The never-ending arguments about evolution and creationism (or intelligent design) mystify me. I can’t understand why one of the most beautiful and fascinating aspects of biology is so controversial.
Evolution is all about change, adaptation, and dumb luck. It’s nature’s version of the Las Vegas crapshoot. It’s exciting, and sometimes scary.
From a biological standpoint, evolutionary changes result from a genetic roll of the dice (every time an egg is conceived) or from mutations (random changes to our genes). Most of these changes don’t mean a thing, a few alter our appearance or increase our risk of disease, and once in a while they give us nature’s version of seven-eleven.
Cancer is a good example of evolution in action. Cancers evolve, and they are a microcosm of the entire evolutionary process. I doubt that anyone would ever argue that cancer is just a theory.
Cancers develop from mutations that change the programming of our genes and the behavior of cells. When doctors treat cancer with chemo or radiation, they destroy the weakest cells, but cells with treatment-resistant genetic mutations survive. That’s natural selection—part of the evolutionary process—and that’s why most cancers eventually return.
The randomness of evolutionary process can be unforgiving or serendipitous. You never know how the dice will roll. A moth born bright yellow becomes easy pickings for a bird. But a moth of a different color may blend in to its surroundings, survive, and pass its lucky genes onto another generation.
A century and a half ago, Charles Darwin noticed how different beaks among Galapagos finches were adapted to different types of food. Birds born with maladapted beaks couldn’t feed themselves and so they died off, whereas birds with beaks suited to a particular island’s food sources flourished.
Segues from one species to another take a long time. Monkeys did not turn into human beings overnight—their evolution occurred through a lot of minor changes over millions of years. That’s a difficult time scale for most people to imagine. After all, many of us have trouble imagining what life was like 100 years ago.
It takes my breath away when I think about how life changes through the evolutionary process. I wish I could see a time-lapse film depicting all the little biological changes in the transition from primates to humans, or how mammals returned to the sea and became whales and dolphins. But the millions of years these changes take make that kind of film impossible.
Don’t ask me why all this happens or how it got started. I’m pretty humble about things like that, and rather than ascribe them to one thing or another, I’ll admit that I just don’t know. I can live with not knowing.
I do believe that the irony in all this is that creationists have also evolved. They’ve evolved from a literal Biblical explanation of life on Earth to the more clever argument of intelligent design. I believe that’s a good example of change and adaptation. Too bad they don’t see their own evolution or appreciate the wonder of how life evolves. I think it’s the greatest show on Earth—maybe not in the heavens, but definitely here on Earth.
Monday, February 9, 2009
Friday, January 23, 2009
How to Achieve Real Change in Health Care. Is Anyone Listening?
A physician I knew (he died at a ripe old age) once quipped, “Medicine is America’s fastest growing failing business.” And unless we refocus our entire approach to health care, it’s going to grow and fail even faster.
Most proposals for health-care reform have focused on either expanding the availability of insurance or reducing the costs of prescription drugs. While necessary, these approaches are essentially extensions of a dysfunctional health-care system, and they fail to correct its fundamental flaws.
Health care (of which medicine is part) is an oxymoron. It’s really a disease-care system that continues to exist only because of the rationing of treatment. Millions of people are excluded from health-care coverage, and others must deal with huge out-of-pocket expenses or simply do without.
The solution I envision would transform this disease-care system into a genuine health-care system. The only way to accomplish this, at a price this nation can afford, is to emphasize prevention.
I don’t mean inoculations or well-baby checkups, although they certainly should be part of any health-care system. Nor do I mean near-compulsive cholesterol and blood pressure checks, although they too have a place.
Rather, I recommend that the incoming Obama administration fund a large federal and state campaign that tackles prevention in a way similar to how government discouraged the use of tobacco products. The anti-tobacco campaign has largely worked, and one focusing on prevention can work as well.
Focusing on prevention is imperative. Unless we reduce the demands placed on disease care, the current or extended disease-care system will eventually collapse financially.
Nearly all experts agree that most chronic health problems result from poor eating habits, a lack of physical activity, and other lifestyle issues, such as smoking and alcohol consumption. These are behaviors that can be modified to reduce the risk of disease, and less disease means lower health-care costs.
It’s important that this campaign convey the message that each and every one of us is a partner in our own health. We can’t abuse our bodies and then expect doctors or magic pills to reverse the damage, regardless of who pays. We must acknowledge our personal responsibility for staying healthy and do a much better job of eating more nutritious foods and staying reasonably fit.
I would make nutrition the foundation of any health-care campaign, for a couple of reasons. First, it’s the basis of our biology and biochemistry. Second, two of every three Americans are now overweight or obese. More than 23 million have type 2 diabetes, and somewhere between 40 and 100 million have some form of prediabetes. These are signs that our eating habits and lifestyles are truly warped. Ominously, these health problems increase the risk of heart disease and most other chronic degeneration diseases.
There’s no need to get distracted by arguments over which diet is best. Everything I’ve learned about healthy habits boils down to emphasizing fresh foods over almost anything that comes in a box, can, jar, bottle, or bag. It’s as simple as that. Opt for a piece of fish or chicken and some vegetables instead of a burger and fries in the drive-thru. And yes, eat smaller portions.
Physical fitness is important as well. While we don’t have to build Schwarzenegger-type bodies, we do need to realize that all the time we spend in front of televisions and computers helps make us fat. Just going for a daily walk improves blood sugar and weight, and obviously the more we do, the better off we’ll be.
Food companies could certainly be given incentives to help spread the word about eating better and becoming more physically active. They could also retool some of their food products to wean people off junk foods. After all, the health of their profits will at some point depend on the health of the nation.
A consortium of medical societies, food-industry lobbying groups, and vitamin supplement associations could also help underwrite consumer-education campaigns geared to preventing disease.
Even the Food and Drug Administration could play a role by clearly discouraging the use of hydrogenated oils and caloric sweeteners, maybe by requiring warning labels on some packages. The FDA could also streamline the now complicated processes of making health claims for foods and supplements.
Doctors may dismiss my proposal by saying that patients want a quick fix (code word for prescription drug) and aren’t compliant with dietary changes. But the studies show that one-on-one nutrition coaching and follow-ups do result in compliance and consistency.
Will there be resistance to what I propose? Of course they will be. Every billion dollars saved in disease care will translate to a billion lost in drug company and hospital profits.
But something has got to give. As a nation, we’ve got to get off our duff and make some changes. It’s far easier, better, and less costly in the long run to prevent (or lower the risk of) disease than to struggle to treat it. Furthermore, as people get healthier, they will also have more energy, use fewer sick days, and be more productive. That can only be good for our economy.
We need more than a Band-Aid when it comes to reforming health care and controlling costs. I hate to say it, but for a permanent cure, health care needs major surgery followed, of course, by a lean diet and time to heal. This process will certainly take more than a couple of years to yield clear benefits, but so did the campaign to reduce tobacco use.
Most proposals for health-care reform have focused on either expanding the availability of insurance or reducing the costs of prescription drugs. While necessary, these approaches are essentially extensions of a dysfunctional health-care system, and they fail to correct its fundamental flaws.
Health care (of which medicine is part) is an oxymoron. It’s really a disease-care system that continues to exist only because of the rationing of treatment. Millions of people are excluded from health-care coverage, and others must deal with huge out-of-pocket expenses or simply do without.
The solution I envision would transform this disease-care system into a genuine health-care system. The only way to accomplish this, at a price this nation can afford, is to emphasize prevention.
I don’t mean inoculations or well-baby checkups, although they certainly should be part of any health-care system. Nor do I mean near-compulsive cholesterol and blood pressure checks, although they too have a place.
Rather, I recommend that the incoming Obama administration fund a large federal and state campaign that tackles prevention in a way similar to how government discouraged the use of tobacco products. The anti-tobacco campaign has largely worked, and one focusing on prevention can work as well.
Focusing on prevention is imperative. Unless we reduce the demands placed on disease care, the current or extended disease-care system will eventually collapse financially.
Nearly all experts agree that most chronic health problems result from poor eating habits, a lack of physical activity, and other lifestyle issues, such as smoking and alcohol consumption. These are behaviors that can be modified to reduce the risk of disease, and less disease means lower health-care costs.
It’s important that this campaign convey the message that each and every one of us is a partner in our own health. We can’t abuse our bodies and then expect doctors or magic pills to reverse the damage, regardless of who pays. We must acknowledge our personal responsibility for staying healthy and do a much better job of eating more nutritious foods and staying reasonably fit.
I would make nutrition the foundation of any health-care campaign, for a couple of reasons. First, it’s the basis of our biology and biochemistry. Second, two of every three Americans are now overweight or obese. More than 23 million have type 2 diabetes, and somewhere between 40 and 100 million have some form of prediabetes. These are signs that our eating habits and lifestyles are truly warped. Ominously, these health problems increase the risk of heart disease and most other chronic degeneration diseases.
There’s no need to get distracted by arguments over which diet is best. Everything I’ve learned about healthy habits boils down to emphasizing fresh foods over almost anything that comes in a box, can, jar, bottle, or bag. It’s as simple as that. Opt for a piece of fish or chicken and some vegetables instead of a burger and fries in the drive-thru. And yes, eat smaller portions.
Physical fitness is important as well. While we don’t have to build Schwarzenegger-type bodies, we do need to realize that all the time we spend in front of televisions and computers helps make us fat. Just going for a daily walk improves blood sugar and weight, and obviously the more we do, the better off we’ll be.
Food companies could certainly be given incentives to help spread the word about eating better and becoming more physically active. They could also retool some of their food products to wean people off junk foods. After all, the health of their profits will at some point depend on the health of the nation.
A consortium of medical societies, food-industry lobbying groups, and vitamin supplement associations could also help underwrite consumer-education campaigns geared to preventing disease.
Even the Food and Drug Administration could play a role by clearly discouraging the use of hydrogenated oils and caloric sweeteners, maybe by requiring warning labels on some packages. The FDA could also streamline the now complicated processes of making health claims for foods and supplements.
Doctors may dismiss my proposal by saying that patients want a quick fix (code word for prescription drug) and aren’t compliant with dietary changes. But the studies show that one-on-one nutrition coaching and follow-ups do result in compliance and consistency.
Will there be resistance to what I propose? Of course they will be. Every billion dollars saved in disease care will translate to a billion lost in drug company and hospital profits.
But something has got to give. As a nation, we’ve got to get off our duff and make some changes. It’s far easier, better, and less costly in the long run to prevent (or lower the risk of) disease than to struggle to treat it. Furthermore, as people get healthier, they will also have more energy, use fewer sick days, and be more productive. That can only be good for our economy.
We need more than a Band-Aid when it comes to reforming health care and controlling costs. I hate to say it, but for a permanent cure, health care needs major surgery followed, of course, by a lean diet and time to heal. This process will certainly take more than a couple of years to yield clear benefits, but so did the campaign to reduce tobacco use.
Thursday, January 22, 2009
Early Diagnosis Is Not Prevention
Several years ago I wrote about a disturbing example of what George Orwell called “double-think” – holding simultaneous contradictory views. At the time I focused on mammography, which has often been promoted for “preventing” breast cancer.
Mammography, however, has nothing to do with preventing breast cancer. It’s a diagnostic tool. You can have a hundred mammograms performed, but they won’t prevent a single case of breast cancer. (In fact, a recent study suggested that mammograms might even increase the risk.) Once diagnosed, a patient will usually be pushed into a medical maze with surgery, chemotherapy, and radiation.
The idea that early diagnosis equals prevention is returning. Recently, a story in the New York Times kept referring to colonoscopies as a way of “preventing” colon cancer. When I emailed the editor that colonoscopies don’t prevent colon cancer, she steadfastly defended her writer’s choice of the word.
Huh? Early diagnosis is not the same as prevention. Confusing the two is double-think.
Meanwhile, a supermarket ran an ad in my local newspaper encouraging people to get various medical tests from a portable testing lab. People could pay for a “heart disease prevention package” or a “stroke and aneurysm prevention package” of tests.
The tests are fine if you want them and if you want to pay for them. But they do not prevent cancer or cardiovascular diseases. They too are a form of early diagnosis.
If such tests do reveal serious health problems, then you have a choice: you can enter the medical maze and subject yourself to drugs and surgery, or you can improve your eating habits and lifestyle. But once in the medical maze – the same one that confuses early diagnosis with prevention – odds are that you’ll be pushed toward the more aggressive and more expensive therapies. After all, the point of early diagnosis is only partly to help patients. The other part is to make money off you.
Mammography, however, has nothing to do with preventing breast cancer. It’s a diagnostic tool. You can have a hundred mammograms performed, but they won’t prevent a single case of breast cancer. (In fact, a recent study suggested that mammograms might even increase the risk.) Once diagnosed, a patient will usually be pushed into a medical maze with surgery, chemotherapy, and radiation.
The idea that early diagnosis equals prevention is returning. Recently, a story in the New York Times kept referring to colonoscopies as a way of “preventing” colon cancer. When I emailed the editor that colonoscopies don’t prevent colon cancer, she steadfastly defended her writer’s choice of the word.
Huh? Early diagnosis is not the same as prevention. Confusing the two is double-think.
Meanwhile, a supermarket ran an ad in my local newspaper encouraging people to get various medical tests from a portable testing lab. People could pay for a “heart disease prevention package” or a “stroke and aneurysm prevention package” of tests.
The tests are fine if you want them and if you want to pay for them. But they do not prevent cancer or cardiovascular diseases. They too are a form of early diagnosis.
If such tests do reveal serious health problems, then you have a choice: you can enter the medical maze and subject yourself to drugs and surgery, or you can improve your eating habits and lifestyle. But once in the medical maze – the same one that confuses early diagnosis with prevention – odds are that you’ll be pushed toward the more aggressive and more expensive therapies. After all, the point of early diagnosis is only partly to help patients. The other part is to make money off you.
Saturday, January 10, 2009
The Controversy Over Vitamin C and Cancer
A recent study – in cells and mice – was published in the journal Cancer Research and immediately followed by newspaper and internet headlines screaming that vitamin C interfered with the cancer-killing effect of several chemotherapeutic drugs.
The finding contradicted several promising studies – in cells, animals, and people – showing that large amounts of vitamin C enhance the body’s ability to fight cancer. What gives?
The study, conducted by researchers at the Memorial Sloan-Kettering Cancer Center in New York City, used an awful methodology. That’s what gives. I’ll explain.
Most of the vitamin C found in foods and supplements is chemically known as ascorbic acid. The Sloan-Kettering researchers did not use this type of vitamin C. Instead, they used dehydroascorbic acid, which is the “oxidized” form of the vitamin, and found that it reduced the effectiveness of chemo drugs on cells. Meanwhile, in the mouse study, the researchers used dehydroascorbic acid in doses known to be toxic.
No one in the entire world sells dehydoascorbic acid supplements. In fact, when dehydroascorbic acid is formed in the body, it is quickly broken down because of its inherent toxicity. It makes absolutely no sense to (1) call dehydroascorbic acid vitamin C or (2) to use it in cancer experiments.
Several studies have successfully used large amounts of real vitamin C to destroy cancer cells in cell experiments, animals, and people. The current theory is that large amounts of vitamin C – large intravenous doses of vitamin C in people – generate hydrogen peroxide, which functions as a natural chemotherapeutic agent but does not harm normal cells.
The finding contradicted several promising studies – in cells, animals, and people – showing that large amounts of vitamin C enhance the body’s ability to fight cancer. What gives?
The study, conducted by researchers at the Memorial Sloan-Kettering Cancer Center in New York City, used an awful methodology. That’s what gives. I’ll explain.
Most of the vitamin C found in foods and supplements is chemically known as ascorbic acid. The Sloan-Kettering researchers did not use this type of vitamin C. Instead, they used dehydroascorbic acid, which is the “oxidized” form of the vitamin, and found that it reduced the effectiveness of chemo drugs on cells. Meanwhile, in the mouse study, the researchers used dehydroascorbic acid in doses known to be toxic.
No one in the entire world sells dehydoascorbic acid supplements. In fact, when dehydroascorbic acid is formed in the body, it is quickly broken down because of its inherent toxicity. It makes absolutely no sense to (1) call dehydroascorbic acid vitamin C or (2) to use it in cancer experiments.
Several studies have successfully used large amounts of real vitamin C to destroy cancer cells in cell experiments, animals, and people. The current theory is that large amounts of vitamin C – large intravenous doses of vitamin C in people – generate hydrogen peroxide, which functions as a natural chemotherapeutic agent but does not harm normal cells.
Thursday, December 18, 2008
Pediatricians Ensuring Vitamin D Deficiency in Children
One of the ironies in health care is that drug treatments laden with dangerous side effects will almost always be quickly adopted by conventional physicians, in part because of aggressive and shrewd marketing by pharmaceutical companies, but doctors fret over the alleged dangers of nutrients.
In October, the American Academy of Pediatrics took the “bold” step of recommending a doubling of the amount of vitamin D for infants, children, and adolescents. The previous recommendation had been for 200 IU daily of vitamin D beginning sometime during the first two months of life. The new recommendation called for 400 IU of vitamin D daily starting within a few days after birth.
Unless your head has been in the sand, you have seen many articles describing the remarkable research on vitamin D. Nearly everyone becomes deficient during the winter months, when the sun is too low to stimulate production of the vitamin, and large percentages of the population are deficient throughout the year.
As a result, even generally conservative and cautious physicians, such as Walter Willett, MD, of Harvard University, have been recommending 1,000 IU of vitamin D daily for every infant, child, and adult – with a doubling of this dose for people with dark complexions (who are more resistant to the vitamin D-producing effect of sunlight on skin).
So while the American Academy of Pediatrics has increased its recommendations for vitamin D, the organization essentially chickened out when it came to a meaningful recommendation. By proposing that infants and children receive only 400 IU of vitamin D daily, the Academy has ensured continued, widespread deficiencies.
In October, the American Academy of Pediatrics took the “bold” step of recommending a doubling of the amount of vitamin D for infants, children, and adolescents. The previous recommendation had been for 200 IU daily of vitamin D beginning sometime during the first two months of life. The new recommendation called for 400 IU of vitamin D daily starting within a few days after birth.
Unless your head has been in the sand, you have seen many articles describing the remarkable research on vitamin D. Nearly everyone becomes deficient during the winter months, when the sun is too low to stimulate production of the vitamin, and large percentages of the population are deficient throughout the year.
As a result, even generally conservative and cautious physicians, such as Walter Willett, MD, of Harvard University, have been recommending 1,000 IU of vitamin D daily for every infant, child, and adult – with a doubling of this dose for people with dark complexions (who are more resistant to the vitamin D-producing effect of sunlight on skin).
So while the American Academy of Pediatrics has increased its recommendations for vitamin D, the organization essentially chickened out when it came to a meaningful recommendation. By proposing that infants and children receive only 400 IU of vitamin D daily, the Academy has ensured continued, widespread deficiencies.
Glucosamine and Chondroitin Do Work in Osteoarthritis
A couple of months ago, researchers published the latest findings of the Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT), a study that compared these natural building blocks of knee cartilage against the drug Celebrex and placebos. Based on
x-rays of the subjects’ knees, the researchers concluded that none of the treatment groups fared any better than the placebo group, according to their report in Arthritis & Rheumatism.
A valid study? It helps to track the history of the GAIT study.
In 2006, the researchers reported how the different treatments affected symptoms of knee osteoarthritis after just six months. At the time, they wrote that there was no reduction in pain or swelling. But the study actually showed that people with the most pain had significant benefits from a combination of glucosamine and chondroitin supplements. In fact, these supplements led to greater pain relief than with the drug Celebrex. No conclusions could be drawn from people with mild osteoarthritic pain because such cases are difficult to assess.
In the latest GAIT report, the researchers acknowledged numerous problems with their data: the progression of osteoarthritis among people taking placebos was less than half of what had been anticipated. That alone would have skewed all data from the study, yet the researchers still argued that glucosamine and chondroitin were of no value.
My friend Jason Theodosakis, MD, author of The Arthritis Cure, told me that the study had three methodological problems – fatal flaws, if you will. First, the number of subjects remaining in the study was too small to achieve statistical significance. Second, the study ran for only two years, whereas other studies have shown that three years is the minimum time needed to demonstrate regeneration of knee cartilage. Third, the x-ray instruments used to measure joint-cartilage deterioration or growth was not sophisticated enough to make clinically meaningful measurements.
Despite all of these limitations, glucosamine hydrochloride supplements did lead to an improvement in joint cartilage compared with all of the other treatments. Inexplicably, however, people taking a combination of glucosamine and chondroitin experienced the greatest progression of joint damage. (I’m guessing, but it is conceivable that the patients taking glucosamine and chondroitin had such a great reduction in pain that they became too active physically, and in the process they injured their tender joints.)
Meanwhile, a separate article by the same researchers, published in Osteoarthritis and Cartilage, found that people taking chondroitin supplements benefited from substantial reductions in joint swelling. Essentially, the researchers published positive findings in one journal and negative findings in another journal. My head was left spinning.
A valid study? It helps to track the history of the GAIT study.
In 2006, the researchers reported how the different treatments affected symptoms of knee osteoarthritis after just six months. At the time, they wrote that there was no reduction in pain or swelling. But the study actually showed that people with the most pain had significant benefits from a combination of glucosamine and chondroitin supplements. In fact, these supplements led to greater pain relief than with the drug Celebrex. No conclusions could be drawn from people with mild osteoarthritic pain because such cases are difficult to assess.
In the latest GAIT report, the researchers acknowledged numerous problems with their data: the progression of osteoarthritis among people taking placebos was less than half of what had been anticipated. That alone would have skewed all data from the study, yet the researchers still argued that glucosamine and chondroitin were of no value.
My friend Jason Theodosakis, MD, author of The Arthritis Cure, told me that the study had three methodological problems – fatal flaws, if you will. First, the number of subjects remaining in the study was too small to achieve statistical significance. Second, the study ran for only two years, whereas other studies have shown that three years is the minimum time needed to demonstrate regeneration of knee cartilage. Third, the x-ray instruments used to measure joint-cartilage deterioration or growth was not sophisticated enough to make clinically meaningful measurements.
Despite all of these limitations, glucosamine hydrochloride supplements did lead to an improvement in joint cartilage compared with all of the other treatments. Inexplicably, however, people taking a combination of glucosamine and chondroitin experienced the greatest progression of joint damage. (I’m guessing, but it is conceivable that the patients taking glucosamine and chondroitin had such a great reduction in pain that they became too active physically, and in the process they injured their tender joints.)
Meanwhile, a separate article by the same researchers, published in Osteoarthritis and Cartilage, found that people taking chondroitin supplements benefited from substantial reductions in joint swelling. Essentially, the researchers published positive findings in one journal and negative findings in another journal. My head was left spinning.
Medical Journals, B Vitamins, and Cardiovascular Disease
Most medical journals claim to publish “peer-reviewed” articles, implying that the research has passed the muster of qualified physicians or researchers. In practice, many journal articles lack any substantial critical analysis before publication.
I believe this is one reason why so much poor-quality research, especially research critical of nutritional therapies, finds its way into print. Then, once in print, this junk science becomes an urban gospel – repeated in the form of poor advice to patients and in newspaper articles. The real peer review occurs after publication, often months later as letters to the editor, and without any newspaper headlines. Consider the following study as an example.
Earlier this year, researchers from the Harvard Medical School published a study in JAMA (Journal of the American Medical Association) in which female health professionals took either B-complex vitamins or placebos for an average of 7.3 years. The vitamin supplements lowered levels of homocysteine – a risk factor for cardiovascular diseases – but did not seem to reduce the risk of cardiovascular disease.
The study was touted as proof that B vitamins were worthless when it came to lowering the risk of heart disease and stroke. But four months later, in letters to the editor of JAMA, other physicians pointed out what should have been obvious early on: the study’s subjects, who were doctors and other medical professionals, were unlikely to be deficient in folic acid. In fact, the blood levels of the vitamin were normal in more than two-thirds of the subjects, meaning that they were less likely to benefit from supplements.
The original researchers acknowledged the critics’ comments and responded in part by writing that the folic acids’ lack of benefit “may not apply to populations with a greater prevalence of folate deficiency.” So, the vitamin might work after all.
The body’s use of folic acid is strongly influenced by genetics. Some genetic variations – an important variable – increase individual requirements for folic acid. These genetic variations were not assessed in this study, so it is very possible that folic acid supplements did benefit some people, but not others.
Earlier this year, researchers from the Harvard Medical School published a study in JAMA (Journal of the American Medical Association) in which female health professionals took either B-complex vitamins or placebos for an average of 7.3 years. The vitamin supplements lowered levels of homocysteine – a risk factor for cardiovascular diseases – but did not seem to reduce the risk of cardiovascular disease.
The study was touted as proof that B vitamins were worthless when it came to lowering the risk of heart disease and stroke. But four months later, in letters to the editor of JAMA, other physicians pointed out what should have been obvious early on: the study’s subjects, who were doctors and other medical professionals, were unlikely to be deficient in folic acid. In fact, the blood levels of the vitamin were normal in more than two-thirds of the subjects, meaning that they were less likely to benefit from supplements.
The original researchers acknowledged the critics’ comments and responded in part by writing that the folic acids’ lack of benefit “may not apply to populations with a greater prevalence of folate deficiency.” So, the vitamin might work after all.
The body’s use of folic acid is strongly influenced by genetics. Some genetic variations – an important variable – increase individual requirements for folic acid. These genetic variations were not assessed in this study, so it is very possible that folic acid supplements did benefit some people, but not others.
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