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Everyday, a new medical study is announced purporting to tell the American population how to live, eat, work, play, etc. Some tell you what to do while others caution the opposite. While some studies reaffirm previous studies, many are diametrically opposed. In fact, the more sensational and controversial the headline, the more likely you are to hear about it. This reality gives me constant pause for thought. How does anyone figure it all out in such an environment?

Of course, all studies are not the same. Some are well constructed, scientifically valid, and worth consideration. In previous blogs, I've discussed how to differentiate between good and bad studies.  In a nutshell, a large double-blind randomized controlled study done by a reputable university, not paid for by a commercial interest, done by researchers with no financial conflict of interest is the most trustworthy study.  Most people never read the actual study so they have to rely upon a trustworthy news source for a reasonable interpretation of what the study's results actually mean in practical terms. Even then, results can be reported in such a way to support one bias or another.

Consider this Olympic inspired example. The United States and China were in a contest. The U.S. came second and the Chinese were second to last. Who did better?  It depends. If there were only two participants in the contest, then China came in first, or second to last, and the U.S. came in second, or last. See how not knowing all the facts allows for some clever manipulation. I've seen this happen more times than you would predict.

Why am I telling you all this? The reason is when YOU read about a study that sounds reasonable and valid, YOU would still be foolhardy to implement its finding(s) on your own without consulting a physician. Why? Because no matter how well constructed the study, by definition, studies are limited in the number of variables they consider. They can't look at all the variables that may affect YOU. They don't consider everything YOU eat, what medications YOU take, your medical and family history,  allergies, food sensitivities, age,  gender, race, etc. In other words, they don't know YOU and in fact, the results may have no value to YOU.

For example, cars typically need four wheels. A study was done with cars that had three wheels, but needed four. Adding a fourth wheel improved the performance of the car. The headline blares, "Adding Wheel to Cars Improves Performance." You read this headline and think that adding a wheel to your car will also improve its performance. The only problem is that your car already has four wheels and a fifth wheel not only makes little sense, but may also actually impede your car's performance.

According to the recent issue of Consumer Reports, there are 55,000 dietary supplement products now marketed in the U.S. That's 55,000 reasons for someone to sell you on the value and greatness of their product. These products also often need to advertise/market their products in mainstream media to get your attention. That's a lot of product information coming at you on a daily basis. Who's on the other side of this tsunami of info?  Hardly anyone because there is no money in telling you what not to take. There are only a few of us in the U.S. expressing caution about dietary supplements and virtually none of us gets paid to do so. It's lonely on this side of the aisle, but it's a worthwhile endeavor.

Ultimately, taking advice from a news source without consulting your physician is outright foolish and dangerous. Forgive my bluntness, but I'm tired of seeing so many people fooled into spending their hard earned money on bad products that may actually harm them. Don't be a guinea pig. Discuss your options with your physician and take a rational approach to your health needs. There's only one YOU and you need to take care of him or her by making the right decision for YOU. Got it?

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

Dr. Oz, Green Coffee Extract, and Dietary Supplement Beliefs

In September 2011, John Cloud, a writer for Time Magazine, published an article about his own experience with dietary supplements titled: "Why Most Dietary Supplements Aren’t Worth the Money." Using himself as the subject of his home-based experiment, he took 3,000 pills over a 5 month period to see what effect it would have on his health. Checking his blood at the beginning and end of the the trial period revealed that the "lab rat experiment," as he referred to it, changed nothing except for his weight.

As a result of consuming some twenty pills a day, which he thought must provide some protective health benefits, he rationalized that he had a license to eat poorly, and as a result, gained 15 pounds.  Obviously, this one man study is not extrapolatable, but it is a curiosity.  What effect would these same pills have on the health of others?  The comments posted online in response to Mr. Cloud's article were generally negative. Most responders railed at how he basically proved nothing and failed to recognize the true value of taking supplements.

You may remember my blog on March 18, titled A New Religion Is Sweeping America. I called this religion Supplementum, and it referred to the unshakeable belief that many people hold that the dietary supplements they take are what is keeping them healthy. They have a fervent religious faith in these pills that rivals any other possible religious belief. They often refer to the studies that prove that their supplements are the right ones. By refer, I mean state that there are such studies, but of course, can't produce them.

Everyday, I try to read studies and articles from reliable, and sometimes not so reliable sources about dietary supplements. Often, there are comments associated with such articles, and as with the John Cloud article, the comments almost always vigorously defend the use of supplements based on purported studies. However, I can't usually find such studies (most don't exist!?).  More importantly, when I do, the studies are usually worthless.

For example, Dr. Oz recently promoted Green Coffee Extract as an effective weight loss supplement. It has become a rage on the internet as the next great weight loss product. Oz did so based on quoting a recent study. I believe I found the study to which he was referring. The study involved sixteen people and was performed in Bangalore, India (with some involvement from the chemistry and psychology departments at the University of Scranton).  I found discrepancies in the study and emailed specific questions to the author in India. He actually responded to write that he will be in touch again. I am still waiting.

However, the author of the study made passing reference that upon follow-up (time period not given) to the study, the subjects who had lost weight had kept it off. This doesn't make much scientific sense as the effects should wear off after the study is done. It was also presented as a double-blind randomized control study, but was in fact, a cross-sectional study, which means that all study subjects both received the product (in two different doses) and the placebo at one point, which means that they all lost weight when they took the highest amount and apparently kept it off, regardless of what they received first.  At least a third received the full dose first, and another third received the half dose first.

Ignoring the fact that a 16 person study is essentially nonsensical for scientific validity, other aspects of the study also were illogical. The argument for the green coffee extract is that it prevents absorption of glucose thereby reducing calorie intake thereby resulting in weight loss. By description, it works actively to prevent such absorption. It should work as an active ingredient similar to the short-term effects of drinking coffee.


Again, this makes no sense because if they received the product first, and kept off the weight, what effect did the placebo even have? The study also states that the study subjects may have figured out when they got the placebo and when they got the coffee extract. Not quite a blind study then, huh? Finally, there was no actual description of what the subjects ate during the study.  I think everyone can agree that would make a huge difference on weight gain or loss.

Today, a patient of mine that regularly corresponds with me responded to my advice for her to take a vacation from her daily supplements. She is a true believer in supplements. Her response was that she does for a month whenever she goes for blood work and when she stopped it one time, the pressure in her eyes increased so much she needed surgery from which she is still recovering. Pressure in the eyes is referred to as Glaucoma, and based on my research there is no body of good evidence that any supplements have any effect on this medical condition. (There are studies that show some benefit with macular degeneration, another eye condition, but that's a subject for another day. I also recently heard a leading ophthalmologist trained at the University of Pennsylvania state the same conclusion.)

Nevertheless, she believes wholeheartedly that stopping the supplements caused the increase in pressure. Of course, I can't know for certain that it didn't, but I suspect that it was happenstance because if it happened once, it should have happened every time, and again, there is no science to support her assertion.

As my wellness and preventive medicine practice grows, I often encourage patients to take these supplement holidays and I will tell you that the feedback has been nothing less than euphoric. The blood-work I perform after a month of supplement holiday, just as with John Cloud, generally show no difference. Why?  Because most of what my patients were taking is treated by the body as excess and is excreted away.  (The old joke is that people who take costly dietary supplements have the most expensive urine.)

Interestingly, people who stop the supplements report that they have more energy than they have had in a long time. This is a subjective report and I also don't put much faith in it.  My thinking, albeit not fully confirmed, is that most supplements usually have little to no short-term effect, despite the subjective reports, and mostly negative or also little to no long term effects.  

My biggest concern is for those patients that have become so psychologically dependent on these pills that they have been taking for so long that they are truly afraid to stop them. I really feel for these patients and pray that they ultimately don't do themselves any real long term harm. In the interim, I am delighted to report that the number of patients who wisely are stopping these wasteful and potentially harmful pills continues to grow with no appreciable difference noted in their health or blood-work.

If you are taking such pills, please allow me to prove to you that you also probably don't need most of what you are taking under any circumstances and definitely less so if you make some tweaks to your diet.  As the cartoon above humorously depicts (this was proved in actual study conducted by Cornell University), marketing can be very persuasive. Don't let the supplement marketers and their TV pitchmen have their way with you.  I'm not sure they really have your best interests at heart.

Can We Prevent Aging? National Institute of Aging Speaks

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

Here’s an excerpt from his website about resveratrol:

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

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

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

 

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

The headings include:

Antioxidants

Resveratrol

Hormone Therapy and “'Anti-Aging' Supplements”

Hormone Replacement Therapy

Testosterone

Bioidentical Hormone Therapy

Dehydroepiandrosterone, or DHEA

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

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

On Antioxidants:

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

On Resveratrol:

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

 

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

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

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

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

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

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

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

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

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

 

On Testosterone:

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

On Bioidentical Hormone Therapy:

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

On Dehydroepiandrosterone, or DHEA:

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



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

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

And The Study Showed What?

Virtually not a day goes by that headlines don't blare the results of some new medical studies.  Just today, two studies caught my attention. One showed that even low-dose aspirin is associated with a significant increased rate of bleeding episodes and another showed that ginseng improved fatigue in cancer patients.

As with all studies, these two demanded closer attention to understand if they were even reliable. They were both pretty good studies but not easily applicable to the layperson. They require further consideration based on personal circumstances.  Today, I want to educate you about any study you may come across.  There are seven questions to ask yourself whenever you see a medical related study. I will present each question with some thoughts.

Was it a study in the laboratory, in animals, or in people?

As far as I am concerned, the only studies that truly matter involve people. That's the only way to know for sure how it will affect most people.

Does the study include enough people like you?

If you are an Asian-American and the study was done in African-Americans, it may not be relevant to you. Likewise, if you are Okinawan and the study was done with Ashkenazi Jews. The most relevant studies for you are the ones done in your ethnic group, age group, gender, economic and social level, health state, and disease state. Notwithstanding, studies done in any humans can be expected to have some relevance to all humans.

Was it a randomized controlled clinical trial involving thousands of people?

These are the gold standard studies and can be best relied upon. They are also very expensive to do, so you don't see them often enough.

Where was the research done?

Better research facilities typically do better research. For example, a study done at a top medical school or large hospital system, may have greater resources to perform complicated experiments or have deeper experience with the subject matter. The best studies involve multiple, quality institutions working together.

If a new treatment was being tested, were there side effects?

Authors report results because of an intended consequence. For example, statins lower cholesterol. But they also increase your risk for diabetes. When results are reported, they often play down side effects but these side effects may be highly problematic for you personally. Therefore, don't just focus on what the main thrust of the study was, but also review what side effects it caused.  Sometimes the cure can be worse than the disease. 

Who paid for the research?

This is a big one. Who controls the results? Is there a conflict of interest? For example, is the Cattle Rancher's Association paying for a study to show the health benefits of meat? If so, do they have final say on withholding negative results? Can they repeat the experiment ten times and report the one time it worked in their favor?  Federal government studies, like the National Institutes of Health, or a large foundation not supported or beholden to industry, are the most reliable sources of funding. With new drugs, it's a different story. Clearly, the study is paid for by the pharmaceutical company and they stand to benefit from positive results. However, the results are reviewed by the FDA and there can be a fair amount of reliance that the process has undergone the necessary scrutiny. Notwithstanding, it is an imperfect process that sometimes goes awry. 

Who is reporting the results?

The source of the news about the study may be the most important fact to consider. News media can often distort study results for a certain newsworthy angle. Never rely solely on one source of news regarding a study. Also, be careful of interpretations of studies. Know who is interpreting it and what dog they have in the fight.

Ultimately, the best approach to understanding the significance of any study is to share it with your doctor and to figure out together if it applies to you. I always say, an educated patient is my favorite kind.