Do Multivitamins Prevent Cancer? Part 2

The media is having a field day with the recent study titled Physician Health Study II (PHS II) which claims that multivitamins may slightly decrease cancer rates among men.  If you simply read the headlines and you are a man that wants to decrease your risk of developing cancer, you would think that you should immediately run out and buy a multivitamin, and if you are taking one, you should keep taking it.

Don't!

The results are not quite living up to all the hype.

According to the study, after 11.4 years of taking multivitamins, only men, predominantly older than 70, showed mild decreases in certain cancers. In fact, this study included men who had previously been diagnosed with cancer, among whom for some unknown reasons were found the best results.

This study, paid for by the multivitamin manufacturers, including Pfizer, actually showed the following:

Slight increases in prostate cancer (662 placebo takers versus 667 among multivitamin users) and melanoma (89 increased to 100).
Slight decreases in total cancer (1253 to 1195).
Slight decrease in colon cancer (95 to 88).
Total mortality (death) slightly decreased from 1,134 to 1,092. That means for over 13,000 total men in the study, there were still over 2,200 deaths and only a decrease of 42 total deaths.

Get this. By my calculation, over 26,000,000 (million) pills over 11 years were taken by 6,660 men to spare 42 deaths. Ouch!  No wonder the drug companies want to push the results of such a study.

Basically, the men who took a daily multivitamin for over 11 years so no improvement in prostate, colon, and bladder cancer and no change in their overall cancer mortality. Also, a careful review of the study shows that the multivitamin users were also slightly less likely to smoke and slightly more likely to eat fruits and vegetables.

Finally, the study did not identify if any of the men had vitamin deficiencies prior to the start of the study. As they focused on physicians, who generally work long hours, there is a high probability that these men spent little time in the sun and therefore had an increased risk of Vitamin D inadequacy or deficiency.

Ladies and gentleman, overall, this study and the numbers presented basically prove nothing. With the overall cancer rate decreasing from 18.4 to 17.6 for every 1,000 years, there remains no reason to believe that multivitamins offer any benefit in the absence of deficiency.

The bottom line is that most importantly, despite taking a multivitamin every day, about 20% of the men still developed cancer and about 20% died.  Save your money!


So once again you are chastened to remember, Caveat Lector! (Let the reader beware).

Do Multivitamins Prevent Cancer? Part 1

If you are tuned in to health news, you may have heard about the new study that showed that among older men who took multivitamins, the incidence of cancer was reduced by 8%. Just like the studies that showed increased death rates in women who took multivitamins, this study failed to control for overall health.  

Therefore, when considering the relevance of these findings one does not know if the results were due to cause and effect or coincidence.

Undoubtedly, almost everyone, including the authors of this study, agree that foods that contain such multivitamins in their natural form as those studied have value in cancer prevention. Therefore, without controlling for the diet of the subjects of this study, one cannot reach conclusions whether the moderate reduction in non-prostate cancer rates (there was no reduction in prostate cancers, which represented half of the cancers that developed) we're due to pills or food.  Also, the study did not identify those who had nutritional deficiencies that can impair proper immune system functioning that can lead to cancer growth. 

Furthermore, this research was paid for by companies that provided the vitamins used in the study, which always raises red flags. 

So what's the take-away?  Eat whole foods like vegetables, fruits, nuts, beans, whole grains and wild salmon that contain all the essential vitamins, minerals, fatty acids, and amino acids our body needs that exist in a presumed synergistic relationship with hundreds of other nutrients and avoid synthetic pills of isolated chemicals.

But don't take my word for it. Tomorrow I will give you the actual numbers from the study and you can reach your own conclusions.

Super Immunity - Not!

When I hear the word "Super," my thoughts race back to my childhood and my dalliance with  Superman, the DC Comics superhero from the planet Krypton who gains super powers from exposure to our sun. We all know the old rephrase that he's "able to leap tall buildings in a single bound, faster than a speeding bullet, more powerful than a locomotive." We also all know that he's a fictional character and such powers simply do not exist. Yet, like my older brothers, I could not get enough of the comic books and TV shows featuring the super fellow and other super heroes.  Everyone loves the idea of something super.

During my residency, the word "super" took on new meaning. Whenever I needed a lab result right away, I would write that I needed it STAT. However, I found that since every resident would write STAT on every blood work request, the lab began to dismiss the qualification. It then became necessary to write "SUPER STAT" to try to differentiate my request from the others. Soon, all my fellow residents were equally connoting "SUPER STAT" on each request and that too lost significance. It then became a game of how many "SUPERs" you could add before STAT. It wasn't uncommon to see "SUPER SUPER SUPER SUPER SUPER SUPER STAT" on a lab slip. The lab techs, I am sure, got a good chuckle, from our efforts of one-upmanship.

Today, "super" seems to have a new affixation. People love to attach it to all sorts of concepts related to health and nutrition. Case in point is a new book just featured on The Dr. Oz Show (yes, he's back for a new season) titled Super Immunity by Dr. Joel Fuhrman. In general, I think Fuhrman is a highly reputable doctor who fully understands the value of healthy eating. Notwithstanding, I have to take exception to his, or anyone's, concept of super-immunity or super foods or super anything for that matter. The reason is that I can find no evidence whatsoever to support the concept of super immunity or super foods. From my perspective, a food is either health promoting or it is not. It either supports a healthy immune system or it does not. You get the drift.  I don't know about you, but I don't want my body to do anything but function properly and that includes my immune system. In fact, I love wild Salmon, but I would never call it a super food (because it's not--it's just a healthy source of protein, fatty acids, etc.).

You may think this is a question of semantics, but I think there is much more at stake here. Dr. Fuhrman would be the first to tell you that eating properly is not a question of adding healthy foods to your diet; rather, it is a matter of building a foundation of healthy foods. Yet, when you suggest to the public any suggestions of quick fixes, eg. super foods, you run the risk of people thinking that they can balance unhealthy foods with such super-foods. This is how people are confused into believing the popular adage that eating healthy means "eating in moderation." Bad foods will often neutralize the benefits of healthy foods, super or otherwise.  Moderation simply doesn't apply to certain foods like trans-fats, sucrose, high fructose corn syrup, etc.

A writer, speaker, or doctor must choose his or her words carefully as to not mislead the reader, listener, or patient. I know this from first-hand experience. Through my lecturing, I have learned the importance of choosing the right words so as to not lead listeners to wrong or invalid conclusions. For example, I can't make a general statement that medications are bad (although not a fan of many due to indiscriminate use, many medications serve useful purposes) for fear that someone may stop all their medications inappropriately. I know because this has happened. Nevertheless, I heard Dr. Fuhrman make such a statement on the Oz show. I also can't say that a little bit of neurosis about one's health can contribute to longevity because someone may take that as a reason to start obsessing about every facet of their health. I know that because unfortunately that also happened.

Some doctors may feel it is appropriate to take liberties with superlatives like "Super" to grab attention with the good intention to deliver important information. (Isn't the road to hell  paved with good intentions?) I feel it strains credibility and undermines the ultimate message.  Let's leave "Super" to Superheroes and let's stick to science instead of science-fiction when it comes to dispensing health advice. Otherwise, it won't be long before you see a book with the title SUPER SUPER SUPER SUPER SUPER IMMUNITY trying to grab your attention.

What A Difference A Day Makes

Over the past few months, the big health related news was the Institute of Medicine's report regarding the increasing percentage of obese Americans. The expected increased girth of the nation raised alarms because of all the other medical problems that are likely to ensue.  Unfortunately, we will not have to wait because a new medical report by Virginia Fried and colleagues was just released by the U.S. National Center for Health Statistics, part of the U.S. Centers for Disease Control and Prevention. The report titled, NCHS Data Brief, "Multiple Chronic Conditions Among Adults Aged 45 and Over: Trends Over the Past 10 Years," is truly frightening. 

According to new research, between 1999-2000 and 2009-2010, the number of Americans aged 45 and older with two or more chronic conditions has grown, with senior citizens especially at risk of developing both diabetes and high blood pressure. The study reveals that the percentage of Americans in the 45 to 64 year age group with two or more of the conditions grew from 16 percent to 21 percent and in the 65 and older age group, the percentage increased from 37 percent to 45 percent.

The report also revealed that 23 percent of adults aged 45 to 64 with at least two chronic conditions -- out of the list of nine -- either didn't receive necessary medical care or delayed it because of cost. That's up from 17 percent a decade earlier. The percentage of people in that group who didn't get necessary prescription drugs due to cost also grew from 14 percent to 22 percent over the period. Isolating individual conditions in people aged 45 or older, high blood pressure grew from 35 percent to 41 percent, diabetes from 10 percent to 15 percent, and cancer from 9 percent to 11 percent.

The most troubling part is that these numbers are expected to get even worse.  But I have reason for hope because of someone I spent time with today.

I met with a patient of MDPrevent today who has been participating in our LEAN Weight Loss program.  Prior to starting the program, her cholesterol was about 230, her fasting blood sugar was around 120, and her body mass index (BMI) was over 30. In the span of a few months, she has shed 16 pounds, dropped her BMI to 27.5, dropped her cholesterol to the 160s, and her fasting blood sugar to around 105. She accomplished this without any medications, surgery or supplements. She did it simply by changing the way she eats based on what she learned in our program. The best news is that her program was covered 100% by Medicare so it didn't cost her a penny.

Starting a new practice over the past couple of years has had its challenges. However, today it all came together when I witnessed first-hand again what a profound effect a change in lifestyle can have on someone's health. I am so proud to be part of such an effort and take great satisfaction in knowing that our team of Preventioneers are truly making a difference one life at a time. The best news is that our program is covered 100% by Medicare for those who qualify.

Busting Myths: Does Dr. Oz Have A Monopoly?

Yesterday, I wrote about Dr. Oz's suggestion to snack with up to 200 calories two hours before eating your dinner in order to lose weight. There seemed to be no good logic to doing so. Imagine my surprise when today I get an email from RealAge.com, which is at least partially owned by Dr. Oz (see http://www.realage.com/press-release-sharecare) with the headline, "3 New Weight Loss Myths Busted."

Here is my favorite myth the article clams to bust.

"Myth 1: Eat five mini meals throughout the day.
The initial idea was to eat small, healthy amounts of food every couple of hours to keep blood sugar levels steady and energy high. The trouble is, many people end up eating what amounts to five full meals. "I find that people do much better when they sit down and have three balanced meals a day with two small snacks in between," says nutrition counselor Katherine Tallmadge, MA, RD. "Real meals stave off hunger. If you eat tiny bits throughout the day, you're hungry all the time."

This is diametrically opposed and mutually exclusive to Dr. Oz's concept of eating a small meal, which he calls a 200 calorie snack, two hours before dinner. Which is it? He probably doesn't even know, but busting myths seems to be one of his favorite concepts on his show. It's as if he has a monopoly on doing so. However, I never thought that in the span of one week, I would see him connected to both creating and busting a myth.

Here is another myth supposedly debunked by the article.

Myth 2: Eat less by using small plates. Studies have shown that large plates lead to more eating because they make portions look smaller, but the small-plates idea only works if there's a limited amount of food to put on the plate. In a recent diet study at Texas Christian University in Fort Worth, Texas, 10 overweight and 10 normal-weight women were randomly assigned a large or small plate for eating lunch on two different days, then allowed to serve themselves. The result? The ladies ate until they were full, regardless of plate size. "Make what you need, or measure the amount before putting it on a plate, then put things away," recommends Tallmadge, who was not involved in the study. "It's having easy access to food that keeps you eating more."

Contrary to what RealAge would have you believe, there is actually science that confirms the small plate approach to weight loss. See http://smallplatemovement.org/doc/big_portions.pdf for a review of the science. Brain Wainsink of Cornell University is one of the leading food investigators in the U.S. After reading his book, Mindless Eating, I am more inclined to trust his studies over the new study. I also know it works because it worked for me. I switched from a larger to a smaller bowl for my breakfast and never missed a beat on my way to a 20+ pound weight loss. Either way, with the conflicting study results, I hope you agree that this does not fall into the myth-busting category; however, it should fall into the sensationalistic headline one.

Here's a quote from Dr. Oz's website under the title "5 Diet Myths Making You Gain Weight" about the small plate issue:

"Dieters have been advised to eat from smaller plates in order to limit the amount they eat. Why? Because smaller plates make regular portions look larger. However, new research published in the Journal of Human Nutrition and Dietetics found that plate size had no impact on the calorie consumption of either normal weight or obese individuals. Despite these findings, Dr. Oz still recommends using small plates to help guide you in terms of how much you eat. But use them the right way – a small plate is not an excuse to pile on food vertically or go back for seconds."

So what are we expected to trust? The Dr. Oz Show or a website Dr. Oz has ownership in?


The third myth the article purports to bust is "it doesn't matter what meal plan you're on because you'll lose weight as long as you stick to it." Really, any food you eat as long as you stick to it will help you lose weight? The study the article referenced used 5 specific plans. There is definitely more than one way to lose weight, but the meal plan (and total number of calories) will always matter.

It is because of articles such as this one and the Dr. Oz Show that there is so much confusion out there that allows anyone to claim he or she is busting a myth. Besides, I caution trusting anyone that constantly claims they are a myth-buster. Wouldn't it be better if shows and websites just presented the science in layperson's terms and let intelligent people make the decision on their own. I think so. Do you agree?