A recent article in the British Medical Journal, a news release from the publisher, and news stories published around the world was nothing less than misleading and alarming. The article, based on an analysis of nine previously published studies, reported that vitamin E supplements increased the risk of stroke.
Wait a minute! The study and all the negative publicity were deeply flawed.
First, none of the individual studies had found an increased risk of stroke. Second, the dosages varied from 300 IU to 800 IU of vitamin E daily, some using natural and others using synthetic vitamin E. The studies ranged from about a year and one-half to 10 years, the subjects varied from middle-age to seniors, and some were healthy while others were at high risk of cardiovascular disease (and whom were likely to be taking several medications). With this disparate data, the researchers concluded that one additional person in every 1,250 taking vitamin E would suffer a hemorrhagic (bleeding) stroke, whereas about 2.6 additional people in 1,250 would be less likely to suffer an ischemic (clotting) stroke.
You would think that the significantly greater reduction in ischemic stroke would be the subject of headlines. But it wasn’t. The researchers downplayed the benefits, and headlines warned that vitamin E increased the risk of stroke.
Here’s what else you need to know: you are far more likely to suffer an ischemic stroke. That’s because 90 percent of all strokes are related to blood clots. You are far less likely to suffer a hemorrhagic stroke; they account for only 10 percent of all strokes.
Even though this study was poorly designed, it showed that vitamin E supplements significantly reduced the risk of the most common type of stroke, whereas it slightly increased the risk of the least common stroke. You don’t have to be a rocket scientist – or a statistician – to figure out that the benefits:risk ratio of vitamin E supplements is strongly in your favor.
Sunday, December 19, 2010
Mixed Messages for Health Care
Two recent newswire stories caught my attention. One article noted that there will be a significant shortage of doctors as “baby boomers” hit their 60s and 70s. The other story noted that too much health care is unnecessary and harmful.
Am I the only one who saw a contradiction here?
The second story, sent to newspapers by the Associated Press, noted that “More medical care won’t necessarily make you healthier—it may make you sicker.” The article went on to report that as many as one in three medical tests and treatments aren’t needed.
Fewer medical tests might not be a popular idea among people who keep asking their doctors to identify the cause and then to treat their aches and pains and other health problems. But I would agree, at least to an extent – conventional medical tests and treatments are overused, while nutritional assessments and treatments are sorely underutilized.
In the United States, medicine is a “for profit” business, and most doctors earn a living through some sort of intervention, such as by prescribing a drug or doing surgery. When a patient asks for help, his expectation is that the doctor will do something. Of course, doctors are trained to intervene, and income is related to ordering more tests and doing more interventions. Sometimes the result is iatrogenic disease – physician-caused illness.
Although I believe most doctors are sincere and do want to help their patients, they also know the economic realities of medicine. But not everyone is so sincere. Some years back, I happened to be meeting with a hospital administrator on the morning the government announced that it was reducing Medicare payments to doctors. The administrator was livid. “Do you know what the doctors are going to do?” she asked rhetorically. “They’ve got big mortgages and boats and kids in college. They’re just going to wheel in more patients so they (the docs) don’t have to take a cut in income.”
So, do we really need more doctors? Or unnecessary tests and treatments? Or do we need more doctors who think in terms of more efficient and lower cost nutritional therapies?
Am I the only one who saw a contradiction here?
The second story, sent to newspapers by the Associated Press, noted that “More medical care won’t necessarily make you healthier—it may make you sicker.” The article went on to report that as many as one in three medical tests and treatments aren’t needed.
Fewer medical tests might not be a popular idea among people who keep asking their doctors to identify the cause and then to treat their aches and pains and other health problems. But I would agree, at least to an extent – conventional medical tests and treatments are overused, while nutritional assessments and treatments are sorely underutilized.
In the United States, medicine is a “for profit” business, and most doctors earn a living through some sort of intervention, such as by prescribing a drug or doing surgery. When a patient asks for help, his expectation is that the doctor will do something. Of course, doctors are trained to intervene, and income is related to ordering more tests and doing more interventions. Sometimes the result is iatrogenic disease – physician-caused illness.
Although I believe most doctors are sincere and do want to help their patients, they also know the economic realities of medicine. But not everyone is so sincere. Some years back, I happened to be meeting with a hospital administrator on the morning the government announced that it was reducing Medicare payments to doctors. The administrator was livid. “Do you know what the doctors are going to do?” she asked rhetorically. “They’ve got big mortgages and boats and kids in college. They’re just going to wheel in more patients so they (the docs) don’t have to take a cut in income.”
So, do we really need more doctors? Or unnecessary tests and treatments? Or do we need more doctors who think in terms of more efficient and lower cost nutritional therapies?
Tuesday, November 30, 2010
Vitamin D: The "Safe" Official Recommendation May Be Dangerous to Your Health
In a report issued today by the Institute of Medicine, a committee of physicians and researchers cautioned against taking large amounts of supplemental vitamin D and calcium because they are unnecessary and potentially harmful. However, the committee did recommend slight increases in the Recommended Daily Allowances (RDAs) for calcium (1,000 to 1,300 mg/d) and vitamin D (600 IU/d).
If you follow the advice of the Institute of Medicine, you'll increase your long-term risk of disease.
It’s always safer for researchers and physicians to take the more conservative approach when recommending supplements—except that it reveals a naiveté about clinical nutrition and can lead to chronic nutritional deficiencies and harm to patients. That is the case with this cautious increase in the RDA for vitamin D, combined with a warning about high-dose vitamin D supplementation. Maintaining the status quo by saying “no” to higher dose supplements carries relatively little risk, at least for doctors. It's a very different story for the average person, though.
The truth is that three of every four Americans are deficient or marginally deficient in vitamin D, a number that most likely gets even worse during the winter months when people huddle indoors. (Ginde AA. Arch Intern Med, 2009;169:626-632.) By refusing to acknowledge the scale of vitamin D deficiency, and the easy and inexpensive means of treating it, the committee from the National Institute of Medicine is guilty of malpractice. The committee members have reversed the Hippocratic Oath, from “first do no harm” to “first do harm.” Their action, or lack of action, is simply unconscionable.
The situation was made even worse by incredibly sloppy reporting in newspapers, particularly by Gina Kolata of the New York Times. In her article in today's NYT, she simply related a summary of the Institute of Medicine’s report without critical comment by any expert on vitamin D, such as Michael Holick, M.D., Reinhold Veith, Ph.D., or Robert Heaney, M.D. No mainstream reporter would be so uncritical in echoing a self-serving news release from politicians or corporations. But then, the committee did not even include a recognized expert on vitamin D, so the cautious nature of report may have reflected the fact that the committee members were out of their depth.
The cost of ongoing vitamin D deficiencies will mount with susceptibility to infectious diseases and a greater risk of cancer, heart disease, and depression. But then, there is much more money to be made on treating these diseases than on preventing them.
If you follow the advice of the Institute of Medicine, you'll increase your long-term risk of disease.
It’s always safer for researchers and physicians to take the more conservative approach when recommending supplements—except that it reveals a naiveté about clinical nutrition and can lead to chronic nutritional deficiencies and harm to patients. That is the case with this cautious increase in the RDA for vitamin D, combined with a warning about high-dose vitamin D supplementation. Maintaining the status quo by saying “no” to higher dose supplements carries relatively little risk, at least for doctors. It's a very different story for the average person, though.
The truth is that three of every four Americans are deficient or marginally deficient in vitamin D, a number that most likely gets even worse during the winter months when people huddle indoors. (Ginde AA. Arch Intern Med, 2009;169:626-632.) By refusing to acknowledge the scale of vitamin D deficiency, and the easy and inexpensive means of treating it, the committee from the National Institute of Medicine is guilty of malpractice. The committee members have reversed the Hippocratic Oath, from “first do no harm” to “first do harm.” Their action, or lack of action, is simply unconscionable.
The situation was made even worse by incredibly sloppy reporting in newspapers, particularly by Gina Kolata of the New York Times. In her article in today's NYT, she simply related a summary of the Institute of Medicine’s report without critical comment by any expert on vitamin D, such as Michael Holick, M.D., Reinhold Veith, Ph.D., or Robert Heaney, M.D. No mainstream reporter would be so uncritical in echoing a self-serving news release from politicians or corporations. But then, the committee did not even include a recognized expert on vitamin D, so the cautious nature of report may have reflected the fact that the committee members were out of their depth.
The cost of ongoing vitamin D deficiencies will mount with susceptibility to infectious diseases and a greater risk of cancer, heart disease, and depression. But then, there is much more money to be made on treating these diseases than on preventing them.
Thursday, August 12, 2010
Too Much to Do ... and Only One Jack
Has it really been months since my last post?
Apologies. I've been very busy writing and traveling and lecturing about nutrition and health. And reviewing the edited manuscript of my next book, on fatigue and energy, to be published in March 2011.
Enjoy the blogs posted below.
Jack
Apologies. I've been very busy writing and traveling and lecturing about nutrition and health. And reviewing the edited manuscript of my next book, on fatigue and energy, to be published in March 2011.
Enjoy the blogs posted below.
Jack
Attacks on Multivitamins
I like to read what other newsletters and magazines write about vitamin supplements. The Tufts Health & Nutrition Letter, Reader’s Digest, and even Prevention recently published long articles attacking multivitamins. These rabid attacks cited widely criticized scientific articles, and by repeating misinformation, they may have misguided and harmed millions of people.
As one example, the Tufts newsletter claimed to investigate the “top 20” multivitamin supplements (apparently those sold in drug stores) and warned that they don’t contain enough calcium and vitamin D for bone health, not enough antioxidants for eye health, not enough DHA (one of the omega-3s), not enough ginkgo, not enough bilberry, and not enough probiotics.
First, I could quibble about ingredients in multivitamins, but these formulas have never been intended as the end all of
supplements. They’re basically a form of nutritional insurance, one that’s needed more than ever given the disastrous state of malnutrition in the United States and other Western nations. It’s physically impossible to pack ideal amounts of every nutrient into a capsule or tablet.
Second, in its diatribe against multivitamins, the nutritionally conservative Tufts newsletter indirectly suggested that, if people wanted higher potencies of some nutrients or herbs, they should go buy standalone supplements of calcium and D, lutein, antioxidants, DHA, ginkgo, bilberry, and probiotics. After all, if you can’t get enough of these nutrients in a multivitamin, it only makes sense to make up the difference with whatever individual supplements are important to your health.
There is so much good research supporting the benefits of taking a high-potency multivitamin. Taking a daily multi reduces inflammation and your risk of heart disease, cancer, mood problems and many other health problems.

I have long recommended that people take at least a high-potency multivitamin, and I continue making this recommendation. Given the millions of Americans (and others) who do not get adequate nutrition, it only makes sense.
As one example, the Tufts newsletter claimed to investigate the “top 20” multivitamin supplements (apparently those sold in drug stores) and warned that they don’t contain enough calcium and vitamin D for bone health, not enough antioxidants for eye health, not enough DHA (one of the omega-3s), not enough ginkgo, not enough bilberry, and not enough probiotics.
First, I could quibble about ingredients in multivitamins, but these formulas have never been intended as the end all of
supplements. They’re basically a form of nutritional insurance, one that’s needed more than ever given the disastrous state of malnutrition in the United States and other Western nations. It’s physically impossible to pack ideal amounts of every nutrient into a capsule or tablet.
Second, in its diatribe against multivitamins, the nutritionally conservative Tufts newsletter indirectly suggested that, if people wanted higher potencies of some nutrients or herbs, they should go buy standalone supplements of calcium and D, lutein, antioxidants, DHA, ginkgo, bilberry, and probiotics. After all, if you can’t get enough of these nutrients in a multivitamin, it only makes sense to make up the difference with whatever individual supplements are important to your health.
There is so much good research supporting the benefits of taking a high-potency multivitamin. Taking a daily multi reduces inflammation and your risk of heart disease, cancer, mood problems and many other health problems.

I have long recommended that people take at least a high-potency multivitamin, and I continue making this recommendation. Given the millions of Americans (and others) who do not get adequate nutrition, it only makes sense.
Who Says You Don’t Need Supplements?
A recent article on supplements in the New York Times said what we’ve all heard a hundred times before: “Doctors and nutritionists say that people who eat a normal diet generally don’t need nutritional supplements, even if they exercise vigorously.”
The problem is such statements have absolutely no foundation.
First, what exactly is a normal diet? The definition varies among cultural and ethnic groups. Is it normal to eat the typical American (Western) diet, rich in sugars, starches, and unhealthy oils? Is it normal to eat on the run, out of boxes and microwave ovens?
Second, even if you assume that a normal diet is one consisting of fish, chicken, veggies, and other whole foods, are you really absorbing adequate amounts of the nutrients in foods? Eating healthy foods is certainly important, but poor absorption means you may not be getting those nutrients.
Third, drugs almost always interfere with nutrient absorption and utilization – and half of Americans take at least one prescription drug. Acid blockers (where prescription or over the counter products) reduce absorption of vitamins B12 and C and probably others. Antibiotics, oral contraceptives, and other common medications interfere with many of the B vitamins.
If you want to take the guesswork out of what you need and don’t need, find a nutritionally oriented doc who can measure your blood levels of nutrients. Such measurements aren’t perfect, but they do provide an idea of what you’re absorbing.
The idea that eating right means you don’t need supplements belongs in the wastebasket, along with another stupid idea: taking supplements and you’ll just make expensive urine. The truth is that everything that goes into the body eventually exits in one form or another. So if someone tells you that vitamins only make expensive urine, remind them that the $30 steak and $50 bottle of wine they had in a restaurant made even more expensive urine.
The problem is such statements have absolutely no foundation.
First, what exactly is a normal diet? The definition varies among cultural and ethnic groups. Is it normal to eat the typical American (Western) diet, rich in sugars, starches, and unhealthy oils? Is it normal to eat on the run, out of boxes and microwave ovens?
Second, even if you assume that a normal diet is one consisting of fish, chicken, veggies, and other whole foods, are you really absorbing adequate amounts of the nutrients in foods? Eating healthy foods is certainly important, but poor absorption means you may not be getting those nutrients.
Third, drugs almost always interfere with nutrient absorption and utilization – and half of Americans take at least one prescription drug. Acid blockers (where prescription or over the counter products) reduce absorption of vitamins B12 and C and probably others. Antibiotics, oral contraceptives, and other common medications interfere with many of the B vitamins.
If you want to take the guesswork out of what you need and don’t need, find a nutritionally oriented doc who can measure your blood levels of nutrients. Such measurements aren’t perfect, but they do provide an idea of what you’re absorbing.
The idea that eating right means you don’t need supplements belongs in the wastebasket, along with another stupid idea: taking supplements and you’ll just make expensive urine. The truth is that everything that goes into the body eventually exits in one form or another. So if someone tells you that vitamins only make expensive urine, remind them that the $30 steak and $50 bottle of wine they had in a restaurant made even more expensive urine.
Food Addictions and Overweight
Each new year prompts millions of people to go on diets and sign up for gym memberships to lose weight and get back into shape. Within a month or two, most people resume their former eating and sedentary habits, leading to an annual weight gain.
Why are the vast majority of Americans now overweight or obese? There are many reasons, including the lipogenic effects of high-fructose corn syrup, trans fats, and simply eating too many empty calories, most of which are cheap mass-produced carbohydrates and fats.
A commentary in the Canadian Medical Association Journal focused on what I have long believed: that unrecognized food addictions are a major factor in overweight and obesity. The concept of food addictions, the authors wrote, is controversial – but there are many similarities to drug and alcohol addictions. Powerful cravings and withdrawals symptoms are signs of food addictions. And interestingly enough, anti-opioid drugs seem to reduce food cravings.
There are many factors behind food addictions. Some foods, such as wheat and dairy, contain trace amounts of natural opioids. Sweet foods stimulate the brain’s production of its own opioids. Some foods lead to increased dopamine levels – one of the brain’s pleasure neurotransmitters.
Breaking food addictions is like dealing with any other addiction: It’s going to be rough for a little while. But once an addiction is broken, most people gain a renewed sense of well being. During this process, it certainly helps to be mindful of what you put into your mouth – and to stop rationalizing that a little bit of this and a little bit of that won’t hurt. Just as a little bit of tobacco, alcohol, or cocaine will sabotage some people, little bits of problematic foods will reestablish food addictions.
Why are the vast majority of Americans now overweight or obese? There are many reasons, including the lipogenic effects of high-fructose corn syrup, trans fats, and simply eating too many empty calories, most of which are cheap mass-produced carbohydrates and fats.
A commentary in the Canadian Medical Association Journal focused on what I have long believed: that unrecognized food addictions are a major factor in overweight and obesity. The concept of food addictions, the authors wrote, is controversial – but there are many similarities to drug and alcohol addictions. Powerful cravings and withdrawals symptoms are signs of food addictions. And interestingly enough, anti-opioid drugs seem to reduce food cravings.
There are many factors behind food addictions. Some foods, such as wheat and dairy, contain trace amounts of natural opioids. Sweet foods stimulate the brain’s production of its own opioids. Some foods lead to increased dopamine levels – one of the brain’s pleasure neurotransmitters.
Breaking food addictions is like dealing with any other addiction: It’s going to be rough for a little while. But once an addiction is broken, most people gain a renewed sense of well being. During this process, it certainly helps to be mindful of what you put into your mouth – and to stop rationalizing that a little bit of this and a little bit of that won’t hurt. Just as a little bit of tobacco, alcohol, or cocaine will sabotage some people, little bits of problematic foods will reestablish food addictions.
Up and Down Media Reports
The media roller coaster continued with recent news reports on the good and bad of nutritional supplements – all without providing any real context.
In one study, published in the New England Journal of Medicine, researchers combined either niacin (a form of vitamin B3) and a statin drug or the drug Zetia with a statin (a combination known as Vytorin). The niacin combination worked far better in terms reducing the thickening of the carotid artery, a major blood vessel.
As good as niacin is, the finding was neither new nor surprising. Abram Hoffer, MD, PhD, discovered that niacin lowers cholesterol back in 1955 – and it has been approved by the FDA for that purpose for more than 50 years.
Meanwhile, the Journal of the American Medical Association published a study claiming that supplements of the B-vitamin folic acid increased the risk of cancer. The study was a statistical shell game. Folic acid allegedly increased the risk of cancer by 38 percent, but the results were not statistically significant.
If you read the actual study, not just the panicky newspaper and web news, you would have learned that 70 percent of the subjects were current or former smokers, all of the subjects had a high risk of cancer, and nearly all of the cases were lung cancers. Omitting this information was nothing less than sloppy journalism. So, if you smoke, should you stop taking your vitamins or stop smoking?
In one study, published in the New England Journal of Medicine, researchers combined either niacin (a form of vitamin B3) and a statin drug or the drug Zetia with a statin (a combination known as Vytorin). The niacin combination worked far better in terms reducing the thickening of the carotid artery, a major blood vessel.
As good as niacin is, the finding was neither new nor surprising. Abram Hoffer, MD, PhD, discovered that niacin lowers cholesterol back in 1955 – and it has been approved by the FDA for that purpose for more than 50 years.
Meanwhile, the Journal of the American Medical Association published a study claiming that supplements of the B-vitamin folic acid increased the risk of cancer. The study was a statistical shell game. Folic acid allegedly increased the risk of cancer by 38 percent, but the results were not statistically significant.
If you read the actual study, not just the panicky newspaper and web news, you would have learned that 70 percent of the subjects were current or former smokers, all of the subjects had a high risk of cancer, and nearly all of the cases were lung cancers. Omitting this information was nothing less than sloppy journalism. So, if you smoke, should you stop taking your vitamins or stop smoking?
Saturday, January 2, 2010
Gotta Answer That Call? Check That Email? Read That Text?
In the 1970s—and yes, in a galaxy far away—I discovered the addictive power of Space Invaders, one of the first digital precomputer games.
I was at a holiday corporate retreat. One of my coworkers, Rob, and I discovered what was essentially an electronic pinball machine. The screen showed wave after wave of attacking enemy space ships. Our job was to blast them into oblivion.
Space Invaders practically became an addiction. We probably spent every quarter at the resort destroying digital aliens from outer space.
Flash forward. Space Invaders has morphed into email, texting, and twittering. We don’t need huge pinball-like machines anymore, just a cell phone and apps to experience the same dopamine rush and addiction.
Calls, emails, and texts are so addictive that California and a few other states have banned all but hands-free cell phone use when driving a car.
But you can multitask, you say? Think about that painfully slow driver in front of you, yacking on her cell phone and oblivious to the fact that she really can’t multitask. (Hint: you’re probably no better.) There’s the texter who killed a bicyclist. And yes, there’s the pedestrian whose emailing stopped when he was run over crossing the street.
But it’s not just bad habits states are trying to ban. And it’s not just stupidity. It’s addiction.
The New York Times has published several articles in a “driven to distraction” series, focusing on how drivers screw up when they’re making calls, emailing, or texting while driving. Another article focused on the absurdity of the Type n Walk app, which uses the iPhone’s camera to track the sidewalk ahead while you’re looking at your phone.
On one level it’s silly and absurd. On another it’s totally neurotic.
Technology has helped fuel what I call impulse-addictive behavior in my book, The Food-Mood Solution. Think obsessive-compulsive disorder or gambling addiction. You know it’s bad, but you can’t stop.
For many people it’s near impossible to resist the electronic ping. It has to be read and responded to immediately.
We’ve forgotten our basic prerogative: Just because a telephone rings doesn’t mean we have to answer it. That’s what Caller ID is for. Ditto for emails, texts, and twitters.
So why can’t we just ignore the beckoning technology?
A both a social scientist and a nutritionist, I naturally see connections between society, food, and mood. Our brain’s biochemistry ultimately depends on nutrition.
Technology has also changed the way we eat. Faster. Cheaper. Junkier. Yep, fast food is the nutrition equivalent of a twitter.
But junk food doesn’t give the brain the nutrients it needs to function.
So many of us get shortchanged when it comes to B-complex vitamins and omega-3s (fish oils), two of the most important groups of nutrients influencing mood and behavior.
So, if you have impulsive-control problems, I have a couple of suggestions. Consider slowing down enough to eat some real food. And taking a B-complex vitamin formula or one or two fish oil capsules in the morning. And, yeah, being a little more mindful.
You might just find that you’re back in control of your technology. Not the other way around.
I was at a holiday corporate retreat. One of my coworkers, Rob, and I discovered what was essentially an electronic pinball machine. The screen showed wave after wave of attacking enemy space ships. Our job was to blast them into oblivion.
Space Invaders practically became an addiction. We probably spent every quarter at the resort destroying digital aliens from outer space.
Flash forward. Space Invaders has morphed into email, texting, and twittering. We don’t need huge pinball-like machines anymore, just a cell phone and apps to experience the same dopamine rush and addiction.
Calls, emails, and texts are so addictive that California and a few other states have banned all but hands-free cell phone use when driving a car.
But you can multitask, you say? Think about that painfully slow driver in front of you, yacking on her cell phone and oblivious to the fact that she really can’t multitask. (Hint: you’re probably no better.) There’s the texter who killed a bicyclist. And yes, there’s the pedestrian whose emailing stopped when he was run over crossing the street.
But it’s not just bad habits states are trying to ban. And it’s not just stupidity. It’s addiction.
The New York Times has published several articles in a “driven to distraction” series, focusing on how drivers screw up when they’re making calls, emailing, or texting while driving. Another article focused on the absurdity of the Type n Walk app, which uses the iPhone’s camera to track the sidewalk ahead while you’re looking at your phone.
On one level it’s silly and absurd. On another it’s totally neurotic.
Technology has helped fuel what I call impulse-addictive behavior in my book, The Food-Mood Solution. Think obsessive-compulsive disorder or gambling addiction. You know it’s bad, but you can’t stop.
For many people it’s near impossible to resist the electronic ping. It has to be read and responded to immediately.
We’ve forgotten our basic prerogative: Just because a telephone rings doesn’t mean we have to answer it. That’s what Caller ID is for. Ditto for emails, texts, and twitters.
So why can’t we just ignore the beckoning technology?
A both a social scientist and a nutritionist, I naturally see connections between society, food, and mood. Our brain’s biochemistry ultimately depends on nutrition.
Technology has also changed the way we eat. Faster. Cheaper. Junkier. Yep, fast food is the nutrition equivalent of a twitter.
But junk food doesn’t give the brain the nutrients it needs to function.
So many of us get shortchanged when it comes to B-complex vitamins and omega-3s (fish oils), two of the most important groups of nutrients influencing mood and behavior.
So, if you have impulsive-control problems, I have a couple of suggestions. Consider slowing down enough to eat some real food. And taking a B-complex vitamin formula or one or two fish oil capsules in the morning. And, yeah, being a little more mindful.
You might just find that you’re back in control of your technology. Not the other way around.
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