Physician Health Study II (PHS II) which claims that multivitamins may slightly decrease cancer rates among men.  If you simply read the headlines and you are a man that wants to decrease your risk of developing cancer, you would think that you should immediately run out and buy a multivitamin, and if you are taking one, you should keep taking it.

Don't!

The results are not quite living up to all the hype.

According to the study, after 11.4 years of taking multivitamins, only men, predominantly older than 70, showed mild decreases in certain cancers. In fact, this study included men who had previously been diagnosed with cancer, among whom for some unknown reasons were found the best results.

This study, paid for by the multivitamin manufacturers, including Pfizer, actually showed the following:

Slight increases in prostate cancer (662 placebo takers versus 667 among multivitamin users) and melanoma (89 increased to 100).
Slight decreases in total cancer (1253 to 1195).
Slight decrease in colon cancer (95 to 88).
Total mortality (death) slightly decreased from 1,134 to 1,092. That means for over 13,000 total men in the study, there were still over 2,200 deaths and only a decrease of 42 total deaths.

Get this. By my calculation, over 26,000,000 (million) pills over 11 years were taken by 6,660 men to spare 42 deaths. Ouch!  No wonder the drug companies want to push the results of such a study.

Basically, the men who took a daily multivitamin for over 11 years so no improvement in prostate, colon, and bladder cancer and no change in their overall cancer mortality. Also, a careful review of the study shows that the multivitamin users were also slightly less likely to smoke and slightly more likely to eat fruits and vegetables.

Finally, the study did not identify if any of the men had vitamin deficiencies prior to the start of the study. As they focused on physicians, who generally work long hours, there is a high probability that these men spent little time in the sun and therefore had an increased risk of Vitamin D inadequacy or deficiency.

Ladies and gentleman, overall, this study and the numbers presented basically prove nothing. With the overall cancer rate decreasing from 18.4 to 17.6 for every 1,000 years, there remains no reason to believe that multivitamins offer any benefit in the absence of deficiency.

The bottom line is that most importantly, despite taking a multivitamin every day, about 20% of the men still developed cancer and about 20% died.  Save your money!


So once again you are chastened to remember, Caveat Lector! (Let the reader beware).

Do Multivitamins Prevent Cancer? Part 1

If you are tuned in to health news, you may have heard about the new study that showed that among older men who took multivitamins, the incidence of cancer was reduced by 8%. Just like the studies that showed increased death rates in women who took multivitamins, this study failed to control for overall health.  

Therefore, when considering the relevance of these findings one does not know if the results were due to cause and effect or coincidence.

Undoubtedly, almost everyone, including the authors of this study, agree that foods that contain such multivitamins in their natural form as those studied have value in cancer prevention. Therefore, without controlling for the diet of the subjects of this study, one cannot reach conclusions whether the moderate reduction in non-prostate cancer rates (there was no reduction in prostate cancers, which represented half of the cancers that developed) we're due to pills or food.  Also, the study did not identify those who had nutritional deficiencies that can impair proper immune system functioning that can lead to cancer growth. 

Furthermore, this research was paid for by companies that provided the vitamins used in the study, which always raises red flags. 

So what's the take-away?  Eat whole foods like vegetables, fruits, nuts, beans, whole grains and wild salmon that contain all the essential vitamins, minerals, fatty acids, and amino acids our body needs that exist in a presumed synergistic relationship with hundreds of other nutrients and avoid synthetic pills of isolated chemicals.

But don't take my word for it. Tomorrow I will give you the actual numbers from the study and you can reach your own conclusions.

Why You Stay Fat...Part Two

This is Part Two. Please read Part One from yesterday first.

In the next step of my initial encounter with a patient, I always share a personal anecdote about my children and college. It starts with my denoting the perceived value of a great education. I believe there are few equals, in terms of value gained in knowledge, future employment possibilities, and self-esteem, compared to an excellent education. Today, college is a necessity for most, but an increasingly expensive proposition, and the more rigorous, higher vaunted and sought after private and public colleges are no exception. Accordingly, I confess to a bias that all teenagers should strive to get the best possible college education for the money (or their parents' money for the fortunate ones) spent.

To gain admission to the more intellectually challenging schools, a high school candidate most usually presents an exceptional academic record (except if you are a gifted athlete or have legacy).  What does such a record entail?  Mostly As.  How does one get mostly As?  By studying to get A pluses. You see, when you study for an A minus, you may and can often end up with a B. Study for a B and failure becomes an option.  Studying for an A plus offers no guarantees, but it does increase the likelihood of success.

Suffice it to say that my three, now adult children, were exposed to this philosophy early in life, and I am glad to say they all made it their own. Effort, diligence, attention to detail all paid off for them as it usually does for most people. (Just ask my children the three personal traits that lead to success and each will independently rattle off "persistence, perseverance and tenacity." I began to share these ideas with them when they were barely out of diapers.)

Regardless of one's mental capacity and education acumen, there is no substitute for motivation and effort when it comes to any level of success.

Likewise, people who want to change their weight status and health, most also strive for similar excellence. Even if you didn't go to college or an A was not your usual grade (or you never even saw an A), the pursuit of excellence is inherent in all of us. You must believe as much if you are to make changes in your life. I have yet to meet a regular person incapable of making changes. I know you can, but you must believe in yourself as well.

How does this rah-rah cheer-leading apply to your life and what does my excellence-in-school example have to do with anything? For that, you need answer, as my patients do, the next question.

What percent of food in your house would you deem unhealthy? To qualify as unhealthy, let's include the following: bread, crackers, cookies, cakes, chips, pasta, yellow cheeses, creams, margarine, butter, ice cream, fruit yogurts, fruit juices, etc.  What ever number comes to your mind that is less than 20% should be doubled as you probably missed a few.  Now think back to my school example. If there is any unhealthy food in your house, what is the probability that you will not consume it at some point, any point? Are you aiming for an A+ or are you aiming from the get go for a B or C?  Are you setting yourself up for failure before you even start?

If the unhealthy food is there, regardless of your excuse that it's for your spouse, your children, your guests, etc., you are rationalizing trouble ahead. The reason is because if you are depending on willpower to save you from devouring the food, it will eventually fail you.  Willpower almost never does well against constant temptation. In fact, according to scientific studies (see the book Willpower by Roy Baumeister), willpower gets depleted as you repeatedly make decisions to spurn temptation. At some point, mistakes, weakness, if not disaster looms. It is said that the average person makes about 200 food related decisions per day. With so many decisions to make throughout the day, isn't it likely you will make a few bad choices? That's just one of the reasons you can't rely on willpower. The best approach to willpower is developing a process, such as food shopping when you are not hungry, but that's a topic for another day.)

So what's a person to do to avoid the trap of eating unhealthy foods and snacks at home? Remove in their entirety (donate to homeless shelter or just discard) such unhealthy foods from your house and replace them with health promoting foods like vegetables, fruits, beans, seeds, nuts, whole grains and wild salmon. This is the FIRST step towards taking control and reinventing YOU.

So the first reason people stay fat is that they deceive themselves into believing that they can control their urges at all times and they don't need a process in place to make good choices consistently.  This is true whether they eat at home or at restaurants.

But I'm not done with the analogies just yet.

Have you ever owned a car, or know someone who has, that required premium fuel only. If you or they owned (as opposed to leased) the car, did you or they put anything, but premium gas in the tank? The common answer I get to this question is "no" and the reason I'm given is that the person believes that the car will not function as well with inferior quality gas.

But more importantly, most would agree that the engine of a car that requires one level of gas and receives an inferior level may ultimately fail. So what's the big deal? Can't you replace the car if the engine fails? So you are out of pocket a few bucks, but who doesn't like to get a new car once in a while? Cars are replaceable!

Well by now you probably get the point. Your body is not replaceable and yet many people, particularly those who eat poorly, treat it like they can swap it out anytime. (Maybe when science fiction collides with reality that may become true, but don't depend on that happening any time soon.)

Therefore, the secret to losing weight for health reasons is not to focus on losing weight, but to focus on getting healthy. To borrow again from the car analogy, if you feed the car premium gas, the engine will run better and last longer. Just like premium gas helps maintain the value of your asset, health promoting foods enhance the vitality of your life.

Accordingly, the second reason people stay fat is because of the type of foods they eat far more than the amounts of foods they eat. Premium foods like whole foods mostly promote health without weight gain; processed foods do the opposite.

Therefore, although I am not a psychologist, I know if people can't wrap their minds around the notion of changing their behavior and are not fully committed to make critical changes to their food selection, they simply aren't going to succeed. BUT... if they can light the candle of inspiration so it shines bright...if they can flip the switch and make the connection in their minds...if they can follow the label that says 'Premium Fuel Only"...and they are willing to work for the A...wonderful things can and will happen.

I often ask my patients if they are religious and the answer is usually no. They always have this immediate look of concern as they wonder if I am a proselytizer? I am not. In which case, I tell them that losing weight will require them to find religion. I am not referring to the religion of believing in a sovereign being (as I do); rather, I am denoting the religion of faith and conviction in one's own actions. I tell them, using a wide variety of references to holy war such as "crusades" and "jihad," that it's time to take up the battle against their fat-craving bodies and regain control. (I mean no offense to anyone that thinks such terms should not be used lightly given their historical consequences. I use them because they strike powerful images in people's minds and I am prepared to go to great lengths to help people get healthy.)

The battle of the bulge is as great a fight as any human being can ever be expected to fight on their own terms.  It takes that level of consciousness to win this war of attrition and claim back which is rightfully yours--your health and waistline!

As partners with my patients, I help them help themselves realize their aspirations, whether to look and feel better, or for whatever reason they are motivated to do so. Together, we take the first steps to a higher quality, healthier life. Yes, the process begins with what feels like a psychological intervention. But this is merely the first step of a method proven to work without drugs, supplements, and surgery to improve health and lose weight.

We teach how to eat right at all times without ever feeling hungry: No tricks, just a changed attitude that results in changed needs.

You can change your life, improve your health, and have more energy today if you are clear about your motivations. If you are not, let's speak.


www.mdprevent.net
www.myMDPrevent.com
(561) 807-2561

Why You Stay Fat...Part One

In my previous blog "Why You Get Fat...," I explained that there are five factors that contribute to weight gain (medical, diet, physical activity, sleep and stress). Of course, to lose weight you must address these factors. But once you have gained weight, to shed the unhealthy excess pounds becomes more complicated than just confronting the factors that caused you to get fat in the first place. That's because your body actually doesn't want to give up it's fat stores. It sees fat as energy storage and is invested in the rainy day theorem that you can never have enough fat for difficult times.

(In fact, according to a recent study dealing with diabetes, as the disease progresses, the human body begins to waste away. Therefore, the study showed that those with more body fat actually fare better because they survive longer. Diabetics take note: Just because extra fat can sometimes have perverse benefits, please don't let your disease get to that wasting away stage because there are ways to prevent such progression.  Nevertheless, for most people excess weight actually causes problems like the metabolic syndrome with elevated blood sugar, cholesterol, triglycerides, and blood pressure.)

So, why you stay fat has a lot to do with why and how you try to lose the weight.

The most simplistic, albeit meaningless, answer as to why must people stay fat is because as Albert Einstein once gave as the definition of insanity, they do the same thing over and over again and expect a different outcome. They bounce from one diet plan to another. Or they look to miracle cures, magic pills and quick fixes, offered by the likes of Dr. Oz and thousands of other pill-pushers. They know such approaches never offer permanent solutions, but they are so desperate, they will  try anything. (I make this point in the hope that by sheer dint of repetition it will eventually sink in.)

They try diets that include cookies, low-carb and high fat, hCG injections, appetite suppressants, calorie restrictions, gluten free, vegan, etc. and still inevitably end up around the same weight or worse.

The real problem is that most people never truly understand why they got fat other than thinking they simply ate too much. In response, they spend their time and money floundering around in search of ways to control their appetites, chasing the latest and greatest fad.

Everyone knows and many have tried diet programs with names like Atkins, The Zone, South Beach, Weight Watchers, Medi-fast, etc. and yet.... if it was only that simple. Diet programs fail for most people.

I think, based on now treating hundreds of patients with weight problems, that there's a much more profound reason why people keep their excess weight. Please read on to learn what I hope will be a new, life-changing perspective.

Patients who come to me for treatment of a weight problem often ask me during our first encounter if I am a psychologist or a physician. (I am the latter.) The reason is that our first meeting often begins with a discussion about their motivation.  When someone has gained a lot of weight, even reaching a point where they are defined as obese, the road back can be difficult and challenging.  In order to succeed, one has to have the right attitude and be optimistic, if not confident that if he or she does the right things, success will follow. Most importantly, they must be motivated to do so.

In order to gauge such motivation, I often ask a simple question, "Why are you here?" If they answer "to lose weight," I counter with "Why do you want to lose weight?" Some look at me puzzlingly when asked such a question as if the answer is obvious. Others chip right in with answers that range from the aesthetic, "because I want to look better" to the practical "I want to feel better." Some proceed to elaborate how they are sick and tired of feeling sick and tired.

But virtually all patients pause to answer my next question which is a variation of "Why do you want to look or feel better?" They puzzlingly ponder how I could ask such a question, so much so that I often have to repeat it to get an answer.

After a few more iterations of my probing deeper into their answers, we eventually settle on that aspect of their life which is what they label as their number one priority. We identify that aspect of their life for which they are motivated to make sacrifices to succeed. While I encounter a wide variety of ultimate answers, with most often including reference to grandchildren and spouses, we also sometimes settle on what appear to be mundane core statements such as "I truly enjoy life and just want to keep going" or "I have a fear of death and want to delay it as long as possible." These actually reveal a far deeper motivation as they strike to the essence of one's perspective.

With a candid answer finally in hand, my questions turn to how much do they want to succeed on a scale of 0 to 100.  Any answer that is less than 100 is met with further probing questions about why they are not 100% motivated to succeed. There is no right answer and 100 may simply never be in the cards for some, but it is very important for both the patient and I to know exactly what their motivation is to lose weight and how motivated they truly are to succeed. (The spouse sitting next to them and prodding them usually doesn't work.)

Take a moment and ask your self the same questions. Challenge yourself to find YOUR truth. Keep asking yourself the question until you reach past the easy, cheap answers. Dig deeper until you are absolutely certain you fully understand your motivation(s) and how deep they run.

Everyone's reasons are different. One poignant example illustrates this point.  A patient once shared that although she was married, she loved another man. Although she longed to be with this other person, she was committed to her husband and was steadfast in her fidelity. However, she believed that if she outlived her husband (of course, dying from natural causes and not foul play), then she may eventually have the opportunity to spend some time with her true love.  Her commitment to increase her health and lose weight was based on this single desire. It is difficult as a physician to hear about a patient's torment, but I was delighted to help the woman articulate her ikigai (Japanese for purpose in life) that would lead her to make positive life-altering changes to her health.

(By the way, it is never my place to judge, but it is always to help. I respect the diversity in people and recognize the very different lives they have lived. No one can, or should ever presume why someone does what he or she does. Studies show that some people gain weight because it offers a protective shield around them from the cruel world in which they suffered childhood adverse events.  Some studies have shown a direct linear correlation between the number of vices, such as binge eating and alcoholism, and the number of adverse childhood events, like the loss of a parent, living with an alcoholic parent, or experiencing some form of abuse before the age of 10.  In such cases, identifying such traumas and dealing with them is vital to changing eating habits. So the next time you see a heavy weight person, please hold back judgment. You certainly have no idea what led to his or her weight gain.)

End of Part One. See next blog for Part Two.


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(561) 807-2561

Why You Get Fat...

I recently read a book called "Why We Get Fat" by Gary Taubes. It was an enjoyable read as long as I ignored the facts. You see the facts of the book were that getting fat is all about insulin control. Taubes, with apparently limited knowledge of metabolism, completely tied his weight boat to insulin as the single hormone that controls why we get fat. It's an interesting thesis except for the problem that there are at least 10 more hormones that are known to play a role in metabolism and weight gain, including Proneurotensin which was recently added to the list.

Here's the list:

Ghrelin
Leptin
Adinopectin
Humersin
Irisin
Cholecystokinin
Neuropeptide Y
Growth Hormone
Epinephrine
Proneurotensin

Each of these hormones plays a distinct role in weight gain and loss. When and how they play their role is still a matter of some debate, but we know that we can control them to some extent.

So when somebody, or for that matter anybody, tells everybody exactly why they get fat, consider it rubbish.  As a doctor that treats obesity and related weight problems, I can tell you honestly that it's a different reason in every case.  Many claim the reason is the conventional wisdom that it's simply "calorie in, calorie out," but they would be wrong because not all calories are created equally. For example, recently it was discovered that the fat in nuts are not as well absorbed as previously thought due to the fat's attachment to the fiber which prevents full absorption, and therefore it turns out that nuts produce less calories than previously believed. However, the biggest problem with "calories in and out" is the simple saying doesn't explain why you may have a problem controlling your calorie intake.

Most people gain weight because of a combination of five main reasons, but in each case each reason contributes a different percentage and that's why each person is different.  The reasons include an underlying medical condition, a sedentary lifestyle, a poor diet, insufficient sleep, and undue stress.   Diet is a usual suspect. Yet for example, undiagnosed thyroid disease can be a major culprit in weight gain, but it can only be diagnosed definitively with a medical assessment including blood test. For sleep related problems, it's well known that insufficient sleep affects the hormones ghrelin and growth hormone, releasing them in greater amounts. Both these hormones cause increased appetite, which leads to added weight.  Don't even get me started about stress and sitting around all day.

So when evaluating someone with a weight problem, the only reasonable and meaningful approach is to systematically identify his or her own root causes and then develop a plan to address the guilty parties. My practice does this with a combination of factors including:

1. For medical: evaluation by a MD
2. For stress, emotional and psychological support: counseling by a Clinical Psychologist (PhD) who also leads a weekly mindfulness meditation class; massage therapy and acupuncture to help people relax
3. For nutrition and diet: nutritional counseling, meal planning, and food shopping by a registered dietitian/nutritionist who also leads healthy cooking classes
4. For exercise: support through cardio and yoga classes
5. For sleep: sleep hygiene counseling and referral to a sleep study as needed

By tackling each of these areas individually and collectively, we help people get healthier, feel better, and -- lose weight.

So when someone tells you off the cuff, or you read in a magazine or a book, why you gained your weight, just ignore them. Until they know you, they really don't know why you gained weight.  There are healthy and unhealthy ways to lose weight, and which way you choose can have a profound impact on your long-term health.

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Can You Trust Bill Sardi?

I've often used this blog to identify people who I think pose a public danger. Oftentimes, it's people who lack the training, licensing or any form of validation to give them credibility. Today, I found a doozey. I thought I would share the entire unedited exchange with this gentleman for those with the time on their hands to be entertained, and to recognize how easy it is to try to mislead people with lots of fast and loose, but mostly misleading, facts.

It all started with a recent article that appeared on October 1, 2012 in The Wall Street Journal titled "Questioning the Superpowers of Omega-3 in Diet," to which after reading I submitted the following comment online:

"According to Consumer Reports' September 2012 issue, there are over 55,000 dietary supplements for sale in the U.S. That's 55,000 products sold by commercial interests trying to convince Americans that we can't live without them. There's hardly anyone on the other side shedding light on their value to overall health. In fact, there is not a single study ever published that shows that a supplement in the absence of deficiency extended a single day of human life.

Furthermore, there were no such products for the first 150,000 years of our history until about the 1930s. (Yes, some plants were discovered early to have medicinal purposes but they were often used in their natural state without factory processing.) Yet Michelangelo lived to 87 and the Greek philosophers into their 90s. The Sardinians' trace their extended longevity to the Bronze Age.

However, virtually every day now a new study comes out that questions the usefulness of taking one of the many popular supplements like Fish Oil, Vitamin D, Ginkgo, etc. Each time people leap to the opportunity to defend or criticize the validity of the studies. The nature of such studies that look at isolated variables offer plenty of room for debate. This means they completely ignore the synergism among hundreds of other nutrients found in different foods.

What is not debatable is that most (some exceptions best determined with the help of a knowledgeable physician) people would be better off eating whole foods like vegetables, fruits, beans, nuts, seeds, whole grains, and wild fish (this is obviously debated by Vegans, but it's hard to argue with the health benefits of wild Salmon, a non-predatory fish, low in contaminants like mercury and PCBs, but high in Vitamin D, DPH, EPA, and an excellent source of amino acids.) Aspects of such a diet has been the staple of multiple cultures around the world for thousands of years that count among them the highest percentage of centenarians.

The bottom line is that people should not take any supplements in the absence of a known deficiency, which should only be determined by proper testing with the input of a knowledgeable physician or registered dietitian, and should stick with non-processed foods to the extent possible and stop looking for salvation in the form of a pill.

Finally, I say Caveat Lector, "Let the reader beware." Don't take medical advice from the mass media. As Mark Twain once said, "Don't take advice from a health book. You could die from a misprint." This equally applies to health websites, newsletters, magazines, and TV shows.

They don't know YOU (your medical and social history, medications, diet, stress, etc.) and the advice may not apply. Find a physician willing to invest the time to know you well and who has spent time to acquire (usually not taught in medical school) knowledge of nutrition so he or she can guide you appropriately."

In response to my submission, a gentleman by the name of Bill Sardi posted this response.

"Of course, studies show ~40% of Americans are deficient in magnesium, ~40% are short on vitamin B12, most Americans have low levels of vitamin D at some time of the year, few Americans achieve optimal levels of vitamin C, a large portion of Americans are deficient in vitamin B1 due to poor absorption caused by drugs (diuretics, digitalis), coffee, tea, alcohol or refined sugar. Nearly all smokers are vitamin C deficient. Many older Americans are zinc deficient. Growing kids and pregnant and lactating mothers have nutritional needs that are not commonly met by the best diet. Stress, medications, and lack of stomach acid induce essential nutrient deficiencies. And yes, too many Americans have undetectable levels of omega-3 oils in tissues. So much for the idea of skipping supplements. --Bill Sardi, Knowledge of Health, Inc."

To which I responded:

"It's wonderful that you can rattle off a number of statistics to prove your point. However, I must challenge their accuracy. In the most recent 2012 CDC study of American's nutritional state, none of the numbers you cite proved to be accurate. Can you provide a valid source for your reference?

I'm not sure what your agenda is to push supplements, but as a doctor who regularly checks for vitamin deficiencies, I believe you to be misguided. When relying on studies, it is important to subject such studies to close scrutiny to determine their validity and applicability. I find that most dietary supplement studies that claim proof of usefulness fail these two tests.

For example, a recent study showed that Vitamin D decreased cold symptoms. However, the Vitamin D was given to people with extreme levels of deficiency. The study did not show efficacy in inadequate to normal levels of Vitamin D.

No one would disagree that someone with very levels of Vitamin D would benefit from correction. But before I would prescribe a pill, I would suggest increased sun exposure, albeit in small doses (about 15-30 minutes during the late day) and without exposure to the face, and ingestion of wild salmon and Almond milk, both rich in the vitamin.

The bottom line is no one should take a single supplement without consulting his or her physician. It's often been said that a doctor that threats him or herself has a fool for a patient. I say that someone that treats him or herself has a fool for a doctor.

Please let's leave medical decision-making to trained and licensed professionals. Of course, patients should always ask questions and challenge assertions if they see fit."

After writing my response, I became curious as to who exactly is this Bill Sardi. So, I found his email address and wrote him the following email.

"Hi Bill,

Can you please let me know what scientific credentials or degrees you have?

To your health,

Steve"

Here is the response I got:

"Dr. Charlap

Doctors only ask that question when threatened.  Don't throw your credentials in my face.  It is a disgrace that a well-trained physician like yourself makes such a foolish and uninformed statement as to recommend others not take supplements unless they have a known deficiency.  Patients often walk in and out of a doctor's office with burning feet, sore tongue, short-term memory loss, all overt symptoms of pernicious anemia, and doctors may or may not order a B12 test, which is often normal, meaning the norm on the test is flawed.  This is well documented.  A patient can get a blood calcium or blood magnesium level, which only measures how much mineral is being lost, not conserved (red cell magnesium levels may be more helpful).  Serum zinc levels are notoriously inaccurate.  A vitamin C and B serum levels only reflect recent consumption as they are water soluble nutrients. Why are all diseases considered drug deficiencies?  

You are an advocate for health, but do you know what that is?  The absence of disease?  Everyone has the disease of aging.

Why is it that the biological action of most prescription drugs can be replicated with a nutritional supplement that is far cheaper and less problematic, yet doctors continue to prescribe drugs to the point of breaking the insurance pool financially?

Tell me what prevention is.  You advocate that.  Is it colonscopies, PSA tests, mammograms?  All this is is scouting for more disease to treat.  It prevents no disease.  

In regard to your statement that no supplement has ever been shown to add a day of life unless a deficiency exists, I submit to you the following:

A study of 11,000 Americans over 10 years revealed that individuals with the highest level of vitamin C intake, only about 300 milligrams, suffered 35 percent fewer deaths than those with the lowest intake, about 50 milligrams a day. This amounts to about 6 added years of life to those who consume higher levels of vitamin C. Since 300 mg of vitamin C is difficult to obtain from dietary sources alone, the primary group that exhibited increased life span were the vitamin C supplement users. A person would have to consume five oranges a day to get 300 milligrams of vitamin C from their diet alone.  Reference: Cowley G, Church V, Live longer with vitamin C, Newsweek May 18, 1992 and Enstrom JE, et al, Vitamin C intake and mortality among a sample of the United States population, Epidemiology 3: 194-202, 1992.   There are other examples, but this one will suffice.

You need to be cleaning up your own profession before you give advice to the public.

Bill Sardi"

And finally, here was my response:

"Hi Bill,

I would be happy to review the study you cite if you would send it to me. I am well aware of all the NHANES research, having previously carefully reviewed the  body of it. If my recollection is correct, no conclusions can generally be drawn from NHANES data, however, It's been a while since I last reviewed such data.

From the study abstract I reviewed, this particular study you cite appears to be a retrospective, observational study the type that almost always fails to show causality.  Also, quoting from the abstract, it states the Vitamin C data was from "detailed dietary measurements and use of vitamin supplements," which means that the vitamin C came from both diet and pills, thereby skewing the results even further for validity for cause and effect. Vitamin C is an essential vitamin and a deficiency is known to cause disease.   If I am wrong about the study, after reviewing again whatever you send me, I would be happy to admit my error. 

Also, if you are aware of the NHANES related data such as the CDC's Second Report that came out in 2012, then why did you cite inaccurate deficiency data in your Wall Street Journal response?

Beyond that, the presumptive answer based on your response is that you have no formal scientific training. If I am wrong, please correct me.  Although I am sure that one can self-teach themselves quite a bit, there is no substitute for formal training, testing, and validation. You, may I assume, have no clinical experience, other than your own or family's medical encounters. Yet, you think you have it all or mostly figured out and it's all a BIG pharma conspiracy. 

Well, I have news for you, I don't meet with pharmaceutical reps, don't take personal compensation for my services, and aren't tied to any school of thought other than that unlicensed, and therefore lacking credibility people like you should stop giving other people dangerous advice.

BTW, have you even read any books on how to evaluate clinical studies for relevancy, validity, accuracy, etc.? If so, which ones?

Now let's turn to your insults such as "disgrace…foolish…uninformed." You are obviously the defensive one as you chose to insult as opposed to just answer my question and engage.

It's a shame that you don't have a license, in which case I could notify the appropriate authorities and have you censured for presenting science fiction as science. But as this is a free country, you have the right to spew forth your diatribe, regardless of how inaccurate, misdirected, and meaningless it may be.

As to your question, "what is prevention?", the answer depends on what level you are referring, primary, secondary, etc.  I believe in primary prevention, which is based on lifestyle modification.  I always prescribe dietary changes and other lifestyle adjustments before drugs for high blood pressure, obesity, depression, pre-diabetes, etc. 

The bottom line is you decided to insult the wrong person who actually gets it and practices it clinically every day. 

Finally, I will say it again. Supplements have no role to play until such role is defined by a knowledgeable physician who has done an appropriate evaluation. To do otherwise, is to put people at risk unnecessarily.

To your health,

Steve" 

Beware of Bill Sardi. 

Update as of March 21, 2013 

Bill Sardi or someone working on his behalf sent me two copies of his book, The New Turth About Vitamins & Minerals. On the cover of the book, he displays Purity's Perfect Multi, the multivitamin he sells.  The entire book is dedicated to persuading the reader that if you want a quality multivitamin, only he sells it. In fact, in the back of the book, Sardi includes a survey of multivitamins where he grades the major brands out of 100 points. Not surprisingly, his product gets a 96, with the next closest product is graded 68 out of 100, with the numbers dropping fast from there.

Out of curiosity, I started reading the book, but had to stop when I realized that although he occasionally quoted some reasonable studies, many were studies done in animals, which hold little relevance to humans. The book was the most self-serving book I have ever tried to read. After a few pages of copious notes, I had enough.

Again I caution, beware of people telling you how great are the supplements they are trying to sell you.