Vitamin D and Breast Cancer: Are they married or just acquaintances?

With recent headlines like Vitamin D Enhances Breast Cancer Survival, a woman could hardly be faulted for running out and stacking up on Vitamin D pills.  The meta-analysis study (a compilation of studies) upon which this headline and similar ones are based, was published in Anticancer Research and showed that the higher the Vitamin D level at the time of diagnosis, the better the prognosis. On the surface, this would suggest a cause and effect relationship.  To the untrained eye, one might conclude that raising Vitamin D levels has some type of anti-cancer effect.

However, the evidence to date would suggest that this is not the case. First, even in this study, even women with very high levels of Vitamin D were still diagnosed with breast cancer.  The higher levels of vitamin D simply meant average longer survival. So what do I think is going on?

I believe, and a recent study, which I will discuss in a moment, supports my tentative conclusion, that this is a matter of correlation between vitamin D levels and one's state of health..  As correlation does not imply causation, raising vitamin D levels artificially high with Vitamin D supplements will neither prevent cancer, as the first study clearly showed, nor improve its prognosis. Why?

In a study published in the Lancet, the British medical journal, titled,  The effect of Vitamin D supplementation on skeletal, vascular, or cancer outcomes: a trial sequential meta analysis, the researchers compiled a representative group of Vitamin D studies and divided them into two groups. The first group included studies such as the breast cancer study above that showed consistently that higher levels of vitamin D correlated well with better health and disease outcomes. The second group of studies were double.blind randomized controlled studies that showed that Vitamin D supplementation versus placebo had little effect on overall health.

The authors of this study proffered what they believe to be the plausible explanation for the inconsistencies between the two groups of studies.  They tentatively concluded that raising Vitamin D levels above a certain threshold of adequacy doesn't prevent disease; rather, disease lowers Vitamin D levels.  as applied to the breast cancer study, this means that the women with the highest level of Vitamin D at the time of breast cancer diagnosis were healthier than those with lower Vitamin D levels and therefore had a better prognosis.  The worse the breast cancer, the unhealthier the patient, the lower the Vitamin D level, the poorer the prognosis.

As with all studies, one can reach no conclusive decisions from either of these studies. They merely add to our knowledge. My take-away from these studies is that Vitamin D is essential to human health and having levels above 20 mcg is essential and some say above 30 mcg. is ideal. 

The best way to get your Vitamin D remains 15 minutes of daily sun exposure to your torso/extremities. Alternatively, consuming food products with high concentration of Vitamin D like unsweetened Almond Milk and wild Alaskan Salmon are second, with Vitamin D pills coming in third. If you are taking pills because you absolutely can't do the first two then the recommended daily allowance (RDA) if you are below age 70 is 600 iu. and above age 70 it's 800 iu. That's not a typo. By the way, RDAs were developed to cover 97% of the population's needs. 

Supplementing with levels above these numbers has not been shown to have any benefit so save your money.  Again, this is what the current preponderance of evidence shows.  I'll let you know if something changes. Some large population studies are underway with expected publication in 2016 and 2017 so stay tuned.

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.

What Can You Eat If You Have Cancer?

The other day, I saw a patient who had been diagnosed, a number of years ago, with metastatic breast cancer (it had already spread to the lymph nodes in her arm).  She was advised to undergo chemotherapy, but decided instead to undergo a rigorous process of fruit and vegetable juicing. Here she was now years later standing in front of me with no apparent evidence of cancer.  What is the take away from this story? For me, there is none. Anecdotal stories of cures from cancer by food alone offer no compelling scientific evidence. Perhaps the surgeon had effectively removed all the cancer and that is why the patient had no recurrence?  Perhaps she had a very slow growing tumor that continues to spread but goes undetected?  Maybe the fruits and vegetables actually did make a difference? Nevertheless, there can be little doubt that eating healthy foods helps ward off diseases, but the question remains: can you depend on them for a cure?

The problem is that cancer is a confounding disease and can act dissimilar from one person to another even when it is of a similar histology (micro-anatomy) such as squamous, adeno, or sarcoid types of cells. Also, our bodies immune responses to cancer is also different because of our diverse genetic make-ups. That's why we sometime hear of someone being diagnosed with cancer and then passing away a few short months later, while others with similar cancers enjoy many more years of life. It is also true that certain cancers, such as pancreatic cancer, are often discovered very late in their course and often portend very poor short-term outcomes.  Ultimately, the staging (how extensive it is and if it has spread beyond its primary location) of a cancer really does make a difference. The sooner you find cancer, the more effective interventions usually prove to be.

Yesterday, I spent time reviewing various websites that proffer advice on how to eat properly when one has cancer.  What I found was frightening and I am sure very confusing for someone searching for the right answers. The government based sites recommended eating meat and milk products to maintain strength while virtually every other site discouraged consumption of such food materials because of their links to causing and propagating cancer.  The government sites seem to offer their information on the basis of what the government considers healthy eating.

There can be little doubt of the sway of the Dairy and Cattle Associations on the government's recommendations. This is well established.  Nevertheless, a person with cancer is left guessing which set of directions to follow. Unfortunately, I profess some uncertainty in answering this very question. However, I will try.

Based on everything I have read to date, meat and dairy products seem more problematic than helpful when dealing with cancer.  Fruits, vegetables, nuts, beans, seeds, whole grains, and wild Salmon seem more helpful than problematic.  Sugar, other than the natural fructose found in in fruits (don't confuse with high fructose corn syrup, which is horrible), seems universally bad.

Given the choice between conventional therapies and home grown remedies, I would choose both.  My relative battling cancer has made that very choice. He is being bombarded every day with a heavy dose of juicing which includes pomegranates, papaya, berries, apple, citrus fruits, collard greens, turmeric, cinnamon, etc., while also taking prescribed medicine. He is getting the best of both worlds.

As a side note, the person who prepares his food got carried away one day and tried to sneak some very healthy sardines into his smoothie. Suffice it to say, it did not go well. There are limits to what kind of foods can be combined together at one time and still be palatable.  Cancer patients with taste buds need to at best enjoy their food like everyone else, and at worse, not detest it.  There are ample good recipes for combining healthy ingredients; while some experimentation is encouraged, it is advised to not get carried away such as by throwing blueberries and sardines together.

For example, while recently traveling, I got to enjoy a smoothie of my own. There was an airport kiosk offering a smoothie they called "Habit." It contained fresh squeezed orange juice, whole banana, fresh pineapple, raw kale and spinach, and nothing else other than ice. There was no sugar of any type added and I must tell you it was delicious. I understand why they call it "Habit" because I could get use to drinking one of those smoothies every day.


By the way, on another note, this morning I received an email from Harvard Medical School titled "The Top Health Headlines of 2012." The fifth headline was "Do vitamins and other supplements live up to their promise?"

I read the accompanying article and here is a quote from it worth noting:

"Despite their popularity, there is no evidence that multivitamins enhance health or prevent illness. In fact, both the U.S. Preventive Services Task Force and a National Institutes of Health State-of-the-Science Conference concluded that multivitamins do not offer protection against heart disease or cancer."

Now the truth be told, I don't agree with everything I read from Harvard Medical School because sometimes the information provided is outdated or simply wrong. Therefore the information provided is merely offered as another view about the ubiquitous multivitamins and dietary supplements.  As always, consult with your physician before initiating taking any pills.

In summation, although no one can tell you definitively what foods can stop cancer once it develops, it seems prudent, if you or someone you know find him or herself in that situation, to eat like we ate thousands of years ago when meat and dairy were in short supply, and we lived off the land and ate fresh oily fish.

Are Dietary Supplements and Multivitamins Addictive?

The Merriam Webster dictionary definition of addiction is a "compulsive need for and use of a habit-forming substance characterized by tolerance and by well-defined physiological symptoms upon withdrawal; broadly: persistent compulsive use of a substance known by the user to be harmful."

Psychology Today defines it as "a condition that results when a person ingests a substance (alcohol, cocaine, nicotine) or engages in an activity (gambling) that can be pleasurable but the continued use of which becomes compulsive and interferes with ordinary life responsibilities, such as work or relationships, even health."

Pursuant to such definitions, one who takes multivitamins and supplements would not classically be deemed an addict because he or she doesn't know that such pills may be harmful and typically would not experience physiological withdrawal symptoms from the use of such products.

Yet, I would like to offer an alternative definition of addiction.  My definition is the compulsive use of a substance in the absence of any evidence that the product enhances health or that it is not harmful. Furthermore, my definition includes the use of such a product as a crutch and substitute for otherwise engaging in healthy behaviors such as a health promoting diet, physical activity, stress management, etc.

Under my definition, we have an epidemic of supplement addictions in the U.S.

Over the past year, I have been giving lectures to over a thousand people on why supplements and multivitamins are mostly worthless and may be harmful. Yesterday evening, I gave this presentation to a group of about 70 people. As often happens with this lecture topic, I was peppered with questions both during and after the presentation.

Despite citing specific very large studies that demonstrate potential harms related to the use of such products, I was asked repeatedly if there was definitive proof that taking such products is absolutely harmful. One audience member went so far as to state that she had been taking such products for years and had suffered no apparent harm so why was I certain in my pronouncements. Certain audience members shook their head in agreement challenging me to refute this apparent fact.

As the intensity of the pro-supplement voices rose, I took a deep breath, composed my thoughts and answered as follows. First, I reminded the audience of Mark Twain's quip that "It's not what we know that gets us into trouble. It's what we know for sure that does." I explained that that I could not state with absolute certainty, given the biological diversity of people, that all multivitamins and supplements were equally worthless and/or harmful to everyone.

People have different medical histories, use different prescriptions, engage in different lifestyles, eat different diets, and have different genetic predispositions. Such diversity often challenges and complicates the application of research results to any given individual. Furthermore, some people may actually suffer from a deficiency that for one reason or another can't be addressed simply by regular food. By the way, this is extremely rare.

I also explained that sometimes the evidence of harm can be many years in the making. The development of a mesothelioma, a cancer, may not be evident until thirty years after exposure to a single strand of asbestos. Also, many of the diseases that afflict most western civilization inhabitants such as heart disease, stroke, dementia, etc. do not develop for many decades after steadily engaging in unhealthy behaviors. Even most sugar addicts and cigarette smokers don't develop diabetes and lung cancer respectively for many years of use. (True, some never develop it.)

Yet, something more nefarious was underfoot. I felt like I was suddenly challenging certain people's religious or political beliefs. There was palpable angst in the audience. Then it hit me. Instead of sharing my facts about such products, I should be asking questions.

"Hold everything," I said to the audience, "Why has the burden fallen on me to produce evidence that such products demote health, are harmful, shorten life, etc.?" I further queried, "Why are you not demanding proof of benefit and of no harm prior to spending your hard earned money on products that offer no such evidence?" Why are you blindly following advice from people who have a pure profit motive in getting you to buy their products?"

I shared with the audience an encounter three weeks prior at another such lecture when a Shaklee representative (Shaklee is a multilevel marketing supplement distributor) chimed in from the audience that based on a landmark study it performed, Shaklee offers such proof that it's products are worth the money spent on them.

I've since obtained the study to which he was referring. It is a ridiculous study confabulated by Shaklee to produce desired results. Basically, Shaklee compared selective data they gathered from their affluent product users to data collected by the government from many poor and elderly citizens.  It is not a valid comparison and the study was essentially a worthless (not for Shaklee) piece of marketing propaganda. No surprise there.

The bottom line is that the supplement industry has sowed so much confusion that even doctors no longer know which products are valid, when they are necessary, how much to recommend, etc. As Consumer Reports published in September 2012, there are now 55,000 products for sale and over $100 billion of nutritional products sold each year.

The weight and consistency of the marketing has been so effective that people are no longer asking the most basic of questions. Will this product help or hurt me? Is there any scientific validity to the use of this product for the reason I am taking it? Is it worth the money I am spending?

Since 1994, the law of this land is that supplement product companies need offer no proof of effectiveness to market their products--and so they don't. But like lambs to the slaughter, people continue to line up sheepishly and buy millions of these pill bottles of uncertain value. It is estimated that somewhere between 50 to 80% of Americans now take one form or another of supplement.

The value of these products, now occupying only 80 years of our 150,000 year chronicle (millions more if you include early man), may be the single biggest hoax in mankind's history.

Taking invalidated, potentially harmful supplements may not seem like an addiction to you, but it sure does to me.

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.

Will The Consumer Reports Issue On Supplements Make A Difference?

I have always respected Consumer Reports (CR). It takes no outside commercial money and it runs no advertisements. It simply tells it like it is. Will it's new report on the dangers of dietary supplements make a difference? Probably not.

With an article in the magazine reporting that there are over 55,000 supplement products on the market and with the current law squarely on the side of supplement marketers, allowing them to sell their products with almost impunity and without the need for any scientific validity whatsoever, the salvo fired by CR will probably make little difference.  Supplements have become a big business with reports estimating the industry sales being somewhere between $28 and $100 billion.  They will not go gently into the night.

That's a shame because as CR states frankly, and I've been bellowing for months (see my two YouTube videos titled, Why Supplements and Vitamins Are Usually A Waste Of Money and May Be Harmful, at http://www.youtube.com/watch?v=TzU1UN1Wr0o  and  http://www.youtube.com/watch?v=MSc5xtnPZl0 ), these products are not just a mostly big waste of money, they are potentially harmful.

The most important part of the article by CR is its reference to the over 100 people who died from these products. It is important to get this out in the media stratosphere because supplement marketers often claim their products never kill anyone and therefore there is no harm in taking them. Well they do kill and the numbers are probably much larger than reported because the connection between use of products and untimely death is probably often missed.  I find that patients often forget to mention one supplement product or another that they have been taking. Unlike prescriptions, there is usually no formal record of a patient taking a supplement. (One of the things we do at MDPrevent during an Annual Wellness Visit is make a record of such use.)

At this point, if there is still any single reader of this blog taking even a single supplement without having consulted his or her physician, no matter how many times you read or heard how wonderful it is and how great it makes you feel, please stop immediately. You simply can't rely on information you get from the internet or friends. Anyone who has ever been burned by a stock pick from a friend knows what I mean.

Please, please, please come to your senses and stop relying on pills for your health and salvation. Learn how to eat properly to enjoy the benefits of a healthy and long life. Find a doctor knowledgeable in nutrition and supplements to help you make good choices. It's your life, health, and money at stake. Isn't it worth getting it right?

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®.

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!

Who Knew???

In 1987, during my first year at Harvard Business School, my class was asked to consider a case study of whether or not there was a market for gourmet coffee shops in the United States. The significance of the question rested on the fact that due to Americans' increasing focus on health, coffee consumption had consistently dropped for the previous twenty years. Coffee had primarily been replaced by fruit drinks. We debated the case at length and overwhelmingly, students took the position that coffee was unhealthy, that its consumption would continue to drop, and therefore there was no market for such a product. Well the product turned out to be Starbucks and the rest is history.

This anecdote is relevant for several reasons.  It points out that what most people think doesn't necessarily pan out to be true. Second, the alternative that Americans pursued in place of coffee turns out to be less healthy than coffee. A well constructed, largest study of its type, conducted by Neal Freedman, PhD of the National Institute of Cancer and the National Institute of Health, revealed that  men who drank 2 to 3 cups of coffee daily had a 10% decrease in their risk for death during the 13 years of the study compared with men who drank no coffee. Women who drank 2 to 3 cups of coffee daily had a 13% decrease in their risk for death.

On the other hand, fruits juices proved to be generally unhealthy because many of their nutrients and fiber are removed during the juicing process.  Instead of a beverage full of vitamins, minerals and other healthy nutrients, you mostly get one with highly concentrated fructose, an unhealthy sugar in such large quantities. So it turns out that the health choices of Americans were simply wrong at that time.

This stroll down memory lane offers more than a nostalgic moment. It is a cautionary tale about the dangers of following the masses when what may seem to make sense simply does not. Today, I believe the situation is repeating itself with dietary supplements (and continuing with fruit juices). The idea that supplements are an insurance policy is just wrong. The science simply doesn't support this conclusion. Supplements have a role to play when used judiciously. However, it is estimated that nearly 80% of the population takes one form of supplement or another, with over 40% consuming multi-vitamins.  It is time for the facts to be widely disseminated regarding the dangers of random supplementation. In 1990, the FDA was given the power to do so. By 1994, Congress bowing to pressure from the supplement industry, took it away. We need to give it back to the FDA before real harm is done.

I Just Don't Know

Today's blog has two parts and thought-trains.

Part 1

I typically don't read Glamour Magazine. However knowing my penchant for all things related to vitamins, my youngest daughter was delighted to share an article she came across in the magazine. The gist of the article were the responses from three experts to a question regarding the appropriateness of taking multivitamins after recent studies have suggested they may be harmful.

The first response came from a PhD who works at the Fred Hutchinson Cancer Research Center whose response was basically no, they are not needed. The second response came from a MD and professor of prevention at a Harvard teaching hospital who basically said no except in specific cases like folate during pregnancy shown to avoid birth defects. The third response came from Dr. Michael Roizen, the Chief Wellness Officer of the Cleveland Clinic who basically said yes because people don't eat good diets.

I was infuriated that he answered as he did. I met the man a little over a year ago when I visited the Cleveland Clinic in Ohio. The purposes of the trip was to explore partnership with him and the Clinic regarding my new prevention initiative. (For full disclosure, there were a number of subsequent conversations and correspondences after the trip as I vigorously pursued the opportunity. Eventually, however, I walked away because I found their terms of partnership to be highly lopsided.)

Notwithstanding, during the trip, I had an opportunity to speak to Dr. Roizen in privacy. During that time, which was relatively early in my auditing the field of prevention, I asked Dr. Roizen which dietary supplements he believed stood out among all others and that he would personally recommend for daily consumption. His list included baby aspirin, fish oil, probiotics, Vitamin D, and turmeric.

On the surface, it's not a bad list. Under the right set of circumstances, the first four have clear benefits. However, he did not know my medical history and therefore it was probably imprudent to him to make such specific recommendations, but then again I asked and he was happy to oblige. (Read more about this in part 2 of this blog.) 

For example, aspirin can prevent platelet aggregation (thereby decreasing blood clots) and some studies show some benefit in preventing colon cancer, but aspirin can also increase gastric bleeding and can lead to the development of macular degeneration. Given my history of gastric ulcer, aspirin is a tough choice.

One of my recent blogs dealt with fish oil at length, so just to summarize, its not the panacea everyone has made it out to be and given the option, eating fish like Wild Alaskan Salmon beats it hands-down.

Another one of my blogs dealt with probiotics and an extensive body of research supports my assertion that probiotics have no benefit if you have a generally healthy gut. They can be beneficial when taking antibiotics and when dealing with inflammation of the bowels, but they are not useful routinely.

Many people are apparently (I say apparently because no one knows for sure) Vitamin D deficient because of lack of sun exposure. However, treating anything on presumption, I believe is a mistake. First of all, many foods are fortified with Vitamin D so even though one does not get much sun exposure one is not necessarily deficient. Second, it is easy enough to check for a Vitamin D deficiency and by doing so the result will indicate if you there is a need to supplement and also how much should be taken.

So viewed in their entirety, the first four suggestions from Dr. Roizen were not outlandish as they generally do not cause harm (except for aspirin.) and may be beneficial at times. Tumeric, however, is another story.

Dr. Roizen told me that tumeric prevents Alzheimer's and is good for brain health. Based on Dr. Roizen's suggestion that day (and my hearing him repeat the same advice a few days later on the Retirement  Living TV channel), I naively purchased tumeric and began to add it regularly to my food.

Unfortunately, the highly staining substance turned my teeth bright yellow.  After this disconcerting turn of events, I began intensively researching tumeric and discovered two disturbing facts. First, tumeric has little validated science to support its use for the indications Dr. Roizen asserted. Second, I discovered that in the absence of a black pepper called piperine, tumeric is very poorly absorbed by normal ingestion and so adding it to my food was an effort in futility, except if turning my teeth yellow was my endgame. (By the way, I had to go to a dentist to get rid of the stain.)

Despite these five recommendations, I should have been even more wary of Dr. Roizen's advice when he also practically whispered to me, as to share a well-kept secret, that a certain statin drug had also been shown to decrease the development of Alzheimer's. The whispering should have been the giveaway. All statins are now widely accepted to have no efficacy for such purposes, but I suppose he was depending on some source of information to make his claim.

So now you know why it was disturbing for me to read about Dr. Roizen confidently disseminating advice about multivitamins.

Part 2

After reading Dr. Roizen's comments, I became curious about his background and read his bio available online. I find his credentials to be excellent.  I started thinking why a person like him would spew out what I believe is basically worthless, if not harmful advice, with such certainty. I also started thinking about Dr. Oz, a close friend of Dr. Roizen, (they've authored a number of books together and Dr. Roizen is an adviser to the Dr. Oz Show). Like Roizen, Oz's credentials are also top-notch.

Why, I asked myself, are such erudite men propagating such apparently bad advice about dietary supplements?  Why were they either ignoring or reaching different conclusions that I do from the numerous studies now widely available that show the dangers of dietary supplementation?

So let's assume for a moment that I am reaching the more valid conclusions. If so, what causes them to support the industry? Your first instinct may be to say money, but I dismiss money as the main motivator because I suspect they have already accumulated enough to live quite comfortably and I don't believe that for such distinguished and successful clinicians, it is the end to end all.

So what's the answer? I thought back to a recent episode of The Dr. Oz Show. The guest was a cryptographer (hand-writing expert). As part of the show, the expert analyzed a writing sample from Dr. Oz. His conclusion based on how Dr. Oz forms a wide-open at the bottom scripted 's.' was that this demonstrates that Dr. Oz is very susceptible to the opinion of others. Basically, he concluded that Dr. Oz's popularity stems from his genuine desire to please others. I think most people would agree that this is a pretty good trait to possess.

Let me preface my next comments by stating I have basically no training in psychotherapy. All that follows is conjecture. If you are interested, allow me to speculate why I think this trait of wanting to please others can be problematic especially for physicians in the limelight.

Most physicians are highly intelligent and possess a great deal of accumulated knowledge. Patients know this and expect doctors to be able to routinely answer their questions. However, the body of clinical knowledge, which continues to grow daily, is already far beyond anyone's grasp and that is why there are many specialties and sub-specialties in medicine.

For doctors in the limelight, however, they work hard to create a persona of all-knowing. They want to be viewed as saviors of sorts, able to help both small and wide audiences alike. They never want to disappoint by saying I don't know or I'm not sure.

This realization has caused me to think about my own approach. Until a few weeks ago, I grew more confident in my assertions and more provocative in my conclusions. Then a funny thing happened which I wrote about in another blog. During one of my lectures, an audience member challenged my statements virtually one by one. This forced me to recalibrate and make sure that everything I was saying was defensible. I think my conclusions were generally accurate, but generally was no longer good enough.  I realized after that talk that I was falling into the same trap that I think many before me have fallen into.  I realized that because almost nothing in regards to science can be said with absolute certainty, that it is not fair for someone who can get up and comfortably speak to an audience to assert otherwise.  A speaker should not be expected to always please his or her audience out of expediency if it is the truth that the audience needs and wants.

I believe that many of the doctors like Hyman, Oz, Roizen, etc, say what they say not because it will make them even more money; rather, because it will make their audiences like them more as they offer simple solutions to complicated problems. Some problems require the audience to work hard to accomplish effective solutions and promising quick fixes may be dangerous and inappropriate.

I promise to keep Mark Twain's words close to heart whenever I speak and write. Twain said "it's not what you know that gets you into trouble, it's what you know for sure that does."  Accordingly, as I continue to learn more about dietary supplements, I will work hard to report the facts (if they can be called as much), not my biases. I promise to answer "I just don't know" when that is the most appropriate answer. I think my patients and audiences deserve no less. What do you think?

Is Dr. Oz Doing More Harm Than Good?

It seems that hardly a day goes by that Dr. Oz doesn’t recommend or scare his audience into believing they need a new supplement. On one episode, he alarmed the audience with a statistic that as many as 30% of Americans may have a vitamin B12 deficiency. On a different show, he recommended that people take milk thistle for liver health, and on yet another show he suggested elderberry to treat the common cold. The list goes on and on.  Is his advice always helpful? I don’t think so.

There can be no question about Dr. Oz’s credentials.  He’s obviously a smart and well-trained physician. So why do I have a problem with his almost daily pronouncements?  The answer is because I think they are misguided.  Why?  Without knowledge of a patient’s medical history or current condition, there is no way any physician can provide sound medical or nutritional advice.  One size does not fit all.

There is no question that certain supplements provide critical benefits, which are otherwise difficult to secure in our typical everyday lives. For example, many people don’t get the sun exposure they need to naturally produce Vitamin D and therefore require supplementation.  Vegans may in fact develop Vitamin B12 deficiencies by relying on vegetables and fruits alone as a source of Vitamin B12.  For these people, a B12 supplement might be indicated. Omega three fatty acids confer so many unique benefits that if you are not eating enough fish, krill oil, or flax seed containing these healthy fats, it may be prudent to take a fish oil supplement.

But Dr. Oz’s recommendations, among them, milk thistle, probiotics, and multi-vitamins for everyone, are a mistake and a waste of money.  In fact, a tsunami of recent data suggests that multi-vitamins may in fact, be harmful.  In recent large studies published by the Agency for Healthcare Research and Quality and the Fred Hutchinson Cancer Research Center, the results are the same: multi-vitamins may do more harm than good. And there are many other recent large, quality studies that have reached the same conclusion. 

So if you want to watch Dr. Oz for the entertainment value of his show, that’s great. But under no circumstances take medical advice from anyone on TV, including Dr. Oz, and definitely don’t follow that advice without first consulting a physician or nurse who has intimate knowledge of your medical and surgical history, allergies and current medications, supplements and vitamins. Otherwise you may discover as many of my patients already have - the supplements you take may be worse for your health than the problems that prompted you to take them in the first place.

 MDPrevent