Is Dr. Oz Reliable? You Decide

On Dr. Oz's show today, Oz sounded an alarm about the misuse of anti-depressants by primary care doctors for treating their patients' depression and the off-label use for other psychological illnesses, such as anxiety and insomnia.  He explicitly made the statement that no patient should be prescribed an anti-depressant by anyone other than a psychiatrist. He made that point emphatically. (By the way, I actually agree with him on this one  However, because I find that psychiatrists are often quick to prescribe, I prefer to send a patient first to a psychologist for a proper evaluation.)

To quote his own blog, "On today’s show, we’re addressing the growing problem of the over-prescription of antidepressants in our health-care system. In order to treat common medical conditions, many physicians have resorted to unnecessarily prescribing medications to patients who don’t need them. We’ve already seen this issue with pain medications and antibiotics. Not only does it cost a lot of money, it carries risks as well."

Oz goes on to write in regards to the fact that most anti-depressant prescriptions are written without a psychiatric diagnosis that, "This can lead to dangerous results. Recently published research suggests that antidepressants may make one more prone to depression later in life. They also may increase your risk of suicide. In 2004, the FDA required a label on antidepressants, warning of the risk of increased suicidal thinking and behavior among children and adolescents who take antidepressants.

He adds, "There’s also research that suggests that antidepressants may not even work at all. Most antidepressants work by increasing levels of serotonin in the brain. However, there’s very little evidence that shows that depression is caused by a serotonin imbalance alone. Usually, there are other psychosocial or medical factors that play a factor in someone’s depression."

So to be clear, Oz is saying that raising serotonin levels in the brain may have nothing to do with treating depression as there is scarce evidence, according to him, to support that conclusion.

So why is Oz a hypocrite you may ask? I'll let you be the judge.

Two weeks ago, the Dr. Oz show featured a trio of practitioners, two MDs, and one naturopath declaring the great value of using a compound called 5-HTP to treat depression among other disorders.  5-HTP is an over the counter, virtually unregulated dietary supplement that has had no major clinical trials to support its effective, safe, and long-term use in depression. In fact, a number of organizations warn against its use for any indication, such as weight loss.

I can't make this stuff up. Here's Oz's own website material.

A Q&A posted on his website.

Can 5-HTP be used to treat depression? 5-HTP is typically used to treat mild depression based on the theory that as a precursor to serotonin, a neurotransmitter that has a calming effect, these supplements can increase serotonin levels and influence mood, sleep patterns and pain control. 5-HTP effectively increases the central nervous system (CNS) synthesis of serotonin. Serotonin levels have been implicated in depression, anxiety, pain sensation, and sleep regulation.   

Here's a quote from his blog.

"5-HTP is a chemical compound that is naturally produced in your body as it makes serotonin, an important hormone for regulating your mood...In addition to suppressing your appetite, there is some research that suggests that 5-HTP can also help treating headaches, insomnia, depression... [bold added for emphasis]." end of quote. 

So let's make sure we all got Oz right. If a primary care physician who knows a patient well prescribes an anti-depressant for his or her patient, that's bad because the patient hasn't been evaluated by a psychiatrist. But it's okay for Dr. Oz and a couple of doctors on his show to tell a national TV audience of patients they know nothing about, including any medical history whatsoever, that it's proper to use 5-HTP to treat depression because it apparently increases serotonin, the brain hormone.  Wow!  

When it comes to supplements that may screw with your brain, he doesn't flinch in telling you to take them even when the science is iffy. But when it comes to other doctors, particularly primary care doctors and internists, prescribing approved medications he doesn't hesitate to throw them under the bus.  

If that's not inconsistency, then I don't know what is. What do you think?

Dr. Oz and Asprin: Is He Being Irresponsible?

Do not, and I repeat do not, stop taking aspirin prescribed by your physician (Dr. Oz on TV is not your physician) based on what you read here today. Today's blog highlights why it is a huge mistake to take medical advice from any doctor, including Dr. Oz, who does not personally know your medical history.

On a recent episode of The Dr. Oz Show, Dr. Oz spoke about aspirin -which he calls the Miracle Over The Counter Drug. As he has done multiple times before, Oz recommended that everyone take two baby aspirins every day. He prefaced his recommendation based on a video stream of medical conditions that he claims benefit from aspirin therapy. Heart attacks, strokes, arthritis, etc. were on the list. He highlighted aspirin's anti-inflammatory benefits and the role it may play in cancer prevention (a topic obviously dear to my heart). He did not, however, cite any of the side effects of aspirin therapy. He did not mention the risk for bleeds, easy bruising, ulcers, asthma, macular degeneration, etc. Aspirin can wreak havoc if used inappropriately and he gave no hint of such dangers. In my opinion, this is irresponsible and unprofessional behavior, worthy of revocation of his medical license.

Why am I so strident in my feelings?  Personal experience. First, I use to take aspirin and developed an ulcer from it. It took months of suffering, an eventual endoscopic procedure to make the diagnosis, and months of drug treatment to cure it. Anytime I take a baby aspirin, my nose begins to bleed the next day. Obviously, aspirin and I do not agree. But I am not alone. Aspirin and other anti-platelet drugs are known to cause bleeding and be corrosive to the esophagus and stomach linings. In fact, aspirin, a member of the non-steroidal anti-inflammatory (NSAIDS) class of drugs, has been cited as one of the top four categories of drugs responsible for emergency room visits and hospitalizations. (By the way, on a subsequent episode Oz cited the potential harms caused by NSAIDS, but did not make a single reference to aspirin.)  Many patients who take aspirin note the easy skin bruising that develops.

Another one of my family members has a condition where aspirin therapy triggers an asthmatic attack.  This well known syndrome is a triad that includes aspirin, asthma, and a nasal polyp.

A number of recent studies have shown a correlation between aspirin therapy and the development of age-related macular degeneration, an eye condition with very poor treatment options.

The bottom line is that a daily aspirin has both associated benefits and risks and no one should initiate therapy with out first consulting a physician who can help you calculate your risks and benefits.

But what gets me really upset about Oz's pronouncements is that he not only fails to identify potential risks to an unwary audience, but he goes so far as to recommend two baby aspirins instead of one despite the paucity of evidence to support his stand. Don't take my word for it. Quoted below is information from the United States Preventive Services Task Force, which gives aspirin therapy prescribed by a physician its highest recommendation. But here's what it writes about the dose:

"The optimum dose of aspirin for preventing cardiovascular disease events is not known. Primary prevention trials have demonstrated benefits with various regimens, including dosages of 75 and 100 mg/d and 100 and 325 mg every other day. A dosage of approximately 75 mg/d seems as effective as higher dosages. The risk for gastrointestinal bleeding may increase with dose."

Two baby aspirins represent 162 mg.

Not good enough for you? Here's the Mayo Clinic's weigh in on the topic quoted directly from their website:

"Should you take a daily aspirin?

You shouldn't start daily aspirin therapy on your own in an effort to prevent a heart attack. Your doctor may suggest daily aspirin therapy if:

• You've already had a heart attack or stroke
• You haven't had a heart attack, but you have had a stent placed in a coronary artery, have had coronary bypass surgery, or you have chest pain due to coronary artery disease (angina)
• You've never had a heart attack, but you're at high risk of having one
• You're a man with diabetes older than 50, or a woman with diabetes older than 60

Although aspirin has been recommended in the past for certain groups of people without a history of heart attack, there's some disagreement among doctors about this approach. Guidelines are changing and have varied between organizations. The bottom line is that before taking a daily aspirin you should have a discussion with your doctor."


Still want another opinion? Here's an excerpt from a gastroenterologist writing in The New York Times:

"February 1, 2010, 11:42 am

A Hidden Danger of ‘an Aspirin a Day’

By THE NEW YORK TIMES

Dr. Neena S. Abraham, a gastroenterologist at the Michael E. DeBakey V.A. Medical Center and associate professor of medicine at the Baylor College of Medicine in Houston, recently took readers’ questions about ulcers, a potentially life-threatening condition increasingly tied to Nsaid pain relievers. Here, Dr. Abraham discusses the potential dangers of taking a daily baby aspirin, which doctors often recommend for those at high risk of heart disease.
An Underappreciated Risk of an Aspirin a Day
By Neena Abraham, M.D.
If your physician has suggested you take aspirin to reduce your risk of heart disease, it is important to remember that even small doses of daily aspirin — including “baby aspirin,” at a dose of 81 milligrams daily — can increase your risk of ulcers and bleeding. It is important to remember that all Nsaids, including over the counter aspirin, have the potential to damage the tissue of the gastrointestinal tract. Damage can occur anywhere, from mouth to anus.
Over-the-counter doses of aspirin, or buffered or enteric coated aspirin preparations, do not eliminate the risk of developing an Nsaid-related ulcer. Your risk for bleeding is still two- to four-fold greater than if you were not taking the aspirin product at all.
This risk increases in magnitude as the dose of the aspirin increases. Some studies have suggested that one-third of aspirin-induced ulcers are related to over-the-counter aspirin use. The excess ulcer bleeding risk associated with aspirin use is estimated at 5 extra cases per 1,000 patients per year.
However, it is important to remember that your risk of aspirin-induced ulcer will further increase if you have high-risk features such as:

• being older than 60,
• having a history of gastric or duodenal ulcer,
• having active Helicobacter pylori infection (the bacterium linked to ulcers),
• taking aspirin at the same time as you take full strength Nsaids (such as ibuprofen, Motrin and naproxen), anticoagulants (such as warfarin) or antiplatelet agents (such as clopidogrel or ticlopidine); or taking aspirin if you are a chronic steroid user.

Aspirin is not a nutritional supplement — it is a medication with real risks and side-effects, so it should not be taken without explicit cardiovascular risk assessment by your physician.
If you and your doctor determine that the benefit of taking aspirin to prevent heart disease exceeds the risk of gastrointestinal bleeding, ensure you are only taking the minimum dose of aspirin required for cardiovascular risk reduction (in the United States, that is a dose of 81 milligrams a day).
If you have high-risk features for aspirin and Nsaid-induced ulcers, as discussed above, discuss with your physician the appropriateness of taking a stomach protecting medication, such as a proton-pump inhibitor. It may also be important to be tested and treated for H. pylori infection to minimize your risk of ulcer formation."

The bottom line is that aspirin therapy may be indicated for certain, if not many patients, under the right set of circumstances. But is it for everyone? Absolutely not. Do you need two baby aspirins? No good evidence to support that position. Should Dr. Oz be telling a national television audience to start aspirin therapy without consulting a physician, and to take two, not one baby aspirins when they do? You be the judge.

I say shame on you, Dr. Oz.

Dr. Oz, Dr. Block and Donuts. Can You Trust Them?

To paraphrase an old English saying, "You can trust a man by the company he keeps." If we accept this notion, then it must also be fair to say a man can be judged trustworthy by considering those in whom they implicitly trust.

On his show last week, Dr. Oz said he "implicitly" trusts Rovenia Brock, a nutritionist with a PhD from Howard University. He made these comments in response to Dr. Brock's statement that it was okay to consume a sweet for breakfast in order to lose weight. She claimed she based her statement on studies that supported her.  In fact, she offered a donut as an example of a sweet that could be consumed and Dr. Oz said he trusted her judgment. (Let's not forget this is the same Dr. Oz who says people should eat regular ice cream. See my previous blog on the topic.)

Before we tackle the question of which study or studies, if any, support this statement, let's analyze the substance of donuts for a moment.  Donuts come in different shapes, sizes, and flavors. There are glazed donuts, cream filled donuts, sugar-coated donuts, etc. Donuts are often fried.  Most donuts have somewhere between 200 and 400 calories with fat often comprising half of the calories. Dr. Brock made no distinction between the type of donut she was recommending and Dr. Oz asked for no clarification. He simply stated he trusted her.

Now let's look at the science.  In the journal Steroids, a paper was published based on research done in Israel that included 193 obese (BMI 32.2±1.0kg/m(2)), sedentary non diabetic adult men and women (47±7years) who were randomized to a low carbohydrate breakfast (LCb) or an isocaloric diet with high carbohydrate and protein breakfast (HCPb). (To read about the study, cut and paste this url: http://www.ncbi.nlm.nih.gov/pubmed/22178258 Meal timing and composition influence ghrelin levels, appetite scores and weight loss maintenance in overweight and obese adults.)

During the study, both groups of subjects consumed the same amount of total daily calories, except one group consumed more calories during breakfast than during other meals. These calories came from both proteins and carbohydrates.  This loading of mixed calories to breakfast resulted in subsequent greater weight loss than those who balanced out calories during the day.

Carbohydrates come in several forms. There are simple and complex carbohydrates and there is soluble and insoluble fiber. A whole grain cereal can be high in both carbohydrates and fiber.  Fiber can be expected to increase a sense of fullness. In fact, a previous study showed that consuming cereal for breakfast results in greater net weight loss. (To read about the study, cut and paste this url: http://www.ncbi.nlm.nih.gov/pubmed/16339127  Dietary intake of whole and refined grain breakfast cereals and weight gain in men.)

So the question is how did Dr. Brock and Dr. Oz make the leap from the Israeli study (which is the only study available to show such results) to declaring on national television that it is okay to consume a donut for breakfast if you want to lose weight.

By the way, at no time did he or she add that doing so required less calorie consumption later in the day. Rather, they implied that doing so would result in less calorie consumption during the day, a fact not supported by the study that required specific adherence to a strict calorie count. The study did show that a larger breakfast with protein and carbohydrates increased satiety for the rest of the day. Wow, imagine that. Eating a big breakfast may make you less hungry later in the day. Where's the news in that? Nevertheless, the study never said you should use fatty donuts as a source of your carbohydrates, so don't.

Furthermore, the researchers did not study what results would be obtained if the breakfast only included protein without carbohydrate. A recent study done in England and published in the European Journal of Nutrition showed that, in fact, consuming protein for breakfast offered more satiety than carbohydrates (in the form of a croissant and orange juice), with ingesting the protein alone resulting in lower subsequent calorie consumption during lunch and dinner. (To read about the study, cut and paste this url: http://www.ncbi.nlm.nih.gov/pubmed/22948783 Variation in the effects of three different breakfast meals on subjective satiety and subsequent intake of energy at lunch and evening meal.)

So why did Dr. Brock and Dr. Oz use donuts as an example.  In my opinion, it's TV ratings, pure and simply.  If they had said you should eat more whole grain cereal as a source of carbohydrate, no one would notice. But say you can eat a donut for breakfast to lose weight and that becomes newsworthy and sensationalistic; people take note.

One can only wonder how many Dr. Oz disciples hastened to follow the show's advice and will now add a donut to their breakfast routine. Poor, misguided souls.

So to answer the question posed in the title, should you trust Dr. Oz and Dr. Brock, I say no. You cannot trust their advice on donuts, and once you can't trust one thing they say, you make the decision regarding what you can trust.

If you want to include carbohydrates in your breakfast meal and want to satisfy your sweet tooth, then include a naturally sweetened, healthy, non-preservative muesli and leave the donuts to mortals foolish enough to take advice from doctors who have sold out to celebrity and TV ratings.