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.

The American Medical Association AMA) has issued a report about hormones promoted on anti-aging websites. These include such products as Human Growth Hormone (HGH), DHEA, and testosterone, and they are sometimes available through online websites, or at many stay-young clinics around the world. HGH is one of the most popular, and the AMA states “evidence suggests long-term use can present more risks than benefits”. I agree. The research regarding this product, in particular, is turning more and more negative. I would be very suspicious of anything you take by mouth and especially injections, even of  “natural” products, that promise to keep you young.

Zinc Nasal Products and Loss Of Sense of Smell

Speaking of natural, one of the most popular over-the-counter products sold to prevent and treat the common cold is Zicam spray, and the active ingredient is the metal zinc. Here’s a glowing report from 2003 citing research showing that if you start Zicam within 48 hours of the onset of a cold, your symptoms can be cut by 50%. Now it turns out that the makers of Zicam have received over 800 reports of partial or complete loss of the sense of smell, often permanent. The company has settled 340 lawsuits regarding the product, and many more will be filed. Fortunately, the company has withdrawn many of their products from the market. “Natural” doesn’t mean effective, nor safe. Some of them are, but most probably are not, and like Zicam, can be found to be harmful years later when serious side effect reports roll in. Most are not regulated by the FDA. Buyer beware, even for “natural” over-the-counter products.

Vitamin D and Dieting

Here’s another possible benefit of what is currently the “hottest” vitamin, that is, vitamin D. (You can search on this blog to see the various recent reports.) The latest research, just presented at the Endocrine Society Annual Meeting in Washington, showed that people who had a higher vitamin D blood level before dieting lost a significantly greater amount of weight during their diets than people with lower vitamin D levels, and the higher the level, the greater the weight loss. This doesn’t prove that if you take vitamin D, you will lose weight. More research will be done to see if taking vitamin D supplements allows you to lose weight more successfully.  While there is no proof at this point, vitamin D in reasonable doses is considered safe, so if I was trying to lose weight, I would make sure I was getting enough of this vitamin, either through sunshine, diet (especially fatty fish, such as salmon), or supplements.

Just this month another report about vitamin D and its possible “brain protective” effect appeared in the Journal of Alzheimer’s Disease. The author suggests people over 60 have their vitamin D level checked, and strongly consider vitamin D3 supplements or…get more sunshine.  This is not the first researcher to suggest vitamin D is “neuroprotective”. Earlier this year there was a large U.S. study showing that people with low vitamin D blood levels were more than twice as likely to have dementia as people with high blood levels. Of course, this doesn’t prove that taking vitamin D will cut your risk for dementia, but it seems likely, and for me, I think the potential benefits of daily 1000 IU of vitamin D3 far outweighs any risks.

I was surprised to see a report in the June American Journal of Medicine. The author examined health habits on over 15,000 adults over two different time periods: 1988 through 1994 and 2001 through 2006. The question was: are people practicing a healthier lifestyle now than they were 15 to 20 years ago? The answer is that currently, more people are doing worse when it comes to good health habits!

Yes, more people in the current study are obese (36 percent now vs. 28 percent in the older study), fewer people are exercising regularly (now 43%, and it was 53%), and even worse, the percentage of people who eat five or more servings of vegetables and fruits daily dropped from 42% to the current level of only 26%.

All this despite a flood of health information in the media, including blogs like this. Maybe people are becoming overloaded with health information and just… tune it out? Perhaps the constant flood of data, combined with contradictions from study to study, leads people to think: why bother? What do you think?

I guess the only good news from this is that if YOU choose to live a reasonably healthy life (in short: eat a good diet, exercise and keep your weight under control), you will  look better and better as you get older compared with the growing number of people who are all also getting older, but who aren’t taking care of themselves like you are.

I initially heard of this “healthiest fruit in the world” —a reputation it carries in Brazil—on my first trip here in 2001, and since it was exotically blue, tasty, and apparently full of antioxidants, I have eaten it frequently. Acai is a grape-sized fruit from an Amazonian palm tree (another part of the same tree is sold as “palm hearts”), usually sold in frozen packs of blue pulp. Typically it is prepared as a thick smoothie, mixed with banana and the sweet caffeine-rich syrup of another Amazonian berry, guaraná. It’s fashionable to cover the whole bowl with granola.

Acai indeed has the reputation as being mysteriously healthy, full of antioxidants, and the science indicates that it is, but exactly how heavily it’s loaded with antioxidants is controversial. Some studies indicate a medium level, some higher; it depends on which “system” of oxidation in the body or test tube is being tested. It seems likely though that the basic antioxidant content is quite high, somewhere around that of a blueberry.

Interestingly, the value of antioxidants in the body is a hot topic now…are they helpful or could they be in some cases harmful? A recent study regarding vitamins C and E and exercise suggest that antioxidants, at least as pill supplements, might actually weaken our own body’s natural system of mopping up oxidative damage, and antioxidant pills might weaken these defenses. So a new theory is that these supplements might make our own natural antioxidant systems lazy, and in the long run, lead to more oxidative damage, more aging.

But it is much too soon to reach any conclusions; almost certainly, other studies with different formulations of vitamin E, different dose schedules, etc, will give different results. Most scientists seem to agree however that the antioxidants you consume in foods like tea, red wine, colorful vegetables, legumes, coffee, chocolate, etc, are beneficial as far as cutting risk of heart disease, some cancers, and possibly dementia.

Back to acai. Besides whatever natural antioxidants it contains, it is full of the best form of (monosaturated) fatty acids, similar to olive oil, and has lots of fiber. But as a weight loss aid? No proof at all, and no good evidence either. Don’t waste your money. Acai in body creams as a wrinkle reducer? Again, no evidence; better to spend your money on a visit to a dermatologist, a prescription for topical retinoic acid, and a good sunscreen. Still, I’ll continue to eat my acai mixed with banana and guarana, but I’ll rely on the gym and lots of walking to keep my weight in line…certainly not acai, green tea, or any supplement.

So for the past several years at least, the conventional wisdom has been that drugs that decrease inflammation also lower the risk of dementia, and much hope has been directed towards the non-steroidal anti-inflammatory drugs (NSAIDs) such as over-the-counter ibuprofen and naproxen (U.S. trade names like Aleve, Advil, Motrin).

Indeed, it was almost exactly one year ago that the esteemed journal Neurology published a huge study of veterans (about 250,000 people) over the age of 55, and found that during a five-year period, NSAID use appeared to lower the risk of developing Alzheimer’s by 24-40%. Considering the grand theory of inflammation, this all made sense. But now a University of Washington study, spanning 12 years, showed the opposite result—those who used NSAIDs most heavily (which, we would think, should markedly cut the inflammatory effect), had a 66% higher risk of developing Alzheimer’s than those who didn’t use NSAIDs.

The authors of this new study suspect the reason for this contradiction is that the earlier research studied younger people, and the latest study looked at people over 75. So perhaps NSAIDs only have the protective effect for younger people, and if you are above 75, NSAIDs markedly raise your risk? Is it perhaps that NSAID use by younger people delays the onset of Alzheimer’s, but ultimately raises the risk? This is still a very messy and complex topic, which won’t be resolved soon. What is certain is that much new research will come out over the next decade, and maybe by then the issue will be resolved.

The news about vitamin D just keeps getting better and better. In fact, it’s hard to find much news that is negative about this vitamin. The latest work comes from studying Costa Rican children with asthma, and those with the lowest vitamin D levels had a much higher risk of severe asthma.

Want to avoid diabetes? (who doesn’t?)  It seems likely that most cases of diabetes in people 65 or older are preventable… it’s not just fate, or family history. Nine out of ten cases can be avoided if you “live right”. According to a recent report in The Annals of Internal Medicine, people who follow some basic health principles regarding diet and exercise have a 89% lower risk of developing diabetes.

Here’s how to do it…see the details in MedPageToday, and of course, consult your physician for your specific situation:

1. above average physical activity
2. healthy diet regarding fat and fiber intake
3. don’t smoke, or have quit 20 or more years ago
4. light to moderate alcohol use, vs. not drinking at all
5. avoiding obesity
6. keeping your waist under 34.6 inches (88cm) for women, and under 36.2 inches (92 cm.) for men

A recent report from UCLA studied people in California’s agricultural Central Valley who lived close to crops exposed to the pesticides paraquat and maneb (and a matched “control group” who lived far away from the treated crop fields) and found that the people living close by had a 75% increased risk of developing Parkinson’s. Those pesticides are commonly used on a number of vegetables including soybeans, potatoes, lettuce, and corn. This is another reason to seriously consider buying organic when you can. Especially if you have a worrisome family history for any neurological problems, the cost difference should be well worthwhile. On the positive side, keep in mind, as mentioned in a previous post, that caffeinated coffee seems to markedly decrease the risk of Parkinson’s disease.

And, while the UCLA study was only directed at the association between pesticides and Parkinson’s disease, I suspect further research will show an association between chronic pesticide exposure and other neurologic disorders….it seems logical that if pesticides cause damage in the dopamine-producing neurons, that they also cause damage elsewhere in the nervous system, and increase the risk of other degenerative neural disorders. Maybe dementia, or the tremor commonly seen in many (not all) older people…for example the little shake when some grab a cup of coffee…that is harmless but serves as one marker indicating that yes, this person seems to be getting “old”.

OK, now here comes a link that will make the cost of your subscription to LLAW worthwhile (hehe…drDave just wanted a little chuckle to himself there)—it’s my favorite list of veggies and fruits with the highest pesticide content, with lower pesticide alternatives (if you don’t or can’t buy organic)…print and consult this list.  You just might live longer and better!

http://www.organicconsumers.org/organic/pesticide-residues.cfm

To finish the week…vitamin D and the racial health gap

You probably know that in the U.S. at least, African-American individuals suffer from a greater incidence of many health disorders, and at an earlier age, such as colon and breast cancer, and more aggressive forms of prostate cancer, and there are various theories why. Now it’s been found that darker-skinned individuals have lower levels of vitamin D, and perhaps that’s  one of the major reasons for the health gap.

Darker-skinned people, and people who live farther from the equator—especially during the winter—can easily suffer from low vitamin D levels, and more and more data is showing how important vitamin D is for our health (click on the “Pick A Topic” cloud on the LLAW right sidebar, and you’ll find a number of posts about vitamin D). While the current recommendation for D is from 200 to 600 units a day, most likely in a year or so these will be raised, maybe to 1000 units per day. Check out and click on Pick A Topic to see more about the vitamin that probably deserves so much praise. Keep posted here for the latest updates. Have a great weekend!

p.s. If you want to read even more about vitamin D this weekend (or whenever), check out this non-profit source:

http://www.vitamindsociety.org/about.php

In the post two days ago I addressed some safety concerns regarding mind drugs (known otherwise as “cognitive enhancers”), including the risk of addiction. Beyond safety issues, others object to cognitive enhancers because they are not “natural” for the brain, and further, that use is not moral as they give some people an unfair advantage.

The first issue regarding “natural” I don’t believe has credence. Much of what is done today in medicine—to people and by people—is not “natural”, and the pace of what is acceptable yet unnatural seems to be accelerating. I suspect only the most religiously orthodox today would protest contraceptive pills or condoms (not natural), though I know many who might be squeamish about Viagra or breast implants as unnatural, but they might well accept kidney transplants or in vitro fertilization; certainly far from natural. I think it’s very difficult to condemn anything in medicine today as unnatural.

The issue regarding morality and cognitive enhancers is a thornier topic, but it seems that over time, more mainstream scientists and doctors are saying yes, it’s fine for otherwise normal people to take a prescription drug that enhances one’s brain function temporarily by helping them think more clearly and delaying their need for sleep.

The moral question brings us back to coffee. Caffeine enhances calcium release from muscles, which allows those athletes who take it before competition (in pill form or as coffee) to run faster and longer—and as it also acts on the brain—with less sense of fatigue. Those who use it get at least a five percent performance boost over non-users.

Cognitive enhancers such as modafinal (Provigil), our model drug for this mini-series, likely improves the test-taking performance of those who take it before, say, a college-entrance exam, or a police qualification test (consider the comment from last post). There is no way to blood-test and know who took it versus those who did not. Is this mental-doping moral? Certainly it is less of an issue if everyone has equal chance to take an enhancer beforehand, but many would choose not to for a number of reasons: moral or fear of short term side effects or addiction or the possibility of long term brain damage. Modern medicine and advanced pharmaceuticals are presenting us ever more with these dilemmas, running faster than our answers.

Next….Indecisive Medical “Experts”, Dr. Oz, And Real Age®

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”).