How Do You Stay Healthy and Prevent Disease?

People expect fast answers to even tough questions, and in this era of internet access, such answers are usually readily available. Therefore, one would expect to easily find the answer to the question posed in the title above.  Alas, if that was only true.

A new study sheds light on why I find it difficult to tell people with any certainty that a certain course of action will definitively keep them healthy. This is a result of apparent contradictions I read about all the time. It seems that some people who engage in unhealthy behaviors are healthier than others who swear by a healthy lifestyle. It's like the old philosophical religious question of why do bad things happen to good people?  It turns out there is a reason when it comes to health.

One of the toughest questions for genetics researchers is not only how to identify which genes are responsible for causing a disease, but what turns these genes on or off? More simply put, why does one person get a disease while another with identical genes does not?

For example, the other twin of an identical pair whose sibling develops rheumatoid arthritis only has a twelve percent probability of developing the disease. Multiple studies support the notion that the presence of a gene does not always promise the manifestation of disease. That is why when it comes to health, we can not look at our parents, our siblings, or our children to know definitively what will happen to us.

In an important paper, researchers at the Johns Hopkins School of Medicine and the Karolinska Institute in Sweden published a method to evaluate an important gene-regulation system: chemical tags that tell genes to be active or not. Their approach was to compare 354 newly diagnosed rheumatoid arthritis patients and 337 healthy people who served as controls. Researchers reviewed both groups’ white blood cells, examining their DNA for chemical tags — methyl groups — that could attach themselves to genes and turn them on or off. 

This involved more than just studying the isolated genes. While it is well established that a gene can remain stable, the chemical tags that turn the genes on and off are not so predictable. These chemical tags' activities can be affected by the environment, medications, or even the actions of other, distant genes. Chemical tags can develop as a consequence of a disease or be responsible for it. 

In the study, researchers found that even when the gene variations that are associated with developing rheumatoid arthritis were present in an individual, the absence of certain chemical tags resulted in no disease.

So what does this all mean? Basically, it means we still have a lot to figure out on how to precisely prevent diseases such as autoimmune diseases and cancer because we know little about these chemical tag triggers. 

So what does one do in the interim?  Play the odds. By that. I mean follow the conventional wisdom of eating a mostly plant-based diet, avoiding processed foods full of chemical additives whenever possible, limiting environmental exposure to other chemicals when also possible and practical, staying physically active, managing stress effectively, getting adequate sleep, being socially engaged, and finding meaning and purpose in life.  Following such advice offers no guarantees, but based on current knowledge it does seem to shift the odds in your favor. Also, avoid medications and supplements unless prescribed by your physician. (Even when prescribed, it will do you well to understand and question why you need it.)

Until scientists discover how to control the chemical tags that turn genes on and off, that's the best advice I can give you. But as always, don't take my advice. Seek guidance from a physician who knows your medical history and life-situation and can best counsel you. 

Don't try to figure out health on your own. It's still too complicated.

The Case Against Antioxidants

Yesterday, I received a call in my office from a David Feld. David Feld identified himself as a physician that specializes in Obstetrics/Gynecology and is a distributor for Nu-Skin. (For a recent article about NuSkin see http://www.forbes.com/sites/taesikyoon/2012/12/20/guilt-by-association/)  Nu-Skin is a multi-level marketing company that distributes supplements full of antioxidants based on what they claim is a sound, if not the only, practical approach for people to maintain good nutrition.

Dr. Feld and I spent several minutes conversing about the Pharmanex Scanner and Nu-Skin's antidote to low carotenoid (a type of anti-oxidant) levels.  I challenged his science and he pushed back with references to some clip on the Discovery Channel and something he called the Cady Report.  (By the way, I read the Cady report and consider it rubbish.)

Today, I read an article quoting James D. Watson, PhD, who shared the 1962 Nobel Prize in Physiology or Medicine for the discovery of the double-helix structure of DNA.  Dr. Watson has a hypothesis that antioxidants may undermine metastatic cancer treatment and even contribute to cancer development.

Here is an excerpt from a MedPage article on the story.

"Antioxidants neutralize DNA- and RNA-damaging reactive oxygen species that would otherwise trigger apoptosis," Watson explained in an article online in Open Biology. [Note: Apoptosis means the death of a cell. To stop cancer, the cancer cell must undergo apoptosis.]

Although that balance is helpful under normal conditions, the vast majority of cancer treatments -- radiotherapy, most chemotherapy, and some targeted therapies -- rely directly or indirectly on reactive oxygen species to block key steps in the cell cycle and thus kill cancer cells.

"Unless we can find ways of reducing antioxidant levels, late-stage cancer 10 years from now will be as incurable as it is today," Watson said in a statement, calling this among his most important work since the double helix discovery.

WenYong Chen, PhD, a cancer genetics researcher at City of Hope in Duarte, California, "agreed."

What does all this mean in layman's terms?  Despite the popular belief that free radicals and oxidative stress is always bad for human health, in fact, both free radicals and oxidative stress contribute to the human body's ability to fight infection and kill fledgling cancer cells. Accordingly, overwhelming the body with antioxidants in pill form, according to Watson, would neutralize the immune system's ability to function properly and would both contribute to the development of full blown cancer and death from it. Watson does point out that this is not true for antioxidants found naturally in consumed fruits and vegetables.

Although Watson considers this a novel hypothesis, it's really not new.  Under the label of hormesis, there is a studied phenomenon that is characterized by low dose stimulation, high dose inhibition. In other words, a little is good, but a lot becomes bad.  The natural antioxidants found in fruits and vegetables, surrounded by other synergistic nutrients including vitamins, minerals, enzymes, co-enzymes, activators, and precursors may be healthful to the body, but when isolated in pills they become harmful.

This turned out to be exactly true with beta-carotene, a powerful antioxidant. Found naturally in carrots, it is considered a healthy nutrient. In a study involving smokers and beta-carotene synthetic supplements, the study was stopped when it was discovered that the beta-carotene was increasing the risk for lung cancer.   Basically, when beta-carotene acting as an antioxidant neutralized a free radical, it became a more harmful and dangerous free radical. Go figure.

So after reading about Watson's research hypothesis, I wrote David Feld and asked the following:

"Did you read what Watson, the Noble Prize winner recently said about the role of antioxidants in causing and interfering with cancer treatment?  That should give you pause for thought."

His response:


"Only pause. I know what I've done for patients health in the last 5 years."


I am not surprised by his answer. Dr. Feld apparently does not remember that we met over a year ago at a medical conference. At that time, he gave me the same spiel about the greatness of the products he was peddling. He apparently also doesn't remember that I asked him then, as I did now, to send me a single or multiple studies that showed the promoted benefits of his supplements.  He eventually sent me some studies, but not surprisingly they showed no such benefits. All they showed was the more supplement you took, the higher the level of that supplement in your blood 


True to form, he sent me two studies today. This time, one study showed that low carotenoid levels are consistent with slow walking speed among elderly women. Of course, this was an observational study and as such proved no cause and effect. In fact, if one is low in carotenoids, one would expect to also be lower in other essential nutrients. One would also expect an undernourished older women to walk slowly.  His other study proved the point, as it showed that low carotenoids were consistent with low selenium, one of the fifteen essential minerals the body needs to function properly. The study showed that such nutritional deficiencies can contribute to increased mortality.  As you should know by now, most supplements have no benefit in the absence of deficiency.


No one would disagree that nutritional deficiencies are problematic and harmful to overall health. But Feld still hasn't produced a single study that shows that using his supplements make any difference in cancer prevention or show any other health benefits for that matter (except with macular degeneration treatment, not prevention.)


No one can say for sure what is in Dr. Feld's heart and mind, but forgive me for being cynical when he has a distinct profit motive in pushing and distributing his wares directly to his patients and to other doctors so he can succeed at multi-level marketing.


My opinion is that you should run from doctors who try to sell you things based on the Pharmanex scanner and stay clear of NuSkin's nano lifepak technology, as well as their new genetic LifeGen technology products.   

Just because they say their products are great, doesn't make it so. Plus, a $150 saved is $150 earned.

Dr. Oz and His So Called Miracles: Red Palm Oil

My wife sometimes has a perverse sense of humor. I came home last night and she was excited to tell me that she had recorded yesterday's episode of The Dr. Oz Show. She was absolutely gleeful with delight as she said that the name of the episode was "Dr. Oz's 13 Miracles for 2013."

Dr. Oz loves to use the word "Miracle."  Miraculously, he seems to produce more miracles than any clergy-person I have ever heard about. He calls the people who help him find his miracles appropriately miracle-workers. Now the last time I checked, a miracle is an event attributed to divine intervention. Coincidence?

When I was in medical school, we were told that there are no atheists among doctors because every doctor thinks he or she is G-d. Although we went to different medical schools, I wonder if Dr. Oz heard the same thing, but took it literally. Now I grew up in a religious household and I find it objectionable to hear the word miracle bandied around so loosely. This is painfully true at the moment for me as a loved one struggles with an aggressive kidney cancer, and it may actually take a miracle for him to be spared from its short term ravages.

Sometimes, I wonder if the only true miracle in regards to Dr. Oz is that he hasn't really harmed anybody yet with his reckless proclamations. Of course, I am only making an assumption that no one has been harmed because I don't really know for sure. It wouldn't surprise me to learn that some poor soul that followed Dr. Oz's 2012 litany of weight loss miracles developed a serious or life threatening health issue. In 2012 alone, Oz recommended Green Coffee Extract, Sage Leaf Tea, Raspberry Ketones, Glucomannan, and Garcinia Cambogia as magic, if not miracle, weight loss pills. He's even been known to use phrases like "breakthrough," "revolutionary," and "holy grail" to describe his offerings. Imagine if someone took him literally and tried all these pills at the same time. I know patients who have tried a combination of some of these, of course with no success. Ouch!

But 2012 was not the end of his malarkey.

(see article in Slate magazine published January 1, 2013 about Dr. Oz and his dubious science:

http://www.slate.com/articles/health_and_science/medical_examiner/2013/01/can_you_trust_dr_oz_his_medical_advice_often_conflicts_with_the_best_science.html.)

As recently as yesterday, he outdid himself when by only the third day of the month he was already pronouncing the greatest miracle, if not product of the year. This was something new and great.  As my wife and I watched the show he proceeded to explain how Red Palm Oil (RPO), the first "miracle" that could prevent Alzheimer's, clear blood vessels of fatty plaque build-up, and remove fat from around the omentum (the expanded fat that surrounds bulging waists).

After Oz effectively used contraptions to demonstrate each principle, my wife (who is highly intelligent, but subject to the same persuasiveness that beguiles many Oz followers after one of his pronouncements) turned to me and asked how I knew that the product didn't work as promised.

I diligently explained that what he had described made no scientific sense because the known mechanisms involved in Alzheimer's, calcified plaque build-up in blood vessels, and white fat deposits around the waist were basically different.  In addition, if such a product actually existed or were discovered, it wouldn't simply be the best product of 2013. In fact, it would be the best product of all time.

Why?

Heart disease is the number one killer of Americans. If there were actually a product that cleaned out fat deposits in our blood vessels it would essentially eliminate cardiovascular disease. If there were a product that effectively removed waist fat it would eliminate the weight loss industry. If you could prevent Alzheimer's, you would eliminate sixty plus percent of all dementia cases and with some artery cleaning, at least another ten to fifteen percent.

This would seriously be the greatest scientific discovery of our time.

So what is the actually story about Red Palm Oil?

First, it's not a new discovery. As early as 1929, a study was published in the Biochemistry Journal titled

Vitamin A and carotene: The vitamin A activity of red palm oil carotene. III. The absence of vitamin D from carotene. IV. The effect of various dietary modifications upon the vitamin A activity of carotene.

 

They knew it then, as they do now, that Red Palm Oil contains a lot of beta-carotene and tocotrienols, a type of Vitamin E. There have been dozens of studies over the years in rats showing various benefits of taking RPO and several studies in humans showing it to be a good source of carotene. So are carrots and similarly pigmented vegetables. Like Olive Oil and Safflower Oil, studies in humans have not shown any particular harm related to using this mono-unsaturated oil.

In one human study published in 2003 and done in China, which was a single blind (researchers knew who got what; test subjects did not) randomized controlled study titled Effects of red palm oil on serum lipids and plasma carotenoids level in Chinese male adults, results showed that blood concentration of total cholesterol, triglyceride, high density lipoprotein cholesterol, apolipoprotein AI and apolipoprotein B of all subjects showed no significant changes in the RPO group during the study. In other words, although RPO apparently does no harm and raises levels of carotene and Vitamin E, it does nothing to body lipids.

Numerous other studies have also shown no increase in lipids either from this monounsaturated fatty acid. In total, there are less than 100 studies done in regards to RPO and almost all are lab or animal based studies that offer little human relevance.

Therefore, the claims Dr. Oz made on his show yesterday about Red Palm Oil were simply not realistic. Suffice it to say that claiming that RPO has miraculous qualities is at best blustery, and at worse, abject dishonesty.

One final note. At the completion of last evening's show, Oz made a point to share letters from fans illustrating the great benefits people have had from watching his show. Perhaps he was smarting from the unfavorable Slate article (see above) and needed to stroke his ego after this uncommon media bruising. I understand. He had been called out in a major media publication and it hurt. What was bemusing is that not one of the letters he read from grateful fans included any reference to any supplements he has recommended on his show. Instead the thank you letters all referred to the actual science he sometimes discusses on his shows like the importance of early detection for breast and colon cancer.

If he stuck to the mundane, but important work of reminding Americans to be diligent in cancer prevention and early detection, then I doubt few would ever fault him again. But to expect that with yesterday's show heralding no less than 13 new "Miracles," would be nothing less than a miracle itself. That's a shame.

Government Reports Extra Weight May Be Healthy. Really?

Is anyone else shaking their heads in disbelief over the new government study that shows that people who are overweight are less likely to die in any given period than people of normal weight?  This study was based on a review of 97 other studies.

First of all, many are calling the study proof of the "Obesity paradox," although the study clearly showed that obese people, that's people with a BMI above 30, had an overall increased risk of dying. Also this was an observational study, not a cause and effect one, which already makes the results somewhat questionable.

Second, if 67% or so of the population is overweight and 36% is obese, which means that 31% are overweight and not obese, that only leaves 33% of the population as either normal weight or underweight.  Included in the 33% are people who have lost weight due to illnesses such as cancer, eating disorders, hyperthyroidism, malnutrition, etc.

The study does not account for why people fall into the normal and underweight category (healthy or unhealthy lower weight) given the preponderance of people in the overweight category.

Third, it doesn't account for people who have normal BMIs, but high waist to hip ratios which signifies excess white fat, the dangerous kind of fat. A recent Mayo Clinic study showed  that among 14,000 study subjects, those with a normal BMI, but a high waist-to-hip ratio, were the most likely to die of heart-related disease during the 14-year follow up, even at higher rates than those in obese ranges.

Fourth, it is well established that people in advanced stages of cancer and diabetes do better with additional weight because as the body wastes away, it takes longer to do so. G-d forbid you should need excess weight for that reason.

Fifth, the study did not assess people who were underweight as it is known that such people have increased mortality. The underweight people were lumped together with the normal weight people to come up with a total death rate, so one can expect that the underweight inclusions skewed the numbers somewhat.

Sixth, the study did not address people who are overweight on the road to becoming obese, as opposed to those who are chronically overweight. By not knowing if recent illness is contributing to change in weight, we can't do an apples to apples comparison.

Seventh, the study underscores why BMI may not be the most reliable indicator of unhealthy weight because it does not take into account the muscle to fat ratio. Athletes, for example, could have increased muscle mass that will increase their BMI and put them into the overweight (even sometimes obese) category despite their otherwise good health.

Eighth, it is well know that excess weight, in and of itself, does not mean you are unhealthy if you don't have concomitant increases in cholesterol, blood pressure or blood sugar.

Ninth, is there a difference between a BMI of 25.1, which puts you into the overweight category and 29.9, which keeps you out of the obesity category? The study does not address gradations of being overweight.

Tenth, and finally, it not entirely clear to me what exactly is the point of this study. Is it to tell people that being overweight is not as bad as most people think? Should people who are overweight, but not obese be less concerned about their diet and lifestyle?

Of greatest concern, should people who are overweight, but not obese, make sure that they don't lose any weight as that may increase their risks for death?

I am not surprised that this is a government study as I find such studies to sometimes be the most generically misleading. Such a study would seem to offer comfort to the 67% of Americans who find themselves in the overweight category as you can rest assured that most people will not even bother to look past the headline that states that extra weight may be healthy. They will just take comfort in the notion that that extra piece of bread or serving of pasta may be health promoting.

G-d help us all if the government keeps doing these types of studies. Next thing we know they will tell us to cut out fats and eat more carbs. Oops, they did that already and we all know what happened.

Update, February 3, 2913:  A recent study offers support for the notion that far more important than BMI is the waist to hip ratio. This measurement of "belly fat" is more indicative of overall health because the build-up of white fat cells at one's midsection is more reflective of overall inflammation within blood vessels and risks for heart disease.  So those who took heart from the study that it's better to be heavier than be normal weight, please understand that this referred to well distributed weight and not weight concentrated around your gut.

What Can You Eat If You Have Cancer?

The other day, I saw a patient who had been diagnosed, a number of years ago, with metastatic breast cancer (it had already spread to the lymph nodes in her arm).  She was advised to undergo chemotherapy, but decided instead to undergo a rigorous process of fruit and vegetable juicing. Here she was now years later standing in front of me with no apparent evidence of cancer.  What is the take away from this story? For me, there is none. Anecdotal stories of cures from cancer by food alone offer no compelling scientific evidence. Perhaps the surgeon had effectively removed all the cancer and that is why the patient had no recurrence?  Perhaps she had a very slow growing tumor that continues to spread but goes undetected?  Maybe the fruits and vegetables actually did make a difference? Nevertheless, there can be little doubt that eating healthy foods helps ward off diseases, but the question remains: can you depend on them for a cure?

The problem is that cancer is a confounding disease and can act dissimilar from one person to another even when it is of a similar histology (micro-anatomy) such as squamous, adeno, or sarcoid types of cells. Also, our bodies immune responses to cancer is also different because of our diverse genetic make-ups. That's why we sometime hear of someone being diagnosed with cancer and then passing away a few short months later, while others with similar cancers enjoy many more years of life. It is also true that certain cancers, such as pancreatic cancer, are often discovered very late in their course and often portend very poor short-term outcomes.  Ultimately, the staging (how extensive it is and if it has spread beyond its primary location) of a cancer really does make a difference. The sooner you find cancer, the more effective interventions usually prove to be.

Yesterday, I spent time reviewing various websites that proffer advice on how to eat properly when one has cancer.  What I found was frightening and I am sure very confusing for someone searching for the right answers. The government based sites recommended eating meat and milk products to maintain strength while virtually every other site discouraged consumption of such food materials because of their links to causing and propagating cancer.  The government sites seem to offer their information on the basis of what the government considers healthy eating.

There can be little doubt of the sway of the Dairy and Cattle Associations on the government's recommendations. This is well established.  Nevertheless, a person with cancer is left guessing which set of directions to follow. Unfortunately, I profess some uncertainty in answering this very question. However, I will try.

Based on everything I have read to date, meat and dairy products seem more problematic than helpful when dealing with cancer.  Fruits, vegetables, nuts, beans, seeds, whole grains, and wild Salmon seem more helpful than problematic.  Sugar, other than the natural fructose found in in fruits (don't confuse with high fructose corn syrup, which is horrible), seems universally bad.

Given the choice between conventional therapies and home grown remedies, I would choose both.  My relative battling cancer has made that very choice. He is being bombarded every day with a heavy dose of juicing which includes pomegranates, papaya, berries, apple, citrus fruits, collard greens, turmeric, cinnamon, etc., while also taking prescribed medicine. He is getting the best of both worlds.

As a side note, the person who prepares his food got carried away one day and tried to sneak some very healthy sardines into his smoothie. Suffice it to say, it did not go well. There are limits to what kind of foods can be combined together at one time and still be palatable.  Cancer patients with taste buds need to at best enjoy their food like everyone else, and at worse, not detest it.  There are ample good recipes for combining healthy ingredients; while some experimentation is encouraged, it is advised to not get carried away such as by throwing blueberries and sardines together.

For example, while recently traveling, I got to enjoy a smoothie of my own. There was an airport kiosk offering a smoothie they called "Habit." It contained fresh squeezed orange juice, whole banana, fresh pineapple, raw kale and spinach, and nothing else other than ice. There was no sugar of any type added and I must tell you it was delicious. I understand why they call it "Habit" because I could get use to drinking one of those smoothies every day.


By the way, on another note, this morning I received an email from Harvard Medical School titled "The Top Health Headlines of 2012." The fifth headline was "Do vitamins and other supplements live up to their promise?"

I read the accompanying article and here is a quote from it worth noting:

"Despite their popularity, there is no evidence that multivitamins enhance health or prevent illness. In fact, both the U.S. Preventive Services Task Force and a National Institutes of Health State-of-the-Science Conference concluded that multivitamins do not offer protection against heart disease or cancer."

Now the truth be told, I don't agree with everything I read from Harvard Medical School because sometimes the information provided is outdated or simply wrong. Therefore the information provided is merely offered as another view about the ubiquitous multivitamins and dietary supplements.  As always, consult with your physician before initiating taking any pills.

In summation, although no one can tell you definitively what foods can stop cancer once it develops, it seems prudent, if you or someone you know find him or herself in that situation, to eat like we ate thousands of years ago when meat and dairy were in short supply, and we lived off the land and ate fresh oily fish.

Are Dietary Supplements and Multivitamins Addictive?

The Merriam Webster dictionary definition of addiction is a "compulsive need for and use of a habit-forming substance characterized by tolerance and by well-defined physiological symptoms upon withdrawal; broadly: persistent compulsive use of a substance known by the user to be harmful."

Psychology Today defines it as "a condition that results when a person ingests a substance (alcohol, cocaine, nicotine) or engages in an activity (gambling) that can be pleasurable but the continued use of which becomes compulsive and interferes with ordinary life responsibilities, such as work or relationships, even health."

Pursuant to such definitions, one who takes multivitamins and supplements would not classically be deemed an addict because he or she doesn't know that such pills may be harmful and typically would not experience physiological withdrawal symptoms from the use of such products.

Yet, I would like to offer an alternative definition of addiction.  My definition is the compulsive use of a substance in the absence of any evidence that the product enhances health or that it is not harmful. Furthermore, my definition includes the use of such a product as a crutch and substitute for otherwise engaging in healthy behaviors such as a health promoting diet, physical activity, stress management, etc.

Under my definition, we have an epidemic of supplement addictions in the U.S.

Over the past year, I have been giving lectures to over a thousand people on why supplements and multivitamins are mostly worthless and may be harmful. Yesterday evening, I gave this presentation to a group of about 70 people. As often happens with this lecture topic, I was peppered with questions both during and after the presentation.

Despite citing specific very large studies that demonstrate potential harms related to the use of such products, I was asked repeatedly if there was definitive proof that taking such products is absolutely harmful. One audience member went so far as to state that she had been taking such products for years and had suffered no apparent harm so why was I certain in my pronouncements. Certain audience members shook their head in agreement challenging me to refute this apparent fact.

As the intensity of the pro-supplement voices rose, I took a deep breath, composed my thoughts and answered as follows. First, I reminded the audience of Mark Twain's quip that "It's not what we know that gets us into trouble. It's what we know for sure that does." I explained that that I could not state with absolute certainty, given the biological diversity of people, that all multivitamins and supplements were equally worthless and/or harmful to everyone.

People have different medical histories, use different prescriptions, engage in different lifestyles, eat different diets, and have different genetic predispositions. Such diversity often challenges and complicates the application of research results to any given individual. Furthermore, some people may actually suffer from a deficiency that for one reason or another can't be addressed simply by regular food. By the way, this is extremely rare.

I also explained that sometimes the evidence of harm can be many years in the making. The development of a mesothelioma, a cancer, may not be evident until thirty years after exposure to a single strand of asbestos. Also, many of the diseases that afflict most western civilization inhabitants such as heart disease, stroke, dementia, etc. do not develop for many decades after steadily engaging in unhealthy behaviors. Even most sugar addicts and cigarette smokers don't develop diabetes and lung cancer respectively for many years of use. (True, some never develop it.)

Yet, something more nefarious was underfoot. I felt like I was suddenly challenging certain people's religious or political beliefs. There was palpable angst in the audience. Then it hit me. Instead of sharing my facts about such products, I should be asking questions.

"Hold everything," I said to the audience, "Why has the burden fallen on me to produce evidence that such products demote health, are harmful, shorten life, etc.?" I further queried, "Why are you not demanding proof of benefit and of no harm prior to spending your hard earned money on products that offer no such evidence?" Why are you blindly following advice from people who have a pure profit motive in getting you to buy their products?"

I shared with the audience an encounter three weeks prior at another such lecture when a Shaklee representative (Shaklee is a multilevel marketing supplement distributor) chimed in from the audience that based on a landmark study it performed, Shaklee offers such proof that it's products are worth the money spent on them.

I've since obtained the study to which he was referring. It is a ridiculous study confabulated by Shaklee to produce desired results. Basically, Shaklee compared selective data they gathered from their affluent product users to data collected by the government from many poor and elderly citizens.  It is not a valid comparison and the study was essentially a worthless (not for Shaklee) piece of marketing propaganda. No surprise there.

The bottom line is that the supplement industry has sowed so much confusion that even doctors no longer know which products are valid, when they are necessary, how much to recommend, etc. As Consumer Reports published in September 2012, there are now 55,000 products for sale and over $100 billion of nutritional products sold each year.

The weight and consistency of the marketing has been so effective that people are no longer asking the most basic of questions. Will this product help or hurt me? Is there any scientific validity to the use of this product for the reason I am taking it? Is it worth the money I am spending?

Since 1994, the law of this land is that supplement product companies need offer no proof of effectiveness to market their products--and so they don't. But like lambs to the slaughter, people continue to line up sheepishly and buy millions of these pill bottles of uncertain value. It is estimated that somewhere between 50 to 80% of Americans now take one form or another of supplement.

The value of these products, now occupying only 80 years of our 150,000 year chronicle (millions more if you include early man), may be the single biggest hoax in mankind's history.

Taking invalidated, potentially harmful supplements may not seem like an addiction to you, but it sure does to me.

It's Never One Thing

It would be an understatement to state that I have become fascinated with all aspects of longevity and disease prevention. Over twenty thousand studies and a dozen books later, my search for the quintessential answer to a long and healthy life goes on.  The body of knowledge is so vast and the hours are so short that I suspect that I shall never fully grasp all the intricacies of what allows any single person to optimize his or her longevity and minimize susceptibility to disease. While scrutinizing certain cultures that appear more successful at longevity may offer some clues, even among their members you will find those that die far younger than others despite similar lifestyles.

However, one thing has become abundantly clear to me: a long and disease free life is never dependent on just one thing.

This statement is made with the caveat that obvious detriments to health, such as consuming lethal poison or jumping off a perilous cliff, offer certain consequences.  Nevertheless, when one removes from the list such immediate threats to continued living, it becomes crystal clear that a host of factors contribute to the life we live and the day we die.

Foremost, but often not close to the most important factor, is the role that genetics plays. This is the influence least under our control as we obviously have no role in choosing our parents. But numerous studies, and in particular, the Swedish Twin Studies (that began in the 1870's, involving tens of thousands of identical twins who happened to grow up separately with varying lifestyles who developed different diseases and died at vastly different ages),  have demonstrated that genetics plays no more than a 15 to 30% role in our overall longevity and disease development. Of course, those born with Down's syndrome, hemophilia and other genetic disorders would argue otherwise and they would be right. But for most people, genetics at most represents a predisposition for diseases whose ultimate manifestations are under our control.

So what does matter? For one, but not alone, it is environmental factors. Which? That's the $64,000 question. Is it processed foods, gluten, pesticides, household chemicals, pollution, contamination, etc., or could it be some mix and match of all of them?

Anyone who tells you they know with certainty is either delusional or just flubbing.

The reason no one can tell you the absolute answer is that it is often different for different people. For example, there are smokers who live to 100 and others that die far earlier. Some obese individuals have heart attacks in his or her 30's while others survive into their 90's.

More importantly, no one can do better than hypothesize because the scientific method can never be applied to such a multivariate question. The gold standard of scientific inquiry into a population's health would require a double-blind, randomized controlled study where all confounding variables are controlled. Unless we could snugly place people in a bubble, we could never firmly establish a definitive working conclusion.

Nevertheless, scientists slog on trying to make sense of what they can. They can show a strong correlation between smoking and lung cancer, alcoholism and cirrhosis of the liver, obesity and heart disease, etc. What they can't do is tell you if you simply avoid or consume one particular food then your longevity is guaranteed to be positively or negatively impacted, respectively.

For example, I think there is a strong basis in science to call sugar a human poison, albeit a slow acting one. My patients are cautioned to avoid it and to go to great lengths to minimize their exposure to it. Nevertheless, I don't believe that avoiding sugar alone guarantees a long life.

I often tell my audiences that if they eat plenty of fruits and vegetables, nuts and beans and seeds, whole grains and wild fish--they are going to die.  I suspect they expect a different conclusion than the one proffered, but it's the truth.  Long before processed foods even existed, people died and some at relatively young ages from a myriad of other factors--infections foremost among them.  Food allows you to live by providing essential nutrition, but it doesn't guarantee health. Healthy eating doesn't offer protection against many simple infections like chickenpox and viruses or more esoteric infections like tuberculosis and tetanus.  These sometimes life-threatening ailments often depend on passing exposure to these pathogens.

So what else matters? The mind.

Many an otherwise healthy person has been befallen by stress, anxiety, depression or any other number of mental health issues. Such factors may have a genetic or familial disposition. Some may be purely situational. Sometimes it's both. The connection between the mind and body is well established. It facilitates innocuous placebos to work and allows real, measurable systemic diseases to develop in the absence of any other factors.

I have witnessed this first hand. Learning about my family member's cancer brought back my heartburn which I thought I had banished forever. No diagnostic medical test, and I've had plenty of them searching for a clinical reason, has shown any other identifiable cause for this phenomenon. I know it is because of stress.  Despite eating, sleeping, and living well, I have struggled to control my own guttural reaction to difficult news. I know that I must learn to manage my reaction to difficult news and I strive everyday to naturally manage my stress to relieve my symptoms.

This is why I know that the complex human body forged over 150,000 years to it's current form, and millions of years earlier in prior forms, is at once and always will be a very vulnerable and fragile system, highly complicated and efficient-- a veritable miracle of nature subject to forces sometimes beyond our control.

Although many would have you believe by the titles of their books such as "Why We Get Fat" or "Wheat Belly" that your health depends on one thing, I will tell you that it's simply not true.  No pill, prescription or supplement, no food described as super or otherwise, no exercise routine, done in the gym or in nature, will guarantee health.  Alternatively, certain vices like smoking and excess alcohol, consumption of certain processed foods, a sedentary lifestyle, poor sleep, great stress, etc. while expected to have a detrimental effect on your health, don't always factor in your death.

Your health depends on a combination of factors that affect both your body and mind.  Ignoring any of these factors shifts the odds against you for a long and healthy life.

But please take note, it's never one thing.