LiveLongAgeWell

Several weeks ago I detailed some problems with the common over-the-counter pain reliever acetaminophen (otherwise known as paracetamol, and the biggest U.S. brand name is Tylenol). The issue is that this medication, even in what many consumers feel is a safe dose, can lead to permanent liver damage.

Just today there was a big FDA meeting in Maryland, and a number of  recommendations were made (likely to be accepted by the full FDA) which will soon limit your choices for OTC and prescription pain relievers. The committees voted to limit the maximum pill size from 500 to 325 milligrams for acetaminophen, and lower the accepted maximum daily dose to well under the current 4000 milligrams. Further—and significant for many people in chronic pain—it looks like Percocet and Vicodin, two exceedingly popular drugs that mix acetaminophen with a stronger narcotic, will be banned. Read more details here

Normally I publish a post on Monday or Tuesday, and again later in the week. This week has been particularly busy for me, so…sunless tanning, part III of the sunscreen series, will be posted later in the week rather than today. In the meantime, if you are lucky enough to have sun where you are, I suggest you put on a good sunscreen and get outside!

At the end of this post I’ll tell you how you can be considered to enter the study…

If you follow LLAW, you might know that my “favorite supplements” are, currently, fish oil tablets and vitamin D. In various posts I have detailed all sorts of possible benefits from these two supplements, and note that you can get both through natural sources (such as small doses of sunshine, or salmon) as well as from pills (and generally, natural sources are the better option).

The problem is that various other supplements have been heralded in the past as being wonderful and great for a variety of problems, especially for cutting the risk of cancer and cardiovascular disease. But then when really well-designed research studies are done, the supplements often fail to show a good effect, and sometimes they even result in more harm than good.

Vitamin E, folic acid, selenium, and beta-carotene all fall into this category, like Michael Jackson, of “fallen super-stars”, and, who knows, in five years we might be saying the same thing about vitamin D or fish oil (though I doubt it). The type of study that needs to be done—to see if vitamin D and fish oil are really any good—is a double-blind, randomized, prospective clinical trial. This sort of study is not commonly done as it’s expensive and it takes years to see the results.

Such a study starts with a large group of people, preferably many thousands, and splits them up into equal groups, that is, groups that are equally healthy or unhealthy, and then the researchers give some of them an active pill, for example, vitamin D, and the other group a fake pill, a placebo, and then a few years later compare the two groups to see how they did. Best if neither the people taking the drug nor the researchers know who is taking what (“double-blind”), and only break the “code” at the end of the experiment.

But most studies on vitamins and supplements are not like this; instead, they are “retrospective”…the researchers look at the health of different groups of people and look backwards in time (retrospectively) and see what they were taking or doing or eating, and try to deduce if a particular behavior or vitamin or whatever was responsible for the good or bad effect. But this research method leaves a lot to be desired, and it’s one reason you read a study that comes out stating that such-and-such is great, then a year later, you read the opposite. The problem could well be that either study, or both, was poorly-designed, and unless you really dig into an article to see if the study was prospective, double-blind, etc, you don’t know which research to better believe.

So starting early next year Harvard University is going to be doing one of the prospective clinical trials with vitamin D and fish oil (they are calling this the VITAL study). The research will study the subjects for five years into the future (prospective) and see how they all do. In 2016, then, we should know if fish oil and/or vitamin D are good for decreasing the risk of stroke, heart disease, or cancer—the three diseases the research is studying. Now even this is not going to be a perfect study, as it relies on people self-reporting their health via questionnaire (at times inaccurate), and while the researchers try to disguise the placebo pills, some people will try to figure out what they’re taking, try to outguess the researchers, and/or will take extra vitamin D or fish oil or other agents on the side, or not take the pills as they promised to if they think they are placebo.

But still, this study is probably the best we’ll get, and is better than any retrospective study. Here’s your chance to be a part of it… Harvard is now recruiting potential “subjects”. If you are interested in participating, or just want to read more details about this study, click here.

Today’s post is dedicated to the people in the Eastern United States who are now being blanketed with up to 10 inches (25 cm.) of snow, along with temperatures down to 12 degrees F (-11 C)…what a miserable way to start a week. We wish them a quick end to their long cold winter, and now, speaking of “colds”…

If you ask people what vitamin they think of to prevent or treat the common cold, most people will answer: vitamin C. But a review by the Cochrane Collaboration (an international, non-profit group of scientists who develop unbiased recommendations based on analysis of the best accumulated research), found that in most cases, vitamin C has at best a mild effect in preventing colds, and doesn’t do much to treat colds. The biggest benefit was for people exposed to very cold weather or extreme exercise situations.

For sure, the subject of the common cold and vitamin C will continue to be studied and be controversial, but a very new study from Harvard Medical School strongly suggests that people with low levels of vitamin D in their blood get colds significantly more often.  People with a low D levels were 40% more likely to suffer from colds than people with the highest vitamin D levels. And people with pre-existing respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD) seemed to have an even stronger beneficial effect from higher vitamin D levels—people with asthma and low vitamin D levels were five times more likely to suffer from colds than people with high levels. Those with COPD and low D levels were two times more likely to have cold symptoms.

This study was a retrospective analysis (it looked at data from the past), and for that reason the Harvard scientists couldn’t say whether taking additional vitamin D would cut your risk of getting a cold. To know if taking extra vitamin D cut one’s risk of getting a cold, a study would have to start with a large group of people, randomly separate them into two equal groups, then give one group vitamin D pills, and the other group an identical looking/tasting placebo pill, and study over time if one group got colds less frequently. Best if this study was “blinded” to cut the risk of researcher bias, meaning the researchers themselves wouldn’t know which group an individual person was in, so each study participant would be identified only by a code or number, and the code broken only at the end of the study. Such a study has yet to be done.

Still, the lead author in the recent Harvard study, Dr. Adit Ginde, stated “I think we can say that most Americans probably do need more vitamin D for its effects on bone health, as well as for its general benefits with respect to the immune system.” So the reason that vitamin D seemed to help cut the risk of colds is that vitamin D helps strengthen the immune system.

Vitamin D is one of the more difficult vitamins to get from the average diet….stay tuned to LLAW for how to!  (If you want lots of information on how to get vitamin D now, go to the Vitamin D Council link on the LLAW right sidebar under “Nutrition”).

Last week I wrote about how a major research study showed that vitamin C and E supplements were ineffective for reducing the risk of heart disease and cancer. In general, these two vitamins, particularly vitamin E, are falling out of favor in the medical literature. But several others, particularly vitamins D and B12, are gaining more positive reviews in recent research. An interesting study from Oxford University, published in the journal Neurology, showed that individuals with a higher B12 level in their blood had significantly less brain shrinkage as they got older, than people with a lower B12 blood level. (Brain size was measured by serial MRI scans.)

B12 in the diet comes only from animal sources such as meat, including chicken; fish; milk; and eggs. (Strict vegetarians—vegans—require B12 supplements.) Many nutritional experts believe that especially as people are eating less meat, there is a growing crisis of B12 deficiency, and that middle-agers and above need to pay much more attention to B12 intake, either through diet or supplements. I will take up supplements in a later post, but the concern about B12 deficiency is another great reason to regularly eat fish! Salmon in particular is rich in B12. (For much more detail on this vitamin, go to the Nutrition section in the LLAW right sidebar, then click Linus Pauling Institute>Vitamins>Vitamin B12.)

In the next week I will discuss some other ways to help prevent brain shrinkage, at any age, and not through diet or supplements.

Since cancer and heart disease are the number one and two causes of death in the U.S., I would love to report that taking vitamins will lower your risk, but several recent research reports cast doubts at least on vitamins C and E. Actually, these recent studies are part of a research trend showing that many vitamins—taken in pill form that is—have not been as effective as many had hoped for in preventing various diseases.

There is even the suggestion that taking some vitamin pills, particularly the B vitamin folic acid or vitamin E, might increase your chance for certain diseases, but the data is inconclusive and controversial, and further analysis is needed (and being done). Still, caution seems to be in order as far as taking vitamin pills.

At the recent American Association for Cancer Research “Frontiers in Cancer Prevention” meeting, the results of a 10-year long study were presented. This was a randomized clinical trial (the best type of research study), and it followed nearly 15,000 physicians. Some were given 400 IU of vitamin E every other day, some 500 mg. vitamin C every day, and others given placebo (dummy) pills. After a 10-year period the number of cancers was analyzed, and those who had taken the vitamins showed the same cancer rate as those who had taken the placebo. They also measured the rate of heart attack, heart failure, stroke, and angina, and again there was no benefit for the group that took the vitamins.

People who eat a diet full of fruits and vegetables seem to have a lower cancer risk, so it was hoped this long-term vitamin study would show similar benefits. Does this mean that vitamins have no benefit? No, but it does indicate that perhaps the only way to get the anti-cancer and heart-protective benefit, at least for these vitamins, is through your diet, and not through pills or supplements. Most likely there are many more substances in fruits and vegetables, particularly “phytochemicals“, that are more important for disease prevention than the vitamin content.

The status of vitamins in the medical literature will be unsettled for some time; for example, while vitamins C and E are falling out of favor, other vitamins such as D and B12, even in supplement form, are currently showing promise. And keep in mind that today we only considered if these vitamins help decrease the risk of cancer and heart disease; we haven’t touched on other diseases, such as cataracts, where vitamin supplements might be effective. I will discuss this in future posts and more completely in my book.

The trends though in vitamin research indicate this general recommendation: get your vitamins through a diet rich in a variety of fresh vegetables and fruits. Don’t rely on pills. As further vitamin research is released (a good study is underway on multivitamin pills), I will report it here.

Over the years, various vitamins are touted as the having the most wonderful benefits, yet some—such as vitamins C and E—while still important, have lost their super-star status. Now the new darling of the vitamin world is vitamin D, and numerous reports have been published recently linking higher levels of vitamin D (the “sunshine vitamin”) with decreased risk of heart disease, diabetes, even various cancers. Hopes are running high that this vitamin will, over time, maintain its lofty status.

This week’s study showed that people with Parkinson’s disease and Alzheimer’s had lower blood levels of vitamin D, but since this was not a clinical trial, it’s not known if taking more vitamin D will cut the risk of those diseases. Again, more studies are needed. Until then, it seems wise to ensure you are getting plenty of vitamin D either through your diet (not so easy for adults), sunshine, or supplements. This site will keep you informed of the various studies that appear. Much more vitamin D information, including how to ensure you are getting an adequate intake, can be found here (from the very useful Dietary Supplement Index on the LLAW right sidebar).

In a word, yes. They are one of the best supplements you can take for your overall health. Unlike many supplements that are poor substitutes for “real food”, good-quality fish oil pills should give you much of the health benefit of the actual fish they are standing in for.

In my last post I discussed how eating fish can improve your mood and brain function. Beyond that, many recent studies have shown benefits beyond the brain, particularly in decreasing atherosclerosis and cutting the risk of heart attack, keeping triglycerides, blood pressure, and inflammation under control, cutting the risk of macular degeneration in the eyes, and newer studies suggest the omega-3s in fish oil may decrease the risk of Alzheimer’s disease. For a more detailed critical look along with numerous references, check out this issue of Nutrition Action Health Letter.

There seems to be few risks in taking fish oil pills, and lots of potential upside. On days that I don’t eat omega-3-rich fish, I take a one-gram supplement twice a day. Here are some key points:

•    A good dose is 1 gram of a combined EPA and DHA omega-3 fish oil capsule once- to twice-a-day.  A dose over 2 grams per day could cause bleeding problems in some people.
•    Find a high-quality supplement that has been purified and is free of mercury, PCB and dioxin contaminants (this is an advantage of the pills over some fish, which might be contaminated). This Environmental Defense Fund site should help you choose a safe product.
•    Fish oil can cause burping, nausea, even diarrhea in sensitive people. If that occurs, start at a lower dose, maybe one pill every several days, and see if you can build up to one or two pills a day. Try taking it after meals or at bedtime, and sometimes freezing the gelatin capsule will stop the side effects. If side effects persist, try different brands, or just eat more omega-3 rich fish instead.
•    Especially if you have significant heart disease or blood clotting concerns, are pregnant or about to have surgery, check with your doctor before taking this supplement. Fish oil thins your blood a bit (for most people, this is a good thing), but is a concern if you bleed easily or are already on blood thinners.  If you are a vegetarian who does not eat fish, look for omega-3 supplements derived from algae.