Supplement peddlers, supplement peddlers every where, Nor any drop of truth to drink.

In the Rime of The Ancient Mariner, the epic 18th century poem penned by Samuel Taylor Coleridge, there is a famous stanza: 

Water, water, every where,

And all the boards did shrink;

Water, water, every where,

Nor any drop to drink.

The poetry speaks to the frustrations of thirsty sailors aboard a ship surrounded by uncharted waters they dare not drink. Like the craving sailors, I too long to quench my thirst for truth while surrounded by a rising sea of misinformation.

Although I’m not looking to disturb the tranquility of this relaxing 4th of July holiday, I hope you will forgive my trespass as I call out another pill pushing would be health expert adding more confusion to the churning sea of questionable data.

I previously wrote how you can't believe everything you read and I called it Caveat Lector, which in Latin means "Let the reader beware!"  Of course, the obvious question is then how can you trust what I write, and I acknowledge that this is more than a fair question. My forthright response is that I don't have any agenda other than to improve people's health and make the world a better place.

Most people who read my blog will never be my patient for a variety of reasons ranging from they don't live near my office to they already have a doctor they love.  Also, I don't sell anything so I never have to persuade you to buy something from me or extol its virtues for financial gain. Most importantly, I have been blessed that through my hard work, both during my schooling and my entrepreneurial ventures, and a more than a deserving measure of good fortune, I am financially independent.

Finally, I spent many years in schools, both medical and business, and consider myself a life-long learner in search of truth and understanding.  This search for the truth is first and foremost for my own sake, and I often self-remind regarding the dangers of fooling yourself.
But that is not all that drives me. Although not as religiously observant as I was growing up, I still consider myself a religious person.  Accordingly, having studied the Bible extensively when I was young, I remain ever mindful of the biblical prohibition that states "Do not put a stumbling block in front of a blind person." This biblical phrase is jointly understood to mean that one should not deceive someone simply because he or she can and also that one must be mindful of those at a disadvantage as to adjust one's approach and not take advantage of them.

Therefore, it is with great sincerity and purpose that I challenge many people in this country, doctors and laypersons alike, who seek to deceive others into taking action likely to yield no benefit other than to the person pushing the advice or product. Today, I have a case in point.

A patient of mine sent me this morning a newsletter published by a person named Nan Kathryn Fuchs. Fuchs states that she has a PhD, but despite my best efforts, including reviewing her own website, I could not determine the discipline of her PhD and what university granted it. Interestingly, I am not the first to ask this question as the question was previously posted on the internet and it received no response. So I wrote (Dr?) Fuchs today an email asking about the subject matter of her degree and the source of it, and I await her response.  My research in Fuchs did reveal that she is affiliated with an organization called MSIA.

Here's an excerpt from Wikipedia describing MSIA in which Fuchs is quoted.

"MSIA is a nondenominational and ecumenical church, the stated purpose of which is to "teach Soul Transcendence, which is becoming aware of yourself as a Soul and as one with God, not as a theory, but as a living reality. Controversy has surrounded MSIA: it has been accused of being a cult by some former members and by the Cult Awareness and Information Centre and claims have been made that one of its founders Roger Hinkins had unethical sexual relationships with members. MSIA has also been accused of being an "offshoot" of Lifespring, a private, New Age/Human Potential Training company founded in 1974. According to Nan Kathryn Fuchs, a devoted member of MSIA for 13 years and a minister who served on the Ministerial Board for a number of years..."

I respect the full variety of religious perspectives, but this group sounds illegitimate and cultish, and I can't say for certain based on such little detail. 

So why all the fuss then about Fuchs?  Her newsletter with the heading, Women's Health Alert, had a main article titled, "Are the benefits of supplements real?" The article goes on the quote a new report issued by the prestigious and ethical sounding Council for Responsible Nutrition (CRN) titled "The Benefits of Nutritional Supplements (4th Edition), which found consistent and adequate health benefits from using supplements. 

In fact, here's my favorite quote from Fuch's newsletter.  

 

"For years, conventional medicine has pooh-poohed the need for supplements. They used to say you didn’t need them at all — unless you had scurvy. As people began to see their incredible health benefits, though, the medical establishment had to adjust. But they’ve done so very reluctantly. In fact, some still insist supplements just give you expensive urine.

Well, all the naysayers who insist that nutritional supplements are unnecessary better get ready to make more adjustments in their thinking. The Council for Responsible Nutrition (CRN) has a reply in the form of an updated comprehensive report citing sound scientific studies that prove otherwise."

There is only one problem. By their own description, "The Council for Responsible Nutrition (CRN), founded in 1973 and based in Washington, D.C., is the leading trade association representing dietary supplement manufacturers and ingredient suppliers."

Not hard to imagine that the business trade group representing supplement companies would come out with a report stating that supplements have benefits.  Even if accurate, it would be foolhardy to trust such a report under the circumstances. Fuchs, taking cover under this questionable report, and denigrating the reluctant medical profession (why do you think ii is by and large resistant?) in the process, nevertheless uses it to peddle her own supplements.  

What a surprise. Forgive my sarcasm, but it is just incomprehensible to me that any sane person would read this newsletter seriously, let alone buy a product from Fuchs.

There are many such people in this country trying to peddle unneeded and potentially harmful products on an unsuspecting and trusting populace.  I will continue to identify them and call them out as I come across them. If Fuchs writes back, I will in fairness share her reply about her education.  In the interim, whether from Fuchs or other people who write to tell you supplements are good and then in turn, try to sell some to you, I say Caveat Lector and Caveat Emptor, let the reader and buyer both beware!

Dr. Oz's Zany Zinc Recommendation

Arguably, given his national stage and reach, Dr. Oz is one of the biggest pill pushers in the United States. In the seven months I’ve been watching his show, I cannot remember a week going by without him promoting one dietary supplement or another. 

His favorite recommendations seem to involve some miracle cure or magic pill to lose weight. This past Friday morning, in a repeated episode which first aired September 28, 2011, he made three such recommendations. Today’s blog will focus on the zaniest of the three—his recommendation to ingest extra zinc to support weight loss. Before, I offer some information about the role of zinc in the human body; please indulge me as I provide some additional context for his recommendations.

The tile of Friday’s show was no less haughty than the “Seven Day Miracle Plan to Boost Your Metabolism.” Don’t even get me started on what one’s repeated offering of miracles suggests about the person, but that was the title and here’s what his “miracle” offering entailed. It all started innocently enough. He recommended that people on day one of his seven day plan use an online calculator to determine the rate of their metabolism (how many calories based on your gender, height, weight, and age). To quote the show’s website, “Your basal metabolism represents the number of calories your body burns when at rest, but awake, over the course of one day. This number is one of the factors that determine your total calorie needs for the day.”

On day two, he recommended that people reduce their daily intake by 100 calories. To demonstrate how, he took a bowl of chocolate ice cream (really?) and scooped out about three tablespoons and said that represented about 100 calories. Not exactly the example I would have used, but it could be worse. The problem I had with this example was that he started with a heaping bowl of ice-cream so a mere reduction would not factor in any weight loss diet I know. Also, by using ice-cream and imprecise measurements, he was indirectly advocating that conventional sugar-dense and calorie-rich ice cream is a viable part of a healthy diet, let alone a diet meant to result in weight loss. While I am not a fan of the concept of dieting, I do believe that what and how much you eat do affect both weight and health.

Oz then suggested on day three that you add protein to your diet to lose weight. There is logic to the substitution of protein for carbohydrates in one’s diet (amino acids are essential, while carbs are not) although the source of protein may be contentious. I prefer protein to come from nuts, beans, and wild fish rich in Omegas 3s, but I take no issue with this suggestion.

His day four suggestion is somewhat contentious. He stated that to lose weight you must eat every three hours. He recommended snacking with pistachios and dried apricot. First of all, I don’t agree with the dried apricot suggestion. Although preferable to many processed snacks, I am not a fan of dried fruits due to the increased fructose concentration. Nevertheless, I agreed that people should eat their first meal close to awakening. However, if you wake at 6 or 7 each day, I don’t believe you should snack before lunch.  I do believe in snacking between lunch and dinner with an organic apple, baby carrots, and/or mixed unsalted nuts. But these are my personal preferences and his suggestion to snack every three hours is not completely out of whack.

On day five, he recommended that people drink at least three drinks a day with ice-cubes. Oz claimed that when the body comes in contact with an iced drink, it must consume more calories to warm up the drink. An interesting theory, and one that would suggest that people who live in cold climates burn more calories from daily living, right?  For an interesting review of the subject, please see the article at this link, http://www.chow.com/food-news/54270/does-drinking-ice-water-burn-calories/ .

I cannot attest to the accuracy of the calculations presented in the article, but the article, particularly the last sentence, should give one serious pause about following Dr. Oz’s suggestion.

Oz’s suggestion also included using coffee or green teas with the ice to boost your metabolism. That’s a whole topic for another day (although green coffee extract was already repudiated in one of my blogs last week).  However, the question to ask is even if coffee boosts the body’s metabolism, which it probably does in the short-term after consumption, does that increase weight loss? I could not find any studies to support that conclusion. Also, most people don’t drink their coffee black; rather, they add milk or cream and some sweetener so those additions also affect your metabolism and the net effects of coffee and green tea on your weight. Personally, I don’t find coffee drinkers to weigh less than non-coffee drinkers.  Do you?

Up until this point, Oz’s suggestions were harmless enough. He suggested a quick calculation, cutting calories, eating more protein, eating every three hours, and drinking iced coffees and teas. So at this point I was thinking to myself that although these don’t quite represent a miracle, they were reasonable enough suggestions and most importantly, he hadn’t recommended any dietary supplements. I was actually excited and delighted, but it was short-lived.

Oz then made one of the zaniest recommendations I have ever heard him make. To quote his site,

“Day 6: Take Zinc

Zinc reduces hunger by increasing your level of leptin, a key hormone that alerts the body when you’re full so you won’t keep eating when you’re no longer hungry. You can buy zinc in 15mg packets or simply get it from your multivitamin, which usually contains about 12mg of this essential mineral.”

I was actually on my elliptical while watching the show and I almost dropped my cellphone on which I was taking notes when he uttered his words on zinc. “What???” I thought to myself. “Is that true? Does Zinc elevate leptin? Does elevating leptin actually reduce weight? Is there any science to support any of these assertions?”

Now leptin, discovered in 1994 by studying obese mice, is a known hormone produced by our bodies that acts as an appetite suppressant by suppressing neuropeptide Y, a known appetite stimulant that then suppresses another stimulant and continues down a full cascade (too complicated for this blog).  At one point, leptin held promise as a means to reduce weight, but suffice it to say that numerous studies have failed to support the conclusion that increasing leptin reduces weight. 

Notwithstanding, Dr. Oz took it one step further. He was actually recommending that taking surplus zinc would somehow raise the body’s leptin levels and help one lose weight. I knew at that point that I had a major research project ahead of me to research the facts and discover the truth. After seven hours of research, I discovered what I believe to be the facts.

Before I discuss the leptin-zinc connection, let’s first review of role of zinc in our health.

The Role of Zinc in Human Health

The human body requires certain nutrients that are required for normal body functioning that either cannot be synthesized by the body at all, or cannot be synthesized in amounts adequate for good health and must therefore be obtained from a dietary source. These ‘essential nutrients’ include vitamins, minerals, fatty acids, amino acids, water, and air. (By the way, carbohydrates are not essential because glucose is a byproduct of protein breakdown.) The last among these alphabetically is Zinc, but its importance to the human health cannot be overstated.

It is believed that zinc plays a role for between 100 to 300 enzymes, biological molecules that facilitate and control the rates of human reactions essential to healthy living. Without sufficient zinc, many of these biological reactions would not take place and many illnesses could ensue ranging from depressed immunity, eye and skin lesions, impaired appetite, altered mental function, and defects in how the body processes carbohydrates, to chronic liver and kidney disease, sickle cell disease, diabetes, cancer and other chronic illnesses.  Zinc is very important to say the least.

At the same time as with some, but not all, essential nutrients, excess consumed amounts of zinc may lead to a host of problems such as gastrointestinal disorders, e.g. nausea, vomiting, unpleasant taste, taste distortion, indigestion, anorexia, abdominal cramping, intestinal bleeding, and diarrhea. It may also be unsafe in patients with coagulation disorders or those taking antiplatelet medication, e.g. aspirin,  or other anticoagulants, as zinc may affect platelet aggregation, and it may be harmful due to accumulation in patients taking potassium-sparing diuretics as they are shown to reduce urinary zinc excretion.

Zinc must be used cautiously in patients using thyroid hormones, as based on human research, zinc supplementation may alter thyroid metabolism. Administration of zinc in the absence of copper may cause a decrease in serum copper and iron levels and in individuals with hyperlipidemia or in those taking some lipid lowering drugs, as long-term, high-dose administration of zinc may result in decreased HDL (the ‘good’) cholesterol levels. In animal research, cholestyramine, a bile acid sequestrant, decreased urinary zinc excretion.

To sum the consequences of low doses of zinc, in a review paper titled Zinc Toxicity published in 1990 in the Journal of American Clinical Nutrition, according to the author’s abstract for the paper, “Even lower levels of zinc supplementation, closer in amount to the RDA [recommended daily allowance], have been suggested to interfere with the utilization of copper and iron and to adversely affect HDL cholesterol concentrations. Individuals using zinc supplements should be aware of the possible complications attendant to their use.”

The Leptin-Zinc Connection

Let’s take a quick look at how leptin works.

The hormone leptin has garnered attention as a possible target in the struggle against obesity and being overweight. Your fat cells produce leptin, which suppresses hunger and increases your metabolic rate. In general, the more body fat you have, the higher your blood leptin level. Zinc may affect leptin production, a factor that has led to interest in whether zinc supplementation may boost leptin levels and promote weight loss.

How Leptin Works

The hypothalamus is the part of the brain that is primarily responsible for appetite regulation. The hypothalamus receives many signals from both the central nervous system and hormones that affect your perception of hunger. In general, your leptin level informs your hypothalamus the degree to which you have stored body fat so that when your hypothalamus recognizes a low leptin level as indication of low stored body fat, this triggers increased appetite. An increase in leptin levels sends the opposite message, which normally leads to decreased hunger. As body fat storage levels change slowly, leptin is considered a long-term regulator of body weight and metabolism.

For a good review of the role leptin, please cut and paste this link.

http://onlinelibrary.wiley.com/doi/10.1111/j.1467-789X.2006.00270.x/full

 The Link to Zink

It took me a while to review the state of the literature on Zinc and its relationship to leptin, and here’s what I found. After reviewing some 900 hundred titles of studies for specific information, I found a handful of studies that speak to the issue.

Here was one of them.

Effect of Zinc Supplementation on Serum Leptin Levels and Insulin Resistance of Obese Women 

by Dilina Do Nascimento Marreiro, Bruno Geloneze, Marcos A Tambascia, Antonio C Lerário, Alfredo Halpern, Silvia Maria Franciscato Cozzolino

The conclusion of the study was that nothing basically changed including weight, other than the more zinc consumed, the more zinc was excreted in the urine.

Here was another study:

Zinc Deficiency Reduces Leptin Gene Expression and Leptin Secretion in Rat Adipocytes

by Elizabeth S. Ott and Neil F. Shay

This study focused, as the title suggests, on zinc deficiency. When you have a deficiency it is completely different than when you have a non-deficient state. To use a car analogy, a four wheeled vehicle will have difficulty navigating with three wheels, but it will drive no better (perhaps worse?) with five wheels versus four. By the way, it was a rat study so it doesn’t deserve close merit. Either way, the study’s results do not support the assertion that adding zinc to your diet produces weight loss.

Here’s yet another study:

Relationship between plasma leptin and zinc levels and the effect of insulin and oxidative stress on leptin levels in obese diabetic patients.

by Konukoglu D, Turhan MS, Ercan M., Serin O.

One of the main conclusions of the study was that there was a significant negative correlation between leptin and zinc in obese subjects.

To be facetious, there was not quite Dr. Oz’s conclusion.

Here are the last two studies worth noting.

Zinc May Regulate Serum Leptin Concentrations in Humans

by Christos S. Mantzoros, MD, Ananda S. Prasad, MD, MACN, Frances W.J. Beck, PhD, Susan Grabowski, PhD, Joseph

Kaplan, MD, Connie Adair, RD, and George J. Brewer, MD, FACN

and

Zinc May be a Mediator of Leptin Production in Humans

by Ming-Der Chen, Yuh-Min Song, Pi-Yao Lin

As discussed earlier, a zinc deficiency may, in fact, reduce leptin production. So what? In a small study conducted by Dr. Christos Mantzoros and colleagues and published in the "Journal of the American College of Nutrition," experimentally induced zinc deficiency decreased leptin levels. Reversal of the deficiency with supplemental zinc led to a corresponding increase in blood leptin. Again, knowing that zinc plays a critical role in the functioning of at least 100 enzymes, it should come as no surprise that a zinc deficiency would preclude the body from functioning normally, including producing leptin. However, this shows no correlation to a person with normal zinc levels. Dr. Oz made no differentiation between the two nor gave fair warning that his recommendation was geared towards someone with a possible zinc deficiency. The Mantzoros study participants did not experience weight or body fat changes despite varying leptin levels.

In the Chen study, data from animal research supports the existence of the zinc-leptin link. Ming-Der Chen, Ph.D., and colleagues reported in a March 2000 article published in "Hormone and Metabolic Research" that leptin levels increased when a moderate dose of zinc was fed to mice with experimentally induced diabetes. Interestingly, both zinc deficiency and high-dose zinc suppressed leptin production. Now although this was also only an animal study, that last sentence should make you wince. Dr. Oz is recommending that the average person who wants to lose weight should supplement with 12 to 15 mg of additional zinc when it may, in fact, be associated with the opposite intended effect.

Some research speculates that overweight and obese patients develop leptin resistance, which means increasing leptin level may have no affect on the hypothalamus.

One more study for consideration:

"Obesity Research;" Relationship Between Circulating Leptin and Energy Expenditure in Adult Men and Women Aged 18 Years to 81 Years

by Susan B. Roberts, Ph.D., et al.

In her 1997 article," Susan Roberts, Ph.D., and colleagues also found no association between blood leptin levels and energy expenditure, a measure of metabolic rate. These findings again suggest that other factors than just leptin play a role as major regulators of appetite and body weight.

So here’s the only logical conclusion one can reach, as Dr. Oz likes to say, “in case you missed it,” taking zinc to increase your leptin levels in the absence of a zinc deficiency has no expected benefits and potential harmful side effects.

A thorough review of the data and research by Dr. Oz and his, I suspect, substantial staff would have reached the same conclusions if they bothered to do the same level of research.

To add insult to injury, as if the zinc recommendation wasn’t bad enough, Oz went so far as to recommend two additional dietary supplements on Friday’s show as additional ‘metabolic boosters.’ They included, white bean extract and L-arginine, neither of which has conclusive scientific data to support its use for boosting metabolism.

This show was a perfect example of Oz piling fiction on truth to create the impression that he had something unique, what he calls a “miracle,” to offer to his audience. Let's not forget that in his world most things also happen in seven days. (Hmm, miracles and seven days. I wonder what he's trying to tell us?)  

Dr. Oz should stick to giving health advice that doesn’t include dietary supplements because when it comes to such supplements, neither he nor his staff seem able to do meaningful research to ferret out the truth and offer sensible recommendations to his audience.  Perhaps they know the truth, but there may be something more nefarious at play here such as financial consideration and greed. It is hard to know what is in a man’s heart, but what’s on his TV show leaves much to be desired. 

Although zinc deficiencies are rare among Americans, here's are two tables with information on zinc offered for your reference. 

Table 1: Recommended Dietary Allowances (RDAs) for Zinc [2]

Age	Male	Female	Pregnancy	Lactation
0–6 months	2 mg*	2 mg*
7–12 months	3 mg	3 mg
1–3 years	3 mg	3 mg
4–8 years	5 mg	5 mg
9–13 years	8 mg	8 mg
14–18 years	11 mg	9 mg	12 mg	13 mg
19+ years	11 mg	8 mg	11 mg	12 mg

* Adequate Intake (AI)

Sources of Zinc

Food
A wide variety of foods contain zinc (Table 2). Oysters contain more zinc per serving than any other food, but red meat and poultry provide the majority of zinc in the American diet. Other good food sources include beans, nuts, certain types of seafood (such as crab and lobster), whole grains, fortified breakfast cereals, and dairy products.
Phytates—which are present in whole-grain breads, cereals, legumes, and other foods—bind zinc and inhibit its absorption. Thus, the bioavailability of zinc from grains and plant foods is lower than that from animal foods, although many grain- and plant-based foods are still good sources of zinc.

Table 2: Selected Food Sources of Zinc 

Food	Milligrams (mg) per serving	Percent DV*
Oysters, cooked, breaded and fried, 3 ounces	74.0	493
Beef chuck roast, braised, 3 ounces	7.0	47
Crab, Alaska king, cooked, 3 ounces	6.5	43
Beef patty, broiled, 3 ounces	5.3	35
Breakfast cereal, fortified with 25% of the DV for zinc, ¾ cup serving	3.8	25
Lobster, cooked, 3 ounces	3.4	23
Pork chop, loin, cooked, 3 ounces	2.9	19
Baked beans, canned, plain or vegetarian, ½ cup	2.9	19
Chicken, dark meat, cooked, 3 ounces	2.4	16
Yogurt, fruit, low fat, 8 ounces	1.7	11
Cashews, dry roasted, 1 ounce	1.6	11
Chickpeas, cooked, ½ cup	1.3	9
Cheese, Swiss, 1 ounce	1.2	8
Oatmeal, instant, plain, prepared with water, 1 packet	1.1	7
Milk, low-fat or non fat, 1 cup	1.0	7
Almonds, dry roasted, 1 ounce	0.9	6
Kidney beans, cooked, ½ cup	0.9	6
Chicken breast, roasted, skin removed, ½ breast	0.9	6
Cheese, cheddar or mozzarella, 1 ounce	0.9	6
Peas, green, frozen, cooked, ½ cup	0.5	3
Flounder or sole, cooked, 3 ounces	0.3	2

* DV = Daily Value. DVs were developed by the U.S. Food and Drug Administration to help consumers compare the nutrient contents of products within the context of a total diet. The DV for zinc is 15 mg for adults and children age 4 and older. Food labels, however, are not required to list zinc content unless a food has been fortified with this nutrient. Foods providing 20% or more of the DV are considered to be high sources of a nutrient.

The U.S. Department of Agriculture's Nutrient Database Web site lists the nutrient content of many foods and provides a comprehensive list of foods containing zinc.

If you read this far, you deserve this cute video about Zinc. Just copy and paste in your browser, and enjoy!

http://www.youtube.com/watch?v=oAJ4XVmI4dc

A Hodgepodge of New Studies

Making Sense of Two Recent Testosterone Studies:

I am always trying to make sense of the studies I come across. In the past couple of days, I came across two studies involving testosterone, the male hormone. One study showed that overweight men who suffered from hypogonadism (a medical term which describes a diminished functional activity of the gonads, the testes in males) who received testosterone lost weight; the other study showed that men who suffered from hypogonadism who lost weight increased their testosterone to a level where they no longer had hypogonadism (incidence of hypogonadism went from 20% to 11%, about a 50% improvement).

After reading the two studies, I had to ponder for a while how they related to each other and then it came to me. Although I claim no absolute certainty in these conclusions, it seems that for certain overweight men, increasing testosterone, either endogenously (from within) or exogenously (from outside) helps them lose weight. Given the choice, it would seem better to naturally increase a hormone as opposed to getting it from some other derived source. The best way to do so if you are overweight is to change your diet to the a mostly plant-based diet, increase your exercise to moderately-intense 150 minutes per week, and get at least 7 hours of sleep a night.

Are Vitamin D Blood Tests Always Accurate?

Apparently not. A recent study showed that 40% of the time, blood-labs misdiagnose Vitamin D deficiency by reporting lower than actual levels. This may not be true for all labs or all types of equipment used. The equipment/tests that seemed to be the worst offenders were the Architect and Centaur-2 tests. The liquid chromatography/mass spectrometry (LC/MS) test is the gold standard and can generally be relied upon. So the next time you have a test, ask what equipment they are using and consider going to another lab with LC/MS equipment for greater peace of mind.


Is There A Link Between Vitamin B6 and Heart Disease?

A new study shows a link between low Vitamin B6 levels and increased risk for heart disease. The study does not show causality, which means it isn't clear if the low Vitamin6 causes the heart disease or the heart disease causes the low Vitamin B6. It is possible that the inflammation often seen in heart disease may decrease blood levels of the vitamin. Nevertheless, it is important to maintain adequate levels of all vitamins, including B6, so I include the reference table below for your edification.

This table is not meant to be a recommended diet; rather, it is meant to give you a representative sample of sources of Vitamin B6 in regularly available foods.  A healthy diet is one that contains fruits, vegetables, nuts, legumes (beans), whole grains, and fat from fatty fish like Wild Salmon and Wild Cod. It can also include some olive oil, limited red wine, and very occasional chicken or meat. This is often referred to as the Mediterranean Diet and it still seems to pack the most bang for the buck.
Food	Milligrams (mg) per serving	Percent DV*
Chickpeas, canned, 1 cup	1.1	55
Tuna, yellowfin, fresh, cooked, 3 ounces	0.9	45
Salmon, sockeye, cooked, 3 ounces	0.6	30
Chicken breast, roasted, 3 ounces	0.5	25
Breakfast cereals, fortified with 25% of the DV for vitamin B6	0.5	25
Potatoes, boiled, 1 cup	0.4	20
Turkey, meat only, roasted, 3 ounces	0.4	20
Banana, 1 medium	0.4	20
Marinara (spaghetti) sauce, ready to serve, 1 cup	0.4	20
Ground beef, patty, 85% lean, broiled, 3 ounces
Waffles, plain, ready to heat, toasted, 1 waffle	0.3	15
Bulgur, cooked, 1 cup	0.2	10
Cottage cheese, 1% low-fat, 1 cup	0.2	10
Squash, winter, baked, ½ cup	0.2	10
Rice, white, long-grain, enriched, cooked, 1 cup	0.1	5
Nuts, mixed, dry-roasted, 1 ounce	0.1	5
Raisins, seedless, ½ cup	0.1	5
Onions, chopped, ½ cup	0.1	5
Spinach, frozen, chopped, boiled, ½ cup	0.1	5
Tofu, raw, firm, prepared with calcium sulfate, ½ cup	0.1	5
Watermelon, raw, 1 cup	0.1	5

*DV = Daily Value. DVs were developed by the U.S. Food and Drug Administration (FDA) to help consumers compare the nutrient contents of products within the context of a total diet. The DV for vitamin B6 is 2 mg for adults and children age 4 and older. However, the FDA does not require food labels to list vitamin B6 content unless a food has been fortified with this nutrient. Foods providing 20% or more of the DV are considered to be high sources of a nutrient.

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?

MDPrevent

What Do You Put Your Faith In?

Many things are done on the basis of faith. Religion is one example, relationships are another.  However, proper practice of medicine should be based on evidence not blind faith.

Making the headlines yesterday was the United States Preventive Services Task Force recommendation that doctors discontinue routine testing for Prostate Specific Antigen (PSA) in healthy men. This recommendation was based on two studies, one which showed no difference between men tested versus not tested, and the second study which showed that among tested men, there were many false positives that led to further unnecessary testing e.g. biopsies, which led to complications e.g. infections.

Not surprising, many urologists and oncologists came out against this don't test recommendation. What's the answer? My view is that if you have symptoms, you should test, and if not, you should not test. I believe this is true in many medical situations not because I have an opinion but because the facts support that conclusion.

Yesterday, I exchanged a number of correspondences with a lady on LinkedIn regarding the need to test everyone for Vitamin D deficiencies.  She emphatically believes that it is necessary to test everyone because most people who don't take Vitamin D supplements are deficient; I don't agree.  My reason for not agreeing is because that's not what the science shows. As I wrote the other day about Vitamin D and The Endocrine Society, the facts are inconclusive as to the effects of mega-dosing with Vitamin D. This lady insisted that she needed twice the normal lower level of Vitamin D to be healthy. It's not surprising that so many people are confused by what they need because rumors and false information often circulate unabated without correction about supplements. You may remember my blog titled Supplementum, The New Religion. It was a parody of Americans' growing blind faith in supplementation in the absence of compelling evidence.

I can understand why many put their faith in things that aren't true. We sometimes just want to believe; sometimes we just need to believe.  Oftentimes belief is a good thing if it gives you solace or helps you navigate an often confusing world. That's all fine as long as such belief does not lead to dangerous situations and irreversible harm. While I believe that it is important to be vigilant, I don't believe that it is proper to test for no reason. In the Longevity Project book, the authors concluded that a little bit of neuroticism is good for your long term health, but chasing diagnoses in the absence of symptoms is full blown neuroticism and that's not healthy.

My biggest issue with supplement marketers is that they give people false hope by promoting science fiction as fact, when there are better solutions available that won't be pursued because of reliance on placebo-like products. If people had all the facts, the supplement market would be a fraction of its size and it knows it. That's why it fights the FDA with everything it has because the FDA wants the facts to be known.

Faith works, but when it comes to your health, I think you would be better off relying on evidenced based medicine. I know I do.