What Is In Those Supplements?

VitaminsThe Attorney General of the State of New York charged four national retailers on Monday, February 2nd  of selling dietary supplements that were “ fraudulent and in many cases contaminated with unlisted ingredients.” His office said they had run tests on popular store brands of herbal supplements at the retailers – Walgreens, Walmart, Target and GNC and found that out of five products tested, four contained none of supplements listed on the label. At GNC they found that five of six samples from its “Herbal Plus “brand were either “unrecognizable or a substance other than what they claimed to be.” They analyzed Ginkgo Biloba, St. John’s Wort, Ginseng, Echinacea, Saw Palmetto, Garlic and Valerian Root.

For many years now health care advocates have encouraged the Federal government to establish a safety monitoring system for the multibillion dollar vitamin, mineral, herb and supplement product market. Many health care providers question the safety and efficacy of these products to begin with since there are few if any well designed double blinded controlled studies which look at their overall risks and benefits. To now find out that the bottles do not even contain product raises further questions about their efficacy and safety. The American College of Nephrology has been trying to educate the public to the harmful contaminants they have found in many over the counter supplements leading to renal failure and problems in children. Most of these poisons and heavy metal contaminants however, came from products produced overseas.

The time to set up a Federal watchdog on these products is long overdue. The National Institute of Health Division of Alternative and Complimentary Medicine has always taken the position that if products results are positive and reproducible in legitimate studies then the product is not an alternative treatment. That feeling is still shared by me but it does require the product to be in the container you purchase free of harmful contaminants.

Benefits of Exercise on Blood Pressure and Prevention of Atrial Fibrillation

Senior Citizens, exercise v2Junxiu Liu, MD, of the University of South Carolina published an article in the September 15 , 2014 edition of the Journal of the American College of Cardiology showing that exercise and improving fitness levels prevented an age related expected rise in patient systolic blood pressure. His study followed 14,000 men for 35 years. Sedentary men started to see their systolic blood pressure rise at about age 46. Men who were fit delayed this rise in blood pressure until they were 54 years of age. The effect on the diastolic blood pressure was even more pronounced when looking at fitness levels. Men with low fitness ratings elevated their diastolic blood pressure to above 80 by age 42. Those men with a high fitness level did not see the rise in diastolic BP until they were beyond age 90. His research suggests that “highly fit men are likely to reach abnormal BP readings a decade later or more than sedentary men.

In an unrelated study published in the same issue, researchers in Texas found that regular aerobic exercise prevented the hearts left ventricle or main pumping chamber from developing stiffness. The stiff ness of the ventricle contributes too many common cardiovascular conditions effecting older patients. They found that low levels of casual lifelong exercise such as four (4) sessions of 30 minutes per week throughout adult hood was sufficient to keep the ventricle from stiffening.

Marco Perez, MD of Stanford University looked at exercise levels in women and the development of the heart arrhythmia atrial fibrillation. He found that sedentary women were much more likely to develop this pathologic arrhythmia than women who exercised regularly. Obesity and being overweight is a risk factor that increases your chances of atrial fibrillation. Regular exercise by obese women reduced this risk by about nine percent (9%).

The message is very clear that keeping moving and being active improves your blood pressure control and reduces your risk of developing many cardiovascular related problems. My advice is find some activity you enjoy doing and make sure you try it several times per week to gain the natural benefits the exercise provides.

Are Older Women Receiving Too Much Calcium?

CalciumThe June issue of Menopause, a peer reviewed medical journal, carried an original research article by Margery Gass, MD and colleagues which indicated that older women are taking too much Vitamin D and Calcium. She conducted a randomized and placebo controlled trial of 163 women with low Vitamin D levels. The age range of the study group was 57 to 90. They were given Vitamin D and Calcium citrate tablets to reach the recommended daily amount of 400 to 4800 IU per day of Vitamin D and 1200 mg of calcium per day. Follow-up lab studies revealed that almost 10% of the women developed elevated blood calcium levels. More disturbing was the fact that 31% developed elevated levels of calcium in their urine predisposing them to kidney stones.

The lead author suggested that every patient calculate how much calcium they are getting daily in their normal diet before supplementing it with extra calcium. Her group pointed out the benefits of clinicians periodically measuring patients 24 hour urine calcium level. Those with a level > 132 mg were at much higher risk of developing hypercalcemia and its complications and need to reduce their supplemental calcium intake. We will begin suggesting 24 hour urine collection in our patients in the near future.

Chianti Study Refutes Wines Heart Healthy Label

ChiantiResveratrol, the antioxidant found in red wine, grapes, and dark chocolate did not increase longevity or lower the risk of cancer or heart disease in a study conducted in the Italian wine country. The study, led by Richard D. Semba, MD, MPH of the Johns Hopkins University looked at older adults in the Chianti wine making region of Italy with the top dietary intake of resveratrol as indicated by its urinary metabolites. Large consumers were no more or less likely to die over the 9 year study period as small consumers or those who abstained. The actual data showed that those in the lowest consumption range did better than others as reported in the online edition of the Journal of the American Medical Association.

“Inflammatory markers, cardiovascular disease, and cancer all showed the same lack of a significant relationship with resveratrol levels. “The results were different than all of our theories” and hopes. Resveratrol had been hailed as a major component of red wine and dark chocolate and is supposed to be heart healthy. This has led to the growth of sales for it as a supplement. Sales in the USA exceed $30 million dollars per year despite no clinical evidence of its benefits. It is still promoted heavily by noted cardiologist and health televangelist Dr Oz. Derek Lowe, PhD, a drug researcher, doesn’t understand the popularity of the substance. “Personally, I do not see why anyone would take resveratrol supplements.” If it does have an effect it’s sure not a very robust or reproducible one.” The Aging in Chianti Study involved 783 men and women followed from 1998 until 2009. There was no significant difference in cardiovascular disease rates among those with the lowest levels of the drugs metabolite and those with the highest. There were no differences in the incidence of cancer between high consumers of red wine and modest to low consumers either.

While the study clearly did not show any benefit during the study period, critics of the study and its conclusion felt that maybe the benefits were more long term and required a higher dose of resveratrol over a longer period to see any real benefits. Once again I believe consuming dark chocolate and red wine in moderation is probably your best course. It is clear that a larger study with different concentrations of resveratrol over a longer period of time will be needed to reach a definitive conclusion. The study did not show that resveratrol was bad for you either. That being the case, individuals should enjoy their dark chocolate and red wine in moderate measured amounts because they enjoy dark chocolate and red wine.

Skipping Breakfast May Be Fine For Weight Loss

Scale and foodEmily Dhurandhar, Ph.D, of the University of Alabama at Birmingham is a nutritionist who does not believe in following myths and dogma unless there is sufficient research and evidence to back it up. She recently led a team of researchers who looked at the question of whether skipping breakfast was a hindrance to weight loss. Her group conducted the first controlled randomized study on the topic looking at 309 overweight and obese patients over a 16 week period. Patients were assigned to one of three groups:

1.            An intervention group told to eat breakfast

2.            An intervention group told to skip breakfast

3.            A control group not specifically instructed to do eat or skip breakfast

They were all placed on a caloric restricted diet. The results of the study showed that the only thing that mattered in weight loss was whether your intake of calories was less than calories used during the day. The time of day we first eat had no effect on weight loss in this study.

Dr. Dhurandhar reasoned that none of us actually skip breakfast since our first meal of the day after a prolonged overnight fast is still breakfast. The study only looked at weight loss related to skipping or eating breakfast. It did not answer the other age old dietary question of whether eating a large calorie amount late at night and then retiring affects your weight. For those of you who enjoy sleeping in, this is excellent news.

Glucosamine Study: “It Doesn’t Work”

C. Kent Kwoh, M.D., of the University of Arizona in Tucson reported results of a study to examine whether individuals who take glucosamine showed evidence of structural benefits in the treatment of their knee arthritis on MRI scans and in biochemical markers of cartilage deterioration. The study appeared in the online version of Arthritis & Rheumatology.

GlucosamineThere is a big retail market for glucosamine with more than one in ten U.S. adults using it for relief of arthritic pain. Many studies have been done but most were sponsored by manufacturers of glucosamine so the results are felt to be reliable. Worldwide sales of glucosamine top $2 billion dollars per year.

To evaluate the substance, Dr. Kwoh found 201 volunteers from his community with chronic knee pain. The patient’s mean age was 52 years old. More than 50% were women. Their body mass index averaged 29kg/m2 indicating they were not grossly overweight. They were randomized and blinded into two groups one receiving 1500mg of glucosamine hydrochloride (Reganasure) or a placebo in a 16 ounce bottle of a diet beverage. They then followed the patients for six months recording their pain evaluations, their changes on MRI images of their knees and noting any difference in the levels of C-terminal telopeptide of type II collagen – a marker of collagen deterioration. The results showed no differences between the glucosamine and placebo group.

Joanne Jordan, M.D., Chief of Rheumatology University of North Carolina noted that the study showed that glucosamine at this dose and for this length of time does not alter or help arthritis sufferers. “Nobody wishes it worked more than me.” said Nancy E Lane, M.D., director of the Center for Musculoskeletal Health at the University of California Davis in Sacramento. “It doesn’t work. There’s a group of patients who get a reduction in pain when they take glucosamine because glucosamine is a sugar and sugars can be analgesic to some people.”

No one has shown that glucosamine is harmful to anyone. It would be helpful if the study ran for more than six months since arthritis is a long term episodic disease. The investigation of supplements and alternative treatments is long overdue so this scientific study is welcome. It just needs to be continued for a longer period of time to satisfy those who use the product and have gotten relief.

Supplement Toxicity on the Rise

VitaminsIn a report in MedPage Today, the medical newsletter of the University of Pennsylvania School of Medicine, researchers attending the meeting of the American Association of the Study of Liver Diseases reported a striking increase in the number of severe liver injuries reported in supplements between the years 2004 and 2012. They reported the number of cases increased from 7 – 20% and blamed the vast proportion of those cases on dietary and herbal supplements.  Particularly disturbing was the number of injuries in young people involved in bodybuilding.

Mary Rinella, MD of Northwestern Memorial Hospital in Chicago moderated a discussion group on the topic and mentioned what a large problem it is; “It’s made worse by the popular belief that such supplements are harmless, which leads patients to omit mentioning them when they are in a clinic or doctor’s office.”  She went on to say that, “We don’t know what’s in the products or even what’s in the bottle.” Rinella said.  “Dietary and herbal supplements are not considered drugs and so escape oversight by the FDA.”

Warren Kupin, MD, FACP of the University of Miami Miller School of Medicine division of nephrology delivered a similar message on the epidemic of kidney disease in young adults being caused by the contents of common herbs and supplements sold on our shelves with pleasant healthful sounding names. He raised the red flag on products produced in India and Asia or products containing materials from those areas which contain high levels of heavy metals such as mercury, cadmium, arsenic and others. The target market is young women of child bearing age and they expose their partners and children to these products.  He took a commonly sold supplement, opened the bottle and said that the aroma escaping contained so many heavy metals that if this was produced in a US factory OSHA would require the workers to be wearing respirators in that type of toxic environment.

Consumers need to read labels and ask questions of their doctors before they add an herb or supplement to their daily regimen.  Women of child bearing age need to be especially vigilant and discuss these supplements with their obstetricians and pediatricians before considering ingesting them. The National Institute of Health maintains a very objective website on alternative and complimentary medications at nccam.nih.gov/health/whatiscam that is a great resource and location of factual material.   

I always suggest that when you visit your doctor you bring all your medications, vitamins, minerals, herbs and supplements in a plastic bag with you so that the doctor can read the labels with you.  Accepting the advice you receive on the Internet or from the sales personnel at a vitamin and mineral store is not the most accurate way to learn the truth.  The public is injuring and maiming themselves by consuming too much of the wrong things and there is little or no government oversight and regulation of these products. Protect yourself and ask your doctor for assistance!

 

Walking Reduces Stroke Risk

Walking signBarbara Jefferis, PhD, of University College London UK presented data in the journal Stroke that indicated that older men who added a long walk to their daily routine significantly reduced their risk of having a stroke.  The association was independent of activity level or walking pace. Men who walked 8 – 14 hours per week had about a one third lower risk of stroke compared to men who walked no more than three hours per week or at all. The risk was about 2/3 lower for men who walked more than 22 hours per week.  Walking is recognized to be the predominant form of physical activity in older adults and its impact in reducing stroke risk is important to understand.

The study looked at 3,435 men followed over a ten year period.  The lead researcher said there is no reason to believe that the protective effect does not apply to women as well.

This is one of several studies published over the last few months that extol the benefits of modest age related exercise to preserve function and independence.  We have seen the benefits of an after dinner walk on blood sugar levels documented in recent studies. In a recent British Medical Journal article (BMJ 2013, 347:f5555) researchers reviewing 60 research trials conclude that exercise benefits patients with arthritis rather than being sedentary. We have seen other studies linking seniors with active leisure activity life style exhibiting improved cognitive function compared to seniors with a more sedentary leisure life style.

From a doctor’s perspective the advice is simple. Find something you enjoy doing that is active and aerobic such as walking, running, cycling, swimming, dancing, roller skating or roller blading and engage in this activity regularly to protect your health and independence.

 

Do Probiotics Prevent Diarrhea and Antibiotic Related Colitis in Seniors?

ProbioticsProbiotics are medication containing bacteria that normally reside within a healthy intestinal tract and aid in digestion and the production of a solid stool.   Physicians and scientists have known for years that when a patient is given an antibiotic to treat a bacterial infection, that antibiotic works against the invading pathological bacteria as well as the bacteria that normally reside within us and keep us healthy. The theory for years is that by destroying the healthy normal flora of the intestine we are paving the way for virulent pathological and opportunistic bacteria such as clostridium difficile to invade the gut and produce antibiotic related colitis. The hope has been that by giving the intestine back the normal bacteria in the form of a pill containing normal gut flora, we can prevent diarrhea and even the more severe antibiotic related colitis when prescribing antibiotics appropriately to fight a bacterial infection.

Initial small Meta-analysis studies supported the notion. Based on these small studies private firms have produced over the counter probiotics such as Align and a series of prescription only probiotics for human consumption. Hospital and health systems have invested money in purchasing and prescribing probiotics to senior citizens given antibiotics to stave off diarrhea or antibiotic related colitis.  A new large study performed in South Wales and England looked at almost 3,000 patients aged 65 or older who were being treated with antibiotics while hospitalized.   Patients were treated with either a placebo pill or a probiotic pill containing two strains of Lactobacillus acidophilus, Bifidobaceterium bifidum and bifidobacterium lactis, for 21 days and between antibiotic doses.

Despite the probiotic administration, diarrhea occurred in 10.8% of the patients given probiotics and 10.4% of those given placebo. The researchers then went on to analyze the stool of half the diarrhea patients and found that Clostridia difficile was an uncommon finding in both groups. The probiotics did not produce any measurable adverse effects in the patients taking them.

The PLACIDE study was by far the largest study of the effectiveness of probiotics done to date. Its result speaks against the routine use of these agents to prevent antibiotic related diarrhea or colitis. There will be additional studies in the future.

The science of the composition of our intestinal flora is in its infancy. Studies have shown that genetically alike individuals have similar bacterial gut patterns. Studies have also shown that if you develop antibiotic related colitis and receive an enema containing stool from a genetically identical individual, your chances of recovering from previously resistant antibiotic related colitis are much better.   It could be that there will be different compositions of bacteria in future probiotics for genetically different individuals.  More research is needed.

More Anti-Oxidants Provide No Benefit for Aging Eyes

Eye Glasses, Older WomanTwo papers presented at the Association for Research in Vision (ARVO) conference in Seattle emphasized that in a population of patients with adequate nutrition the addition of more antioxidants, vitamins and supplements do not help your vision or prevent progression or development of eye disease. In fact, not only did they not help but there was a significant concern that the addition of lutein and beta carotene to the diet of smokers and former smokers actually increased the risk of those individuals developing carcinoma of the lung. The studies were published in JAMA Ophthalmology and the Journal of the American Medical Association.

The study, known as Age-Related Eye Disease Study 2 (AREDS2), concluded that adding lutein, zeaxanthin, and fish oil to daily multivitamin supplements does not boost prevention of age related macular degeneration or cataracts in high risk individuals.

The original AREDS study showed that adding high doses of Vitamin C and Vitamin E, beta carotene and zinc slowed and lowered progression of early and intermediate age related macular degeneration and associated vision loss. That original study suggested that the addition of more antioxidants might help. This was the basis for the follow-up study AREDS2.  The follow up study randomized patients to receive lutein plus zeaxanthin, or omega 3 fatty acids, plus DHA and EPA, both, or a placebo. No benefit of adding these antioxidants was noted except in patients with extreme nutritional deprivation situations.

Vitamin C is a water soluble vitamin.  You keep what you need and the rest is eliminated harmlessly through the kidneys. Vitamin E is a fat soluble vitamin and excess intake is stored in the cells of your body.  Toxicity can occur from ingesting too much of Vitamin E or Vitamin A.  Beta Carotene has been postulated to have an effect on lung cancer in other studies.   The bottom line, too much of anything is not good for you. 

Patients should be asking their ophthalmologists about the constituents of the supplements being recommended to them for eye health.  If they are a cigarette smoker or former smoker they should question the need for beta carotene and lutein because of the association with lung cancer. They should review their total Vitamin A, E, D and K intake from their ophthalmologic vitamins and supplements and their other vitamins and supplements to insure that their total daily intake does not exceed recommended levels.