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.
Thursday, December 18, 2008
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.
Wednesday, October 8, 2008
Vitamin D - Miracle Vitamin? Or Simply Correcting a Common Deficiency?
Vitamin D is on the fast-track toward nutritional sainthood – that is, of being declared a miracle vitamin.
Indeed, the research shows that vitamin D is required for healthy bones and to maintain the skeletal muscles that hold our bones in place. It helps prevent type 1 and type 2 diabetes. Vitamin D fights infections and may also have anti-depressant benefits. Vitamin D seems necessary for a maintaining a healthy heart. And perhaps most dramatically, vitamin D protects against many different types of cancer, including those of breast, colon, and prostate. All of these benefits point to the fundamental importance of vitamin D in health.
But I’ll argue for a moment that almost everyone is looking at the health benefits of vitamin D from the wrong perspective.
Studies have consistently shown that low levels of vitamin D (either marginal levels or outright deficiencies) are common among both sexes and all age groups, from infants through seniors. The consequences of inadequate vitamin D are nothing less than catastrophic, contributing to the risk of all the diseases that vitamin D supplements correct. As Evan Shute, M.D., once told me, vitamins prevent what they also cure.
The risk of a vitamin D deficiency can be reduced simply by taking a a capsule containing 1,000 to 2,000 IU daily. The benefits might seem miraculous, but they are not a true miracle. They are the result of correcting a single vitamin deficiency.
The conventional medical and dietetic view is that vitamin deficiency diseases were common through the 1940s, but that they are rare today. But this conventional view is wrong – often dead wrong for the people affected by such deficiencies.
It’s incredible that, in 2008, a lack of vitamin D is widespread, not just in the United States, but throughout Europe, Asia, and the rest of the world. And if we looked just a little harder, we would find deficiencies of other vitamins and minerals also to be common. Imagine much much better off people would be if somehow we managed to eliminate all vitamin deficiencies.
Indeed, the research shows that vitamin D is required for healthy bones and to maintain the skeletal muscles that hold our bones in place. It helps prevent type 1 and type 2 diabetes. Vitamin D fights infections and may also have anti-depressant benefits. Vitamin D seems necessary for a maintaining a healthy heart. And perhaps most dramatically, vitamin D protects against many different types of cancer, including those of breast, colon, and prostate. All of these benefits point to the fundamental importance of vitamin D in health.
But I’ll argue for a moment that almost everyone is looking at the health benefits of vitamin D from the wrong perspective.
Studies have consistently shown that low levels of vitamin D (either marginal levels or outright deficiencies) are common among both sexes and all age groups, from infants through seniors. The consequences of inadequate vitamin D are nothing less than catastrophic, contributing to the risk of all the diseases that vitamin D supplements correct. As Evan Shute, M.D., once told me, vitamins prevent what they also cure.
The risk of a vitamin D deficiency can be reduced simply by taking a a capsule containing 1,000 to 2,000 IU daily. The benefits might seem miraculous, but they are not a true miracle. They are the result of correcting a single vitamin deficiency.
The conventional medical and dietetic view is that vitamin deficiency diseases were common through the 1940s, but that they are rare today. But this conventional view is wrong – often dead wrong for the people affected by such deficiencies.
It’s incredible that, in 2008, a lack of vitamin D is widespread, not just in the United States, but throughout Europe, Asia, and the rest of the world. And if we looked just a little harder, we would find deficiencies of other vitamins and minerals also to be common. Imagine much much better off people would be if somehow we managed to eliminate all vitamin deficiencies.
Hospitals Are Some of the Most Dangerous Places
Ads touting the benefits of particular hospitals are common in big city newspapers, but on a recent day, I was struck by the sheer number of full-page ads for hospitals. In particular, one ad read: “For a healthy heart...eat properly, exercise daily and visit St. Francis, the hospital with more of the best cardiac specialists than any other hospital...”
What do hospitals have to do with disease prevention? Virtually nothing.
Visit St. Francis or any other hospital? Unless you need the ER, you may very well be putting your life at risk.
Years ago, while researching an article on the Navajo reservation, I learned that Native Americans had a specific word for hospitals – it translated to “the place where people go to die.”
The truth is that hospitals are among of the most dangerous places in our modern world, and you would do your best to stay out of hospitals. They’re a great place to contract “nosocomial infections,” a euphemism for infections contracted in hospitals. This doesn’t mean that hospitals and surgery don’t help a lot of people. They do, but there are serious downsides – e.g., death – while being hospitalized.
It turns out that whenever physicians go on either a strike or a work slowdown, the area’s death rate decreases.
I’m serious.
When physicians began a major work slowdown in Israel in 2000, the death rate decreased by 68 percent. When Israeli doctors went on strike for a month in 1973, the death rate during that month dropped by 50 percent. No one had seen such a dramatic decrease in death rates since the previous doctors’ strike 20 years before.
In 1976, doctors in Los Angeles went on strike to protest increases in malpractice insurance. You guessed it – the death rate decreased by 18 percent. That same year, doctors in Bogota, Columbia, also went on strike, and the death rate went down by 35 percent.
These aren't the ravings of a lunatic, believe me. Even the British Medical Journal has reported these amazing reductions in death rates when doctors go on strike and disrupt the treatment of people in hospitals.
The risk of death in hospitals also seems to relate to the magnitude of intervention, with more aggres-sive interventions increasing the odds of dying. In a recent study, published in the Annals of Internal Medicine, patients were more likely to die when treated entirely by critical-care physicians in intensive care units (ICUs), compared with patients treated entirely by noncritical-care physicians. You might argue that patients in ICUs are more seriously ill, but the researchers accounted for these differences in the severity of illness.
The problem lies with the pharmaceutical and surgical interventions that lie at the heart of modern medicine. Aggressive interventions are dangerous – and deadly – compared with more conservative therapies, such as nutritional medicine, especially for chronic diseases. Going to a hospital invites such interventions, and doctors often forget their Hippocratic Oath: first do no harm.
References: Siegel-Itzkovich J. BMJ, 2000;320:1561. Mendelsohn RS. Confessions of a Medical Heretic. Chicago: Contemporary Books, 1979:114. Levy MM. Annals of Internal Medicine, 2008;148:801-809.
What do hospitals have to do with disease prevention? Virtually nothing.
Visit St. Francis or any other hospital? Unless you need the ER, you may very well be putting your life at risk.
Years ago, while researching an article on the Navajo reservation, I learned that Native Americans had a specific word for hospitals – it translated to “the place where people go to die.”
The truth is that hospitals are among of the most dangerous places in our modern world, and you would do your best to stay out of hospitals. They’re a great place to contract “nosocomial infections,” a euphemism for infections contracted in hospitals. This doesn’t mean that hospitals and surgery don’t help a lot of people. They do, but there are serious downsides – e.g., death – while being hospitalized.
It turns out that whenever physicians go on either a strike or a work slowdown, the area’s death rate decreases.
I’m serious.
When physicians began a major work slowdown in Israel in 2000, the death rate decreased by 68 percent. When Israeli doctors went on strike for a month in 1973, the death rate during that month dropped by 50 percent. No one had seen such a dramatic decrease in death rates since the previous doctors’ strike 20 years before.
In 1976, doctors in Los Angeles went on strike to protest increases in malpractice insurance. You guessed it – the death rate decreased by 18 percent. That same year, doctors in Bogota, Columbia, also went on strike, and the death rate went down by 35 percent.
These aren't the ravings of a lunatic, believe me. Even the British Medical Journal has reported these amazing reductions in death rates when doctors go on strike and disrupt the treatment of people in hospitals.
The risk of death in hospitals also seems to relate to the magnitude of intervention, with more aggres-sive interventions increasing the odds of dying. In a recent study, published in the Annals of Internal Medicine, patients were more likely to die when treated entirely by critical-care physicians in intensive care units (ICUs), compared with patients treated entirely by noncritical-care physicians. You might argue that patients in ICUs are more seriously ill, but the researchers accounted for these differences in the severity of illness.
The problem lies with the pharmaceutical and surgical interventions that lie at the heart of modern medicine. Aggressive interventions are dangerous – and deadly – compared with more conservative therapies, such as nutritional medicine, especially for chronic diseases. Going to a hospital invites such interventions, and doctors often forget their Hippocratic Oath: first do no harm.
References: Siegel-Itzkovich J. BMJ, 2000;320:1561. Mendelsohn RS. Confessions of a Medical Heretic. Chicago: Contemporary Books, 1979:114. Levy MM. Annals of Internal Medicine, 2008;148:801-809.
Wednesday, August 20, 2008
Science That Distorts Research...And Setting The Record Straight
I was recently in England to lecture on nutrition and to sign copies of my book, Stop Prediabetes Now. (See www.stopprediabetesnow.com.) While there, another negative study on vitamins was published, one that claimed vitamin supplements increased the risk of death. The study’s findings were repeated there and around the world – uncritically. Some consumers, interviewed on TV, were actually afraid to continue taking their vitamin supplements.
The study, by Goren Bjelakovic, MD, and published via what is known as the Cochrane Database, was a rehash of his highly criticized study last year in the Journal of the American Medical Association. It was old news – and bad science.
Bjelakovic’s findings of a so-called significant increased risk of death from vitamins were not significant at all. The study wasn’t even a study – it was a statistical machination of 67 previously published studies, many of which had shown clear benefits from vitamin supplements. Bjelakovic focused on studies in which deaths occurred, choosing to ignore more than 400 studies (from his original pool of research) in which no deaths occurred. In poker, this is called stacking the deck, or outright cheating. Many of the subjects in the studies were seriously ill or terminal, vitamin dosages varied greatly, and the duration of supplement use ranged from a month to years. Bjelakovic had no idea of the causes of death, which might have included car accidents, interactions from prescription drugs, and children suffocating their terminally ill parents.
During the same week, I happened to visit the food hall at Harrod’s, the pricey London department store that prides itself on both quality and expensive goods. Curious, I looked at the ingredients list on tins of cookies. Incredibly, partially hydrogenated vegetable oils (i.e., trans fats) were the first or second ingredient in most of these products. Basically, Harrod’s magnificent food halls had turned into a hall of the worst kinds of junk food. Trans fats are arguably the most dangerous ingredient in processed foods.
Bjelakovic would have provided a far greater service if he had focused on the dangers of artificial food ingredients, such as the trans fats in Harrod’s cookies and hundreds of other common manufac-tured food products. When we take vitamin supple-ments, we often do so in part as a “countermeasure” to protect ourselves against some of the harmful additives whose presence is often not questioned at all.
The study, by Goren Bjelakovic, MD, and published via what is known as the Cochrane Database, was a rehash of his highly criticized study last year in the Journal of the American Medical Association. It was old news – and bad science.
Bjelakovic’s findings of a so-called significant increased risk of death from vitamins were not significant at all. The study wasn’t even a study – it was a statistical machination of 67 previously published studies, many of which had shown clear benefits from vitamin supplements. Bjelakovic focused on studies in which deaths occurred, choosing to ignore more than 400 studies (from his original pool of research) in which no deaths occurred. In poker, this is called stacking the deck, or outright cheating. Many of the subjects in the studies were seriously ill or terminal, vitamin dosages varied greatly, and the duration of supplement use ranged from a month to years. Bjelakovic had no idea of the causes of death, which might have included car accidents, interactions from prescription drugs, and children suffocating their terminally ill parents.
During the same week, I happened to visit the food hall at Harrod’s, the pricey London department store that prides itself on both quality and expensive goods. Curious, I looked at the ingredients list on tins of cookies. Incredibly, partially hydrogenated vegetable oils (i.e., trans fats) were the first or second ingredient in most of these products. Basically, Harrod’s magnificent food halls had turned into a hall of the worst kinds of junk food. Trans fats are arguably the most dangerous ingredient in processed foods.
Bjelakovic would have provided a far greater service if he had focused on the dangers of artificial food ingredients, such as the trans fats in Harrod’s cookies and hundreds of other common manufac-tured food products. When we take vitamin supple-ments, we often do so in part as a “countermeasure” to protect ourselves against some of the harmful additives whose presence is often not questioned at all.
A Safer Therapy for Brain Cancer
Politics aside, the diagnosis of brain cancer is awful. And although there are survivors, the results of conventional treatment are pretty dismal. When I heard that Senator Ted Kennedy had been diagnosed with malignant glioma, I immediately thought of a dear friend who was diagnosed in 2001 with malignant brain cancer. He remained pretty sharp mentally, aside from some forgetfulness, until shortly after he began radiation therapy, when he rapidly went downhill.
The current therapeutic vogue for brain cancer is the gamma knife, which is supposed to be a precise beam of radiation that destroys the tumor and nothing else. So they say. There is collateral damage – if not from the radiation striking normal cells, then from the creation of toxic necrotic disease as the cancer cells die. In 20 years, the gamma knife will probably be viewed as barbaric as we now view bloodletting.
A few days after Kennedy’s diagnosis made the headlines, I accidentally came across a medical review paper published last year, in which the author described cell, animal, and three small clinical (human) studies using gamma-linolenic acid (GLA) to treat gliomas and other types of brain cancers.
GLA is an anti-inflammatory plant oil sold at every health food store in the county. In the human studies, GLA was injected directly into the tumors daily for up to 20 days (obviously something you can’t do at home). Most of the people treated with GLA were alive and well almost three years after diagnosis. They experienced few if any side effects.
None of this means GLA is a cure for brain cancer, or any other type of cancer, for that matter. However, it is another very promising alternative and complementary therapy – one I suspect that Senator Kennedy’s doctors probably have never heard of. (By the way, I did email Senator Kennedy’s office about the GLA study.)
Skeptical? You can read the actual journal article for free by going to www.pubmed.gov, typing “Das UN glioma” (without the quotation marks) into the search box. Share this important article with your doctor and your friends. Maybe, just maybe, we’ll be able to encourage the use of a safe and nontoxic therapy for brain cancer.
Reference: Das UN. Medical Science Monitor, 2007;13: RA119-RA131.
The current therapeutic vogue for brain cancer is the gamma knife, which is supposed to be a precise beam of radiation that destroys the tumor and nothing else. So they say. There is collateral damage – if not from the radiation striking normal cells, then from the creation of toxic necrotic disease as the cancer cells die. In 20 years, the gamma knife will probably be viewed as barbaric as we now view bloodletting.
A few days after Kennedy’s diagnosis made the headlines, I accidentally came across a medical review paper published last year, in which the author described cell, animal, and three small clinical (human) studies using gamma-linolenic acid (GLA) to treat gliomas and other types of brain cancers.
GLA is an anti-inflammatory plant oil sold at every health food store in the county. In the human studies, GLA was injected directly into the tumors daily for up to 20 days (obviously something you can’t do at home). Most of the people treated with GLA were alive and well almost three years after diagnosis. They experienced few if any side effects.
None of this means GLA is a cure for brain cancer, or any other type of cancer, for that matter. However, it is another very promising alternative and complementary therapy – one I suspect that Senator Kennedy’s doctors probably have never heard of. (By the way, I did email Senator Kennedy’s office about the GLA study.)
Skeptical? You can read the actual journal article for free by going to www.pubmed.gov, typing “Das UN glioma” (without the quotation marks) into the search box. Share this important article with your doctor and your friends. Maybe, just maybe, we’ll be able to encourage the use of a safe and nontoxic therapy for brain cancer.
Reference: Das UN. Medical Science Monitor, 2007;13: RA119-RA131.
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