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.

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.

Consumer Reports Investigates Vitamins and Supplements: Ten Dangers That May Surprise You

If you haven't seen this yet, I'll let the news release from Consumer Reports below speak for itself. All I can say is Yay! that Consumer Reports is willing to take on the supplement industry and shine the light on the dangers of supplement products. You may want to consider purchasing the latest issue for all the facts.

Release Date: 08/02/2012

Consumer Reports Investigates Vitamins and Supplements: Ten Dangers That May Surprise You

Plus, advice for protecting yourself against hazards associated with vitamins, minerals, herbs, and other nutritional supplements


YONKERS, NY — In a new report in its September issue and online at www.ConsumerReports.org, Consumer Reports identifies ten hazards that might surprise the large swath of American adults—more than 50 percent—who take vitamins, herbs, or other nutritional supplements.
“Patients sometimes assume that supplements are safe because they are ‘all natural,’ but not all supplements are truly natural. In fact, one of the greatest safety hazards to consumers involves supplements that have been spiked with prescription drugs or toxic metals,” said Jose Luis Mosquera, M.D., medical adviser, Consumer Reports, and an internist who specializes in integrative health and medicine.
Consumer Reports identifies ten hazards distilled from interviews with experts, published research, and its own analysis of reports of serious adverse events submitted to the Food and Drug Administration (FDA), obtained through a Freedom of Information Act request.  Here are some of the hazards discussed in the report, plus advice for staying safe:

Supplements are not risk-free.  More than 6,300 reports describing an excess of 10,300   serious outcomes, including 115 deaths and more than 2,100 hospitalizations, 1,000 serious injuries or illnesses, 900 emergency-room visits, and some 4,000 other important medical events, streamed into the FDA from supplement companies, consumers, health-care providers, and others between 2007 and mid-April 2012.  CR notes that the reports by themselves don’t prove that supplements caused the problems, but the raw numbers are cause for concern. Current laws make it difficult for the FDA to order a problem product off the market. In fact, to date, the FDA has banned only one ingredient, ephedrine alkaloids.

Protect yourself: Search the FDA’s website at www.fda.gov for warnings, alerts, or voluntary recalls involving a supplement you are thinking of taking.  If you suspect you’re having a bad reaction to a supplement, tell your doctor. You can also report your problem to the FDA at 800-332-1088 or www.fda.gov/medwatch.

Some supplements are really prescription drugs.  According to Daniel Fabricant, Ph.D, director of the FDA’s Division of Dietary Supplement Programs, dietary supplements spiked with prescription drugs are the “largest threat” to consumer safety.   Many recalled products have the same or similar active ingredients as prescription drugs such as sildenafil (Viagra), tadalafil (Cialis), and sibutramine (Meridia, a weight-loss drug that was removed from the market in 2010 because of evidence that it increased the risk of heart attacks and strokes). Others contained synthetic steroids.  “As a result, adulterated products can cause some of the same side effects and interactions that a consumer may be trying to avoid by opting for supplements instead of prescription drugs,” says Dr. Mosquera.

Protect yourself. Consult your doctor if you are having trouble in the bedroom (it could indicate an underlying health problem).  And try to slim down with diet and exercise.  Build muscle by weight training.  

You can overdose on vitamins and minerals.  Unless your health-care provider tells you that you need more than 100 percent of the recommended daily intake of a particular nutrient, you probably don’t.  Megadoses of the fat-soluble vitamins A, D, E, and K can cause problems, and even some standard doses may interfere with certain prescription medicines.  “Surprisingly, some people may experience adverse effects from even normal doses of a vitamin or mineral supplement, especially patients with digestive issues or those who take blood thinners,” says Dr. Mosquera. 

Protect yourself: Using information from the labels on the supplements and food you routinely consume, add up your daily exposure to everything, and then check CR’s “How much is too much?” table to see if you’re overdoing it.

You can’t depend on warning labels.  For one thing, the FDA doesn’t require them on supplements with one important exception, iron.  In a market basket study of 233 products purchased online and in the New York City metropolitan area, Consumer Reports found wide variations and inconsistencies in labeling.

Protect yourself:  Make sure your doctor or pharmacist knows what supplements and prescription drugs you are taking or thinking of taking.  You can also check for interactions by using Consumer Reports’ “Guide: 100+ Commonly Used Supplements.” To access the free guide, go to www.ConsumerReports.org/health and click on “Natural Health.”

Heart and cancer protection: not proven.  Omega-3 pills and antioxidants are widely thought to reduce the risk of heart disease and cancer, respectively, and millions of women take calcium to protect their bones. But recent evidence casts doubt on whether those supplements are as safe or effective as assumed.  The report notes that the widely held view that fish-oil pills help prevent cardiovascular disease hit a snag when a study of 12,500 people with diabetes or prediabetes and a high risk of heart attack or stroke found no difference in the death rate from cardiovascular disease or other outcomes between those given a 1-gram fish-oil pill every day and those given a placebo.  These findings were published in a June 11, 2012, issue of New England Journal of Medicine online report.  

Consumer Reports also notes a recent blow against calcium supplements by German and Swiss researchers who followed almost 24,000 adults for an average of 11 years.  They found that regular users of calcium supplements had an 86 percent increased heart-attack risk compared with those who didn’t use supplements, as reported in the June 2012 issue of the Journal Heart. 

Protect yourself: Lay off the antioxidant supplements and reduce your cancer risk safely by quitting smoking, avoiding excessive alcohol, and eating a healthy diet that includes plenty of fruit, vegetables, nuts, legumes, and whole grains.

Publication date 08/02/12

© Consumer Reports 2012. The material above is intended for legitimate news entities only; it may not be used for advertising or promotional purposes. Consumer Reports® is an expert, independent nonprofit organization whose mission is to work for a fair, just, and safe marketplace for all consumers and to empower consumers to protect themselves. We accept no advertising and pay for all the products we test. We are not beholden to any commercial interest. Our income is derived from the sale of Consumer Reports®, ConsumerReports.org® and our other publications and information products, services, fees, and noncommercial contributions and grants. Our Ratings and reports are intended solely for the use of our readers. Neither the Ratings nor the reports may be used in advertising or for any other commercial purpose without our permission. Consumer Reports will take all steps open to it to prevent commercial use of its materials, its name, or the name of Consumer Reports®.

Can We Prevent Aging? National Institute of Aging Speaks

On Sunday, I wrote that I would soon discuss reseveratrol. Resveratrol was one of the products that Dr. Oz had inappropriately touted last week as an anti-aging dietary supplement.

Here’s an excerpt from his website about resveratrol:

“You can further protect your body from the harmful effects of inflammation by taking a resveratrol supplement. Resveratrol is a compound found in plants such as the Japanese knotweed, blueberries, peanuts, red grape skins, and others. While resveratrol has been recommended for fighting the physical effects of aging, a brand new study shows it reduced inflammation of the heart in the study's participants by 26%. Taking one 500 mg capsule of resveratrol daily with food will help you maintain a strong, healthy heart.”

By the way, after an hour of searching, I can find no reference to any human “brand new study” regarding resveratrol. In fact, if you examine his words carefully, he doesn’t refer to humans. He only refers to ”participants.” How misleading is that?

After initiating my research into the facts about resveratrol, yesterday, I received a publication from the National Institute of Aging, part of the National Institutes of Health, titled ‘Can We Prevent Aging?’

 

This publication offers a succinct review of all the current “anti-aging regiments available to us beyond a healthy lifestyle. It’s a fairly long publication, so I’ve taken the liberty to excerpt certain key sections under headings that I think would be helpful to my patients.

The headings include:

Antioxidants

Resveratrol

Hormone Therapy and “'Anti-Aging' Supplements”

Hormone Replacement Therapy

Testosterone

Bioidentical Hormone Therapy

Dehydroepiandrosterone, or DHEA

If you read anything I’ve sent you, read this. It’s an excellent up to date summary of the science regarding a number of popular, but unproven methods to decrease or reverse aging. For those of you who don’t have the time or inclination to read it, here’s the National Institute of Aging’s summary:

Until more is known about antioxidants, resveratrol, and hormone supplements, consumers should view these types of supplements with a good deal of caution and doubt. Despite what advertisements on television, the internet, and magazines may claim, there are no specific therapies proven to prevent aging. Some harmful side effects already have been discovered; additional research may uncover others.

On Antioxidants:

Antioxidants protect the body from the harmful effects of by-products known as free radicals, made normally when the body changes oxygen and food into energy. The discovery of antioxidants raised hopes that people could slow aging simply by adding them to the diet. So far, studies of antioxidant-laden foods and supplements in humans have yielded little support for this conclusion. Further research, including large-scale epidemiological studies, might clarify whether dietary antioxidants can help people live longer, healthier lives. For now, although the effectiveness of dietary antioxidant supplementation remains controversial, there is positive evidence for the health benefits of fruits and vegetables.

On Resveratrol:

In one study, scientists compared two groups of overweight mice on a high-fat diet. One group was given a high dose of resveratrol together with the high-fat diet. The overweight mice receiving resveratrol were healthier and lived longer than the overweight mice that did not get resveratrol. In a follow-up study, researchers found that, when started at middle age, resveratrol slowed age-related deterioration and functional decline of mice on a standard diet, but did not increase longevity. A recent study in humans reported that resveratrol may have some similar health benefits to those in animals; however, it is still too early to make any definitive conclusions about how resveratrol affects human health and aging. More research is needed before scientists know if there is a proper and safe dose of resveratrol or if it has any clinical applicability in people.

 

On Hormone Therapy and “'Anti-Aging' Supplements”:

Higher concentrations of hormones in your body are not necessarily better. And, a decrease in hormone concentration with age is not necessarily a bad thing. The body maintains a delicate balance between how much hormone it produces and how much it needs to function properly. Natural hormone production fluctuates throughout the day. That means that the amount of hormone in your blood when you wake up may be different 2, 12, or 20 hours later.

If you take hormone supplements, especially without medical supervision, you can adversely affect this tightly controlled, regulated system. Replacement or supplemental hormones cannot replicate your body’s natural variation. Because hormonal balance is so intricate, too much of a hormone in your system may actually cause the opposite of the intended effect. For example, taking a hormone supplement can cause your own hormone regulation to stop working. Or, your body may process the supplements differently than the naturally produced hormone, causing an alternate, undesired effect. It is also possible that a supplement could amplify negative side effects of the hormone naturally produced by the body. At this point, scientists do not know all the consequences.

Some hormone-like products are sold over the counter without a prescription. Using them can be dangerous. Products that are marketed as dietary supplements are not approved or regulated by the FDA. That is, companies making dietary supplements do not need to provide any proof that their products are safe and effective before selling them. There is no guarantee that the “recommended” dosage is safe, that the same amount of active ingredients is in every bottle, or that the substance is what the company claims. What you bought over the counter may not have been thoroughly studied, and potential negative side effects may not be understood or defined. In addition, these over-the-counter products may interfere with your other medications. NIA does not recommend taking any supplement touted as an “anti-aging” remedy because there is no proof of effectiveness and the health risks of short- and long-term use are largely unknown.”

On Hormone Replacement Therapy:
Here’s what scientists know:

• Endometrial problems—While estrogen helps some women with symptom management during and after menopause, it can raise the risk of certain problems. Estrogen may cause a thickening of the lining of the uterus (endometrium) and increase the risk of endometrial cancer. To lessen these risks, doctors now prescribe progesterone or a progestin, in combination with estrogen, to women with a uterus to protect the lining.
• Heart disease—The role of estrogen in heart disease is complex. Early studies suggested MHT could lower postmenopausal women’s risk for heart disease—the number one killer of women in the United States. But results from the NIH Women’s Health Initiative (WHI) suggest that using estrogen with or without a progestin after menopause does not protect women from heart disease and may even increase their risk.

In 2002, WHI scientists reported that using estrogen plus progestin actually elevates some postmenopausal women’s chance of developing heart disease, stroke, blood clots, and breast cancer, but women also experienced fewer hip fractures and cases of colorectal cancer. In 2004, WHI scientists published another report, this time on postmenopausal women who used estrogen alone, which had some similar findings: women had an increased risk of stroke and blood clots, but fewer hip fractures. Then, in 2007, a closer analysis of the WHI results indicated that younger women, ages 50 to 59 at the start of the trial, who used estrogen alone, had significantly less calcified plaque in their coronary arteries than women not using estrogen. Increased plaque in coronary arteries is a risk factor for heart attacks. Scientists also noted that the risk of heart attack increased in women who started MHT more than 10 years after menopause (especially if these women had menopausal symptoms). There was no evidence of increased risk of heart attack in women who began MHT within 10 years of going through menopause.

• Dementia—Some observational studies have suggested that estrogen may protect against Alzheimer’s disease. However, testing in clinical trials in older, postmenopausal women has challenged that view. In 2003, researchers leading the WHI Memory Study (WHIMS), a substudy of the WHI, reported that women age 65 and older who took one kind of estrogen combined with progestin were at twice the risk for developing dementia compared to women who did not take any hormones. In 2004, WHIMS scientists reported that using the same kind of estrogen alone also increased the risk of developing dementia in women age 65 and older compared to women not taking any hormones. What possibly accounts for the different findings between the observational and clinical studies? One central issue may be timing. The women in the WHIMS trial started treatment a decade or more after menopause. In observational studies that reported estrogen’s positive effects on cognition, the majority of women began treatment soon after menopause. This has led researchers to wonder if it may be advantageous to begin treatment earlier, at a time closer to menopause. Additionally, it appears that progesterone and progestins (progesterone-like compounds) differ in their impact on brain health.

Despite research thus far, there are still many unknowns about the risks and benefits of MHT. For instance, because women in their early 50’s were only a small part of the WHI, scientists do not yet know if certain risks are applicable to younger women who use estrogen to relieve their symptoms during the menopausal transition.

 

On Testosterone:

“The bottom line: there is no scientific proof that testosterone treatment in healthy men will help them age better. Until more scientifically rigorous studies are conducted, it is not known if the possible benefits of testosterone therapy outweigh any of its potential risks. NIA continues to conduct research to gather more evidence about the effects of testosterone treatment in aging men.”

On Bioidentical Hormone Therapy:

“Large clinical trials of these compounded hormones have not been done, and many bioidentical hormones that are available without a prescription are not regulated or approved for safety and efficacy by the FDA.”

On Dehydroepiandrosterone, or DHEA:

“[S]ome proponents claim that over-the-counter DHEA supplements can improve energy and strength and boost immunity. Claims are also made that supplements increase muscle and decrease fat. To date, there is no conclusive scientific evidence that DHEA supplements have any of these benefits.
The conversion of naturally produced DHEA into estrogen and testosterone is highly individualized. There is no way to predict who will make more or less of these hormones. Having an excess of testosterone or estrogen in your body could be risky.
Scientists do not yet know the effects of long-term (defined as over 1 year) use of DHEA supplements. Early indications are that these supplements, even when taken briefly, may have detrimental effects on the body, including liver damage.”
“Researchers are working to find more definite answers about DHEA’s effects on aging, muscles, and the immune system. In the meantime, if you are thinking about taking DHEA supplements, be aware that the effects are not fully known and might turn out to cause more harm than good.”



Conclusion:
Until more is known about antioxidants, resveratrol, and hormone supplements, consumers should view these types of supplements with a good deal of caution and doubt. Despite what advertisements on television, the internet, and magazines may claim, there are no specific therapies proven to prevent aging. Some harmful side effects already have been discovered; additional research may uncover others.

I  hope this information has been helpful and as always, please feel free to share your comments.