Dr. Oz says Oops - Again!

Ye faithful readers of this blog know of my disdain for Dr. Oz's almost daily pronouncements about the value of taking one supplement or another. On a slew of recent shows, in the face of irrefutable evidence, the good doctor has started to backtrack on a number of his prior recommendations.

On one show, he cut his calcium recommendation in half. Sounds good, but the recommendation was arbitrary. Instead of explaining to people that they shouldn't exceed a total of 1,400 mg of calcium from a combination of pills and food (emphasis on pills) as the study upon which he referenced showed, he still recommended 600 mg. The study showed that if you get all your calcium from food, there are no adverse effects.  But he couldn't bring himself to flat out state that people should avoid the pills altogether. His show's sponsors and other friends in the supplement industry would not appreciate that call.

On another show he cautioned against using L-Carnitine, an amino acid derivative found in meat and dairy products (such as protein drinks, bars and powders containing whey), which during multiple other shows he readily admitted advocating that people should take it. L-Carnitine has now been shown to be strongly related to development of heart disease.  Nice that he says now to stop, but what about the potential tens of thousands of people who took his prior advice and harmed themselves in the process?

Finally, on a third episode, he cautioned viewers that multivitamins may be harmful because their manufacturers may not adhere to ethical standards of producing exactly what the label states is inside. Read my prior blogs to discover that's the least of the problems with taking multivitamins. Don't take multivitamins unless prescribed by your physician.

So on one hand, we should all be very pleased that the good doctor is willing to admit his mistakes. I know I am. Yet, while he backtracks on some products, he continues to advocate for other products that also lack scientific merit, such as still pushing probiotics for general use. (See my multiple blogs on probiotics.)

It is said that the key to computer artificial intelligence is for the machines to learn, particularly from their mistakes. One would expect no less from a licensed physician. Would it really be too much to ask for him to vet his products,. e.g. requiring conclusive scientific evidence before support their use on national television?

If you are still watching his show, for the umpteenth time I say, enjoy it as entertainment, but under no circumstances follow his advice without first consulting your physician.  If his advice harms you or even kills you, his later disavowal won't do you much good.

Finally, those who watched the shows I just referenced may have noted that while he admitted he gave bad advice, he never apologized for doing so.  Therefore, let me say I am sorry on his behalf.

Vitamin D Takes A Couple Of More Hits

Two new studies challenge the sweeping hysteria about the need to supplement with Vitamin D.

In one retrospective study looking at Medicare records, researchers could find no link between Vitamin D deficiency and macular degeneration. Based on this study, if you are self-prescribing Vitamin D to treat your macular degeneration, I would strongly consider stopping.

The second study involved men with prostate cancer who are on hormone depleting therapy. This therapy can lead to osteoporosis so it was always thought wise for these men to supplement with Vitamin D and calcium. This study shows that not only doesn't adding these two supplements help, but they may actually be increasing the severity of the cancer. That's on top of the calcium's effects on adding to the risk of calcification of the arteries and heart attacks.

So based on this information you would say that it is probably best to avoid Vitamin D supplements. But wait, there's more. In April 2012, a study showed that high dose Vitamin D supplementation in patients with low risk prostate cancer seemed to help the patients do better with lower Gleason scores, one of the biomarkers for prostate cancer. But wait again.  In this study, involving 52 patients, led by D.T. Marshall of the Medical University of South Carolina and colleagues, 55% did better, 11% had no change, and 34% did worse.

My read on such a study is to basically ignore it because the number of participants was too low, a good percentage got worse and we know little else about their diets, etc.

So what's the answer on Vitamin D? I say sun. It's the only natural way to increase your Vitamin D levels. Of course, don't burn yourself, but 15-30 minutes a day strategically spread out should avoid any such problems in most people. However, that may not be YOU, so if you can't spend even that amount of time in the sun, your next best choice is wild salmon. If you can't or refuse to eat wild salmon, then fortified foods are your next best choice before supplements.

Yesterday, I reviewed 300 study headlines on supplements, particularly about their antioxidant effects, on pubmed.com, and read about 40 abstracts of some of the studies. This effort fortifies my belief that supplements just aren't cracked up to be what their manufacturers and marketers want YOU to believe.

But I also confirmed something else. The studies showed consistently that even with fruits and vegetables, once your body has the vitamins, minerals, and nutrients it needs, giving it more does nothing. It's like filling a canister. Once it's filled, any more added is just spillover. The principle here is that more of a good thing is not better when it comes to your nutritional state. That's the biggest problem I think posed by most supplement products. They operate mostly on the principle of get more to play it safe. More vitamins, more minerals, more antioxidants. YOU don't need more that YOU need and as recent studies suggest, more may not be safe for YOU.

The real take away from all three studies quoted above is that Vitamin D supplementation may not be the panacea that many proclaim it is on a daily basis. Tread cautiously, my friends, when it comes to taking supplements and heed the Latin phrase, Caveat Lector, "Let the reader beware." That includes reading my blog with a bit of caution as well. Nothing written here should be construed as medical advice. The only medical advice you should heed is from a doctor that knows your medical history personally and discusses treatment with YOU directly.

Something To Laugh About and More On Vitamin D

It's often been said that laughter is the best medicine, and I couldn't agree more. Therefore, I dedicate today's blog to a funny video that a friend shared with me and my wife. I hope you enjoy it as much as we did.

http://www.youtube.com/watch?v=PypsMk_0QxY&feature=youtube_gdata_player

For those hungry for some science, here's a funny, not in terms of humor, but in terms of being a somewhat ridiculous study that was reported on a few days ago. I have no doubt that the results of the study are already being used to feed the recent hysteria about Vitamin D deficiencies.

Why? I'll get to that in a moment but let me first share what happened with an email I received from a service of the U.S. National Library of Medicine and National Institutes of Health that reported on this new study.

Last week, I took exception to material in another article from the same source that implied that calcium could only be obtained from dairy products, which is far from the truth. Here's a link to another government resource listing many other food sources, albeit not all healthy ones. And while dairy products dominate the list, there are other excellent sources as well. Cut and paste: http://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/

When I wrote to the source of the email, the response was that they simply reported what they received from the newswires. I told them that such a response was a cop-out and that they had a responsibility as a government service to make sure that the information they were disseminating was accurate. We went back and forth in a few emails and the net result was that I received an email from the head librarian in which he essentially disavowed any responsibility for the information being forwarded. I found that quite disappointing.

Nevertheless, I knew that henceforth I have to be careful with anything I received from this source. With that in mind, let’s address the headline of the article in a recent email I received from the same source, which was titled, “Low Vitamin D Levels Linked To Weight Gain in Older Women.” Now any reasonable person would conclude based on this headline that women with Vitamin D deficiencies are generally gaining weight as a result of their deficiency. Well, that’s not what the studied showed.

Quoting from the email, “The researchers followed more than 4,600 women aged 65 and older over the course of nearly five years. The study found the women with low levels of vitamin D gained about two more pounds during that time than those with normal levels of the vitamin.” How about that? A whole two pounds more. Is that consistent with what you expected from the headline? Two whole pounds gained over 5 years? I’m sure we all expected that from the headline, right? That’s not all. Which women do you think gained the weight? It turns out to quote the article again, it was the “women [who] generally weighed several pounds more to begin with, the researchers noted.” So the heavier women gained more weight. Not a big surprise that an overweight person would gain more weight as is often the case.

But that’s not the funny part I referenced earlier.

Here’s the funny, or not so funny, part. The article goes on to say, “Although most of the women in the study were not trying to lose weight, over the course of the study 27 percent of the women lost more than 5 percent of their body weight and 12 percent gained more than 5 percent of their body weight, the researchers noted.”So despite the vitamin D deficiency or perhaps because of it, which apparently according to this study was present in 78% of the tested women, more women actually LOST weight than gained it.

Accordingly, why wasn’t the headline “Low Vitamin D Levels Linked To Weight Loss in Older Women” or even “Low Vitamin D Levels Linked To Weight Gain, Weight Loss, and No Weight Change in Older Women.” Now that would have been an accurate headline.

So was the article a total loss? No. Here’s the only semi-reasonable comment coming from the article and I quote, “"Our study only shows an association between insufficient levels of vitamin D and weight gain," study author Dr. Erin LeBlanc, an endocrinologist and researcher at the Kaiser Permanente Center for Health Research in Oregon said. "We would need to do more studies before recommending the supplements to keep people from gaining weight. Since there are so many conflicting recommendations about taking vitamin D for any reason, it's best if patients get advice from their own health care provider."

Finally, a little bit of sense although given the 27% of women actually lost weight it would be more logical to suggest that Vitamin D supplementation should NEVER be used as a weight loss tool.

So as I often recommend, please don’t trust headlines, even from government sources. You need to, at a minimum, read the entire article and ideally, look at the actual study if you want to even get close to the truth. Of course, even looking at the study is not a safe bet because so many studies are done by unreliable sources with an agenda, who manipulate the science, if it even is actual science, in their favor.

So what’s a person to do? Send the article or study it to me. I love to look at interesting studies and dissect them looking for the truth. Consider me your personal truth seeker.

Dr. Oz's Vitamin D Recommendation Doesn't Hold Up To USPSTF Review

Yesterday, a patient came to see me again because she was concerned that I had recommended that she stop supplementing with Vitamin D. I had previously told her that she should get her Vitamin D (and fish oil) naturally from eating Wild Alaskan Salmon and other fish rich in Omega-3 fatty acids such as halibut, cod, sardines, anchovies, herring, etc. at least three times a week, and from fortified foods such as unsweetened almond milk.

She had just been to another doctor for the thyroid disorder I had diagnosed who suggested she reinstate her taking Vitamin D. She wasn't happy in general with this particular endocrinologist, but wanted to discuss what to do next with her thyroid disease and his advice about Vitamin D.

I explained again that my recommendation was based on the prevailing science and the fact that she had a very good level of Vitamin D based on her bloodwork.

As fate would have it, in a draft recommendation released yesterday, the United States Preventive Task Force (USPSTF), confirming my recommendation, said there is no value for postmenopausal women in taking supplements up to 400 IU of vitamin D and 1,000 mg of calcium.

The USPSTF also found the evidence too scant to draw conclusions about vitamin D supplements, at any dose and with or without calcium, for cancer prevention in adults.

It was based on an evidence review finding that "in postmenopausal women, there is adequate evidence that daily supplementation with 400 IU of vitamin D3 combined with 1,000 mg of calcium carbonate has no effect on the incidence of osteoporotic fractures. However, there is inadequate evidence regarding the effect of higher doses of combined vitamin D and calcium supplementation on fracture incidence in postmenopausal women."

At the same time, the USPSTF found, doses at or below 400 IU of vitamin D and 1,000 mg of calcium increase the risk of kidney stones, albeit to a small degree.

But with no benefit from the supplements, even the small risk of harm is enough to tip the balance against them at these low doses, the group indicated.

The bottom line is there are no clear benefits of taking Vitamin D and calcium supplements and you can get all the Vitamin D your body needs, in the absence of deficiency, from natural sources including sun exposure, Wild Salmon, other fishes, etc.

Nevertheless, Dr. Oz repeatedly recommends Vitamin D as a top anti-aging supplement.

What are you going to follow: Science or marketing?

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What Did Dr. Oz Leave Out About Strontium?

Let me preface today's blog with a head's up that I spent 5 hours researching this subject before writing the blog. It's a little technical, but I thought the detail was important. 

Although I may have a pretty good handle on the subject, I may also have missed something that wasn't available on the internet. Please feel free to comment if you feel I missed something.

Last Thursday, Dr. Oz told his audience about four supplements, extensively researched by his staff, which he highly touts as anti-aging supplements. The four were resveratrol, vitamin D, fish oil, and strontium. Please see my previous blogs about fish oil (Tuesday, April 10, 2012 titled ‘Et tu fish pills?’) and Vitamin D (Tuesday, March 20, 2012 titled ‘What's The Big Deal About Vitamin D? It turns out quite a bit.’   

At a later date, I'll write about resveratrol. In the interim, please note that one of the leading, if not the number one in the world, resveratrol researcher, Depak Das at the University of Connecticut, was dismissed from his university post because he was found to have repeatedly falsified his resveratrol research data. This has thrown the entire field of resveratrol research into dispute and a major conference that was scheduled in India called Resveratrol 2012 was cancelled late last year as he was one of the top experts expected to present. Enough about resveratrol for now; today, let's have some fun with strontium.

Dr. Oz recommended that women take 680 mg of strontium each day separated from the calcium he also recommends they take.  Of course, he made no reference to recent studies that suggest potential harm from taking calcium (see my blog from Friday, May 25, 2012, 'Calcium Pills Raise Concerns -- Again!'). He mentioned on the show that strontium has been studied in Europe and that the studied form is not available in the U.S. 

Here's what he didn’t share. The form of strontium studied in Europe was strontium ranelate, a synthetic salt that combines strontium with ranelic acid.  The studies done in Europe were good studies and one of the studies was published in the New England Journal of Medicine, a peer reviewed prestigious journal published by the Massachusetts Medical Society and associated with Massachusetts General Hospital, the premiere Harvard affiliated public hospital. See reference below.

The study involved the consumption of 2 grams of strontium ranelate each day for a period just short of five years. The strontium clearly increased bone density on scans and decreased fracture risks in post-menopausal women. It was generally well tolerated except for increased nausea and diarrhea during the first three months of administration.  All study participants also consumed calcium and Vitamin D at different dosages.  As a result of the study, the drug was approved and is only available by doctor prescription for dispensing by a pharmacist to people at high risk of fractures in Europe, and requires strict medical supervision. 

Why strict medical supervision? Strontium competes with calcium and magnesium and displaces them. What that does to your bone health and overall health has not been studied and is unknown.  There are reports that it can cause a condition called osteomalacia, which involves the softening of the bones caused by defective bone mineralization secondary to inadequate amounts of available phosphorus and calcium, or because of overactive resorption of calcium from the bone, often as a result of hyperparathyroidism. In other words, taking strontium may interfere with your normal function of calcium uptake by bones.

A review of comments from users found on the internet included, a doctor “urged caution and told me about the deaths due to 'hypersensitivity syndrome' and a second consultant told me she was still not happy with calculation of DEXA scores.” The reference to the DEXA scores is that when doing the diagnostic DEXA Scan tests for osteoporosis, the test results are apparently skewed by the use of strontium.  There were many comments that indicated no problems.

So why isn’t it available in the U.S.? The answer is because the French company that owns the patent has not pursued FDA approval. The apparent reason for this and the one most often cited is that the FDA would require some homegrown research before approving it and the company doesn’t want to foot the bill. So you can’t get it here.

Of course, some entrepreneurial folks decided that if you can get the synthetic strontium ranelate here, they should cook up some strontium citrate because as it has no synthetic compound involved (ranelic acid is synthetic and citrate is not) and therefore can be sold as a supplement here in the U.S.  How did they come up with the recommended 680 mg dose? Apparently, strontium ranelate contains 680 mg of strontium. How much strontium does strontium citrate contain? I can’t tell you.

Also, what’s the difference between the way citrate and ranelate act in your body? I don’t know and nor does anyone else because it hasn’t been studied. Let’s look at an example of two other different chemical molecules binding together. Sodium when combined with chloride becomes sodium chloride, the salt we eat. When sodium is combined with citrate, it becomes monosodium citrate, a salt used to prevent anticoagulation of stored blood. Different chemicals when combined create different compounds.

So what’s the biggest problem with taking strontium citrate to prevent or treat osteoporosis? Beyond some of the concerns cited above, it’s never been studied and reported on in humans.

There was a study begun in the U.S. at University of California Davis Medical Center a few years ago that was meant to be completed and results reported in 2010, but the study, named the Scope Study, has mysteriously disappeared.  I’m not kidding. There are conspiracy theories all over the internet regarding what happened to this study. Some claim the bisphosphonate companies got to them. Just theories with no evidence whatsoever to support them. My experience is when a research institute goes mum on a study, it’s often due to something going wrong with the study.  Nonetheless, the results never came out. That gives me pause to ever recommend such a drug under such circumstances.  

Furthermore, while strontium ranelate was studied with 680 mg of strontium, studies with far less amounts have never been reported. If it is actually good for you, could less work just as well?

Strontium is present in our food supply. For example, it is available in vegetables such as spinach, lettuce, carrots, peas, beans, potatoes and celery. Wheat, barley and other grains used to make bread also have significant levels of strontium. According to one source I found, flour, grains and breads average 2,150 mg per gram of stable strontium.

So as always, before taking a pill containing a super high dose of a mineral which has not been studied for a prolonged period of time, you should increase your intake of foods containing that mineral that have been used for millions of years.

It is important to remember that high-dose strontium is essentially a bone drug, and, as with all bone drugs, it is only indicated when there is a clear high risk of fracture defined as a 20% likelihood of a major osteoporotic fracture over the next 10 years.

The bottom line is that the long-term safety and efficacy of strontium citrate has not been evaluated on humans in large-scale medical trials.

That’s why once again I say shame on Dr. Oz for recommending it to the general population without good science to support what is available in the U.S. It only serves to make people more anxious and confused that maybe they have misssed something. It is often dangerous to experiment on your own body.

By the way, here are the chemical structures for strontium ranelate and strontium citrate. Do they look similar? If no, it's because they are not. One, ranelate binds with two atoms of strontium, while the other, citrate, only binds with one atom.

Strontium Ranelate 

 

Strontium Citrate

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References:

Meunier PJ, Roux C, Seeman E, et al. The effects of Strontium Ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis. NEJM 2004 350;459 -68

Reginster JY, Seeman E, DE Vernejoul MC, et al . Tropos Study. J Clin Endocrinol Metab 2004–1774. Strontium ranelate reduces the risk of nonvertebral fractures in post-menopausal women with osteoporosis.

Calcium Pills Raise Concerns -- Again!

If you've heard me say it once, you probably have heard me say it many times -- taking dietary supplements in the absence of known deficiency is a mistake. One of the more controversial supplements I've rallied against has been calcium. Most women are told by their doctors, particularly as they get older, to take calcium supplements, usually about 1,000 mg.

When I give lectures, I often ask of the audience whose doctor adjusted their calcium recommendation based on the calcium the individual consumes through his or her food. The answer is almost always that none of their doctors made any such adjustment. I've always considered this problematic because why supplement at all if you are getting sufficient calcium in your diet, and why not adjust when you are getting calcium from other sources.

My real concerns about calcium began to grow almost two years ago when studies began to emerge challenging the wisdom of taking this supplement.  Specifically, these studies linked calcium supplementation with increased heart attack risks. Some studies suggested the mechanism for this, calcium supplements, were contributing to calcification, or hardening, of the heart.

So a new study that just came out should be of no surprise to my patients.

The large European study showed that people taking calcium supplements had nearly double the risk of heart attack as individuals not taking any dietary supplements. Among 23,980 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC-Heidelberg) study, the hazard ratio for heart attack in those using calcium supplements, compared with nonusers of supplements, was increased according to Sabine Rohrmann, MD, of the University of Zurich in Switzerland, and colleagues.

"This study suggests that increasing dietary calcium intake from diet might not confer significant cardiovascular benefits, while calcium supplements, which might raise MI risk, should be taken with caution," the researchers concluded. In an accompanying editorial, two New Zealand physicians went further and suggested that use of calcium supplements should be actively discouraged.
 
This was an imperfect study as it was an observational study that relies on self-reporting. Nevertheless, once again, the red flag rises over taking calcium pills, or any dietary supplement for that matter. The evidence continues to mount that at best they confer no benefit, and at worst, they are harmful.

Eat a Mediterranean diet consisting of fruits, vegetables, beans, nuts, and some whole grains, add in some wild fish and save yourself some money from not buying unnecessary pills.