Monthly Archives: April 2008

Some Antioxidant Supplements are a Bust!

Some Antioxidant Supplements are a Bust!  In fact, Dangerous!

Competency # 15 Vitamins

Reference: The Cochrane Collaboration  April 16th, 2008  (Today) Date:

Oh dear!  Bad news on antioxidants.  The Cochrane Collaboration is just about the most authoritative summary of literature we have.  The folks in the collaboration take all the available “best” literature, and review the results for authoritative summaries.  In today’s release, the investigators looked at 232,550 subjects in 67 randomized controlled trials for the beneficial effects of Vitamins A, C, E and selenium.  These have been the most often referred to antioxidants.  What they found was that beta-carotene, Vit A and E, as opposed to being good for you actually increase your risk of death.  The jury remains out on C and selenium.  Many of the studies were in specific diseases.

What we do know is that eating high glycemic foods results in a flood of free oxygen radicals as our liver metabolizes the rush of glucose and fructose. Our modern diet has tons of sugar and white carbohydrates that turn into glucose.  It’s easy to measure a pretty heavy “oxidizing” state after a big meal.  And in many isolated circumstances, you can show that antioxidants gobble up those free radicals and reduce the laboratory measures.  So, it’s very tempting to look at that isolated cause and effect and make the erroneous jump in logic to assuming “taking a pill” will reverse the problem.  Because we eat three big meals a day, our bodies are always in an oxidizing state.

The question remains, is your life prolonged?  Our bodies are much more sophisticated than a lab experiment.  The important issue is whether taking extra E, beta-carotene, A, selenium and C will provide your health for the long haul.  I’ve taken both A and E for about 5-6 years back in the late 90s.   I certainly jumped on board.  The mortality was 13.1% in the antioxidant group, 10.5% in the placebo group.  That’s an absolute risk reduction of 2.6%, or relative risk reduction of about 20%.  We’ve had some hints about this and this column has referenced before.  But this is authoritative.  Vit. A, beta-carotene and E are not safe for you in the context of general health.  Might they work for specific diseases?  Maybe.  And the jury is still out on selenium and C.

WWW: What will work for me?  Whole foods have vitamins in them.  Nuts are loaded with E and Brazil nuts are jam packed with selenium.  The literature has shown again and again that your supplement should look like something your grandma recognized as a food.  The DASH and OMNI heart diets, the Lyon Diet, the Mediterranean Diet, all succeed massively because of their emphasis on whole foods.  I added an extra scoop of blueberries on my cereal this morning.  (ORAC score for Blueberries 3500 – ORAC score, developed at Tufts by Dr. Joseph is Oxygen Radical Absorption Capacity).  And I’ve got my Sam’s Club card to renew so that I can buy my annual 50 pounds of blueberries to last me through the year.  And I threw out all my old Vit. A and E.  Sheepishly.

 

Alkali Diet: Unwrapping the Problem with Atkins Diet

Alkali!  That’s What’s Wrong with Atkins

Competency #2: DASH, OMNI and Other Evidence Based Diets

Reference: American Journal Clinical Nutrition: 87:662 Dawson-Hughes “Alkaline Diet Favors Lean Tissue Mass in Older Adults”

I got it!  We want to age gracefully and hang on to muscle mass.  It’s crucial to maintain your muscle mass to maintain long-term health and wellness.  As we age, all of our organs gradually lose the ability to operate in the fashion they did when we were young and vigorous.  That includes our kidneys.  As we age, the amount of acid that our kidneys have to get rid of doesn’t necessarily change, but the ability of our kidneys to do so does.  When you eat extra nutrients your body doesn’t need, you convert them all into fats and store them, or you get rid of the extra right away.  Extra vitamins, you excrete right away.  Extra fat and sugar, you store.  Extra protein is a different issue.  In breaking protein down, your liver has to remove the ammonia group on each amino acid and excrete it.  That makes for acid.  The more protein you eat, the more acid you have to get rid of.  If your kidneys can’t keep up with the acid, your blood gets slightly more acidic.  And that is known to be true.  Elderly folks have a slightly more acidic blood.

Here is the rub.  Some foods are intrinsically “acidic” and some are intrinsically “alkali” or basic.  The core difference between the two is the amount of extra protein you eat (acidic) which correlates with more meat in your diet (Atkins), and the amount of potassium in your diet (basic), which correlates with more fruit and vegetables.

Dr. Dawson-Hughes followed 384 men and women over 65 for 3 years and measured their lean muscle mass and potassium excretion.  The more potassium they excreted, the more fruits and vegetables they were eating, the less muscle mass they lost.  We Americans are only eating about half the potassium the Institute of Medicine says we should be eating.  We could get more by taking potassium salts (yuck), or by eating a good DASH Diet with 9 servings of fruits and vegetables a day.

WWW. What will work for me?  Long range planning is my thing.  I want to be there down the road.  The Atkins Diet works to lose weight. I can accept short-term gain. Part of how Atkins works is that it makes you feel full faster, so you eat less.  But all that protein may, paradoxically NOT protect you from muscle mass loss in the long term.  There are no long-term studies on Atkins and muscle mass.  What I did notice was that nowhere in the equation was there mention of white carbohydrates.  A quality, muscle-preserving diet is full of fruits and vegetables, not unprocessed carbs, and not fructose.  Hurrah.  I had grapes and pears for lunch.

Milwaukee Rules the Frozen Pizza World!

Milwaukee Rules the Frozen Pizza World!

Competency # 20:  The Cuisines of the Long Lived Reference: Forbes Magazine, April 28th, 08 “America’s Junk Obsessed Cities”

It’s official.  We made the top ten list.  We, on average, eat more Frozen Pizza than any other city in America.  And when taking an index of total “junk food” consumed by Nielsen ratings of sales per person per supermarket, we come out #9 in the country, just a shade ahead of Minneapolis.  But when it comes to pizza, we rule.  Our Nielsen rating for pizza is 2.44, which means we are eating about 244% of what the average person eats in America.  Now, Forbes Magazine may not have been in Milwaukee a lot recently because they do suggest that the reason we eat so much pizza is that it goes well with beer, and Milwaukee brews “Pabst, Schlitz and Miller”.  Did I miss something?  Are Schlitz and Pabst still in town?

What’s the big deal?  Pizza, along with a variety of other easy to prepare foods is fast, easy, convenient and calorie dense.  A pizza is not “nutrient dense”.  Nutrient density is a complex concept that many nutrition folks are struggling to figure out.  It combines ideas like amounts of vitamins, fiber, trace minerals, polyphenols, saturated fat, and easily digested refined carbohydrates into formulas that give a summary analysis of the value of that food.  As a general rule, whole fruits and vegetables, nuts, beans, whole grains all rate pretty high.  Spinach is a champion.

This months Tufts Health and Nutrition newsletter has a very nice comparison of the cost of “junk food” and the relative cost of “high nutrient density foods.”  What they found was that it can cost as little as $ 1.76 to buy 1,000 calories of “junk food” and some $ 18.16 to buy 1,000 calories of nutrient dense foods.  Buying low nutrient density foods is an economic decision.  It makes sense in the short term to buy cheap food, with devastating long term consequences.  The resulting obesity in folks who are actually malnourished, or mis-nourished is a phenomenon we have all witnessed.  Our national health costs are directly related to this misdirection in public policy.

The Forbes article outlined very nicely how many cities have taken the amount of junk food their kids want and eat in schools very seriously.  Minneapolis started a School Wellness Policy in 2006 that included the mandate for healthy vending machines, maximum of 35% calories from sugar or fat, less than 10% calories from saturated fat etc.  Changing the environment in schools has also been successful in Wisconsin in the Fox River Schools with their approach to health eating.  It can be done.  If we all put our shoulders to the wheel, and get our political process to start, we can change our city.  We’re number nine, maybe we can drop down to #11 and get off the list!

Want to know the other cities?   Oklahoma CityPittsburghMemphis, Tenn.Little Rock, Ark.St. LouisMinneapolis, Minn.,Milwaukee, Wis.Birmingham, Ala.Indianapolis and Nashville, Tenn.

WWW: What will work for me?  My junk food life is in terrible jeopardy.  I can’t eat a cookie anywhere and not get grief from someone who says, “You aren’t really going to eat that!”  This virtuous living stuff is a drag.  I’m heading for ice-cream tonight and unstressing.  I had a bad day.  Ok.  So, just one scoop with nuts on top. But we have stopped buying frozen pizza.  It’s just not there in the freezer.

 

Vitamin D: Recent Updates on how to dose deficiency!

Vitamin D: Recent Updates on how to dose deficiency!

Competency # 15  Vital Vitamins

Reference: AJCN, March 2008; Circulation, January 2008; Arterioscl.Thromb Vasc Biol. 2008;28: published online before April 16

I have to just share a compendium.   There have been so many updates and ideas.  Having heard various talks and grand rounds with a variety of cutting edge experts, here is a summary of what I’ve added to my knowledge in the last 3 months that would be new for you too!  I use all these talking points when I see patients.  You should too!  Memorize them.  Use them.

1.  What’s a good blood level?  Evidence based data shows that humans living in the tropics will settle at a blood level of about 60 ngrams.  If you go to a tanning booth 10 times for 20 minutes, your blood level will likely rise up to about 50.  (If you have young, Caucasian skin and are normal weight.) Conclusion:  ideal human blood level should be above 50.  We’ve done many emails suggesting a minimum level of 32 ngrams.  This is in stark contrast to health care systems that measure Vit D and state that 9-52 is normal range.  Normal, or healthy should start at 32.  I want 60 in me.

2.  What dose will get me there?  Data shows 2000 U a day for a year given to African American patients failed to achieve 32 ngrams in 40%.  4,000 U a day given to Canadians in an endocrinology clinic got them to 44 ngrams.  Only side effect was improved mood.

3.  Vitamin D is NOT a Vitamin.  It’s a hormone.  Hormones affect genes.  Vitamins are cofactors in metabolism.  Hormones are built off the cholesterol molecule, as is Vitamin D.   Vit D affects over 200 different genes.  It is, in effect, your bodies STEM CELL MODULATOR.  It turns on cells to mature into their mature state.  Over 900 specific cell types are affected.  This explains why it has so many effects on so many systems.

4.  How can I rapidly get there?  March, American Journal of Clinical Nutrition showed that a single dose of 100,000 units will get you to an average level of 40 ngrams or 100 nanomoles in about 3 days.  And you stay up for about a month.

5.  Toxicity?  No toxicity under 10,000 U a day that the NEJM could find.  One recent article with 50,000 three times a week increased BONE VOLUME 40% by bone biopsy when given for 3 years.  No toxicity. Palmieri et al.  Jr. Calcified Tissue6.

6.  Peripheral Artery Disease Declines 50% from 8.7% to 3.1% if your blood level is above 30 ngm vs below 17 Just like heart attack risk drops 62%.

7.  How much sunshine do you get?  15 min twice a week equals 12 hours a year of effective sunshine in Milwaukee.  That’s all the sunshine your skin has to make enough.  No wonder we are all so low.  That’s why we are in a crisis.  We evolved in Africa getting 10 hours a day, 365 days a year.  12 hours a year isn’t enough.

8.  How much sunshine?  Hold the sunblock!  Get 15 minutes twice a week in the summer.  1-2 hours if you are African American.

9.  Prescription:  I’m writing 50,000 U once a week for 8 weeks as a way to start and fill an empty tank.  Then, 2,000 IU a day for life.

10.  Kids.  You can cut your risk of insulin dependent diabetes as much as 80% if given 2,000 U a day at birth.  (Hypponen from Finland) And hold the sunblock for 10-15 minutes.  Don’t protect your baby too much.  DONT SUNBURN!  Just a slight tan is peachy.

11.  Pregnant Mothers or Breastfeeding Mothers:  7,000 U a day to keep your child properly nourished.

WWW.  What Will work for Me.  This is a flood of new information.  And it’s the cutting edge.  Not to overwhelm you or me.  My synthesis is that we certainly need much more than our Wisconsin sunshine provides.  Evidence based on blood levels is now reaching critical mass.  I’m telling Caucasian, slender, young folks that they need 10,000 U a day for a month to get themselves up to good blood levels.  Then 2,000 U a day for life.  But if you are older, overweight, or have more melanin in your skin, you will need more.  I’ve personally had three people with chronic pain conditions report to me that their pain was drastically improved in the last three months on 10,000 U a day.  If you have a chronic pain condition, I would advise 10,000 a day for 6 months.  We know that 20,000 U a day doesn’t cause toxicity in Palmieri’s data.  It may just save you from many, many diseases.