Don Goldberg's Blog

A report, “Dietary Reference Intakes for Calcium and Vitamin D,” was issued by the National Academy of Sciences Institute of Medicine, on November 30^th. This was reported by the press in a way that created a great deal of confusion and concern. Most of this concern was misguided, and unnecessary.

 There are several things to bear in mind, right off the bat. First, the headlines in some of the newspapers and news broadcasts do not accurately reflect what was actually contained in the study. You can easily see that this is the case by merely comparing the headlines from The New York Times with that of The Wall Street Journal on the morning of November 30^th. “Extra Vitamin D and Calcium Aren’t Needed” was the headline in the Times, while “Triple That Vitamin D Intake, Panel Prescribes” was the headline in The Wall Street Journal.

Could they have been talking about the same study? Yes, they were. Hard to believe, isn’t it? This is an excellent example of letting your agenda dictate your reaction.

So which is it? Does the study say you don’t need vitamin D and calcium, or your need more? The answer is yes. You have to bear another thing in mind, and that is the identity of the authors–The Institute of Medicine. Wonderful folks, I’m sure, but these are the people responsible for determining those levels of vitamins and minerals necessary to prevent deficiency diseases–scurvy, pellagra, beri-beri, rickets, etc. They create the data (DRI’s, etc) historically utilized in setting the MDR’s, the RDA’s, and the DV’s.

There is nothing wrong with this, of course. But that is not what most of us taking supplements are concerned about. We are not looking to take just enough supplemental vitamins to prevent overt deficiencies. Instead, we are taking supplements in an attempt to achieve optimal health, to prevent various other types of disease, aging and deterioration, and, in some cases, we take supplements for their therapeutic value.

If you do not bear this distinction in mind, you risk missing the point of the study. Saying that we need to increase the amount of vitamin D by three-fold, but do not need more–which is what the study recommends–can be interpreted differently, as it suits you purpose.

Everyone agrees that vitamin D is essential to maintaining strong bones. But hundreds of studies in recent years have linked low vitamin D levels to a higher risk of chronic health problem such as heart disease, stroke, diabetes, prostate cancer, breast cancer, colon cancers, auto-immune diseases, infections, depression and cognitive decline. At the same time, concern about levels of vitamin D have increased because of the increased use of sun screen and reduced exposure to sunlight.

The Institute of Medicine based its new recommendations on the levels needed to maintain strong bones. They said there wasn’t enough evidence to prove that low vitamin D causes such chronic diseases. The key word here is “prove.”

“The evidence for bone health is compelling, consistent and gives strong evidence of cause and effect,” said Patsy Brannon, a professor of nutritional sciences at Cornell University and member of the IOM panel. For the other health problems, she said, “there are relatively few randomized controlled trials, and even in the observational studies, the effects are inconsistent.”

When is “proof” necessary? Do I need “proof” to conclude that jumping out of an airplane without a parachute is not good for my health? If there are hundreds of studies that indicate that high levels of vitamin D may prevent or treat heart disease, enhance immune function, prevent various cancers, depression, and diabetes, and no evidence that these levels are harmful, and at little cost to me, just how much more “proof” do I, or any reasonable person need?

Maybe not all of those studies are “randomized, controlled trials.” Maybe the effects are “inconsistent.” But maybe, in a case like this, that is good enough. It may not be good enough for the Institute of Medicine, but it is good enough for you and me.

Good enough, because that may be the best we can get. Be wary of those who imply that all medical studies, such as those supporting the approval and use of conventional pharmaceutical drugs are ironclad “proof.” We know that is not the case. The type of studies that would provide the proof we are looking for are difficult to design, and expensive to run. There is little incentive for anyone to do so.

Even those who worship at the alter of “proof” often do so only when it suites their purpose. This, it seems, is the case for the Institute of Medicine as well. If you read the article in The New York Times carefully, you will see the hypocrisy:

“After reviewing the data, the committee concluded that the evidence for the benefits of high levels of vitamin D was ‘inconsistent and/or conflicting and did not demonstrate causality.’” So all of these studies are dismissed. Yet they go on to say “Evidence also suggests that high levels of vitamin D can increase the risks for fractures and the overall death rate and can raise the risk for other diseases. While those studies are not conclusive, any risk looms large when there is no demonstrable benefit. Those hints of risk are ‘challenging the concept that ‘more is better,” the committee wrote.”

So “inconclusive and inconsistent studies” are dismissed when they do not agree with your position, but similar studies are accepted when they do support your agenda?

This comment at the end of the report in the Wall Street Journal sums it up nicely: “I supplement patients who are deficient and they feel better. They come in and say, ‘I’ve been much less achy and stiff or my mood’s been better since I’ve been taking the vitamin D,’ said Alan Pocinki, an internist in Washington D.C. Most of his patients are office workers, and 75% of them are below the 30 ng/ml level he considers necessary. “

“Do we have the data to prove this conclusively? No. We don’t have evidence for much of what we do in medicine, but if you wait for the evidence, you may be depriving your patients of beneficial treatments,” Dr. Pocinki said.

Don Goldberg,

December 4, 2010

“Hello Don: I take a tablespoon of fish oil each day, I want to add 1 tablespoon of flax oil but I am concerned about the studies that suggest flax oil is not good for the male prostate, the reason I want to use flax oil is its supposed to help with the bad acrylamides that come from eating meat, would you feel safe with a tablespoon of flax oil a day. . . . Peter”

This question is an interesting one because it is an excellent example of misinformation and misdirected concerns.

First, “acrylamides” do not “come from eating meat.” Acrylamides result from the combination of high temperature, certain simple carbohydrates, and an amino acid, asparagine. Thus, the most common foods typically associated with risk of acrylamide formation are potato chips and French fries. So to avoid acrylamides in food, avoid carbohydrate-rich foods that are cooked at high temperature. Another source is cigarette smoke.

The person asking the question was probably concerned about substances such as nitrates, nitrites, heterocyclic amines, etc that are sources of concern as potential carcinogens in cooked and processed meat.

Is this a cause of concern, in either case? Yes and no. As researchers looked into this, the list of potential carcinogens and mutagens started to grow, with no end in sight. The list of substances that showed potential toxicity in animal studies became longer and longer.

So what do we do? I think the answer is that we have to use a little common sense. We have been cooking our food ever since our cave-man ancestors discovered fire. We have been eating charred polycyclic aromatic hydrocarbon-rich meat on toasted acrylamide rich-sesame seed buns ever since Nathan the Neanderthal set up his first trail-side dino-burger joint.

Moderation may be the key. You could eat only raw meat, and cut the crust off your bread, but there is no end to finding substances that are potentially bad for you. Instead, using this information, modify your diet and eating preferences to minimize these less healthy foods, and less healthy methods of food preparation. Increase your intake of healthier foods.

“The effects of many of these toxins can be mitigated through the consumption of fresh fruits and vegetables. Foods high in antioxidants like garlic, green tea, berries, and cruciferous vegetables should be eaten daily. A large percentage of the diet should be fresh fruits, vegetables, and boiled or steamed grains . . . Fried and baked foods should be avoided or minimized. Since dry cereal can have a high acrylamide content, oatmeal or other boiled hot cereal is a healthier substitute. Steaming foods is preferable to baking, frying or broiling. When eating baked breads, removing the crusts will minimize the acrylamide content. Avoidance of heated or cooked nuts, seeds and unsaturated oils (especially those high in omega-3 like flax and walnuts) is highly recommended. If oil is necessary when cooking, coconut oil, a stable, saturated oil with added health benefits, is a better choice. Oils should be packaged in dark glass and be within their expiration date. In addition, olive oils that list a high phenolic content can help prevent LDL oxidation.”(1)

This leads to the second part of the question, concerning the proposed use of flax seed oil to, apparently, counter or protect against carcinogens such as acrylamides. Peter is concerned, however, that flaxseed oil “is not good for the male prostate.” This may be another example of a little knowledge gone awry. There indeed is some controversy over the role that flax seed oil may play in prostate cancer. Some evidence suggests it is helpful, and other evidence suggests it might not be. Here is the summary offered by one source: “Use cautiously in patients with prostate cancer. Due to some conflicting reports associating alpha-linolenic acid intake with the development of prostate cancer, there was a tendency to avoid flax in prostate cancer in the past. Recent reports show the opposite with promising results on the benefits of flaxseed use.”(2) On the other hand, omega-3 rich oils have been shown to be beneficial to other types of prostate conditions (benign prostatic hypertrophy, prostatitis). So Peter’s concern may be valid to some extent if he is worried about prostate cancer, but not valid if his concern is BPH.

More to the point, however, is this question: What does flax seed oil have to do with acrylamide, or other carcinogens? And, if you are concerned about food-derived toxins and carcinogens, why choose a food/supplement that is one of the most highly poly-unsaturated oils you can get? Flax seed oil is very easily oxidized, with a very short shelf life. It is not a supplement for use by someone worried about toxins in food.

That leads up to the final question. Is there something one can do, other than avoidance of cooked food, bread crust, potato chips and fries. The answer is yes.

Supplement with anti-oxidants, especially “whole food” or phyto antioxidants. I take 1-2 Antiox Phyto Complex capsules with each meal. This supplement, from Willner Chemists, contains a blend of several plant derived phyto-antioxidants–Acai Berry, Mangosteen , Goji, Pomegranate, Green Tea, Grape Skin and Grape Seed. (Product Code: 57091) I also use the companion product, Antiox Phyto Blend, which is a liquid version of the same thing. I place two dropper fulls in my water bottle. I squirt a dropper full into my margarita at dinner time, etc. (Product Code: 57551).

Take supplements that support liver function. The liver has a wide range of functions, including detoxification. This is an important part of our body’s mechanism for protecting against environmental and dietary toxins. Individual supplements–artichoke extract, milk thistle extract, curcumin, and alpha-lipoic acid are very important.

A study published in the Journal of Agricultural and Food Chemistry, for example, concluded that “consumption of curcumin may be a plausible way to prevent acrylamide-mediated genotoxicity.”(3)

Many supplement companies have combination products designed to enhance and protect liver function. Jarrow Formulas has a product called Liver PF (Product Code: 52813). Willner Chemists has a product called Liver Support (Product Code: 56948 and Product Code: 56971 for the liquid drops), and Liver Support Capsules (Product Code: 57048). Solgar has a nice herbal blend, Herbal Liver Complex, in Vegetable Capsules (Product Code: 28289). Doctor’s Best has a good Curcumin product called Best Curcumin C3 Complex Tablets (Product Code: 56393) and Willner Chemists has a liquid curcumin, Phyto-Tech Turmeric Root 1:1.5 (Product Code: 57016). Doctor’s Best also has the Meriva Curcumin Phytosome complex (Product Code: 58527).

Antioxidant Optimizer, from Jarrow Formulas, contains a nice blend of phyto-antioxidants and liver protectant herbs in one combination formula (Product Code: 23113).

While on the subject of detoxification, if you are concerned about heavy metal contamination, several companies have products for this purpose, including Jarrow Formulas’ Heavy Metal Detox, which contains a PectaSol Chelation Complex (Product Code: 52692).

In summary, it is important that we recognize the dangers of toxins generated in cooked foods. It is also important, however, that we keep this in proper perspective. Total elimination of these toxins is probably not necessary, but prudent reduction in exposure is indeed called for. Moderation is the key. Along with modification of our food and cooking choices, nutritional supplementation is an effective measure as well.

Don Goldberg,

References:

(1) Reeve, Wendy, MS. Focus On Health, Vol 34, No. 1

(2) Natural Standards

(3) “Curcumin Attenuates Acrylamide-Induced Cytotoxicity and Genotoxicity in HepG2 Cells by ROS Scavenging” J. Cao, et.al. Journal of Agricultural and Food Chemistry

According to this study from China. Curcumin, the natural pigment that gives the spice turmeric its yellow colour, may reduce the potential detrimental effects of acrylamide. The compound curcumin may exert an antioxidant effect and prevent the cytotoxic and genotoxic effects of acrylamide, according to findings of a cell study with human cells.

“Consumption of curcumin may be a plausible way to prevent acrylamide-mediated genotoxicity,” wrote lead author Jun Cao from Dalian Medical University.

Acrylamide is a potential carcinogen that is created when starchy foods are baked, roasted, fried or toasted. It first hit the headlines in 2002, when scientists at the Swedish Food Administration first reported unexpectedly high levels of acrylamide, found to cause cancer in laboratory rats, in carbohydrate-rich foods. Despite being a carcinogen in the laboratory, however, many epidemiological studies have reported that everyday exposure to acrylamide in food is too low to be of concern.

Commenting on the mechanism of action, the researchers noted that it was probably due to the antioxidant effects of curcumin.

Previous research from China has reported that extracts of green tea and bamboo leaf may also reduce acrylamide formation in foods. Researchers from Zhejiang University’s Department of Food Science and Nutrition reported that extracts from bamboo leaves and green tea could reduce the formation of acrylamide by 74.4 per cent and 74.3 per cent, respectively, when used at a level of 0.1 micrograms.

In response to questions posted on the “Ask Question – Suggest Topic” page, I will briefly comment on Insomnia and the role of 5-HTP and other herbs.

i have another question i have alot of trouble sleeping, im 62 female, and i think i tried everything things work for about 4 days then stop working i tried warm milk, decaffinated tea, melatonin, valerian, L Theanin, something called deep sleep.
What do u suggest??

M r. Goldberg
I cant sleep as usual so im on the computer googling all kinds of supplements to help u sleep.. I have insomina and i was just reading about 5htp, what r your thoughts on this supplement? i so desperate for good help and u r the one to give the good help to me..
I read that it has a few side effects but they dont seem so bad ill try anything at this point….as long as its not life threating….. HELP!! Thank You

Insomnia can be related to numerous underlying conditions, and those conditions should be ruled out by a thorough medical evaluation. Absent such conditions, various “natural” remedies (and lifestyle adjustments, such as avoidance of caffeine before bedtime, etc, can be helpful). It seems you have tried many of the common natural remedies. If you have not tried 5-Hydroxytryptophan (5-HTP), I think it is certainly worth trying. 5-HTP is the precursor to the neutrotransmitter serotonin. Tryptophan, by the way, is the precursor to 5-HTP. For several reasons, 5-HTP is thought to be more effective. Before taking any supplement of this type, however, especially if you are taking other medication, you should get approval from your physician.

If you go to the www.willner.com, and enter “5-HTP” in the keyword search box, you will see many products to choose from.

Two other products worth considering for those having trouble sleeping would be Phyto-Tech Sleep Complex (#57028, #57045) and Phyto-Tech Relax-PM (#56959, #57025). Sleep Complex contains melatonin, valerian, skullcap, passion flower, chamomile and California poppy. It comes in liquid and capsule form. Here is a link to those items. For more information, go to page 233 and 230 of the digital version of the Willner Chemists Product Reference Catalog on the Willner Chemists website.

I received the following question: “I have a 3 part question. Before i buy policosanol, is it good for lowering cholorestol? My total is 255 and my hdl is low and my ldl is very high, can i safely take 10 mg, 2 a day. Where can i buy it made with sugar cane not bees wax ?  and will my sugar increase alot?? Does Wilner make it with sugarcane? . . .”

Policosanol is a substance derived from sugar cane wax, bees wax, rice bran wax, or wheat germ. Chemically, it is a purified mixture of long-chain alcohols, or waxes. It’s primary claim to fame is that it may lower blood cholesterol levels. Earlier, a type of policosanol, octacosanol, derived from wheat germ, was thought to boost energy and stamina.

It’s reputation as a cholesterol lowering agent was based on a large number of studies done in Cuba in the 1990′s. The material used in these studies was derived from sugar cane wax.

The studies were impressive. It was shown to decrease total cholesterol and LDL cholesterol, and increase HDL cholesterol. This, of course, is good. Various theories were put forward to explain it action, usually revolving around its ability to inhibit the synthesis of cholesterol in the liver. Interest, and, of course, marketing fervor, in policosanol went through the roof.

One small problem. Almost all of the initial, positive research on policosanol was done in Cuba, by a single research group that just happened to own the policosanol patent. Later, when researchers in other countries tried to replicate the research, they did not find the same benefit.

Why not. Perhaps there is something unique about the material manufactured from Cuban sugar cane. Perhaps policosanol derived from other substances–beeswax, rice bran wax, wheat germ, etc–is significantly different, although from a chemistry standpoint you would not expect that to be the case. Or, maybe the initial research, done by a group with self-serving goals, was not as objective as it could have been.

The bottom line is that we do not know for sure just how effective policosanol really is as a cholesterol-lowering agent. It may work. The good news is that one thing that everyone does agree on is that it is not harmful. Years of use have revealed no concern about toxicity.

There are many nutritional and herbal treatments for elevated cholesterol. In addition to policosanol, there is beta-glucan containing substances from yeast and oat bran, plant stanols and sterols, water-soluble fiber supplements (psyllium, oat, guar), tocotrienols, chromium, niacin, pantethine, red yeast rice, artichoke, garlic, gum guggul and others. When faced with so many choices, how do you decide whether policosanol should be at the top or bottom of that list?

I cannot answer that, except to say that it is a mistake to think that any one of these agents, alone, is going to do the job by itself. These non-drug agents are effective, but work best when combined. This includes diet and lifestyle modifications as well. When choosing the combination of nutritional interventions that seem right for you, policosanol could very well be included.

One challenge remains. What type of policosanol supplement do you choose. Theoretically, the source of the policosanol–whether sugar cane or rice bran–should not matter. It’s hard to understand, from a chemistry standpoint, why one would work and the other not work. So I do not worry that much about the source. On the other hand, if research on sugar cane derived policosanol was so positive, why not use that material? Why take a chance? Why not use the material that yielded positive results?

The problem is that due to patent issues, trade embargo issues, etc, Cuban sugarcane policosanol is not readily available in the United States. You can get the following at Willner Chemists (www.willner.com). They claim to contain policosanol derived from sugar cane.

Metagenics Brand: Cholarest SC (Willner Code 43922, 180 tab and Code 41257, 60 tab)
Pure Encapsulations Brand: Policosanol 10, (Willner Code 45249, 120 vcap)
Pure Encapsulations Brand: Policosanol 20, (Willner Code 50334, 120 v caps)
Rx Vitamins Brand: Policosanol 10 (Willner Code 40258 60 cap)

I like to combine a phytosterol supplement (such as beta-sitosterol, stanols) along with a policosanol supplement. While it is thought that policosanol blocks the hepatic synthesis of cholesterol, it is thought that plant sterols block the absorption of cholesterol from the intestines. Thus, logic indicates a complementary action between the two agents. Two examples of supplements containing phytosterols are the following:

Solgar Brand: Phytosterol Complex 1000 mg, 100 Softgels (Willner Code: 58105)
Twinlab Brand: Cholesterol Success 120 Tabs (Willner Code: 38951)

Finally, for those of you who might be getting frustrated by having too many choices, and too many decisions to make, there are many good products on the market that contain combinations of the various agents I have mentioned above. If you are interested in products of that type, here are some examples:

Solgar Cholesterol Support, 60 Tab (Willner Code: 29038)
Jarrow ChoLess Optimizer, 120 Tab (Willner Code 58177)
DaVinci Labs CholestSure, 20 Vcaps (Willner Code: 42193)

Don Goldberg

For your convenience, the following link should take you to a listing of the products mentioned above. Some of these are “professional” products, so full pricing may not be indicated. Call 1 800 633 1106 for additional information)

(http://www.willner.com/products.aspx?pid=43922,41257,45249,50334,40258,58105,38951,29038,58177,42193)

Question: YOU HAVE STATED THAT A MULTI VITAMIN SHOULD BE AT LEAST 2X’S PER DAY FOR BETTER PROTECTION REGARDING THE WATER SOLUBLE VITAMINS. A VERY WELL KNOWN NUTRITIONIST SAYS THAT ONCE A DAY IS FINE, BECAUSE THE CONSUMER SHALL OBTAIN THE VITAMINS FROM HIS FOOD. WHAT’S YOUR TAKE?

Answer: There are several reasons why I think your “well known nutritionist” is providing you with poor advice.

First, my reasons for preferring a “two per day” multivitamin or B-complex over a “one per day” formulation are very simple. For one thing, the water-soluble vitamins will be excreted within a half day, so logic dictates that maximum benefit will be obtained if they are taken at least twice a day. In addition, you can fit more into two tablets than one. So a “two per day” formulation has the capacity to provide a more comprehensive or broad spectrum of nutrients.

Second, to say that your vitamin supplement needs are minimized due to the fact that you get the nutrients you need through diet is fine in theory, but clearly not true in real life. I recently commented on this on our radio show (The Willner Window, WOR (710 AM in NY) and WGKA (920 AM in Atlanta)). Here is an excerpt:

Don: There were some very interesting studies published in the last couple of weeks, and I think they tell an important story. As you know, the value of nutritional supplementation remains a matter of controversy, at least in the minds of some people. There are those who jump at every possible opportunity to downplay the value, even the advisability of taking vitamins supplements. So let’s look at some research.

The argument that supplementation is unnecessary is even less valid, of course, when you are talking about using supplements as therapeutic agents. Preventing a vitamin deficiency is one thing, and should be easily achieved in the United States with a proper diet. Preventing a sub-clinical deficiency may not be so easy. And reaching therapeutic levels through diet alone is most likely impossible.

Don Goldberg

Question:
Dear Sir
I have been advised to purchase Jarrow sublingual methyl b12 (1000m)
My questions are:
1) Is a lozenge classed as sublingual? I understand that a lozenge slowly absorbed under tongue is better than swallowing b12 in pill form. But with a lozenge are you not also swallowing a lot of the product with your saliva and wasting it? As I have been advised sublingual is best do you recommend I purchase your methyl b12 lozenge? would that be correct?
2) Is it necessary to take other supplements with it for it to work properly for eg. folic acid and b6? and if so what doses do I need with daily b12 (1000) lozenge?
Thank you for any advice . . .kind regards,
[DP]

Answer:

Your question highlights one of the more common misconceptions in the nutritional supplement field, i.e. that sublingual vitamin B12 is superior to other oral dosage forms. It’s amazing how so many health food store clerks and so-called nutritionists continue to perpetuate this idea.

Here is how it started. One of the major causes of vitamin B12 deficiency is malabsorption, and one of the most notorious forms of vitamin B12 malabsorption is pernicious anemia. A substance secreted by cells in the stomach, intrinsic factor, is needed for the normal absorption of vitamin B12. When this substance is not present, as is the case in pernicious anemia, a vitamin B12 deficiency occurs. At one time, the only way to overcome this was thought to be the administration of vitamin B12 by injection, which, of course, bypasses the need for “intrinsic factor,” and absorption from the gut.

Well, you cannot sell injectable vitamin B12 in the health food store, so some clever marketing guy came up with another idea for getting around the absorption problem–sublingual absorption! What a great idea. You can bypass the malabsorption problem by having the substance be absorbed directly from under the tongue. Sublingual vitamin B12 was thus born, and has become a very popular type of nutritional supplement.

There is only one problem. Vitamin B12 is not absorbed sublingually.

Sublingual absorption works for small molecules, not large ones, and vitamin B12 is a very large molecule.

It turns out, however, that subsequent research revealed that even people with pernicious anemia can, in fact, benefit from oral vitamin B12. The trick is that they need to take very high dosages. If they do this, enough will be absorbed in spite of the malabsorption problems. Since B12 is inexpensive, and “high dosage” is still very small compared to other vitamins (micrograms vs milligrams), this is easy to accomplish.

So what about sublingual, or lozenge-forms of vitamin B12? It turns out that they work, but only because you end up swallowing the vitamin B12 as the lozenge dissolves, allowing it to be absorbed in the gut just as if it was a normal tablet or capsule.

You were concerned that swallowing the vitamin B12 was “wasting it.” Ironically, the opposite is true.

Buy a lozenge if you wish, but don’t be misled into thinking it will result in sublingual absorption. What is important is that it is a high dose.

The methylcobalamin (Methyl B12) form is thought to be better absorbed than the regular form of B12, and I see no reason not to use it. Jarrow (and others) makes a 5,000 mcg dosage, however, as well as a 1,000 mcg dose, and I would opt for the higher dose.

Vitamin B6 and folic acid work with vitamin B12 to control homocysteine levels, and if that is the reason you are taking the B12, then you should consider that. You should be taking a multivitamin supplement, and perhaps an additional B-Complex supplement, however, and this should provide plenty of those two vitamins.

Don Goldberg