Did we loose our way while shopping for vitamins?

Sometimes, I wonder . . .

Do we sometimes loose site of what really matters? Do we let ourselves get so caught up in marketing hype that we forget to question, to apply basic common sense before falling in step with the crowd?
I wonder about this, for example, when I observe the effect of current marketing efforts on nutritional supplement trends.
For example. We all understand and appreciate the importance of essential vitamins and minerals. We know they cannot be made within our body–that they have to be obtained from foods.
We also understand that it is necessary for foods to be broken down so that these essential nutrients can be made available to the body. We call this digestion. It starts in the mouth, with chewing, and the action of numerous digestive enzymes and pH changes throughout our digestive tract. Different vitamins and minerals are absorbed in different ways. Some are passive and some are active (vitamin B12 and “intrinsic factor, for example). In each case, our body has developed it’s own complex mechanisms to free up the vitamins and minerals from food.
In fact, we have learned over time that there are other measures we can take to enhance the bioavailability of nutrients from food. Cooking, for example, can increase the digestibility of our food. Other techniques, such as fermentation, are effective as well.
In recognition of the importance of freeing up these essential nutrients from their food matrix, we attempt to enhance the digestive process by ingesting exogenous digestive enzymes in supplement form. These supplemental enzymes further assist in the breakdown of food, increasing the availability of proteins, fats and carbohydrate as well as freeing up the micronutrients for enhanced absorption.
Science has revealed the actual identity of many of these essential nutrients–the vitamins and minerals we need so badly. We know their molecular structure. And that’s not all–we can obtain these nutrients in pure form. Isn’t it wonderful? We can now prevent scurvy not only by eating oranges, but also by taking pure vitamin C tablets! We can prevent beriberi, pellagra, rickets, anemia etc by taking pure vitamins as an alternative to various foods.
In fact, studies on certain nutrients have shown that the pure nutrient is sometimes better absorbed than the same nutrient from food. Folic Acid is a well known example of this.
What I wonder about, then, is why we ignore this, and shun supplements that contain pure nutrients? Why do we embrace, instead, supplements that contain vitamins and minerals supposedly bound to food. Why do we take pure, isolated vitamins and minerals that are potent and ready to be used by the body and take a step backwards, mixing them with various food substances?
Perhaps it has something to do with the concept of “natural?’
Natural is good. Synthetic is bad. That is the mantra. The distinction between natural and synthetic, when it comes to vitamins, however, is very blurred. The processes involved in deriving “natural” vitamins, in meaningfully high potencies, seems to me to be little different from those employed in the “synthesis” of many of the same pure vitamins.
In fact, I suggest that perhaps the word “pure” is much more meaningful in this regard than the word “synthetic.” (. . . or “USP.”)
This is not to say that “food” complexed vitamin supplements are not of value. There are many additional co-factors that occur in nature alongside the vitamins and minerals. It makes sense that these co-factors may exert synergistic actions, and have biological activity of their own.
As is usually the case, however, there is a tradeoff. The more room taken up by the food, the less room there is for the actual vitamins and minerals.
So I have to wonder. Why take pure vitamins and minerals and make them less pure? Why take a high potency, highly bioavailable, economically priced vitamin mineral supplement and dilute it with food?
Food is good. And I recommend taking your vitamin/mineral supplements with meals. That way, you get your vitamins and your food.
Don Goldberg

References:

“Folic acid absorption appears to be enhanced by gastric hydrochloric acid.1 However, achlorhydric individuals were found not to have low serum folate levels (even though folic acid absorption was reduced),2 apparently because achlorhydria leads to small-intestinal overgrowth of bacteria that synthesize folate.3
“The bioavailability of folic acid, when administered at usual doses, is close to 100%. At a dose of 5 mg, 93% was absorbed by healthy volunteers,4 and at a dose of 1,000 mg/day at least 10% was absorbed.5 The absorption of poly-glutamate forms of folate (the forms present in food) is less than that of synthetic folic acid,6 perhaps in the range of one-third to one-half.7,8 In developing recommendations for folate intake, the absorption of food-derived folate has been estimated to be half that of folic acid.”

(Gaby)
Gaby, Alan R., MD. Nutritional Medicine. Alan R. Gaby, M.D., 01/2011. VitalBook file.
The citation provided is a guideline. Please check each citation for accuracy before use.

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Where have you been?

I’m still here. I’ve been busy trying to transition from the radio show, which we ended after over eighteen years, into web based “social media.” The problem is that I’ve never understood the appeal of “social media,” never been comfortable with it, and find it difficult to utilize. I thought the best approach would be to use an e-newsletter approach, as we have accumulated a large number of emails over the years, but that has not worked out. I set up a facebook page (willner.chemists.ny) and I started to “tweet.” Actually, I find Twitter to be the most promising, as it combines some of the benefits of the e-newsletter concept without many of the headaches. So I urge you to “follow” me on Twitter. The Twitter address is @willnerchemists.

Here are links to some of the articles I have recently written for Twitter:

Fructose and High Fructose Corn Syrup: Toxic or Tortured Logic?
I’ve always been somewhat uneasy about the recent demonization of fructose and high fructose corn syrup. Fructose occurs naturally in fruit, and is one-half of the sucrose (sugar) molecule. I certainly do not encourage or condone the over indulgence of refined sugar and/or high sugar foods. Calorie-dense and nutrient-poor foods, whether the empty calories are from unhealthy fats (saturated, hydrogenated, trans, etc) or refined carbohydrates, is what we should worry about . . . Read More!

Are you minding your PQQ’s? Maybe you should be!
PQQ (pyrroloquinoline quinone) is an exciting “new” micronutrient that you will be hearing a lot about in the future. Similar to CoQ10, PQQ affects mitochondrial function. The mitochondria are the parts of cell that generate energy. They are often called the “cellular power plants.” They are involved in other critical cellular functions as well, including cell growth. Recent interest has focused on energy, cardiac function, aging, longevity and mental health. . . Read More!

Restless Leg Syndrome and Nutritional Supplements
Restless legs syndrome is defined as “a neurological disorder characterized by a periodic need to move the legs in order to relieve an unpleasant or uncomfortable sensation in the legs. . . What causes this problem? . . . Read More.

Don Goldberg

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What would be the best multivitamin for me?

“I haven’t taken vitamins since my last pregnancy in 1994. I am a 53 year old woman in good health. The only medication I take Is synthroid for hypothyroidism. What would be the best multivitamin for me? And what other supplements do you recommend? I recently started listening to your radio show. I love it but I am not sure where to start? Thanks in advance for your help.”

I haven’t taken vitamins since my last pregnancy in 1994. I am a 53 year old woman in good health. The only medication I take Is synthroid for hypothyroidism. What would be the best multivitamin for me? And what other supplements do you recommend? I recently started listening to your radio show. I love it but I am not sure where to start? Thanks in advance for your help.

Yes, the number of choices can be overwhelming. But let’s see if we can simplify it for you and others who may share your concern. We will start by pointing out that you are in “good health” except for the hypothyroidism.

I will also point out that when it comes to the choice of your basic multivitamin, multi mineral and possible other “base” supplements, the choices are often the same, regardless of whether or not you have other health problems. The reason for this is that my approach is to establish a “nucleus” or base supplement regimen, and then add to it, as necessary, to address any specific health problems you may have. No health problems? No additional supplements necessary.

In your case, due to your age, you do not need a high level of iron in your supplement. So I would look for a product that contains no more than the recommended daily value (18 mg) at most.

I will also make the assumption that your reason for taking a multi is along the lines of “insure adequate or optimal intake of all the essential nutrients.” You want to grow old, and you want to remain relatively healthy while doing so.

And, finally, I have to assume that your diet is “average.” Good but not great. If you are a vegetarian, don’t eat dairy, eat a lot of dairy and red meat, never eat vegetables and fruit, etc, your needs will be different.

So we arrive at the following conclusion. You need a basic, balanced multivitamin supplement. You need supplemental calcium and magnesium and, perhaps, extra vitamin D. You will probably benefit from two additional supplements: an omega-3 fish oil supplement, and a phyto antioxidant blend.

The most difficult choice is the first one, the multivitamin. The reason for this is that there are many options: form, dose, green, all-in-one. Let’s look at each option.

Form. You can get multivitamins in capsule, tablets, powder and liquids. If you cannot swallow tablet and capsules, you might prefer the convenience of powders and liquids. With powders and liquids, however, you have greater stability concerns, flavor (taste) considerations, and liquids are usually lower potency. Some people find it easier to swallow a capsule than a tablet, but tablets are usually less expensive and contain the highest dose. The same daily dose, for example, that you get in six capsules will fit into four tablets. You will see a variety of other marketing claims touting one form over another, but a properly formulated, properly manufactured tablet will work just fine.

Dose. You can get a one-a-day multi. You can get two-a-day, three-a-day, four-a-day, and even six-a-day multivitamin supplements. What is the difference? One obvious difference is that the more you take, the greater the amount (and perhaps variety) of nutrients you will get. It is easy to fit all of the vitamins and trace minerals into one or two tablets or capsules. But calcium and magnesium are required in higher quantities, and these will not fit into a one or two per day multi. I will discuss this further in a moment, under the “all-in-one” heading. The one thing I strongly urge you not to do is choose a one-per-day multi. Here is the reason. Most of the vitamins and trace minerals in a one-per-day multi are water soluble. They will be absorbed relatively easily and quickly and reach peak blood levels within an hour or so. Then, they begin to be excreted, and whatever does not get absorbed into the tissues during that time finds its way into the toilet bowl. In other words, after half the day, you no longer are getting any benefit from the multi. If you divide your daily dose into at least a twice per day dosages, you are now getting roughly double the benefit! I suggest a minimum of two-per-day, one with breakfast and one with dinner.

Green. Many multivitamin supplements are now being marketed as “food grown,” “food based,” and similar terms. This is nice. Nothing beats food as a source of your essential vitamins and minerals, and including as much food concentrate in the multi as possible is no doubt a good thing. Just we warned that the more food concentrates you include, the less room you have left for the actual vitamins and minerals themselves. So the good news is that this type of multi contains a lot of healthy food-derived cofactors, etc but the bad news is that they are usually lower in potency. To get potencies similar to the “non-green” multi preparations, you many need to take a larger number of tablets or capsules. This is fine if you are willing to do so.

All-In-One. As I said earlier, you cannot obtain the full daily dose of calcium and/or magnesium in a one or two per day multivitamin supplement. There is just not enough room. And it makes no sense to me to take several hundred percent of the U.S. Daily Value of the B-vitamins, while only taking 20% of the Daily Value of calcium and magnesium. So you have two choices. You can take a separate calcium-magnesium supplement, with a dose of two or more per day depending on the type and quality, or you can take a multivitamin supplement that includes the full dose of calcium and magnesium all in the one product. Of course, the daily dose of this “all-in-one” multi has to be higher, to accommodate these added ingredients–usually four tablets daily or six capsules daily.

The total number of tablets, whether you take a separate multi and a separate calcium-magnesium may end up being the same, but many people prefer the convenience of the all-in-one type of product.

So you can narrow down your choice by making four choices as defined above: What form do you prefer? How many are you willing to take each day? Do you want a straight multivitamin multi mineral supplement, or one that includes food concentrates? And do you want everything in one product, or a separate multivitamin and a separate calcium-magnesium?

If you call Willner Chemists (800 633 1106) pre-armed with this information, or stop by one of the Willner Chemists stores in Manhattan or Atlanta, one of the pharmacists or nutritionists will easily and quickly provide you with appropriate options. I am not going to mention specific products here, as we carry numerous quality brands at Willner Chemists. The recommendations might vary from one time to another depending on several factors including which brands might be on sale at the time.

I will provide an example of the “all-in-one” multivitamin multi mineral that is under the Willner Chemists brand. It is called “Willvite,” and the four per day dose provides everything, including calcium and magnesium, in the proper balance and potency.

There are, of course, other supplements that relatively healthy adults might want to take in addition to a multivitamin, calcium and magnesium. I would suggest the following three supplements should be part of most general regimens:

(1) An omega-3 fish oil supplement. The type chosen depends on your diet and health. If you have heart disease, inflammatory conditions, etc, I suggest a high potency EPA/DHA concentrate. If you are healthy, or if you do not eat fish, a “whole” fish oil concentrate might be appropriate.

(2) Vitamin D. At this time, the consensus of opinion is that most of us do not get enough vitamin D. And vitamin D is being increasingly targets as important in the prevention of many serious health problems. Most multivitamins do not contain more than 400 IU of vitamin D, so additional vitamin D is indicated. Many experts consider 800 to 1,000 IU per day as the new “minimum” dose. You can get vitamin D as a stand alone supplement, or you can get omega-3 fish oil supplements with added vitamin D. Natural Factors and Nordic Naturals are two brands that have that combination.

(3) Phyto Antioxidants. Increased antioxidants appear to be beneficial in numerous health conditions, from macular degeneration to aging. Most multivitamin supplements provide the standard vitamin and mineral antioxidants such as vitamin C, vitamin E, zinc and selenium. But many of the powerful antioxidants are those found in plants–the flavonoids and polyphenols found in grape skin, green tea, berries, fruits and vegetables. “Phyto” refers to plants, and a “phyto-antioxidant” supplement is a perfect complement to the regular multivitamin supplement. I recommend the Willner Chemists Phyto-Tech “Antiox Phyto Complex” (liquid filled capsule) or “Antiox Phyto Blend” (dropper bottle liquid).

On the one hand, I have provided a recommendation of what you might call a basic, or “nucleus” nutritional supplement regimen, suitable for almost everyone. A multivitamin, calcium-magnesium (either separate or included in the multivitamin), omega-3 oils, extra vitamin D, and extra “phyto” antioxidants. On the other hand, everyone is different, and everyone has unique needs. The challenge of decided on a multivitamin pales when compared to getting qualified and factual guidance on the remainder of your supplement requirements tailored to your unique health, diet and medical needs. You will not find this guidance in health food stores. You will not find it from your multilevel marketing salesman. You will find it at Willner Chemists.

Don Goldberg, R.Ph.

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Safety of Calcium Supplements Confirmed

Expert Panel Confirms Safety of Calcium Supplements in Relation to Cardiovascular Disease

Calcium Supplements Remain a Valuable Tool For Maintaining Bone Health

Last year, a report was published that surprised most people, patients and doctors alike. It seemed to indicate that calcium supplements increased the risk of cardiovascular disease. Why was this so surprising? For one thing, the benefits of calcium supplementation were widely accepted, with its effect on bone health at the top of the list. For another, it just doesn’t make sense. The report concluded, for example, that only calcium from supplements seemed to be the problem, not calcium from food. The study was far from conclusive, being observational in nature, and had many short comings. Many experts urged caution, and suggested we should not over react. But that did not stop the popular press.

While studies such as this should not be taken as the final word, they certainly should be looked at. There may be lessons to be learned. It may be that it is inadvisable to take a high dose of calcium, via supplements, all at one time, for example. Some people do that. The report may merely highlight the importance of not taking calcium alone, i.e. without magnesium, vitamin D, vitamin K, etc. It may be that some people make the mistake in thinking “if 1,000 mg a day of calcium is good, 2,000 mg a day is better.” We don’t know. At the least, it suggests that more investigation and research might be appropriate.

Such research has been ongoing, and the following findings published in Advances in Nutrition indicated that calcium supplements can indeed be used, safely and effectively, to achieve and maintain bone health by people who do not get optimal calcium from their diet. The following summary of results was posted on the website of the Council for Responsible Nutrition (www.crnusa.org):

Individuals who do not obtain recommended intake levels of calcium through dietary sources can safely utilize calcium supplements to achieve optimal bone health, an expert panel concludes. These findings appear in the November online edition of Advances in Nutrition, a journal that highlights the significance of recent research in nutrition and illustrates the central role of nutrition in the promotion of health and prevention of disease.

Responding to questions raised last year about a possible link between calcium supplements and a potential increased risk of cardiovascular disease, an expert panel composed of academic and industry experts in the fields of nutrition, cardiology, epidemiology, bone health, and integrative medicine convened on Nov. 10 and 11, 2011 in Washington, D.C.

The panel collected and examined the available body of scientific literature, including randomized controlled trials (RCTs) and observational data, assessing whether long-term use of calcium supplements could promote the occurrence of strokes, coronary heart disease, heart attacks and other forms of cardiovascular disease, and cross-referenced these findings with four of the Bradford-Hill criteria for causal interference: strength, consistency, dose-response and biological plausibility. The panel concluded that the available science does not suggest an increased risk for cardiovascular disease from calcium supplement use.

“There is a strong body of evidence from a variety of rigorous scientific studies reinforcing the benefits of calcium in promoting bone growth and maintenance. After reviewing the entire scope of scientific literature for calcium, we are now more confident than ever in both its health benefits and safety,” said panelist Robert P. Heaney, M.D., Osteoporosis Research Center, Creighton University Medical Center. “Consumers can feel confident about the safety of their calcium supplements and should continue taking them with confidence. They should, however, be aware of how much calcium their diets provide, and then supplement accordingly.”

In addition to Dr. Heaney, panel experts included: Stephen Kopecky, M.D., Division of Cardiovascular Diseases, Mayo Clinic; Kevin Maki, Ph.D., Provident-Biofortis; John Hathcock, Ph.D., former senior vice president, scientific and international affairs, Council for Responsible Nutrition (CRN); Douglas MacKay, N.D., vice president, scientific and regulatory affairs, CRN; and Taylor Wallace, Ph.D., senior director, scientific and regulatory affairs, CRN.
The CRN Foundation, the educational non-profit affiliate for CRN, the dietary supplement industry’s leading trade association, commissioned the panel after results from a meta-analysis of RCTs, and reanalysis of the Women’s Health Initiative by researchers at a New Zealand laboratory, prompted concern about a potential association between calcium supplement use and a small increase in risk for adverse cardiovascular events. However, a number of issues with the meta-analysis and accompanying studies—such as exclusion of the majority of RCTs which indicate calcium has no effect on the cardiovascular system; large reliance on unpublished data; failure to appropriately ascertain cardiovascular events; and a lack of information on known cardiovascular risk determinants—warranted a complete examination of the scientific literature.
The CRN Foundation assembled the expert panel to study the findings of this analysis in context with the larger body of scientific research on calcium.

“In light of our safety findings combined with the well-documented benefits of calcium, we urge physicians to continue recommending calcium supplements to their patients as appropriate, as our review of the scientific literature further reinforces the valuable role of calcium in helping consumers maintain bone health,” said the Mayo Clinic’s Dr. Kopecky. “Building and maintaining calcium is vital for all age groups—young children to adolescents to adults and the elderly must obtain adequate amounts of calcium, either through diet or supplementation. For those who are unsure if they need to supplement their diets with additional calcium, make sure to discuss your current nutritional picture with your physician.”

Supporting the expert panel’s conclusion is the recent “Framingham Study,” published online in the Nov. 7 American Journal of Clinical Nutrition by Elizabeth Samelson, Ph.D., et al., which also looked at the association of calcium and coronary artery calcification and found that “…calcium intake from diet and supplements appeared to neither increase nor decrease vascular calcification, which is a measure of cardiovascular risk…The use of calcium supplements is important for many older adults to ensure adequate intake for bone health.”1

The Institute of Medicine currently suggests women ages 19 through 50 and men up to 71 obtain a Recommended Dietary Allowance (RDA) of 1,000 milligrams calcium daily; women over 50 and men 71 and older should obtain 1,200 milligrams daily to ensure they are meeting their daily needs for strong, healthy bones. Calcium is popular among U.S. consumers, and according to CRN’s most recent survey of U.S. adults, 17 percent indicate they take a calcium supplement.

(The Council for Responsible Nutrition (CRN), founded in 1973, is a Washington, D.C.-based trade association representing dietary supplement manufacturers and ingredient suppliers. In addition to complying with a host of federal and state regulations governing dietary supplements in the areas of manufacturing, marketing, quality control and safety, our 75+ manufacturer and supplier members also agree to adhere to additional voluntary guidelines as well as CRN’s Code of Ethics. Visit http://www.crnusa.org. The CRN Foundation was established in 2009 as a non-profit 501(c)(3) organization for the purpose of educating people about the beneficial, safe and responsible use of dietary supplements and their ingredients as part of a culture of wellness.)

1 Samelson, E.J., Booth, S.L., Fox, C.S., et al. (2012). Calcium intake is not associated with increased coronary artery calcification: the Framingham Study1–3. Am J Clin Nutr, 96(5), 1-7.

Don Goldberg

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Sorry, But There Is Good News About Multivitamins

The Good News About Multivitamins

There was good news about nutritional supplements recently. Very good news. A good study–a very good study–showed remarkable benefit associated with the use of multivitamin supplements. In short, this new study indicates that men who took a modest potency multivitamin multimineral supplement reduced their risk of cancer, overall, by eight percent.

An overall eight percent reduction in cancer is not something to take lightly. Especially when it merely involves taking a basic multivitamin supplement. What a large benefit from so small an effort. Why wouldn’t everybody support the idea of taking, at least, a basic multivitamin multimineral supplement every day?

You would think that common sense alone would support the idea. We know how important vitamins and minerals are to our health. We know that a deficiency of one or more of these vital nutrients can lead to life-threatening illness. We know that, for many reasons, many of us do not eat as nutritious a diet as we should. So why would anybody argue against a daily multivitamin multimineral supplement? Why would we even need to “prove” the value of daily supplementation?

That’s a good question. But it seems that “proof” is necessary, but elusive. There is something about ascribing significant health benefits to nutritional supplements that irritates certain people to no end. Health problems, according to these folks, should only be treatable and preventable by a balanced diet, exercise, and medications. Any implication that nutritional supplements belong in that list is met with consistent resistance and scepticism.

A good example of this was the way this recent study was reported in The New York Times. When a negative study comes out pertaining to nutritional supplements, it is given headline status. When a positive study, such as this one, is published, however, it does not receive similar treatment. Instead, it’s importance is minimized. In this case, the positive study about multivitamins reducing the risk of cancer by 8% was covered in an article by Roni Caryn Rabin, titled “Curbing the Enthusiasm on Daily Multivitamins.” The first sentence of the article poses the question “can you reduce your risk of cancer by taking a multivitamin every day?

The article continues “Last week, Boston researchers announced that one of the largest long term clinical trials of multivitamins in the United States–encompassing 14,000 male physicians 50 and older, and lasting over a decade–found that taking a common combination of essential vitamins and minerals every day decreased the incidence of cancer by 8 percent, compared with a placebo pill.”

The article continues with more positive news: “. . . The researchers also looked for side effects and found that daily vitamins caused only minor problems, like occasional skin rashes.

“Even though an 8 percent reduction in the overall cancer rate is fairly modest, Dr. Demetrius Albanes, senior investigator at the National Cancer Institute, said the potential public health implications were vast. “If you think of the hundreds of thousands of new cases of cancer every year, 8 percent can add up quite a bit,” he said.”

Then, however, the author launches a detailed explanation as to why we should not let this positive study lead us to make the mistake of thinking this justifies taking multivitamin supplements. She points out that “previous studies have yielded decidedly mixed results.” She points out that “Current federal dietary guidelines and American Cancer Society recommendations encourage people to eat a balanced diet rich in fruits and vegetables.”

“Until now,” she states, “the consensus has been that there is insufficient scientific evidence to justify taking a multivitamin to prevent cancer or other chronic diseases.” Note that she used the term “until now.” Interesting choice of words.

She continues with a listing of additional cautionary references. She reminds us of the review by the National Institutes of Health in 2006 which “concluded that evidence was ‘insufficient to prove the presence or absence of benefits from use of multivitamin and mineral supplements.’ Again, note the actual terminology: “presence or absence.” Then she reminds of the recent studies that cast doubt on vitamin D and Calcium supplements. She neglects to mention, of course, that these studies have been met with strong criticism and are considered very controversial. She also, it seems, has found it necessary to support her argument by departing from what was initially a critique of daily multivitamin supplements to studies dealing with individual nutrients, at higher dosages.

Thank goodness we have people like Ms. Rabin, and publications like The New York Times out there to protect us from making mistakes such as this.

One of the interesting comments in her article was “Generally speaking, people who take vitamins are a relatively healthy bunch to begin with, experts say. They tend to eat a varied and healthful diet, watch their weight and be physically active. It’s not always clear that the benefits they attribute to vitamins actually result from the pills.” This is very true. But why doesn’t it work both ways. It may not always be clear that the benefits attributed to vitamins actually result from the “pills,” but it is also true that it may not always be clear that negative findings are directly related to the “pills” as well.

The next paragraph in her article confirms this. “There’s a mystique about vitamins, that vitamins are some type of magical ingredient,” said David G. Schardt, senior nutritionist for the Center for Science in the Public Interest, an advocacy group in Washington. “There is a kernel of truth in that, because vitamins are essential to life. But that people will live longer or healthier lives if they take vitamins or eat foods fortified with vitamins–that’s difficult to prove.”

Yes, it’s difficult to prove, and difficult to disprove.

This is not to say we should ignore negative studies. We can learn from negative studies as well as from positive studies. The finding that smokers given high dosages of synthetic beta carotene seemed to experience greater incidence of lung cancer rather than lower incidence, as expected, is not something to be dismissed. There are lessons to be learned from negative findings like this. But we need to look at the full picture. And we need to factor in a large dose of common sense.

Yes, there is the danger that some people might make the “if a little is good, a lot has to be better” mistake. And yes, the benefit of certain nutrients in multivitamin supplements may be more significant, even therapeutic, for those deficient in that nutrient. But we don’t know if we are deficient in one nutrient or another. We don’t know if we are subclinically deficient, i.e. not sufficiently deficient to cause disease, but at levels less than optimal. As they say in the study, a daily multivitamin appears to be safe. The upside is great, and the downside is minimal. Why is taking a multivitamin supplement such a threat?

Those who are so concerned that we might rely on nutritional supplements, rather than a healthy diet rich in fruits and vegetables, act as if the role of diet is somehow “proven” and the role of supplements is not. Is this true? Perhaps not. Here is an excerpt from the actual study, Multivitamins in the Prevention of Cancer in Men: The Physicians’ Health Study II Randomized Controlled Trial, JAMA. 2012;():1-10. doi:10.1001/jama.2012.14641.

“Multivitamins are the most common dietary supplement, regularly taken by at least one-third of US adults. The traditional role of a daily multivitamin is to prevent nutritional deficiency. The combination of essential vitamins and minerals contained in multivitamins may mirror healthier dietary patterns such as fruit and vegetable intake, which have been modestly and inversely associated with cancer risk in some,3 but not all, 4,5 epidemiologic studies.” [emphasis is mine]

Clearly, it seems, the evidence for fruit and vegetable intake is not “proven” either. There are those two references: 4. Löf M, Sandin S, Lagiou P, Trichopoulos D, Adami HO, Weiderpass E. Fruit and vegetable intake and risk of cancer in the Swedish women’s lifestyle and health cohort. Cancer Causes Control. 2011;22(2):283-289. 5. Hung HC, Joshipura KJ, Jiang R, et al. Fruit and vegetable intake and risk of major chronic disease. J Natl Cancer Inst. 2004;96(21):1577-1584

Getting back to the study, “The Physicians’ Health Study II is the first clinical trial to test the affects of multivitamins on a major disease such as cancer,” said lead author J. Michael Gaziano, MD, chief of the Division of Aging at Brigham and Women’s Hospital and an investigator at VA Boston. “Despite the fact that more than one-third of Americans take multivitamins, their long-term effects were unknown until now.”

“Researchers had nearly 15,000 men over the age of 50 take either a multivitamin or a placebo every day for more than 10 years. The men self-reported a cancer diagnosis, and researchers confirmed the diagnosis through medical records. Researchers found the group taking a daily multivitamin had an 8 percent reduction in total cancer compared with the group taking the placebo. They also found a multivitamin was associated with an apparent reduction in cancer deaths.

“Study co-author Howard D. Sesso, ScD, an associate epidemiologist in the Division of Preventive Medicine at Brigham and Women’s Hospital said, “Many studies have suggested that eating a nutritious diet may reduce a man’s risk of developing cancer. Now we know that taking a daily multivitamin, in addition to addressing vitamin and mineral deficiencies, may also be considered in the prevention of cancer in middle-aged and older men.”

“Researchers point out that it is not clear which specific vitamins or minerals in a multivitamin may be responsible for the reduction in cancer risk. Also, it is not known if the results can extend to women or to men younger than the age of 50. Researchers plan to follow up with study participants to determine the affect of a daily multivitamin on cancer over an even longer period of time.

“A similar study is examining the affect of daily multivitamin use on cardiovascular disease risk. Results of that study will be announced at the American Heart Association Scientific Sessions in early November.” (As reported in ScienceDaily, Oct. 17, 2012)

Don Goldberg

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New Line of Supplements for Cancer Patients

Cancer patients often face a difficult choice. They may feel that they would benefit from nutritional and herbal support during and after treatment, but their physicians may be against it. One authority may suggest that nutritional and/or herbal support will work synergistically with conventional treatments, and other experts caution against it. Wouldn’t it be great if complementary cancer specialists developed a line of supplements and skin care products that met the needs of cancer patients and the requirements of your oncologist? Well, such a line is now available, and the name of the line is OncoQOL. Your Oncologist may already know about it.

“OncoQOL’s nutritional supplement products are exclusive, specially formulated products containing nutrients and botanicals that address nutritional needs that can arise during cancer treatment.” I am excited about this, as I think it is very important that Oncologists become comfortable with products that can be recommended to their patients.

To read more about the OncoQOL line, click here.

The products will be available directly from physicians and, I am pleased to announce, from Willner Chemists.

There will be an interview with Sreenivas Rao, MD (an Internal Medicine doctor who has been working in the Oncology field for the past 10 + years) who developed this innovative product line, on The Willner Window Radio Program on Sunday, November 18th, 2012, starting at 2 pm. You can listen live in the greater New York area, on WOR (710 AM). You can also listen live over the internet (www.wor710.com). And, if you miss the live broadcast, an mp3 recording of the show can be found on the Willner Chemists web site, in the Radio section.

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Immune Enhancing Supplements Gain Validation

Immune Enhancing Supplements Gain Validation

There will always be a certain amount of controversy when it comes to recognizing the value of herbal and nutritional supplements as immune system modulators. Historically, conventional medicine has demanded double-blind, placebo controlled human studies. Such studies, however, on these types of products are difficult to set up and impractical to fund. In spite of that, significant progress is being made.

Two new studies provide good examples of this. One study, published in Evidence-Based Complementary and Alternative Medicine – investigated an Echinacea purpurea extract for the prevention and treatment of the common cold. The results were positive. Those taking the echinacea had a slightly reduced chance of coming down with a cold, but those who did get sick had a “highly significant” reduction of days spent with the illness–672 days compared to 850 days in the placebo group. In addition, the echinacea group experienced a 59% reduction in recurring infections.

One interesting thing about this study is that it is one more contradiction to the once fashionable advice against taking echinacea continuously, over a long period of time. This often repeated caution was the result of a misinterpretation of a German publication.

This is only one of many positive studies on echinacea, by the way. A meta-analysis published in 2007 in The Lancet Infectious Diseases (Vol. 7, Pages 473-480) concluded that echinacea may cut the risk of catching the common cold by almost 60%. And researchers from the University of Connecticut combined the results of 14 different studies with positive results. In one of the studies they found in that echinacea taken in combination with vitamin C reduced cold incidence by 86%, and when the herbal was used alone the incidence was reduced by 65%.

The other study I want to call your attention to is related to my recent article on the importance of mushroom extracts as immune system modulators. (You can read that article here.) I am not alone when it comes to having a very high regard for the efficacy of beta-glucan rich mushroom extracts for immune support. It seems the European Union is backing a 240-person trial to investigate the ability of a range of beta-glucans to boost immune systems.

The data will be analyzed using, “many biomarkers including those indicative for the innate immune system, the adaptive immune system, the effect on gut microbiota and metabolites generated by the gut microbiota as a response to the intervention.”

The trial involves several sources of beta-glucans in addition to one of the mushroom extracts I wrote about–a yeast beta-glucan, an oat beta-glucan, a wheat arabinoxylan, and beta-glucan from Shiitake mushroom.

There may be a difference between using echinacea, or similar herbs and beta-glucan rich mushroom extracts. As I pointed out in the above referenced article, “If your immune system is already overactive, as is the case with autoimmune diseases, you should avoid echinacea. It’s also not recommended for progressive diseases such as multiple sclerosis. Finally, the jury is still out on whether echinacea should be used by persons with HIV infections.”

“This is why many experts in the field believe that these conditions are the domain of the adaptogenic herbs. Adaptogens such as astragalus, ashwagandha and eleuthero “tend to enhance the immune system by way of a balancing approach, as opposed to the more nonspecific approach taken by echinacea. This means adaptogens can be used to treat conditions in which the immune system is either depressed or overactive.”

Getting back to the echinacea study, the actual product used was Echinaforce by Bioforce. It was a randomised, double-blind, parallel, placebo-controlled clinical trial with 717 participants. The group assessed safety and efficacy variables over a collective total of 11,472 weeks, or 2,868 months of prophylaxis. The patients mixed 25 drops of Echinaforce or a placebo with water and held it in their mouths for 10 seconds before swallowing it, three times per day over a four month period.

The conclusion, again, was as follows: “the new data reports that three daily doses of the common remedy for four months reduced the likelihood of developing cold and also slashed the duration of the illness by an average of 26%. The herbal supplementation was also reported cut the number of recurrent colds, suffered by those with weakened immune systems, by 60%.
“Prophylactic treatment with Echinaforce over 4 months appeared to be beneficial for many reasons,” explain the researchers, led by senior author Professor Ronald Eccles, from Cardiff University, UK.”

Echinaforce is a mixture of both the herb and root from Echinacea purpurea. As this study shows, along with other studies, this type of extract works. There are other forms, such as root only, as well as other sources, such as Echinacea angustifolia. It should be noted that this study did not compare the efficacy of one type against the other.

The mushroom extract product referenced in my previous article was PhytoTech Mushroom Extract Complex, available from Willner Chemists.

Reference: (1) Evidence-Based Complementary and Alternative Medicine
Published online ahead of print, doi: 10.1155/2012/841315
“Safety and Efficacy Profile of Echinacea purpurea to Prevent Common Cold Episodes: A Randomized, Double-Blind, Placebo-Controlled Trial”
Authors: M. Jawad, R. Schoop, A. Suter, P. Klein, R. Eccles
(2) Immunomodulation: Enhancing Immune Function With Herbal Supplements – Doing It The Right Way. By Don Goldberg. Willner Chemists Catalog/Newsletter Autumn 2012. (Digital version online at http://www.willner.com.
(3) http://www.nutraingredients-usa.com/Product-Categories/Minerals/Top-Immune-Health-Ingredients/(page)/7

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Statin Drugs: New Concerns and Alternative Therapies

New Concerns about Statin Drugs.
Should you consider non-drug alternative therapies?

The FDA recently raised additional safety concerns about statin drugs. They are going to require a warning that statin drugs can increase the risk of higher blood sugar levels and diabetes. In addition, the FDA said labels for statin drugs will now caution that some patients might experience memory loss and confusion.

We already knew that there were potential hazards associated with statin drugs. This is no surprise, as all drugs have side effects. We need to evaluate whether or not the benefits outweight those risks. Some of the side effects previously associated with statin drugs are the following:

- Liver damage
- Muscle and joint aches
- Nausea
- Diarrhea
- Constipation

At the same time the FDA announced the new concerns (blood sugar, memory loss and confusion), they announced that drug makers could remove a label warning that liver enzymes need to be monitored during statin therapy. They cited the fact that “serious liver injury with statins is rare and unpredictable” and that periodic monitoring “does not appear to be effective in detecting or preventing this rare side effect.”

That’s interesting. They are not saying the danger is any less. They are just saying there is no way to detect or prevent it. I don’t find that overly reassuring.

If you are taking a statin, such as Crestor, Lipitor (atorvastatin in its generic version) or Zocor (simvastatin), what should you do? According to most cardiologists, if you are in the “high-risk” category, i.e. someone who has already had a “cardiac event,” the benefit still outweighs the risk. “The vast majority of patients—especially those who are clearly at high risk of a heart attack—should keep taking the medicines, according to several cardiologists.”

Less clear is the advice for people who haven’t had a heart attack but have multiple risk factors, such as high blood pressure, high cholesterol, smoking history and perhaps a family history. Many doctors consider this as high risk as well. I think this is a group that has some serious thinking to do.

“For anyone with moderate or low risk, a decision to start or stay on a statin should be subject to individual belief and judgment and a discussion with a physician. If you’re on the fence and aren’t confident that a statin is called for, these new FDA warnings might give you cause to learn more about your risk before deciding what course to take.

If you are experiencing any of the known side effects, including these new ones, it is definitely time for a consultation with your doctor. “If someone isn’t thinking right, they definitely should stop taking their medicines and see if it gets better.” The effects on blood-sugar levels are also reversible in a vast majority of cases. (WSJ. Dow Jones & Company, Inc 2012)

If you are experiencing any of these side effects, or if you decide that in your case the risk to benefit analysis points in a non-drug solution, there are many effective options available to you. I will present those in a moment. First, let’s look as some additional comments about the statin drugs in general.

Michael Murray, N.D., in his recent book “What the Drug Companies Won’t Tell You and Your Doctor Doesn’t Know,” Atria Books, 2009, makes the following points about statin drugs in the chapter titled “Exploiting The Cholesterol Myth.”

“The cholesteerol-lowering statin drugs are anotheer example of ho the drug industry uses its muscle to peddle a products. There drugs are sold primarily on the premise that they will save lives by lowering cholesterol levels, but in reality they have not convincingly demonstrated an ability to extend life in women, and they produce very little effect in men who show no clinical evidence of heart disease. Also, statins involve a significant risk of serious side effects. It is a one-sided situation: the drugs provide no real benefit to the person taking them, but they are a very important source of revenue for the drug companies. Annual sales of these drugs now exceed $25 billion. They generate huge profits for the drug companies. The statin “empire” is perhaps the greatest accomplishment of the modern drug industry, and this is an achievement the drug companies and doctors should be ashamed of.

“The only reason we are so fixated on cholesterol is the influence of the pharmaceutical industry. It is very interesting to note that more than half the people who die of a heart attack or a stroke have low to normal cholesterol levels. How do the drug companies and the government respond to this fact? They simply recommend making the suggested target cholesterol levels even lower, thereby effectively casting an ever wider net for potential customers. Their goal is to turn all of us into patients hooked on statins. It i8s also very interesting that six of the nine expert members of the government panel that drafted the new cholesterol guidelines had either received grantsw from or were paid consulting or speakers’ fees by the companies that make some of the most popular statin drugs. There may be a conflict of interest here, but in any case these new guidelines should dramactically increase the number of patients on statin drugs. Keep in mind that statins are already the biggest moneymakers in the drug industry.

“Although high cholesterol levels are associated with an increased risk of a heart attack or stroke, the relationship of cholesterol to these cardiovascular diseases (CVDs) is much more complex than the drug companies and many doctors portray it. According to conventional wisdom, lowering cholesterol with statin drugs should decrease the risk of CVD. But except for those taking statins because of a prior heart attack or another significant risk factor, the science simply does not support this assumption. . .”=-0.0
For those of you who are interested in learning more about statins, controlling cholesterol, and alternatives to drugs, I highly recommend the following two books:

What The Drug Companies Won’t Tell You, And Your Doctor Doesn’t Know (The Alternative Treatments That May Change Your Life–And the Prescriptions That Could Harm You). Michael Murray, N.D. Atria Books, 2009. Willner Code: 57314 (List: $25; Willner Price: $20)

What You Must Know About Statin Drugs & Their Natural Alternatives (A Consumers’s Guide to Safely Using Lipitor, Zocor, Mevacor, Crestor, Pravachol, or Natural Alternatives.) Jay S. Cohen, MD. Square One Pub, 2005. Willner Code: 50734 (List: $15.95; Willner Price: $12.76)

As Dr. Murray says, cardiovascular disease is a multifactorial issue, and any attempt to simplify it by addressing only one risk factor is doomed to fail. “Simply stated, there are more important things to consider than the level of LDL cholesterol. The whole premise of reducing LDL cholesterol levels with statins is the mistaken belief that this will reduce the buildup of arterial plaque,” but researchers at Beth Israel Medical Center in New York City demonstrated that the statin-induced reduction of cholesterol “didn’t appear to have any statistical effect on the buildup of plaque. In other words, the buildup of plaque (which is the reason why doctors try to lower cholesterol) didn’t appear to be related to cholesterol levels. Again, there are other factors involved in the process of atherosclerosis that are significantly more important than lowering cholesterol, but are largely ignored because they do not involve drug therapy.”

What are those other factors?

Dietary measures can make a difference. Reduce your saturated fat, trans fatty acid, cholesterol and total fat in your diet by eating less meat and dairy, and more plant foods. Increase your intake of omega-3 fats and monounsaturated fats (cold water fish, nuts, olive oil, etc). Increase your intake of fruits and vegetables. Increase your fiber intake, especially “water-soluble” fiber (psyllium, oat, gums, etc). And limit your intake of refined grains and sugar (simple carbs).

Other lifestyle changes are important. Stop smoking. Lose weight. Exercise.

And take nutritional supplements. Here is a list of supplements of specific interest to those with cardiovascular concerns.

- Multivitamin Multimineral Supplement. Taking some type of “eye” or “vision” formula without also taking a good, balanced, full spectrum multivitamin multimineral supplement is a big mistake. Always take a good multi, as the foundation of your regimen. Make sure you include adequate calcium and magnesium. If you take a one-per-day or two-per-day formula, you will need a separate calcium/magnesium product.

Willvite, by Willner Chemists
120 Tablets – Code: 30439

- Niacin. Niacin is one of the B-Vitamins (B3). It has many functions. It is necessary for the processing of carbohydrates into energy or fat, for example. Niacin also plays a role in the metabolism of cholesterol. At high dosages, niacin acts more like a drug than a vitamin. It reduces total cholesterol and LDL-cholesterol, while raising the good HDL-cholesterol. Niacin also has beneficial action on triglycerides and fibrinogen levels. Most important, perhaps, is that some studies have indicated that niacin reduces people’s risk of heart attacks, including the risk of recurrent heart attacks in cardiac patients, and overall mortality.

What is the down side? At the high dosage needed to lower cholesterol, niacin can cause an unpleasant, although transient, flushing of the skin. The dose in this case can be several grams a day. It is important to note, by the way, that niacinamide, another form of vitamin B3, does not cause this flushing. Unfortunately, it also does not lower cholesterol.

There are three options available to those who want to utilize niacin, perhaps the best anti-cholesterol agent available. First, some people can tolerate regular niacin. Various methods of minimizing the flushing discomfort have been suggested. Second, there is a “intermediate-acting” form of niacin, Niaspan, available on prescription, that is effective in lowering cholesterol and less likely to cause the skin flush. Third, there is a non-prescription alternative, often referred to as “No-Flush Niacin.” It is actually a form of niacin called Inositol Hexaniacinate or Hexanicotinate. It is very popular with alternative physicians, and effective in dosages as low as 600 mg twice daily. It is commonly used at dosages of 500 to 1000 mg, two to three times daily. It has been used at levels as high as four grams daily, with no adverse reactions.

Used in this way, any of the above forms of niacin require monitoring by your physician, checking liver enzymes, uric acid, and glucose levels.

No Flush Niacin, 500 mg, by Solgar
Code: 13148 – 100 Capsules
Code 24663 – 250 Capsules

No Flush Niacin, 800 mg, by Twinlab
Code: 21105 – 50 Capsules

Niacitol No Flush Niacin, 725 mg, by Pure Encapsulations
Code 51737 – 90 VeggiCaps

- Fish Oil. According to Dr. Michael Murray, “Of all the nutritional products that can help prevent Cardiovascular Disease, the most important, without question, is pharmaceutical-grade fish oil.” In his book, Dr. Jay Cohen says “Omega-3 fatty acids (EPA and DHA may be as important as any of the pharmaceuticals and nutriceuticals discussed in this book.”

Dr. Cohen goes on to point out that, “today, it is widely accepted that omega-3 fatty acids reduce heart attacks, strokes, and deaths from heart disease, as well as the overall incidence of death from all causes. . . we also know that omega-3 oils are a critical factor in keeping blood vessels functioning properly and in preventing cardiac arrhythmias when heart attacks occur. For many people, the first symptom of heart disease is a heart attack. Each year, 250,000 people die from sudden cardiac death, usuall from heart attacks that are not in themselves lethal, but which trigger arrythmias that are. Multiple studies have now proven that omega-3 oils reduce the risk of sudden cardiac death by an astonding 40 percent to 80 percent.” According to Dr. Christine M. Albert, the chief of cardiology at Massachuysets General Hospital and the lead author of a major study on this issue, “The higher your blood level of omega-3, the lower your risk” of sudden cardiac death.

I invited Dr. Michael Murray to elaborate on his comments about the importance of omega-3 fish oil supplements, and he responded with the following:

“When your cardiovascular system works well, every other part of your body – including your brain – functions better. Consider that in an average lifetime, the heart will beat 2.5 billion times and pump one hundred trillion gallons of blood and you will start to recognize why it is so important to do everything you can to support your heart.

“One of the key effects of fish oils is supporting healthy vascular tissues. Maintaining the health of our arteries requires that platelets continue functioning properly. These blood cells can become very sticky and form blood clots. A high intake of saturated fat is one factor that contributes to platelet stickiness, and so leading to hardening of the arteries. The good news is that fish oil has been shown by many medical studies to reduce platelet stickiness. This action is thought to be a major factor in maintaining healthy cardiovascular functions. Regular consumption of fish oil supplements has also been shown to support healthy blood triglyceride levels, blood pressure and improve blood flow. These effects are all significant goals for supporting a healthy heart.

One of the most important steps to ensure heart health is to take a fish oil supplement. However, not all fish oil is alike. One of the best fish oil supplements available is Rx Omega-3 Factors™. It is referred to as a “pharmaceutical grade” fish oil because it possesses the following characteristics:

- It is manufactured in a certified GMP facility approved for pharmaceutical products.
- It is manufactured according to pharmaceutical standards that include quality control steps to insure the product is free from lipid peroxides, heavy metals, environmental contaminants and other harmful compounds.

For general health, the suggested usage is 1,000-1,200 mg of the long-chain omega-3 fatty acids EPA and DHA (combined amount) daily.

(Dr. Murray, in conjunction with Natural Factors, has developed the following two omega-3 fish oil supplements:)

RxOmega-3 Factors: Ultra Strength, by Natural Factors
(900 mg Omega-3 Fatty Acids per Softgel)
Code: 59107 – 150 Enteric Coated Softgels

RxOmega-3 Factors, by Natural Factors
(630 mg Omega-3 Fatty Acids per Softgel)
Code: 41830 – 120 Softgels

- Red Yeast Rice. This herbal supplement remains popular, even though the original product, Cholestin, as been taken off the market. The problem is that it’s effectiveness may be due to the fact that it naturally contains, to some extent, a substance similar to that found in the statin drug, lovastatin. If this is the case, it might be expected to exhibit the same side effects, etc, as the drug. The red yeast rice products that remain on the market are said to contain lower amounts (naturally occuring) than was present in Cholestin. Reputable brands assure us that there products are citrinin-free. Citrinin is a potentially toxic fermentation product. Those physicians and nutritionists who recommend red yeast rice claim that it works, and is remarkable side-effect free. They feel that there are other naturally occuring cholesterol-lowering compounds in the product that synergistically combine to explain its efficacy. This may indeed be true.

Red Yeast Rice, Heartsure, 600 mg, by Nature’s Way
Code: 56501 – 120 VeggieCaps

Red Yeast Rice, 600 mg, with CoQ10, by Nature’s Way
Code: 56505 – 60 VeggieCaps

Red Yeast Rice, 600 mg, with Phytosterols, by Nature’s Way
Code: 56504 – 60 Tablets

Red Yeast Rice, 600 mg, by Doctor’s Best
Code: 42861 – 120 Veggie Caps

Red Yeast Rice 600 mg Plus CoQ10 50 mg, by Jarrow Formulas
Code: 58831 – 120 Capsules

Red Yeast Rice – Rice that has been fermented by the yeast Monascus purpureus has been used in Asia for centuries as a food preservative, food colorant and flavoring as well as in traditional herbal formulas. It is part of the diet in China, Japan, and Asian communities in the United States. Jarrow FORMULAS® uses Red Yeast Rice that is carefully fermented to avoid the presence of the natural byproduct citrinin. Coenzyme Q10 complements Red Yeast Rice in supporting healthy cardiovascular function.

- Beta-Glucan. Beta-glucan is a soluble fiber derived from the cell walls of algae, bacteria, fungi, yeast, and plants. The beta-glucan found in yeast and mushrooms contain 1,3-glucan linkages and occasionally 1,6 linkages, whereas the beta-glucans from grains (i.e., oats and barley) contain 1,3 and 1,4 linkages.

If you look for “Beta Glucan” supplements, you will find products that are designed for immune system support, not cholesterol reduction. To get the benefits of beta glucan’s cholesterol lowering action, you want to look for fiber products, such as oat bran.

Oat Bran 750 mg, by Solgar
Code: 13483 – 100 Tablets
Code 13484 – 250 Tablets

- Fiber Supplements. Other fibers, beside oat bran, have been shown to lower cholesterol and LDL cholesterol. Psyllium, and other “water-soluble” fibers, gums, pectins, etc have this effect.

Soluble Fiber Formula, by Yerba Prima
Code: 12121 – 12 Ounces (Powder)
Code: 12120 – 180 Capsules

Fiber Formula: Oat Bran and Psyllium, by Integrative Therapeutics
Code: 54278 – 120 Capsules

Gentle Fibers, by Jarrow Formulas
Code: 24810 – One Pound (Powder)

- Plant Sterols, Beta-sitosterol. Sterols are essential components of the cell membrane in both animals and plants. Cholesterol is a sterol found in humans. In plants, the sterols are different. Beta-sitosterol is a plant sterol. When humans eat plant sterols and stanols, these substances block the absorption of cholesterol from the intestine. According to National Standard, “Many studies in humans and animals have demonstrated that supplementation of beta-sitosterol into the diet decreases total serum cholesterol as well as low-density lipoprotein (LDL) cholesterol and may be of benefit for patients with hypercholesterolemia (high levels of blood cholesterol).”

Cholesterol Formula with Sytrinol, by Natural Factors
Code: 51368 – 120 Capsules
“Combining plant sterols with Sytrinol provides a comprehensive formula that addresses all facets of dyslipidemia including high cholesterol, high LDL and high triglycerides.”

Beta Sitosterol Mega Strength, by Source Naturals
Code: 51407 – 120 Tablets

Phytosterols are natural components of many vegetables and grains. Preliminary scientific evidence suggests that plant phytosterols may help to support cholesterol wellness when consumed as part of a low cholesterol dietary program. The three main phytosterols in phytosterol complex are beta-sitosterol, campesterol, and stigmasterol. They are natural, safe, and derived entirely from plant sources.

Beta Sitosterol Phytosterol Complex, by Source Naturals
Code: 37519 – 180 Tablets

- Garlic. Listen to the recent interview with James LaValle, R.Ph., N.D. on The Willner Window, airing February 26, 2012, for the latest research demonstrating the role that garlic (aged garlic, in this case) can play on cholesterol and cardiovascular health. Go to http://www.willner.com and click on the radio tab.

Kyolic Aged Garlic Extract, Formula 107, by Wakunaga
Aged Garlic and Phytosterols Combination
Code: 44845 – 80 Capsules

Kyolic Reserve 600 mg Cardiovascular, by Wakunaga
Code: 22121 – 60 Capsules
Code: 25640 – 120 Capsules

Kyolic One Per Day 1000 mg, by Wakunaga
Code: 44680 – 30 Caplets

This is not a complete list of supplements that can be an effective part of a cholesterol lowering, heart healthy supplement program. Some of the other supplements that should be considered are the following:

- Pantethine (vitamin B5)
- Vitamin C
- Chromium
- Soy
- Calcium, Magnesium
- Gum Guggle
- L-carnitine
- tocotrienols
- policosanol, octacosanol
- CoQ10, Ubiquinol

In summary, if you are unsure if you should rely on statin drugs, or if you should continue doing so, you do have other options. Effective options. In some cases, availing yourself of these options may allow you to lower your dose of statin drug, if not eliminate it altogether. It is important, however, to work with your physician if you intend to make these changes. A conscientious physician should be happy to work with a patient who wants to substitute dietary changes, lifestyle modification and a therapeutic supplement regimen for prescription drugs.

Don Goldberg, R.Ph.

Note: If you want to order or inquire about the various products mentioned, use the “code number” to easily identify the product. This is true whether your are on the Willner website, or calling the store directly.

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Age-Related Macular Degeneration: Nutritional Therapies

Question: “I was diagnosed with the beginnings of dry macular im 63, female , could u recomend a supplement for me? im taking for 6 months now a formula that is Ronald Hoffman’s Ocular support. 60veggie caps 2 a day $30.00, i have been using that. What do u recommend?
thx julieann”

Answer: Age-related macular degeneration (AMD) is a leading cause of permanent vision loss in the elderly. It is considered to be irreversible, so prevention is important. Treatment with dietary supplements is accepted medically.

There are two forms, dry AMD and wet AMD. Ninety percent of the time, it is the dry form. The wet form of AMD usually begins as the dry form.

According to the Merck Manual of Diagnosis and Therapy, the treatment for AMD is (1) Dietary supplements (dry or wet), (2) Intravitreal anti-vascular endothelial grow factor drugs or laser treatment for wet AMD, and (3) supportive measures.

The acceptance of dietary supplements by conventional medicine as a treatment for AMD is due in part to a study published in the October 2001 Archives of Ophthalmology, publicized by the National Eye Institute, National Institutes of Health in 2001. The headline read “Antioxidant Vitamins and Zinc Reduce Risk of Vision Loss from Age-Related Macular Degeneration.”

While the study concluded that what they considered “high levels” of antioxidants and zinc significantly reduced the risk of advanced age-related macular degeneration (AMD) and its associated vision lossm, they were unable to demonstrate the same effect on the development or progression of cataract.

“Scientists found that people at high risk of developing advanced stages of AMD, a leading cause of vision loss, lowered their risk by about 25 percent when treated with a high-dose combination of vitamin C, vitamin E, beta-carotene, and zinc. In the same high risk group — which includes people with intermediate AMD, or advanced AMD in one eye but not the other eye — the nutrients reduced the risk of vision loss caused by advanced AMD by about 19 percent. The clinical trial — called the Age-Related Eye Disease Study (AREDS) — was sponsored by the National Eye Institute (NEI), one of the Federal government’s National Institutes of Health.”

Now, before we talk specifically about nutritional supplements and age-related macular degeneration, I want to focus on a common mistake most people make. When a study such as this is published, and a particular combination of nutrients, at a certain dosage level, results in a positive outcome, the tendency is to run out and purchase a product that duplicates that regimen. The thinking is that this must be the optimal combination, the optimal dose, etc. That is not necessarily true.

In most studies of this type, the researchers did not compare different formulations and dosages to determine which combination and/or dosage was optimal. Instead, they sat down beforehand and decided what to use. Sometimes that decision is based upon the fact that a certain product is being provided to them. Oftentimes, the decision is based on previous research. Sometimes it merely a “best guess.” Rarely, if ever, should you conclude that the formula used is necessarily the best, because that type of comparison is not usually part of the study.

In the case of this AREDS study, the antioxidant formulation contained a combination of vitamin C, vitamin E, and beta-carotene. The specific daily amounts of antioxidants and zinc used by the AREDS researchers were 500 milligrams of vitamin C; 400 international units of vitamin E; 15 milligrams of beta-carotene; 80 milligrams of zinc as zinc oxide; and two milligrams of copper as cupric oxide. How did they come up with this combination? “In the study’s planning stages, a panel of nutritionists, ophthalmologists, and biochemists reviewed the basic science and epidemiological data and recommended these vitamins and dosages.”

So when the results were published, everybody ran out to buy formulations that mimicked this exact formula. And this might be a big mistake.

For one thing, in the actual study, they divided the participants into four groups. One group received the antioxidants alone (i.e. no zinc). Their risk of AMD was reduced by 17 percent, and risk of vision loss reduced by 10 percent. Another group received zinc alone (i.e. no antioxidants). Their risk of AMD was reduced by 21 percent and risk of vision loss reduced by 11 percent. The third group received a combination of antioxidants plus zinc. Their risk of AMD was reduced by 25 percent and risk of vision loss reduced by about 19 percent. A fourth group received a placebo.

What, then, is the proper conclusion? Do we look at this and run out to purchase a mixture of Vitamin C 500mg, Vitamin E 400IU, beta-carotene 15 mg, zinc 80 mg, and copper 2 mg? Many people do. Or do we say, “Wow! Antioxidant vitamins and minerals do indeed seem to have a profound effect on preventing AMD. Since I’m at risk, I certainly should make sure I am taking ample amounts of these nutrients as part of my supplement regimen.”

Do we look at this “AREDS” formula, and ask whether it would be better if we took natural vitamine E rather than the synthetic version they used? Even better, should we take a natural mixed tocopherol vitamin E. If the AREDS formula lists “dl-alpha tocopheryl acetate,” that is synthetic vitamin E.

Do we look at this “AREDS” formula and ask whether it would be better if we took natural beta-carotene rather than synthetic beta-carotene? Even better, would there be even more benefit if there was some actual vitamin A in the formula, rather than just beta carotene?

Do we look at this “AREDS” formula and ask whether it would be better if we took chelated zinc and copper rather than the oxide?

Do we look at this “AREDS” formula and ask whether it would be better if we included lutein and zeaxanthin in the regimen? Do we ask “if this collection of basic antioxidants was so helpful, might it not be even better if we included a broader selection of potent antioxidants in the regimen, antioxidants such as alpha-lipoic acid, glutathione and/or glutathione precursors, manganese, and phyto antioxidants such as those found in billberry, ginkgo, grape skin.
The researchers demonstrated that one particular mixture of antioxidants was significantly beneficial in reducing AMD. They did not prove that this was the best mixture. They did not prove that other, similar mixtures might not be even better.

My advice–probably obvious by now–is to looks at the bigger picture. You don’t need an “AREDS” formula. Instead, you need to make sure your total supplement regimen includes those nutrients–and more. You are probably already getting those nutrients, at those levels, in the various nutritional supplements you already take. The lesson you should be taking away from this research is that antioxidants are a key to the prevention and treatment of AMD.

You certainly do not want to limit yourself to an “AREDS” formula alone. There are other nutrients (lutein, omega-3 oils, vitamin A, ginkgo biloba, bilberry, goji, selenium, n-acetyl cysteine, alpha-lipoic acid, coenzyme Q10 or ubiquinol, acetyl-l-carnitine, etc) that are important. And tying all of this together with a good broad spectrum multivitamin multimineral is essential.

On a personal note, my primary area of health vulnerability is my eyes. I have had cataract surgery. I am already suffering partial visual field loss due to glaucoma. I have a family history of glaucoma. I was extremely myopic, which increases my potential for various retinal damage. Adjusting my supplement protocol to accommodate this problem is of the highest importance to me. I do not take an “AREDS” formula. Instead, I apply the lesson learned from that research by including the following products in my daily supplement regimen:

* Antiox Phyto Complex (Willner Chemists, Code: 57091)
This is a powerful blend of antioxidants from plant extracts (Acai Berry, Mangosteen, Goji, Pomegranate, Green Tea, Grape Skin and Grape Seed). Dose: One capsule twice a day.

* Blackcurrant with Lutein (Jarrow Formulas, Code: 55410)
Each capsule contains 200 mg of black currant extract, along with 10 mg lutein and 400 mcg Zeaxanthin. Dose: One capsule twice a day.

* Omega Vision (Nordic Naturals, Code: 55601)
A blend of omega-3 fish oil (High DHA to EPA ratio) with extra lutein (10 mg per softgel) and zeaxanthin. Dose: One or two softgels, twice a day.

* Willvite Multivitamin Multimineral (Willner Chemists, Code: 30439)
A full spectrum, balanced multivitamin multimineral, with calcium and magnesium. It provides 30 mg of zinc, as an amino acid chelate and 2 mg copper, as the gluconate. It also provides 300 IU of natural vitamin E and a total of 20,000 IU of vitamin A. That 20,000 IU of vitamin A is divided as follows: 15,000 IU as natural beta-carotein and 5,000 IU as actual, preformed vitamin A. This is a bonus when it comes to various conditions, including AMD prevention. And finally, it also includes 1000 mg of vitamin C, as ascorbic acid and calcium ascorbate along with all the other B-vitamins, trace minerals, etc. Dose: 2 tablets, two times a day.

* Alpha Lipoic Sustain 300 with Biotin (Jarrow Formulas, Code 59190, 32968)
A powerful, fat soluble antioxidant. It has been shown to have special value in glaucoma and diabetes. Dose: One tablet twice a day.

* Ubiquinol 100 mg (various brands, Jarrow Formula QH-Absorb Code: 59922)
Powerful antioxidant. Look for “Kaneka” trademark symbol. Dose: One softgel, two times a day.

* Antiox Phyto Blend (Willner Chemists, Code: 57551)
This is optional. It is similar to the Antiox Phyto Complex, above, but is a liquid (dropper bottler) rather than a liquid-filled capsule. I add a dropper ful of Antiox Phyto Blend to my bottled water, my evening Margarita, as a way to get additional phyto antioxidants. It contains Acai, Mangosteen, Pomegranate and Goji. It has a mild, berry flavor and easily blends in with water, etc.

Now, this is not my total supplement regimen. I also take extra vitamin D3, GPLC (Glycine Propionyl-L-Carnitine, Probiotics, etc). But these are those products I count on to provide the specific nutrients shown to be protective (and perhaps therapeutic) for AMD prevention and other eye problems.

Getting back to the original question, no one product is going to be the answer. You need a broad spectrum multivitamin multimineral. You need extra antioxidants, both regular (vitamins such as lutein, vitamin A, vitamin C, etc) and plant derived (phyto antioxidants such as ginkgo, billberry, goji, grape skin, etc). You need fish oil omega-3′s, in therapeutic quantity. You need a comprehensive supplement regimen, not a single “eye,” “vision,” or “AREDS” formula.

If you need help deciding on a supplement program for this problem, or others, you are welcome to consult with the pharmacists and nutritionists at Willner Chemists. We will evaluate your current supplement regimen, and offer suggestions for improvement or optimization. Stop by any of our stores, or call 1-800-633-1106. An in-person visit is always best, but we will do our best to help you over the telephone if you cannot come to the store.

Don Goldberg, R.Ph.
Willner Chemists

Posted in Uncategorized | 1 Comment

Negative News About Vitamins! . . . Cause For Concern?

I was not going to respond to the two recent news headlines about vitamins supplements. Both were negative, and not surprisingly, were given a great deal of attention by the news media. One was a story about vitamin E supposedly increasing the risk of prostate cancer, and the other was a story claiming that women taking vitamin supplements die sooner than women who do not take supplements.

Why was I not planning to comment? For one thing, neither story is really all that newsworthy. In both cases, the conclusions were surprising, in that they ran counter to what everyone expected and counter to the numerous studies that preceded them. They made no sense, could not be explained, and the nature of the study was such that much room was left for controversy as to whether the results were actually valid and meaningful. This leads to the first important observation I want to call to your attention:

The fact that a study is prominently featured on a news broadcast does not necessary mean it is a valid study. Instead, it just means that it is newsworthy. Unfortunately, newsworthy these days usually translates into “sensational,” “controversial,” or “sexy.” While these vitamin studies may not satisfy the “sexy” requirement, they certainly do satisfy the other two.

Another reason I was not going to comment is that few people really care. Most people who watched the news broadcast, or read about the studies in the newspaper, fall into one of three groups–those who are pro-vitamin supplement, those who are anti-vitamin supplement, and those who don’t really care either way.

There is no need to address comments to the first group, those who for various reasons are convinced of the value of nutritional supplementation, because they dismiss this kind of news as biased, illogical, politically motivated, etc. Their faith remains unshaken. Similarly, those at the other end of the spectrum are quick to embrace anything that seems to support their position that nutritional supplements are unnecessary, evil, a waste of money, etc.

No amount of positive data on vitamins will shake the skepticism of the anti-vitamin folks, and no amount of negative data on vitamins will undermine the optimism of the pro-vitamin folks. Certainly, nothing I say–no critique of the study’s methodology, no suggestions as to why the results were flawed–will change their minds. So, the second observation is as follows:

Few people really care. Those who understand the value of nutritional supplementation will be unimpressed with this type of news headline. Those who are anti-vitamin will gleefully accept the negative headlines, no matter how flawed the study and how illogical the results. And those who do not really care just, well, do not care.

Now, there are many flaws and there are many observations that can be made which diminish the significance of these studies. For those of you who really want to look at that, I will append a collection of such comments at the end of this story. For me, however, the bottom line is this. Studies like these should not be dismissed out of hand. But they have to be taken in context. If something does not make sense, seems illogical, cannot be explained, and runs counter to numerous previous studies, why would it be considered newsworthy?

Many of the “revelations” in these two studies actually support the information I have been giving for years. For example:

• Don’t take isolated nutrients. We always emphasize the importance of a balanced, comprehensive multivitamin-multimineral blend as the cornerstone, or foundation, of any nutritional or therapeutic regimen. I have never recommended an isolated dl-alpha tocopherol 400IU supplement.

• Don’t take high dose iron supplements unless under medical direction, especially if you are menopausal or male. I do not recommend total avoidance of iron, but typically suggest one-half the daily value (9 mg) for those who do not have need for a more therapeutic dose.

• Food is always the ideal way to get your vitamins and minerals. But lets not ignore the fact the few of us eat a sufficiently well-balanced diet to guarantee this. Research clearly shows that the average American is clearly deficient in one or more essential nutrients.

• Moderation is the key. Therapeutic use of vitamins, minerals and herbs is without question beneficial. But use common sense. Anything when taken to extremes can become dangerous.

A little common sense can go a long way when it comes to vitamin supplementation. Common sense, and guidance from qualified, educated health professionals. There is a lot of good information available, but there is also a lot of self-serving misinformation. If you think your supplement regimen may not be safe and optimal, I suggest you come by one of the Willner Chemists stores and talk to our pharmacists and nutritionists.

The overwhelming preponderance of evidence, scientific and anecdotal, supports the value of nutritional supplementation. These recent studies do not change that.

As promised, I will append a collection of comments and critiques to the two recent studies.

——————————————–

An increase in cancer was originally noted in the vitamin E-only group, but the results weren’t statistically significant.

The follow-up, however, which tracked the health of about half the trial’s original 35,000-plus participants, found a 17% increase in prostate cancer, compared with men who took a placebo. For every 1,000 men, 76 who took vitamin E supplements got prostate cancer, compared with 65 men who took placebo.

Dr. Minasian said the Select trial, which began in 2001, was prompted by animal studies, observational studies and secondary findings from other trials suggesting selenium and vitamin E protected against prostate cancer, which causes nearly 34,000 deaths in the U.S. a year.

It wasn’t clear why vitamin E might lead to an increase in prostate cancer, or why earlier studies suggested the opposite, Dr. Minasian said. More needs to be learned about how the nutrient acts at various steps on the progression from normal to cancerous tissue, she said.

New study on supplements’ effects on older women flawed, nutrition experts say

Caren Baginski, newhope360

Oct. 11, 2011

New study on supplements’ effects on older women flawed, nutrition experts say

Industry experts dissect supplement study’s flaws

The natural health industry rallies to respond to a controversial study published yesterday in the Archives of Internal Medicine that found that dietary supplements don’t contribute to lower death rates in older women. Natural health experts and the supplements industry weigh in on the flaws and biases they find in the research.

A new study published yesterday in the Archives of Internal Medicine titled “Dietary Supplements and Mortality Rate in Older Women” claims that dietary supplements overall are not helpful for increasing longevity in older women. The findings have natural health experts rallying to respond to what they say is a biased and scientifically skewed study on dietary supplements.

The study tracked the use of vitamin and mineral supplements in relation to total mortality in nearly 39,000 older women in Iowa from 1986 to 2008. Researchers found that dietary supplements, with the exception of calcium, do not reduce the death rate in older women. Calcium is by far the top-selling mineral supplement, accounting for 54 percent of the $2.2 billion in 2010 mineral supplements sales, according to Nutrition Business Journal.

The study’s conclusion went on to say that “in older women, several commonly used dietary vitamin and mineral supplements may be associated with increased total mortality risk [emphasis added].” The researchers associated use of multivitamins, vitamin B6, folic acid, iron, magnesium, zinc and copper with increased risk of total mortality when compared with groups that did not take supplements.

“It’s important to keep in mind that this is an associative—not a cause-and-effect—study,” said Duffy MacKay, vice president of scientific and regulatory affairs for Council for Responsible Nutrition (CRN), in a statement. “This study … attempts to tease out one piece of the healthy equation for good health—dietary supplements. CRN maintains that nutrients may be robbed of their beneficial effects when viewed as if they were pharmaceutical agents, with scientists looking to isolate those effects, good or bad.”

Industry experts dissect supplement study’s flaws

How does the industry, which regularly comes across studies such as, “Vitamin D reduces mortality rate by 20 percent,” respond to research that paints an entirely different picture of supplements’ benefits?

The same way it always does: consumer education—and pointing out precise biases and flaws in the “Dietary Supplements and Mortality Rate in Older Women” study.

“What the researchers and editors seemed to miss is that older women (or men) have a greater risk of death simply because of their age, their greater likelihood of having serious diseases, and their use of multiple drugs, a common cause of illness (from side effects),” said Jack Challem, The Nutrition Reporter.

Jacob Teitelbaum, MD, a holistic physician and coauthor of Real Cause, Real Cure (Rodale, 2011), said the researchers ignored a key point of the study: the fact that women who took supplements before the study were healthier than those who did not.

“One could come to the same conclusion about exercise not being helpful using this same statistical approach,” he said. Take for example a study with two control groups: those who exercise and those who do not, but both of which are put on a new exercise program. At the beginning of the study, those who already are exercisers are healthier than those who are not. By cancelling this fact out, and negating the prior health of the exercisers, you can find that exercise is not beneficial, he said.

That’s what the researchers did in this supplements study, Teitelbaum said. “The people taking multivitamins at the beginning of the study were statistically doing a lot better—there was less high blood pressure, less diabetes [than the non-supplement users]. The researchers totally ignored that.”

Teitelbaum adds that the omission of these facts wasn’t the only flaw in the study: “The hypothesis wasn’t to state whether supplements will harm or help. It was to see if they would harm, which gives you an idea of what their study was about.”

In a statement, Steve Mister, president and CEO of CRN, pointed to another flaw: The publication invited a scientist whose opinion is already controversial toward supplements to comment on the study.

“In the spirit of true scientific discourse, wouldn’t it have been more appropriate to invite commentary from a researcher who might have looked at the data in its entirety, with sufficient lead time, and provided a different perspective?” Mister asked. “It’s time scientific journals acknowledge they have some biases, just like industry.”

JAMA Article Is No Reason Not to Take Your Multivitamins

I want to share a statement from Natural Products Association (NPA) Vice President of Scientific and Regulatory Affairs Cara Welch, Ph.D., about recent concerns regarding the alleged risks of dietary supplements in the Archives of Internal Medicine:

“The Natural Products Association advocates that consumers use dietary supplements as part of a healthy lifestyle. Most vitamin and mineral supplements are taken to address or prevent deficiencies. While we would prefer that Americans get these nutrients from their diet, studies have consistently shown that they do not take in the essential compounds they need.

I’m always pleased to see analysis on the long-term effects of supplementation. This study, however, is quite limited in scope; the data is observational and self-reported so contributing factors are not addressed. Subsequently, the authors cannot conclude any cause and effect and there is no reason why women should change what they’re doing based on this report.

There are plenty of studies published that demonstrate the benefit of supplementation and fortification. This specific study should not dissuade the general public from the benefits of addressing a vitamin or mineral deficiency with dietary supplements. As always, consumers should discuss their supplement usage with their health care professional.”

The statement is being delivered to all trade publications and the mainstream press. Feel free to share it with your customers and colleagues.

Sincerely,

John Gay, CAE

Executive Director and CEO

In response to these study findings, Steve Mister, president and CEO, the Council for Responsible Nutrition (CRN), commented: “Consumers continue to look for the best way to live long and healthy lives, and as much as we would like for science to easily give us answers, the fact is science is not black and white. But even more concerning is the recent drive to combine political agendas with what should be pure science. The supplement industry regularly gets accused of this practice—in some cases rightly so—yet medical journals seem to be given a pass, as if somehow they held no bias whatsoever.

“Within the article itself are a number of opinions, including: ‘Also, cumulative effects of widespread use, together with food fortification, have raised concern regarding exceeding upper recommended levels …’ It’s quite popular these days to talk about over nutrification, but in fact research consistently shows most people are falling short in several key nutrients.

“The authors advise that dietary supplements only be used ‘with strong medically based cause, such as symptomatic nutrient deficiency …’ Given the high dosages of iron reportedly being used by the women in the study, it is highly likely the participants were taking the high dosage of iron reported in the study under a physician’s care for an iron deficiency, which may itself have resulted in a shortened lifespan. But the piece purports to warn against over-the-counter (OTC) use of vitamins.

“The publication invited a commentary from a scientist whose opinion on supplements and their potential role in good health is already well-known, and whose own work has been the subject of controversy in scientific circles: ‘…Therefore, we believe politicians and regulatory authorities should wake up to their responsibility to allow only safe products on the market.’ In the spirit of true scientific discourse, wouldn’t it have been more appropriate to invite a commentary from a researcher who might have looked at the data in its entirety, with sufficient lead time, and provided a different perspective?

“Critics of dietary supplements will continue to advocate vitamins and minerals should be regulated like drugs, but even they should realize that although drugs undergo rigorous RCT testing, many safety issues for drugs still do exist. Furthermore if nutrients were regulated like drugs, the cost and availability of supplements would make it difficult for average consumers to make these products part of their healthy lifestyle.

“It’s time scientific journals acknowledge they have some biases, just like industry.”

Duffy MacKay, N.D., vice president, scientific and regulatory affairs, CRN, also commented, stating: “Dietary supplements are used by more than 150 million Americans in combination with other healthy lifestyle habits. This study, however, attempts to tease out one piece of the healthy equation for good health—dietary supplements. CRN maintains that nutrients may be robbed of their beneficial effects when viewed as if they were pharmaceutical agents, with scientists looking to isolate those effects, good or bad.

“It’s important to keep in mind that this is an associative—not a cause and effect—study. Further, the authors themselves have noted additional limitations. In fact, when the authors did their initial [minimum adjusted] analysis, it appears they actually found benefit for many of the supplements, not just calcium; yet instead of stopping there, they went on to ‘further adjust’ the data, possibly until they found statistics worthy of this publication’s acceptance. The study may make for interesting scientific water-cooler discussion, but certainly does not warrant sweeping, overstated concerns for elderly women.

“Further, the authors show their own bias with this statement: ‘We recommend that [dietary supplements] be used with strong medically based cause, such as symptomatic nutrient deficiency…’, which basically means these researchers would rather wait till we all get scurvy before acknowledging any need for supplemental nutrients.

“Our advice to consumers: your best chance for living a long and healthy life is to engage in healthy lifestyle practices, and many in the scientific community maintain that rational, reasonable use of vitamins and other supplements is part of that equation.”

Cara Welch, Ph.D., vice president, scientific & regulatory affairs, Natural Products Association (NPA), concurred with CRN’s comments, adding: “The majority of vitamin and mineral supplements are taken to address or prevent deficiencies. While we would prefer Americans get these nutrients from their diet, studies have consistently shown they do not take in the compounds essential for their health and supplementation can help. I’m always pleased to see research done on the long-term effects of supplementation; but this study is limited in that it is observational and self-reported so contributing factors are not addressed. There are plenty of studies published that demonstrate the benefit of supplementation and fortification, this specific study should not dissuade the general population from the benefit of addressing a vitamin/mineral deficiency with dietary supplements. And as always, consumers should discuss their supplement intake with their health care professional.

_____________________________

. . . about the study:

The use of dietary supplements in the United States has increased considerably over the last decade, according to background information in the article. Jaakko Mursu, Ph.D., of the University of Eastern Finland, Kuopio, Finland, and the University of Minnesota, Minneapolis, and colleagues used data collected during the Iowa Women’s Health Study to examine the association between vitamin and mineral supplements and mortality (death) rate among 38,772 older women (average age 61.6 years). Supplement use was self-reported in 1986, 1997 and 2004 via questionnaires.

Among the 38,772 women who started follow-up with the first survey in 1986, 15,594 deaths (40.2 percent) occurred over an average follow-up time of 19 years. Self-reported supplement use increased substantially between 1986 and 2004, with 62.7 percent of women reporting use of at least one supplement daily in 1986, 75.1 percent in 1997 and 85.1 percent in 2004.

Miriam Pappo, director of clinical nutrition at Montefiore Medical Center in the Bronx, N.Y., said the findings likely won’t drive doctors to stop recommending multivitamins to help patients get all the nutrients they need.

“No one disputes that oral intake of food to get your vitamins and minerals is the way to go,” said Ms. Pappo. However, “in reality, most of us don’t make it up to the nine [servings] a day of fruits and vegetables.”

Susan Fisher, chairwoman of the University of Rochester School of Medicine and Dentistry’s Department of Community and Preventive Medicine, noted that the study looks at deaths and not debilitating health conditions that vitamins can help prevent. “If your doctor suggests you should take supplements, it is still wise to follow that direction,” Dr. Fisher said.

Playing with Statistics

Two negative studies on supplements deserve brief comment. A report in the Journal of the American Medical Association found that men who had taken vitamin E supplements had a greater risk of developing prostate cancer, compared with men who did not take the vitamin. First, the vitamin E used in the study was synthetic, which is very different from the natural form. That alone could account for the finding. Second, the diagnoses of prostate cancer were made years after the men had stopped taking vitamin E supplements, which to me would suggest some other cause or combination of causes. Furthermore, prostate cancers are typically so slow growing that many of the cancers were probably undetectable when the study began, which would have further skewed the findings.

A second article in the Archives of Internal Medicine reported that older women who took a variety of supplements, including multivitamins, had a greater risk of death from disease. The only really significant association was between iron supplements and a greater risk of death, which has been known for years. What the researchers and editors seemed to miss is that older women (or men) have a greater risk of death simply because of their age, their greater likelihood of having serious diseases, and their use of multiple drugs, a common cause of illness (from side effects) and of death. For all we know, the risk of death might just as well have been associated with the use of the internet or cell phones.

These reports made for great headlines, but very poor science.

————————————–

Multivitamins and mortality: ‘Seeing-what-you-want’ science

http://www.nutraingredients-usa.com/Research/Multivitamins-and-mortality-Seeing-what-you-want-science?utm_source=AddThis&utm_medium=More&utm_campaign=SocialMedia%23.Tph-yPPwoxE.printfriendlyOctober 14, 2011

During a week when the industry gathered under clear blue skies in Las Vegas to celebrate 15 years of SupplySide West, black clouds rolled in and unleashed a short sharp downpour: I am of course referring to the articles published on multivitamins and vitamin E.

First of all, research published in the Archives of Internal Medicine (a journal from the American Medical Association) concluded that older women who take multivitamins and copper supplements are at greater risk of dying from heart disease, cancer and other causes than women who don’t take them.

And then the headlines followed: Your Multi-Vitamin May Be Killing You (Shape Magazine) and Study: Vitamins may increase death risk in older women (USA Today).

We’ve seen similar studies before (more often than not published in journals from the American Medical Association) but what was different this time was the industry was ready, it had advanced warning and reacted immediately to their publications – this is progress.

Comments came in from the Natural Products Association (NPA), the Council for Responsible Nutrition (CRN), and the United Natural Products Alliance (UNPA) to put the studies in context, to highlight their limitations (which just isn’t done in the main stream media), and for this I would commend the associations.

I would also suggest that the industry gather a team of academic champions to support their comments, much like it has champions in the Senate and elsewhere: A reaction from a trade association, no matter how measured and insightful, will always be seen by some as ‘damage control’ (as someone remarked on Twitter in relation to my coverage of the studies ).

Multivitamins

Which leads me on to the studies themselves. The multivitamin study was observational, and relied on questionnaires – so it was always going to show correlation and not causation.

The researchers did tweak their results to account for a number of potential confounding factors, such as BMI, use of hormone replacement therapy, smoking status, alcohol intake, exercise levels, intakes of saturated fatty acids, and so on, but you can never fully remove the suspicion of confounding.

My one big question is over compliance – just because the women said they were supplement users, does not necessarily mean they were actually taking supplements. Compliance is notoriously low even in clinical trials where participants have signed up and agreed to swallow a capsule every day.

Just because these ladies ticked the box on a questionnaire that came in every 10 years does not mean that they were taking supplements – and the same supplements – everyday for all that time.

In addition, the researchers provide no information whatsoever about actual nutrient levels. No blood samples were taken and so we have no idea – none whatsoever – if the women had high levels of vitamin B6, for example, flowing through their veins. For all their posturing on the questionnaires, they may have been vitamin B6 deficient for all we know.

What did Twain say about statistics?

Also, if you look at the statistics, only copper and the multivitamins actually had a statistically significant association, and even then the one for multivitamins was relatively small.

The copper one was large, and you’d be hard pressed to find people to argue against excessive intakes of copper. Or iron, for that matter. There is too much of a good thing, as I shall come on to in a moment.

On the other hand, the apparent benefits for calcium supplements remained statistically significant, a result that may raise eyebrows for some in the medical fraternity following a high-profile meta-analysis in the British Medical Journal that concluded that calcium supplements may be dangerous.

Observational studies show correlation and not causation and headline writers running with Your Multi-Vitamin May Be Killing You (Shape Magazine) is irresponsible and naïve.

But the study should not be dismissed. It adds to the debate and perhaps does raise questions over when supplements should be used: And so on to the vitamin E-prostate SELECT study: A well-designed study, by all accounts, that shows the benefits of longer term analysis of study cohorts. However, an interesting comment by Bill Sardi, a well known personality in the industry, posted on NutraIngredients-USA today adds some nice context:

“The problem with these studies is that they don’t show cause-and-effect. The researchers could not surmise any mechanism for the increased deaths related to vitamin E use. The problem is that men with prostate cancer take more supplements and in higher doses. They may have also been wearing tennis shoes. But obviously these are only associated factors, not causal factors.”

Take home

So what to make of all this? It’s a high profile journal with a reputation of only publishing damning studies about supplements – look to the likes of the American Journal of Clinical Nutrition or the Journal of Nutrition and you will see tens, even hundreds of studies reporting benefits of good nutrition, of which supplements play a role. JAMA has a better PR department, it would seem, and the medical community looks to it with reverence – don’t get me wrong, it is a great journal… for medical research.

The comments from the supplement trade associations have a lot of wisdom about them. Their comments cannot be simply dismissed as spin or damage control (as someone on Twitter suggested), but they provide some balance to the JAMA articles. Supplements, as the name suggests, supplement the diet, and people with poor diets may benefit greatly.

A wider problem may be that the public view supplements as a fix-it for poor lifestyle. Perhaps industry and academia should work even harder on explaining that supplements should not be expected to undo a lifetime of poor habits or diet: Black clouds will always appear in the sky, but it doesn’t hurt to have an umbrella ready.

——————————-

Be careful not to draw big conclusions from this study. Yes, the study was large—it included nearly 40,000 women. But it was an observational study. In other words, the study observed patterns. It did not randomly divide women into groups and assign them different combinations of vitamins to take. Randomized studies give us much cleaner science, without muddy conclusions.

 

For example, in this study it is possible that many of the women who were taking vitamins were more often feeling unwell in some way, or were seeing doctors more frequently, compared with the women who did not take vitamins. Women may have been taking vitamins in an effort to improve symptoms. If this is the case, who is to say that the vitamins were responsible for the difference of death rates? Other factors may have been to blame.

. . . News Review from Harvard Medical School – Do Vitamin Supplements Help or Harm?
By Mary E. Pickett, M.D.
Harvard Medical School

Posted in Nutrition & Health | 3 Comments