Health Comments

Micronutrient deficiencies, DNA damage and degenerative diseases

Helmut Beierbeck — Thu, 04 Mar 2010 20:54:00 GMT

In my last post I talked about micronutrient triage. When micronutrients — vitamins and minerals — are in short supply they are preferentially allocated to physiological functions crucial for survival; maintenance and repair are temporarily put on hold (1). If our diets are chronically deficient in micronutrients, the prolonged neglect of vital repair functions is bound to take its toll.

That vitamins and minerals play a crucial role in health and disease should come as no surprise. Vitamins are defined as substances that the body needs but cannot make; and we obviously cannot make minerals. Vitamins and minerals act as antioxidants, stabilize protein structures and are enzyme cofactors. They are involved in all aspects of physiology, starting with such fundamental processes as DNA maintenance and gene expression.

Inefficient or incorrect DNA repair due to micronutrient shortages leads to genome instability, a known contributor to increased cancer risk, accelerated aging and neurodegenerative diseases (2). Genome damage caused by micronutrient deficiencies is believed to be at least as extensive as genome damage from environmental genotoxins like chemical carcinogens, UV and ionizing radiation. Genome instability caused by micronutrient deficiencies in turn increases DNA sensitivity to environmental genotoxic stressors.

Since degenerative diseases, the main health problems in the developed world, are partly caused by DNA damage, it makes sense to diagnose and nutritionally prevent the underlying cause, genome instability. This requires a knowledge of optimal intakes for vitamins and minerals that are needed to prevent DNA damage (2):

"Excessive genome instability, a fundamental cause of disease, is often an indication of micronutrient deficiency and is therefore preventable
accurate diagnosis of genome instability using DNA damage biomarkers that are sensitive to micronutrient deficiency is technically feasible
it should be possible to optimise nutritional status and verify efficacy by diagnosis of a reduction in genome damage rate after intervention"

Vitamins C, E, B₂, B₆, B₁₂, folate and niacin, and the minerals zinc, iron, magnesium and manganese are some of the micronutrients known to be critical to genome stability (2). Optimal intakes of most of these micronutrients have not yet been determined, but for those that have been studied — e.g. folate and vitamin B₁₂ — intakes in excess of current RDA values are required to prevent genome damage. Optimal micronutrient intakes will also vary with people′s genetic make-up.

Optimizing micronutrient intakes seems like a promising way to reduce the degenerative disease burdens threatening to bankrupt medical care systems:

"… instead of diagnosing and treating diseases caused by genome damage, health and medical practitioners will be trained to diagnose and nutritionally prevent the initiating cause, i.e. genome instability itself." (2).

We′ll see.

Sources:

Ames BN. Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce resources by triage. Proc Natl Acad Sci USA 2006;103(47):17589-17594.
http://www.pnas.org/content/103/47/17589.full.pdf
Fenech M. Nutritional treatment of genome instability: a paradigm shift in disease prevention and in the setting of recommended dietary allowances. Nutr Res Rev 2003;16:109-122.
http://dx.doi.org/10.1016/S0278-6915(02)00028-5

Chronic micronutrient deficiencies lead to degenerative diseases

Helmut Beierbeck — Tue, 23 Feb 2010 23:12:00 GMT

When our bodies are starved of oxygen, blood flow is redirected from non-vital organs to those crucial for survival - the heart, brain and adrenal glands (1). This is an example of physiological triage — a survival mechanism.

Could micronutrients also be allocated by triage in times of shortages? According to Prof. Bruce Ames the answer is yes (1). When micronutrients — vitamins and minerals, as well as other biochemicals like omega-3 polyunsaturated fatty acids — are in short supply, available micronutrients are first used for life-preserving physiological functions.

Problem solved? In the short run, yes. But in the long run we pay a heavy price for chronic deficiencies in micronutrients; the forced neglect of vital maintenance functions like DNA repair, immune function and other systems not needed for immediate survival eventually leads to health problems. Micronutrient shortages have been linked to mitochondrial damage resulting in increased free radical production, cell damage and late onset diseases like cancer (1).

Because vital bodily functions remain unimpaired in times of micronutrient deficiencies, the problem may unfortunately not be noticed for some time; neglect of DNA repair doesn′t manifest itself immediately in clinical symptoms. We can go on for quite some time falsely believing that we are getting all the nutrients we need from our "balanced diet". Once clinical symptoms appear the damage is done.

Is micronutrient deficiency really such a problem? Unfortunately, the answer is yes. For example, the 2001-2002 National Health and Nutrition Examination Survey (NHANES) found that micronutrient shortages are widespread in the U.S. population (1). Many of the participants in that study had vitamin and mineral intakes below the Estimated Average Requirement (EAR). EAR values are even lower than recommended Dietary Allowance (RDA) values, which in turn are widely believed to be inadequate (2). The situation in other industrialized countries isn′t any better.

Micronutrient deficiency is definitely a problem. Since our eating habits don′t change over time, any nutritional deficiencies are likely chronic. Supplementation is therefore a must for most of us. Taking a daily multivitamin-mineral (MVM) complex is an inexpensive and effective solution with big payoffs down the road:

“Micronutrient inadequacies are widespread in the population, and a MVM supplement is inexpensive. A solution is to encourage MVM supplementation, particularly in those groups with widespread deficiencies such as the poor, teenagers, the obese, African Americans, and the elderly, in addition to urging people to eat a more balanced diet.” (1)

Sources

Ames BN. Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce resources by triage. Proc Natl Acad Sci USA 2006;103(47):17589-17594.
http://www.pnas.org/content/103/47/17589.full.pdf
Doctors say, raise the RDAs now. Orthomolecular Medicine News Service, October 30, 2007.
http://orthomolecular.org/resources/omns/v03n10.shtml

What do doctors think of dietary supplements?

Helmut Beierbeck — Sat, 24 Oct 2009 02:20:00 GMT

"UK professor says supplements are a waste of time". That was one of the headlines in a recent edition of NutraIngredients.com (1). The article quotes a Scottish professor of nutrition and dietetics saying that "People who take multivitamin supplements are probably just wasting their money and boosting the profits of vitamin companies".

He isn′t the first to speak out against the use of dietary supplements. Earlier this year NutraIngredients.com commented on a study of supplement use among American children and adolescents participating in the 1999 to 2004 National Health and Nutrition Examination Survey (NHANES) (2). About one third of children and youths between 2 and 17 in that survey took dietary supplements. The investigators suggested that "health care providers in the country should discourage the use of supplements by children with healthy diets" (2).

Last year NutraIngredients.com quoted a member of the Harvard School of Public Health saying that dietary supplements will not provide the nutritional boost a poor diet requires (3). His exact quote, "A supplement is called a supplement because it′s supposed to be supplementing a healthy lifestyle", is actually quite amusing and presumably not what he meant. He is saying in effect that you need supplements even if you follow a healthy lifestyle, which surely includes the proverbial "balanced diet". Proponents of dietary supplementation couldn′t have put it any better!

How widespread is this anti-supplement attitude among doctors? The Council for Responsible Nutrition (CRN), a trade association representing the dietary supplement industry, conducted a couple of surveys among health care professionals to find out. What they discovered was that dietary supplement use was just as common among health care professionals as among the general public.

The first CRN survey, conducted in 2007, questioned 900 physicians and 277 nurses about their thoughts on dietary supplements (4). The survey revealed that 51% of the doctors and 59% of the nurses took dietary supplements regularly, comparable to supplement use in the general population. 79% of the physicians and 82% of the nurses also recommended dietary supplements to their patients, whether they themselved took supplements or not. The list of supplements taken and recommended included things like fish oils, in addition to vitamins and minerals.

The second CRN survey, released in 2008, questioned around 1200 orthopedic specialists, cardiologists and dermatologists (5). Among the orthopedic specialists 73% took supplements themselves; 94% of those who took supplements also recommended them to their patients. For the cardiologists surveyed those figures were 57% and 86%, and for the dermatologists 75% and 79%. Even many of the doctors who did not take dietary supplements still recommended them to their patients.

Are these health care professionals "just as naive and gullible as the general public"? I doubt it. The doctors and nurses surveyed may not be nutrition experts, but they see the extent and consequences of poor eating habits and sedentary lifestyles in their medical practices; they just have to look at their patients′ expanding waistlines. How do you get obese on a "balanced diet"? Given the shear number of the overweight and the obese, how could most people possibly get all the micronutrients they need from the food they eat?

In 2007 investigators from the U.S. Centers for Disease Control and Prevention (CDC) examined the dietary habits of about 100,000 high school students to find out how many ate the recommended two servings of fruits and three servings of vegetables per day. The results of the survey, released just recently (6,7), were sobering. Only 32% got two daily servings of fruit and only 13% the recommended three servings of vegetable. Less than one in ten high school students surveyed ate enough of both. The adults questioned in the same survey didn′t do much better. So much for the balanced diet.

I let the Independent Vitamin Safety Review Panel, a group of physicians, academics and researchers, have the last word on this subject:

"In the past, over-conservative government-sponsored standards have encouraged dietary complacency. People have been led to believe that they can get all the nutrients they need from a 'balanced diet' of processed foods. That is not true. For adequate vitamin and mineral intake, a diet of unprocessed, whole foods, along with the intelligent use of nutritional supplements, is more than just a good idea: it is essential." (8)

Sources:

Shane Starling. UK professor says supplements are a waste of time. NutraIngredients.com Sept. 10, 2009.
http://www.nutraingredients.com/content/view/print/259495
Lorraine Heller. Most children don′t need supplements, says study. NutraIngredients.com Feb. 4, 2009.
http://www.nutraingredients-usa.com/content/view/print/235056
Shane Starling. Harvard professor slams supplements. NutraIngredients.com Jul. 7, 2008.
http://www.nutraingredients-usa.com/content/view/print/173318
Dickinson A, Boyon N, Shao A. Physicians and nurses use and recommend dietary supplements: report of a survey. Nutr J 2009;8:29
http://www.nutritionj.com/content/8/1/29
Lorraine Heller. Doctors reveal supplement recommendations. NutraIngredients.com Dec. 11, 2008.
http://www.nutraingredients-usa.com/content/view/print/229798
9 in 10 teens fall short on fruits and veggies. Associated Press Sep. 29, 2009.
http://www.msnbc.msn.com/id/33071814/ns/health-diet_and_nutrition/
State indicator report on fruits and vegetables. Department of Health and Human Services, Centers for Disease Control and Prevention.
http://www.fruitsandveggiesmatter.gov/downloads/StateIndicatorReport2009.pdf
Doctors say, raise the RDAs now. Orthomolecular Medicine News Service Oct. 30, 2007.
http://orthomolecular.org/resources/omns/v03n10.shtml

Pharma tricks - ghostwriters part 2

Helmut Beierbeck — Fri, 18 Sep 2009 23:37:00 GMT

"If you are an editor, author, reviewer, or reader of medical journals, or if you depend on your doctor or health care provider getting unbiased information from medical journals, then the 1,500 documents now hosted on the PLoS Medicine Web site [1] should make you very concerned and angry. Because, quite simply, the story told in these documents amounts to one of the most compelling expositions ever seen of the systematic manipulation and abuse of scholarly publishing by the pharmaceutical industry and its commercial partners in their attempt to influence the health care decisions of physicians and the general public."

So starts an editorial, "Ghostwriting: The dirty little secret of medical publishing that just got bigger", in the September 2009 issue of PLoS Medicine (1). This is not the first time that PLoS editors and contributors have spoken out against this practice. What is different this time around is that a clear paper trail detailing these shenanigans surfaced in the course of litigation involving Wyeth and its HRT drug Prempro. Lawyers for PLoS Medicine and the New York Times were instrumental in getting these documents made public (2), and the New York Times ran a piece about this in their Aug 4, 2009 edition (3).

What is medical ghostwriting? The term refers to the Pharma practice of having writing firms produce manuscripts to the company′s specifications, paying "respected" academics to pose as authors, and getting these articles published in medical journals — without acknowledging the company′s involvement of course. As the PLoS Medicine editors put it:

"…articles highlighting specific marketing messages written by unattributed writers, but "authored" by academics, are strategically placed in the medical literature …" (2).

These ghostwritten articles are typically reviews favourable to drugs sold by the company commissioning the manuscript; benefits are exaggerated and side effects are minimized. However, even research papers and clinical trial results may be "authored" by ghostwriters. As cruder methods of persuasion lost their effectiveness, pharmaceutical companies turned to "educating" and influencing medical doctors by faking scholarly articles and submitting them to respectable academic publications.

"What, a cynical reader might ask, can I truly trust as being unbiased? The answer is that, sadly, for some or even many journal articles, we just don't know." (1)

The term "ghostwriting" is actually a bit misleading. It isn′t the writing firms that are the problem; it′s the academics posing as authors. Their names and reputations give credence to articles that are little more than ads masquerading as scholarly publications; the unsuspecting reader can′t tell the difference. Clearly, these "authors"and the pharmaceutical companies recruiting them are guilty of fraud.

"How did an industry whose products have contributed to astounding advances in global health over the past several decades come to accept such practices as the norm?" (1)

Well, judging by the recent scandals in the banking and financial sectors, corruption seems to be endemic in American business. Power tends to corrupt, Lord Acton said. Big Business is certainly powerful, and they are proving him right.

Sources:

The PLoS Medicine Editors. Ghostwriting: The dirty little secret of medical publishing that just got bigger. PLoS Medicine 2009;6(9):e1000156.
http://dx.doi.org/10.1371/journal.pmed.1000156
Wyeth ghostwriting archive. PLoS Medicine.
http://www.plosmedicine.org/static/ghostwriting.action
Natasha Singer. Medical papers by ghostwriters pushed therapy. NY Times Aug 4, 2009.
http://www.nytimes.com/2009/08/05/health/research/05ghost.html

Could you be suffering from orthorexia nervosa?

Helmut Beierbeck — Mon, 14 Sep 2009 22:45:00 GMT

You say you never heard of orthorexia nervosa? Well, neither had I until I read Jenny Thompson′s article "April [Fool′s Day] in August" in the September 8, 2009 edition of the HSI e-Alert (1). Here is how she introduced the subject:

"Do you read nutrition labels to avoid hidden trans fats, harmful additives, and sugar-substitutes? Do you choose organic foods to keep your intake of pesticides and herbides to a minimum? Do you even go out of your way to purchase free-range meat so you′ll get a maximum of omega-3 fatty acids and a minimum of trace antibiotics and growth hormones? If you answered yes to any of these questions, don′t be surprised if your doctor breaks the bad news: You have an eating disorder."

That supposed eating disorder — orthorexia nervosa — is an obsession with healthy eating, an obsessive compulsive disorder centered around food.

Here is what an article in the Observer (2) had to say about this grave new "disease":

"Eating disorder charities are reporting a rise in the number of people suffering from a serious psychological condition characterised by an obsession with healthy eating. The condition, orthorexia nervosa, affects equal numbers of men and women, but sufferers tend to be aged over 30, middle-class and well-educated."

A serious psychological condition characterized by an obsession with healthy eating? Hm.

"I am definitely seeing significantly more orthorexics than just a few years ago", the chairwoman of the mental health group of the British Dietetic Association was quoted as saying. "[Orthorexics] are solely concerned with the quality of food they put in their bodies, refining and restricting their diets according to their personal understanding of which foods are truly ′pure′."

What kinds of foods do these seriously disturbed orthorexics refuse to touch? Sugar, salt, caffeine, alcohol, wheat, gluten, yeast, soya, corn, and dairy foods are mentioned, as well as anything likely to contain pesticides, herbicides, and artificial additives. A bit strict maybe, but hardly a sign of a serious psychological problem. Even mainstream nutritionists warn against excess sugar, salt, and alcohol consumption. Gluten (wheat) as well as dairy products cause problems for many, and when did unfermented soy beans become food? I also try to avoid pesticides and herbicides; I should think you do too.

Who came up with this new-fangled disease called "orthorexia nervosa"? The term was introduced in 1997 by one Steven Bratman, M.D., who describes the affliction this way:

"Many of the most unbalanced people I have ever met are those who have devoted themselves to healthy eating. In fact, I believe some of them have actually contracted a novel eating disorder for which I have coined the name ′orthorexia nervosa.′ The term uses ′ortho,′ meaning straight, correct, and true, to modify ′anorexia nervosa.′ Orthorexia nervosa refers to a pathological fixation on eating proper food." (3)

"[people concerned with healthy eating] are sometimes affectionately called ′healthfood junkies.′ However, in some cases, orthorexia goes beyond a mere lifestyle choice. Obsession with healthy food can progress to the point where it crowds out other activities and interests, impairs relationships, and even becomes physically dangerous. When this happens, orthorexia takes on the dimensions of a true eating disorder, like anorexia nervosa or bulimia." (4)

To better understand Bratman and his "disease", one has to read his (short) original essay on orthorexia (3). It describes his experience with the lunatic fringe of the health food movement at a commune of health fanatics. He himself was part of that commune, before he was brought back to his senses; he is a "recovering orthorexic" himself. On reading this article (3) it becomes clear that he doesn′t apply the term orthorexia nervosa to people who simply focus on healthy eating. It is meant to describe someone with cockamamie ideas about food and a tendency toward obsessive compulsive behaviour.

Bratman is apparently quite sincere in his belief that orthorexia nervosa is an affliction to be taken seriously, a genuine disease requiring treatment. I suppose such misguided eating can actually lead to health problems. But does your typical "orthorexic" believe he needs treatment? And would he take nutritional advice from the medical establishment? Mainstream nutritional advice may be less extreme, but can be just as wrong-headed (dangers of cholesterol and saturated fat, etc).

I have to admit though that the term orthorexia nervosa appeals to my sense of humour. The lunatic fringe of the health food movement deserves a good ribbing, and orthorexia nervosa describes them wonderfully well. Still, there is something very sad about the extent to which we have lost our way in such a simple everyday matter as food.

Sources:

Jenny Thompson. April in August. HSI eAlert Sep 8, 2009.
http://mail.live.com/default.aspx?wa=wsignin1.0
Amelia Hill. Healthy food obsession sparks rise in new eating disorder. The Observer Aug 16, 2009.
http://www.guardian.co.uk/society/2009/aug/16/orthorexia-mental-health-eating-disorder
Steven Bratman, M.D.. Original essay on orthorexia.
http://orthorexia.com/index.php?page=essay
Steven Bratman, M.D.. What is orthorexia?
http://orthorexia.com/Index.php?page=katef

Lifestyle factors and chronic disease

Helmut Beierbeck — Sun, 06 Sep 2009 21:31:00 GMT

If we were asked to name the leading causes of death, most of us would name cardivascular disease and cancer. These are indeed the primary pathophysiological conditions identified at the time of death, but they are not the root causes. Diseases are the result of a combination of (unmodifiable) genetic and (modifiable) lifestyle factors. The real question therefore is what factors make the most significant contributions to these and other diseases.

A 1993 paper (1) attempted to answer that question. The authors searched the scientific literature from 1977 to 1993 for articles that quantitatively related lifestyle factors with disease. Coupled with actual U.S. death rates for 1990, they arrived at the following table of top risk factors and associated death tolls:

tobacco 400,000
diet/activity patterns 300,000
alcohol 100,000
microbial agents 90,000
toxic agents 60,000
firearms 35,000
sexual behavior 30,000
motor vehicules 25,000
illicit drug use 20,000

These ten factors (poor diet and sedentary lifestyle were lumped together) were estimated to account for about 50% of all U.S. deaths in 1990. Smoking, bad diets and lack of exercise are seen to be by far the major problems, accounting for 19% and 14% of all deaths, respectively.

The authors of a 2004 paper (2) put the U.S. death toll from smoking and poor diet/physical inactivity, the leading causes of death in the 1993 article, at 430,000 and 400,000, respectively. Their estimates are based on a survey of the relevant literature from 1980 to 2002 and actual numbers of U.S. deaths in 2000. As these authors point out, poor diet and lack of physical activity may soon overtake smoking as the leading cause of death in the United States.

The authors of a 2009 paper (3) analyzed data from the Potsdam, Germany, segment of the multi-center European Prospective Investigation Into Cancer (EPIC-Potsdam) study to estimate the risks associated with smoking, poor diet, lack of physical activity and high body mass index (a rather strange choice, given its dependence on diet and activity level). People who had none of these risk factors turned out to be 78% less likely to develop any chronic disease compared to those who smoked, ate poorly, were inactive and too heavy. Specific risk reductions were estimated to be 93% for diabetes, 81% for heart attacks, 50% for stroke, and 36% for cancer.

The authors of these papers emphasize that their numbers are only rough estimates of the death toll from perfectly avoidable risks. But these figures show very convincingly just how many of our chronic health problems are self-inflicted.

Sources

McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA 1993;270(18):2207-2212.
http://jama.ama-assn.org/cgi/reprint/270/18/2207
Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA 2004;291:1238-1245.
http://jama.ama-assn.org/cgi/content/abstract/291/10/1238 [Free Abstract]
Ford ES, Bergmann MM, Kröger J, Schienkiewitz A, Weikert C, Boeing H. Healthy living is the best revenge. Findings from the European Prospective Investigation Into Cancer and Nutrition - Potsdam Study. Arch Intern Med 2009;169:1355-1362.
http://archinte.ama-assn.org/cgi/reprint/169/15/1355

Where will future antibiotics come from?

Helmut Beierbeck — Thu, 03 Sep 2009 04:19:00 GMT

In the Aug 27, 2009 edition of The Scientist a UCLA infectious disease specialist makes an impassioned plea to help push for funding for the development of new antibiotics (1). Brad Spellberg, the author of a new book on the antibiotic resistance crisis, Rising plague (2), entreats scientific and lay communities for help in the quest for new weapons against antibiotic-resistant bacteria:

"This crisis will not be averted without your support, without a grassroots movement to put pressure on all sides — political, medical, pharmaceutical, and consumer — to band together to act. I will tell you what can be done, but we need your help to do it." (1)

Why does he need our help? Don′t we have the pharmaceutical industry to save us and keep us healthy? Apparently not:

"The problem here is not scientific. New antibiotics are dying before they have a chance to enter the marketplace due to a murky regulatory landscape and also due to unfavorable economics (i.e., the relatively low rate of return on investment afforded by sales of short-course antibiotics compared to sales of drugs for chronic conditions, such as hypertension, dementia, cancer, arthritis, and high cholesterol). Big Pharma has largely exited the scene. (1) [emphasis added]

Does he really mean to say that the wealthiest of all the multinational companies are unwilling to fund the necessary work, just because there is more money to be made elsewhere — even if our very survival is at stake? And I thought "capitalism" and "free markets" would solve all our problems!

Sources:

Spellberg B. Rising Plague. The Scientist Aug 27, 2009.
http://www.the-scientist.com/news/display/55951/
Brad Spellberg. Rising plague: The global threat from deadly bacteria and our dwindling arsenal to fight them. Prometheus Books, Amherst, New York, 2009.

Fish oils reduce risk of cardiovascular disease

Helmut Beierbeck — Thu, 20 Aug 2009 04:33:00 GMT

In my last two posts I talked about the importance of ω3 polyunsaturated fatty acids (PUFAs). In this post I want to focus on their role as precursors for a group of hormone-like substances collectively known as eicosanoids. The information presented here is largely taken from a recent review article on dietary lipids in inflammatory disorders like cardiovascular disease (1). Some of that material is also summarized on a couple of U.S. National Institutes of Health (NIH) websites (1).

Our bodies make these eicosanoids from two C-20 polyunsaturated fatty acids, the ω3 PUFA eicosapentaenoic acid (EPA) and the ω6 PUFA arachidonic acid (AA). Eicosanoids regulate important physiological functions like inflammation (prostaglandins), blood clotting (thromboxanes), and the immune response (leukotrienes). These are obviously vital defense mechanisms, but when they get out of hand the result is tissue damage and disease.

What could cause these defense mechanisms go awry? Physiological responses regulated by the ω6 PUFA derivatives are usually much stronger and more dangerous than the hormonal effects of EPA-derived prostaglandins, thromboxanes or leukotrienes. Imbalances in the ω3/ω6 ratios therefore have serious health consequences. The higher the ω6/ω3 eicosanoid ratio, the greater the danger of overreaction and disorders like chronic inflammation.

What determines the eicosanoid ω3/ω6 ratio? We can make neither ω3 nor ω6 PUFAs; they have to come from our diets. The ω3/ω6 eicosanoid ratio in our fat stores simply reflects the dietary mix of ω3 and ω6 polyunsaturated fatty acids, This in turn determines the ω3/ω6 ratio of PUFAs incorporated into cell membrane phospholipids, the precursors for eicosanoid synthesis.

Our bodies don′t seem to preferentially make either ω3 or ω6 eicosanoids. Phospholipid-bound ω3 and ω6 PUFAs are equally likely to be released and used as precursors. The elongation of shorter PUFAs to the C-20 fatty acids — linoleic acid to AA and α-linolenic acid to EPA — is catalized by the same enzymes. Other enzymes convert both EPA and AA to eicosanoids, and the ω3- and ω6-derived eicosanoids compete for the same receptors.

There are some quantitative differences in conversion rates and receptor binding between ω3 and ω6 eicosanoids. Nevertheless, the ω3/ω6 eicosanoid ratios are largely determined by the mix of phospholipid-bound ω3 and ω6 PUFAs, and therefore ultimately by the dietary ω3/ω6 mix. There is a clear correlation between the phospholipid PUFA fraction belonging to the ω6 series and death from cardiovascular disease — the higher the ω6 percentage, the greater the death toll (1).

What causes this ω3/ω6 PUFA imbalance in our diets? It is largely due to the excessive consumption of vegetable oils. Canola oil has the least unfavourable ω3/ω6 ratio at about 1:2. That ratio for corn oil is about 1:9, and the other commonly used oils aren′t any better. You can find a table of PUFA compositions for the more common cooking oils on one of the NIH websites quoted in the reference list (1).

Rebalancing the ω3/ω6 polyunsaturated fatty acid mix really requires both a reduction in dietary ω6 PUFA intake and an increase in ω3 PUFA consumption. Given the accumulated excess of ω6 PUFAs in our tissues, taking fish oils is much more effective than adding α-linolenic acid from sources like flax seeds. The conversion from the C-18 PUFA α-linolenic acid to EPA is simply too inefficient; preformed EPA itself is 15 times more effective at raising EPA levels than α-linolenic acid (2).

Compensating for excess ω6 fatty acids is by no means the only role of ω3 fatty acids, nor are imbalances in eicosanoids solely responsible for cardiovascular disease. There can be little doubt, however, that imbalances in dietary polyunsaturated fatty acid intake contribute to heart disease. This connection is both firmly established clinically and physiologically plausible.

So, Eat fatty fish or take EPA/DHA supplements! It is a simple and effective way to reduce your risk of cardiovascular disease and other inflammatory disorders.

Sources:

Lands B. A critique of paradoxes in current advice on dietary lipids. Progr Lipid Res 2008;47:77-106. See also
http://dx.doi.org/10.1016/j.plipres.2007.12.001 [Free Abstract]
http://ods.od.nih.gov/eicosanoids/ and
http://efaeducation.nih.gov/
Brenna JT, Salem Jr. N, Sinclair AJ, Cunnane SC. α-Linolenic acid supplementation and conversion to n-3 long-chain polyunsaturated fatty acids in humans. Prostaglandins Leukotrienes Essential Fatty Acids 2009;80:85-91.
http://www.plefa.com/article/S0952-3278(09)00016-7/abstract [Free Abstract]

Cardiovascular disease and omega-3 fatty acids

Helmut Beierbeck — Mon, 27 Jul 2009 21:37:00 GMT

In my last post I reviewed an article about health risk factors and premature deaths (1). One of the authors′ more surprising findings was that, in the U.S. alone, an estimated 84,000 lives could be saved annually if everyone′s omega-3 fatty acid intakes were optimized, either through diet or supplementation. By comparison, cholesterol-lowering strategies were estimated to save about 113,000 lives annually. I was of course aware of the importance of n-3 (omega-3) fatty acids, but I was surprised by the numbers. Maybe I shouldn′t have been.

In 2003 the Nutrition Committee of the American Heart Association (AHA) had this to say about omega-3 fatty acids and cardiovascular disease (2):

"Omega-3 fatty acids have been shown in epidemiological and clinical trials to reduce the incidence of cardiovascular disease. Large-scale epidemiological studies suggest that individuals at risk for coronary heart disease benefit from the consumption of plant- and marine-derived omega-3 fatty acids, although the ideal intakes presently are unclear. Evidence from prospective secondary prevention studies suggests that EPA + DHA supplementation ranging from 0.5 to 1.8 g/day (either as fatty fish or supplements) significantly reduces subsequent cardiac and all-cause mortality. For α-linolenic acid, total intakes of ∼ 1.5 to 3 g/day seem to be beneficial."

The authors go on to say that even patients with existing heart disease can benefit from omega-3 supplementation (2):

"A dietary (i.e. food-based) approach to increasing omega-3 fatty acid intake is preferable. Still, for patients with coronary artery disease, the dose of omega-3 (∼1 g/day) may be greater than what can readily be achieved through diet alone. These individuals, in consultation with their physician, could consider supplements for CHD risk reduction. Supplements could also be a component of the medical management of hypertriglyceridemia, a setting in which even larger doses (2 to 4 g/day) are required."

In 2005 a meta-analysis of randomized controlled trials of the effects of various lipid-lowering interventions on all-cause and cardiovascular deaths appeared (3). In all, 97 trials involving nearly 140,000 patients and a roughly equal number of controls were included in that analysis. The lipid-lowering interventions consisted of statins, fibrates, resin, niacin, n-3 fatty acids or dietary intervention. This is how the authors summarized their findings (3):

"Statins and n-3 fatty acids are the most favorable lipid-lowering interventions with reduced risks of overall and cardiac mortality."

The actual risk ratios for all-cause mortality were 0.87 for statins and 0.77 for n-3 fatty acids. For death from cardiovascular disease the corresponding values were 0.78 for statins and 0.68 for n-3 fatty acids. The authors point out, though, that in the n-3 fatty acid intervention group the risk reduction was significant only in secondary prevention, i.e. for patients who already had cardiovascular disease.

They might have added that the reduction in the risk of death was even greater in the n-3 fatty acid than in the statin group, that n-3 fatty acids don′t come with the side effects of statins, and that they are a good deal cheaper as well.

The authors do suggest though that "future trials should explore whether n-3 fatty acids in combination with statins lead to additional reductions in coronary heart disease mortality, especially in patients with metabolic syndrome". It′s possible that combination therapy might confer additional benefits, since statins and n-3 fatty acids act differently. Statins reduce cholesterol synthesis, whereas n-3 fatty acids tame inflammation.

n-3 and n-6 polyunsaturated fatty acids are precursors for a group of hormone-like substances — summarily referred to as eicosanoids — which control, among other things, the body′s inflammatory response. Eicosanoids derived from n-6 fatty acids up-regulate inflammation, whereas n-3 eicosanoids keep it in check.

We cannot interconvert n-3 and n-6 fatty acids, which means that the dietary mix of n-3 and n-6 fatty acids determines our ability to initiate and control inflammation. Unfortunately, we get far too much dietary n-6 fatty acids from seed oils (sunflower, safflower, peanut, canola), which leaves us at risk for chronic inflammation, atherosclerosis and cardiovascular disease.

By increasing our intake of n-3 polyunsaturated fatty acids, either through diet or supplementation, and/or by decreasing n-6 fatty acid consumption, we can rebalance the inflammatory response and reduce our risk of cardiovascular and other inflammatory diseases.

Sources:

Danaei G, Ding EL, Mozaffarian D et al. The preventable causes of death in the United States: Comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Medicine April 2009;6(4)
http://dx.doi.org/10.1371/journal.pmed.1000058
Kris-Etherton PPM, Harris WS, Appel LJ. Fish consumption, fils oil, omega-3 fatty acids, and cardiovascular disease. Arterioscler Thromb Vasc Biol 2003;23:e20-e30.
http://dx.doi.org/10.1161/01.ATV.0000038493.65177.94
Studer M, Briel M, Leimenstoll B, Glass TR, Bucher HC. Effect of different antilipidemic agents and diets on mortality. A systematic review. Arch Intern Med 2005;165:725-730.
http://archinte.ama-assn.org/cgi/reprint/165/7/725

Omega-3 fatty acid deficiency causes premature deaths

Helmut Beierbeck — Sat, 11 Jul 2009 04:50:00 GMT

"Omega-3 deficiency causes 96,000 US deaths per year, say researchers". That was the headline of a recent NutraIngredients article (1). The title highlights one of the more surprising finding of a study on "The preventable causes of death in the United States: Comparative risk assessment of dietary, lifestyle, and metabolic risk factors" (2).

A group of researchers set out to identify the lifestyle, dietary and metabolic health risk factors responsible for the greatest number of premature and preventable deaths in the United States. Metabolic risk factors are physiological indicators like blood pressure, glucose levels, LDL-cholesterol, etc. For any given risk factor to be included in their analysis, a number of conditions had to be met:

it had to be a known cause of disease-specific mortality,
a quantitative relationship between magnitude of risk and likelihood of death from a specific disease had to be available from observational or controlled studies,
the risk factor had to be controllable through lifestyle changes or medical intervention, and
representative risk factor distribution data for the general population had to be available.

If one knows the distribution of a given risk factor in the general population, and if the relation between its magnitude and the probability of disease-specific death from that risk factor can be quantified, then one can estimate the proportional reduction in the number of deaths that could be achieved by eliminating that risk factor. With this information it is then a simple matter to estimate the actual number of premature deaths that could be avoided by eliminating that risk factor; it is the product of the proportional reduction in the number of deaths and the actual number of deaths from that disease.

Here are the author′s estimates (2) for the number of deaths that could have been prevented in the U.S. in 2005, if the following twelve risk factors had been eliminated (confidence intervals in parentheses):

smoking 467,000 (436,000 - 500,000)
high blood pressure 395,000 (372,000 - 414,000)
overweight-obesity 216,000 (188,000 - 237,000)
physical inactivity 191,000 (164,000 - 222,000)
high blood glucose 190,000 (163,000 - 217,000)
high LDL-cholesterol 113,000 (94,000 - 124,000)
high dietary sodium 102,000 (97,000 - 107,000)
low dietary omega-3 fatty acids from seafood 84,000 (72,000 - 96,000)
high dietary trans fatty acids 82,000 (63,000 - 97,000)
excessive alcohol use 64,000 (51,000 - 69,000)
low intake of fruits and vegetables 58,000 (44,000 - 74,000)
low dietary polyunsaturated fatty acids (PUFAs) 15,000 (11,000 - 20,000)

Not surprisingly, smoking and high blood pressure were found to be by far the most serious risk factors for premature death. The high health risk posed by obesity, physical inactivity and high blood glucose had to be expected as well. The most surprising finding, though, has to be the importance of omega-3 fatty acids from fish. A lack of EPA and DHA in the diet turned out to be nearly as large a risk factor as high LDL-cholesterol or sodium levels, and more of a risk than trans fatty acids and low intakes of fruits and vegetables.

Some of the variables in this list seem like strange choices. For example, blood pressure and sodium intake aren′t independent of one another; increased sodium intake increases blood pressure. Similarly, there has to be a connection between overweight-obesity and physical inactivity. On the other hand, a number of well-known risk factors — caloric intake, triglyceride and HDL-cholesterol levels — were excluded, because their causal connections to specific diseases are less well established. Vitamin D is another surprising omission.

Be that as it may, these considerations are unlikely to put the omega-3 results in question. So, if you don′t like fish, supplement with EPA/DHA. It′s one of the most affordable and effective health measures you can take.

Sources:

Shane Starling. Omega-3 deficiency causes 96,000 US deaths per year, say researchers. NutraIngredients June 26, 2009.
http://www.nutraingredients-usa.com/content/view/print/252050
Danaei G, Ding EL, Mozaffarian D et al. The preventable causes of death in the United States: Comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Medicine April 2009;6(4).
http://dx.doi.org/10.1371/journal.pmed.1000058

Antioxidant supplementation, exercise and insulin resistance

Helmut Beierbeck — Fri, 22 May 2009 19:53:00 GMT

There have been a number of negative reports on the health effects of vitamin/mineral supplements. Several studies concluded that supplements were either ineffective or made matters worse. The latest negative article on this topic claims that taking vitamins C and E suppresses the health benefits of exercise (1).

How could this be? After all, exercise does create free radials, and free radicals do cause damage. Since I too take supplements, I decided to have a closer look.

The title of the article, "Antioxidants prevent health-promoting effects of physical exercise in humans", is actually misleading. The investigators really set out to determine if and how antioxidant supplementation interferes with the beneficial effect of physical exercise on insulin resistance. Here is how they went about it.

Forty healthy non-diabetic young men were recruited for a two-part trial. Sixteen of the 40 completed the first part; the rest were used in the second stage. Each exercise session consisted of running or cycling (20 min), circuit training (45 min), and warm-up and cooling off periods (20 min). All 40 volunteers were randomly assigned to receive either placebo or 2×500 mg vitamin C and 1×400 IU vitamin E per day.

The first trial part was designed to test whether the chosen exercise regimen generated reactive oxygen species (ROS) — popularly known as free radicals — and whether the chosen antioxidant cocktail suppressed them. The sixteen participants, half getting placebo, exercised on three consecutive days. Muscle tissue samples were taken before and after the intervention and analyzed for ROS content. This stage confirmed that the chosen exercise protocol generated ROS, and that the antioxidants suppressed these ROS, i.e. that the experimental setup worked.

The second trial part was designed to answer the question if and how ROS formation improved insulin sensitivity, and if and how antioxidant supplementation interfered with that effect. In this trial part the remaining 24 recruits completed four weeks of exercise, five days per week. Blood and muscle tissue samples were taken before and after the intervention.

Analysis of the blood samples established that the 4-week exercise regimen improved insulin sensitivity, but only in the placebo group. No significant improvement was observed in the supplement group, i.e. the antioxidant cocktail suppressed the exercise effect on insulin sensitivity.

Analysis of the tissue samples revealed the reason why. In the placebo group, exercise strongly increased the gene expression of known molecular regulators of insulin sensitivity. In the supplement group this effect was much smaller. In other words, antioxidant supplementation largely eliminated the exercise-induced increase in insulin sensitivity.

Interestingly, ROS formation also increased the production of the antioxidant enzymes superoxide dismutase (SOD) and glutathione peroxidase (GPx). If the exercise-generated free radicals aren′t suppressed by antioxidant supplementation, the body will generate its own defenses against them — while simultaneously improving insulin sensitivity.

In summary, this study convincingly demonstrated that, and why, supplementation with antioxidant vitamins C and E suppresses a valuable exercise effect — improved insulin sensitivity.

Does all this mean that supplementation with vitamins C and E is useless? Not at all. These two antioxidants are after all vitamins, which are defined as substances that we need but cannot make at all or only in insufficient amounts. Nothing can take their place where they are needed, but they cannot be used like drugs. In this particular case the exercise-induced free radicals actually played a vital regulatory role — suppressing them backfired.

As the authors put it:

"… antioxidant supplements prevent the induction of molecular regulators of insulin sensitivity and endogenous antioxidant defense by physical exercise"

and

"… we propose that transiently increased levels of oxidative stress reflect a potentially health-promoting process at least in regards to prevention of insulin resistance and type 2 diabetes mellitus"

Sources:

Ristow M, Zarse K, Oberbach A et al. Antioxidants prevent health-promoting effects of physical exercise in humans. Proc Nat Acad Sci, published online before print May 11, 2009;
doi:/10.1073/pnas.0903485106

Vegetables - should you eat them raw or cooked?

Helmut Beierbeck — Thu, 23 Apr 2009 04:37:00 GMT

Are vegetables more nutritious raw or cooked? If you are an omnivore, you probably don′t care — you are used to cooked food. Meat eaters may eat raw vegetables in salads, with dips, or possibly juiced. But we eat our meat cooked, and we want the rest of our dinner cooked as well.

Vegetarians are a different story. If you are a firm believer in the health benefits of a vegetarian diet, you probably want to know if cooking enhances or diminishes the nutritional value of food. Of course, raw foodists are already convinced that raw is the way to go. So what is more nutritious, raw or cooked vegetables? It turns out that there is no simple answer to that question.

There are advantages and disadvantages to cooking vegetables (1,2). On one hand, cooking softens food by breaking down plant cell walls, making nutrients more accessible. Cooking also denatures proteins and softens starches, making them more digestible. On the other hand, heating damages some vitamins and phytonutrients, as well as destroying vegetable enzymes. Frying does more damage than steaming or boiling; the higher temperatures can damage unsaturated fats, which in turn uses up antioxidants. So what′s better, raw or cooked? It′s pretty well a toss-up.

Given today′s industrial food production and distribution system, I doubt very much that we can get enough vitamins and minerals from our vegetables, no matter how we eat them. I am convinced that eating vegetables is more important for their effect on macronutrient intake — carbohydrates, proteins, and fats — that for their micronutrient content.

You can always compensate for what you should have gotten from your food but didn′t — vitamins and minerals; you can take supplements. You′ll end up paying twice for your nutrients, first for food and then again for the supplements. But at least you eat right.

It is a good deal more difficult to compensate for what you ate but shouldn′t have — excess calories. The best way to cut back on high-calorie foods is to add more vegetables to your diet. Vegetables are excellent sources of dietary fiber. Soluble fiber gives you a sense of fullness — you′ll likely eat less. They also slow nutrient digestion and absorption. Insoluble fibers help keep you "regular".

The bottom line? Eat your vegetables any way you like them, but eat them! Learning to prepare tasty vegetable side dishes may well be the easiest way to control your waist-line.

But add a quality nutritional supplement to your diet to ensure that you are getting the vitamins, minerals, and phytonutrients you need.

Sources

Sushma Subramanian. Fact or fiction: Raw veggies are healthier than cooked ones. Scientific American March 31, 2009.
[Full Text}
Jon Barron. Food – raw versus cooked. Jon Barron′s Alternative Health Newsletter March 16, 2009.
[Full Text]

Vegetarianism - healthy eating or fad diet?

Helmut Beierbeck — Thu, 09 Apr 2009 03:27:00 GMT

A recent issue of the NutraIngredients newsletter summarized a strange-sounding article on vegetarianism and weight control behaviours among young people (1,2). About 2,500 youths, 15 to 23 years of age, were enrolled in a study, about 15% of whom were current or former vegetarians. Investigators compared the subjects′ dietary habits and body weight.

What they found was that the vegetarians in the group were less likely to be overweight or obese, but more likely to engage in "binge eating" or "extreme unhealthful weight-control behavior" (2). Interestingly, meat — the food group that sets vegetarians apart from non-vegetarians — wasn′t even mentioned in the abstract (2), which is all I read of the paper.

It turns out that this is not the first time that eating disorders in young vegetarians have been noted:

"Vegetarian diets are somewhat more common among adolescents with eating disorders than in the general adolescent population. … vegetarian diets may be selected to camouflage an existing eating disorder." (3)

I rather suspect that these young people tried a vegetarian diet to get their weight under control. The binge eating episodes presumably involved a perfectly vegetarian "food group" — sweets.

I have no interest in binge eating among vegetarians; the report simply made me look at what′s known about the comparative health benefits of vegetarian and non-vegetarian diets. I found three recent review articles on the topic, published in 2003 (3), 2006 (4), and 2008 (5), respectively. I only had access to the abstract of the 2008 paper.

All three review articles made the point that a vegetarian diet is healthy and suitable for all age groups, but that overall health outcomes are comparable in vegetarians and health-conscious non-vegetarians, with a couple of exceptions.

All three articles reported that vegetarians had a moderately lower death rate from ischemic heart disease than non-vegetarians. This was attributed (3) to lower blood cholesterol levels, which in turn could be due to lower dietary cholesterol and higher fiber intake; plant foods don′t contain cholesterol, and fiber reduces cholesterol absorption. Higher antioxidant consumption from fruits and vegetables is expected to reduce the rate of LDL-cholesterol oxidation, which would further lower the risk of atherosclerosis.

There was disagreement on the effect of a vegetarian diet on death rates from cancer. It was generally agreed that the death rates from most cancers were comparable between vegetarians and non-vegetarians, but the 2003 review reported significantly lower prostate and colon cancer rates in vegetarians. The lower colon cancer rates were attributed to greater fiber intake, lower concentrations of potentially carcinogenic bile acids and fewer intestinal bacteria.

Interestingly, an analysis of a recently completed large-scale prospective study involving more than 60,000 men and women in the U.K (6) found higher colorectal cancer rates in vegetarians than in non-vegetarians; all other cancer rates were somewhat lower among the vegetarians. The authors point out that cancer rates in both the vegetarians and non-vegetarians they studied were below national averages (6).

The reviews (3-5) also noted lower obesity rates, cholesterol levels, blood pressure and saturated fat intake among vegetarians, as well as higher antioxidant, fiber, and phytonutrient consumption.

There is of course no question that fruits and vegetables are an important part of a healthy diet. The question is though whether the health benefits of vegetarianism are due to greater fruit and vegetable consumption or to the avoidance of meat. I tend to agree with the author of the 2008 review:

"Very probably, an ample consumption of fruits and vegetables and not the exclusion of meat make vegetarians healthful. … Vegetarianism is a form of food restriction; and in our overfed society, food restriction is a plus unless it results in a nutritional deficiency “ (5).

Sources:

Benefits and detriments of vegetarian diets may not balance out: Report. NutraIngredients-usa.com Apr 1, 2009.
[Full Text]
Robinson-O′Brien R et al. Adolescent and young adult vegetarianism: Better dietary intake and weight outcomes but increased risk of disordered eating behaviors. J Am Diet Assoc 2009;109:648-655.
[Abstract]
Position of the American Dietetic Association and Dietitians of Canada: Vegetarian diets. J Am Diet Assoc 2003;103:748-765.
[Full Text]
Key TJ, Appleby PN, Rosell MS. Health effects of vegetarian and vegan diets. Proc Nutr Soc 2006;65:35-41.
[Full Text]
Ginter E. Vegetarian diets, chronic diseases and longevity. Bratisl Lek Listy 2008;109:463-466.
[Abstract]
Key TJ, Appleby PN, Spencer EA, Travis RC, Roddam AW, Allen NE. Cancer incidence in vegetarians: results from the European Prospective Investigation into Cancer and Nutrition (EPIC-Oxford). Am J Clin Nutr 2009;.
[Abstract]

Vitamin A revisited

Helmut Beierbeck — Sat, 28 Mar 2009 22:37:00 GMT

In my recent post "Why taking cod liver oil is not a good idea" (1) I made the point that vitamin D supplementation is vital in the winter months, but that getting the sunshine vitamin from cod liver oil is not a good idea. Cod liver oil contains high amounts of vitamin A as preformed retinol. Taking it in amounts necessary to reach effective vitamin D levels can therefore lead to vitamin A toxicity (hypervitaminosis A). In addition, high levels of vitamin A actually negate the effect of vitamin D, the very reason for taking cod liver oil in the first place.

A reader pointed out that this advice is at odds with Adelle Davis′ vitamin A recommendations. In her book "Let′s get well", she apparently claimed that vitamin A deficiency is more widespread than is generally admitted, and that amounts of up to 50,000 IU/day are quite safe and often useful for fighting infections.

I have to admit that I had never heard of Adelle Davis; I had never come across any of her books. According to Wikipedia (2), Adelle Davis (1904 - 1974) was a pioneer in the American health movement, a trained dietitian with a degree in biochemistry. She published a number of books on health and nutrition, the last of which, "Let′s get well", came out in 1965. Nobel laureate and vitamin C guru Linus Pauling acknowledged that "… she was essentially correct in almost everything she said" (2). High praise indeed.

I didn′t find her book at the local library and I therefore don′t know where she got her numbers from. They are much higher, though, than today′s recommendations.

How widespread is vitamin A deficiency?

Vitamin A deficiency is endemic in developing countries and causes a variety of health problems (3). A lack of vitamin A is the leading cause of blindness in the Third World. In those countries carotenoids from plant foods are the principal sources of vitamin A, and carotenoids are less well absorbed than preformed retinol. Malnutrition often compounds the problem.

In industrialized countries, on the other hand, people generally take in enough preformed retinol from fortified foods and multivitamins to reach effective vitamin A levels (3). In fact, observational studies suggest that 75% or more of Americans may routinely ingest more than the recommended dietary allowance for vitamin A, much of it as preformed vitamin A (4). Getting vitamin D from retinol-rich cod liver oil can therefore easily lead to vitamin A overload.

What are the current vitamin A recommendations?

The Food & Nutrition Board of the U.S. Institute of Medicine currently recommends 900 μg (3,000 IU) per day for men and 700 μg (~2,300 IU) for women, with lower values for infants and children, and somewhat higher amounts for nursing women (5). 0.3 μg of vitamin A equals 1 IU (6).

Are these values too low? The Independent Vitamin Safety Review Panel, an independent panel of physicians, academics and researchers, doesn′t think so. In their October 2007 call for a reassessment of vitamin and mineral recommendations they specifically exempt vitamin A:

“Government-sponsored nutrient recommendations, such as the US RDA/DRIs, are not keeping pace with recent progress in nutrition research. While current official recommendations for vitamin A, iron, calcium, and some other nutrients are generally adequate, the public has been asked to consume far too little of many other key nutrients. Inadequate intake, and inadequate standards to judge intake, have resulted in widespread nutrient inadequacy, chronic disease, and an undernourished but overweight population.” [emphasis added] (7)

What evidence is there for vitamin A toxicity?

The main concern with excess vitamin A intake is its possible adverse effect on bone mineral density (BMD), which in turn can lead to an increased risk of hip fractures (3,4). There is sound biochemical evidence for the involvement of vitamin A in bone metabolism. Vitamin A is known to interfere with vitamin D and with calcium-regulating hormones (3,4).

Clinical observations, on the other hand, have shown mixed results (3,4). Some investigators found bone toxicity effects at vitamin A levels as low as twice the daily dietary allowance, whereas others found no correlation between vitamin A intake and hip fractures (3,4). There is enough evidence though for a link between high vitamin A levels and an increased risk of fractures to advise caution (3,4). The Linus Pauling Institute, which certainly supports vitamin/mineral supplementation, also warns against taking excessive amounts of retinol:

"The RDA for vitamin A (2,300 IU/day for women and 3,000 IU/day for men) is sufficient to support normal gene expression, immune function, and vision. However, following the Linus Pauling Institute’s recommendation to take a multivitamin/multimineral supplement daily could supply as much as 5,000 IU/day of vitamin A as retinol, the amount that has been associated with adverse effects on bone health in older adults. For this reason, we recommend taking a multivitamin/multimineral supplement that provides no more than 2,500 IU of vitamin A or a supplement that provides 5,000 IU of vitamin A, of which at least 50% comes from beta-carotene. High potency vitamin A supplements should not be used without medical supervision due to the risk of toxicity". [emphasis added] (6)

All in all, the advice to avoid cod liver oil because of its high vitamin A content seems sound. I could find no support among today′s experts for Adelle Davis′ high vitamin A levels.

Sources:

Helmut Beierbeck. Why taking cod liver oil is not a good idea.
http://healthcomments.info/2009/01/27/why-cod-liver-oil-is-not-a-good-source-of-vitamin-d.aspx
Adelle Davis. Wikipedia.
http://en.wikipedia.org/wiki/Adelle_Davis
Cannell JJ et al. Cod liver oil, vitamin A toxicity, frequent respiratory infections, and the vitamin D deficiency epidemic. Ann Otol Rhinol Laryngol 2008;117(11):864-870.
Penniston KL, Tanumihardjo SA. The acute and chronic effects of vitamin A. Am J Clin Nutr 2006;83:191-201.
http://www.ajcn.org/cgi/reprint/83/2/191
Dietary Reference Intakes: Vitamins. http://www.iom.edu/Object.File/Master/7/296/webtablevitamins.pdf
Vitamin A. Micronutrient Information Center. Linus Pauling Institute.
http://lpi.oregonstate.edu/infocenter/vitamins/vitaminA/
Doctors say, raise the RDAs now. Orthomolecular Medicine News Service, October 30, 2007.
http://orthomolecular.org/resources/omns/v03n10.shtml

HFCS-sweetened foods may contain mercury

Helmut Beierbeck — Sat, 21 Feb 2009 22:28:00 GMT

High fructose corn syrup (HFCS) has taken much of the blame for America′s health problems, since its introduction coincided with a sharp rise in obesity rates. However, a closer look at the situation shows that is is the rapid rise in soft drink consumption, rather than HFCS itself, that is responsible for this trend. I have discussed this matter elsewhere (1) in some detail, so I am just going to summarize the main points here.

HFCS is made from corn starch, a glucose polymer. The starch is hydrolyzed to free glucose, which is then enzymatically converted to a fructose/glucose mixture. This mixture is adjusted to either 55% (HFCS-55) or 42% (HFCS-42) fructose. Soft drinks are sweetened with HFCS-55, whereas HFCS-42 is used to sweeten food products.

By comparison, table sugar (sucrose) is a dimer consisting of one molecule each of glucose and fructose, digestion of which gives 50% glucose and 50% fructose. In fact, sucrose also ends up largely hydrolyzed in soft drinks, because of their low pH. HFCS and sucrose therefore really aren′t all that different.

The problem with the high consumption of sucrose or high fructose corn syrup is the metabolic fate of fructose. While fructose can be converted to glucose, it is preferentially diverted to fatty acid synthesis. Converted to glucose, it adds to the satiety signals generated by elevated glucose levels. Metabolized to fatty acids, it bypasses these controls and leads to overeating.

Interestingly, people seem to react differently to HFCS-sweetened drinks and solid foods. Subject eating HFCS-sweetened foods before a meal compensated for the extra calories by reducing subsequent food intake. When they were given HFCS-sweetened soft drinks instead, no such compensation was observed. In other words, HFCS in soft drinks, but apparently not in solid food, leads to overeating and weight gain.

One would think, therefore, that HFCS-sweetened foods don′t pose much of a problem. Unfortunately, this is not the case, and for a rather unexpected reason. HFCS-sweetened foods may be contaminated with mercury; this seems to be less of a problem with soft drinks.

Where does the mercury come from? Various steps in the conversion of corn starch to the fructose/glucose mixture HFCS use caustic soda (NaOH) and hydrochloric acid (HCl) to adjust the pH of the reaction mixtures. NaOH and HCl are made in chlor-alkali plants, some of which still use antiquated processes involving mercury, even though mercury-free methods are available.

When those chlor-alkali companies couldn′t account for their mercury losses, an Environmental Health Officer at the U.S. Food and Drug Administration (FDA) decided to look for the missing mercury in a food product made with NaOH and HCl input — HFCS (2). Twenty HFCS samples in all were collected, five HFCS-55 and five HFCS-42 samples from one company, five HFCS-55 samples from a second, and five HFCS-42 samples from a third manufacturer. These samples were then analyzed for their total mercury content.

The results were sobering. Only one of the ten samples from the first company showed traces of mercury, but eight of the other ten were contaminated, some containing as much as 0.57 ppm (parts per million) of mercury. Given the high HFCS intake in the U.S. — an average of 49.8 g/person/day — this can lead to a potential average mercury intake of 28.4 μg/day. Remember too that many people, especially the young, consume above average amounts. To put this into perspective, Health Canada estimates that dental fillings in children discharge 0.79 to 1.91 μg/day of mercury, not even a tenth the estimated average amount from HFCS-sweetened treats (2).

To verify that mercury from HFCS sources indeed makes it into food products, a group of researchers at the Institute for Agriculture and Trade Policy in Minneapolis collected commercial food products listing HFCS as first or second ingredients and had them analyzed for their mercury content (3). In all, 55 name brand beverages, dressings, dairy products (chocolate milk), snacks and desserts, soups and entrees, syrups and jellies were tested. Of those 55 samples, 17 contained mercury. Most of the contaminated samples were foods; the soft drinks turned out to be mostly mercury-free. You can find the list of tested products and the test results in their paper (3).

Mercury obviously occurs naturally, and we cannot eliminate all natural hazards. However, knowingly introducing one of the most toxic metals into the food supply is inexcusable. HFCS manufacturers must know where their chemicals come from, how pure they are, and what their own products will be used for. Mercury is an extremely potent neurotoxin and a particular threat to the unborn and to small children, whose brains are still developing. There is no safe level and no safe form of mercury. Even regular exposure at low levels is dangerous, since organometallic mercury accumulates in fatty tissues. Talk about corporate irresponsibility!

Read the labels when you buy packaged foods. If HFCS is listed first or second, there is every chance that you are about to buy a product laced with mercury.

Sources

Beierbeck H. Why soft drinks contribute to obesity. Natural News Sep 1, 2009, and references therein.
http://www.naturalnews.com/024046.html
Dufault R, LeBlanc B, Schnoll R et al. Mercury from chlor-alkali plants: Measured concentrations in food product sugar. Environmental Health 2009;8:2.
http://www.ehjournal.net/content/pdf/1476-069X-8-2.pdf
Wallinga D, Sorensen J, Mottl O, Yabloa B. Not so sweet: Mixing mercury and high fructose corn syrup. IATP Jan 2009.
http://www.healthobservatory.org/library.cfm?refid=105026

Why taking cod liver oil is not a good idea

Helmut Beierbeck — Wed, 28 Jan 2009 04:35:00 GMT

I recently wrote an article on the importance of vitamin D in the fight against influenza (1). The discussion focused mainly on the role of vitamin D in supporting innate immunity, but adaptive immunity obviously plays a role in the battle against infection as well. The innate branch of the immune system produces so-called anti-microbial peptides (AMPs), compounds with broad-spectrum effectiveness against bacteria, viruses, and fungi. Vitamin D is necessary for the expression of some of these AMPs.

The cells of the lining (endothelium) of the upper airways produce AMPs constitutively, i.e. regardless of whether or not pathogens are present. These anti-microbial peptides are released into a thin layer of fluid above the endothelium; this layer in turn is covered with mucus. When a pathogen penetrates the mucous layer and encounters anti-microbial peptides, the AMP molecules bind to its glycoprotein coat, effectively destroying the invader.

If a pathogen makes it past this protective coating and binds to the endothelium, this initiates the synthesis of high concentrations of specific inducible AMPs, thus providing a backup anti-microbial shield. The expression of the genes coding for these inducible AMPs requires vitamin D.

Unfortunately, it is virtually impossible to get adequate amounts of vitamin D from the diet. In the winter it is also impossible to make enough vitamin D by exposing the skin to the sun. In fact, vitamin D deficiency is now even a problem during the summer months, because of widespread sun avoidance. Vitamin D supplementation is therefore essential.

How much vitamin D do we need? It is now believed that serum 25(OH)D (25-hydroxyvitamin D) levels of 50 ng/mL (nanograms per milliliter) or more are required to ensure adequate vitamin D stores. To get to this level, adults would need to take 2,000 IU/day or more. These levels are considered quite safe — the tolerable upper intake level is now believed to be at least 10,000 IU/day (1).

What kind of vitamin D supplement should you take? In my article I recommended getting vitamin D from cod liver oil. No sooner had I written this than I came across a paper warning against cod liver oil (2). The problem? Cod liver oil contains excessive amounts of vitamin A. For every 1 IU of vitamin D, cod liver oil contains at least 10 IU of vitamin A. If you were to take enough to get 2,000 IU of vitamin D, you′d get 20,000 IU or more of vitamin A as retinol. This amount is well above the tolerable upper intake level (UL) of 3,000 μg/day (10,000 IU/day) set by the Food and Nutrition Board of the U.S. Institute of Medicine (3). 0.3 μg equals 1 IU of vitamin A (4).

In contrast to vitamin D, vitamin A is readily available in the diet in the form of provitamin A — carotenoids in coloured vegetables. Consequently, excess vitamin A intake is much more widespread in developed countries than vitamin A deficiency. Taking cod liver oil is therefore a recipe for subclinical vitamin A toxicity. Not only that, but its vitamin A content actually masks the effect of its vitamin D. In other words, the vitamin A in cod liver oil defeats the very purpose of taking it for its vitamin D content.

Of course, the warning against cod liver oil does not apply to fish or krill oil. Fish oil is extracted from the body of the fish and contains neither vitamin A nor D in any meaningful amount. It is, however, an important source of the polyunsaturated omega-3 fatty acids EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). In fact, fish (or krill) oil is one of the most important supplements you can take!

Forget about cod liver oil and take vitamin D3 (cholecalciferol) supplements instead!

Sources:

Helmut Beierbeck. Why you need extra vitamin D during the flu season. Natural News Dec. 2, 2008, and references therein.
[Full Text]
Cannell JJ et al. Cod liver oil, vitamin A toxicity, frequent respiratory infections, and the viamin D deficiency epidemic. Ann Otol Rhinol Laryngol 2008;117:864-870.
Dietary Reference Intakes – vitamins. [Table}
Vitamin A. Micronutrient Information Center. Linus Pauling Institute. http://lpi.oregonstate.edu/infocenter/vitamins/vitaminA/ (accessed Jan. 15, 2009)

Pharma tricks - ghostwriters

Helmut Beierbeck — Wed, 17 Dec 2008 23:02:00 GMT

The subject of medical ghostwriting is in the news again. On December 13, 2008, the NY Times reported on the continuing investigation by Senator Charles E. Grassley, a member of the U.S. Senate Finance Committee, into drug industry influence on medical doctors (1,2). The stories center on the pharmaceutical giant Wyeth and its marketing of the hormone replacement therapy (HRT) drug Prempro, but the practice of using ghostwriters is by no means restricted to Wyeth.

What is medical ghostwriting?

Pharmaceutical companies generate medical articles presenting their products in a favourable light. They then hire medical doctors — ghostwriters — to claim to be the authors of these articles.

Here is how Wyeth worked the scam, according to the NY Times (1):

Company executives came up with ideas and specifications for articles for publication in medical journals
A medical writing company was hired to prepare the manuscripts to the company′s specs
Medical doctors with academic credentials were recruited to put their names on the finished papers — for a handsome fee you can be sure.
The drug company′s name, or the names of the people who actually wrote the articles, didn′t appear anywhere in the publications.

What is wrong with this practice?

It is fraud, plain and simple!

By posing as authors, these medical doctors claim the findings and conclusions in the ghostwritten articles as their own. This is a barefaced lie; they have no way of knowing if the data they present are real or fabricated. And the conclusions favourable to the drugs are dictated by the company. That is the purpose of these articles, and that′s what the "authors" are paid for.

Doctors posing as authors clearly collude with company officials in committing fraud. It is ludicrous to assume that medical doctors deemed credible enough to front for a drug company are too naive to understand what they are doing — fooling the readers into mistaking company spin for objective scientific/medical reporting.

In Sen. Grassley′s words:

"Any attempt to manipulate the scientific literature, that can in turn mislead doctors to prescribe drugs that may not work and/or cause harm to their patients, is very troubling." (1).

The World Association of Medical Editors calls the practice of ghost authorship "dishonest and unacceptable" (1).

The pharmaceutical industry has no credibility left, and they know it. The drug companies admit this by the very fact of using ghostwriters — bribing "independent" medical doctors to front for them.

Sources:

Wyeth′s Use of Medical Ghostwriters Questioned. Duff Wilson. NY Times December 13, 2008.
From Agenda Item to Published Medical Article. Duff Wilson. NY Times December 13, 2008.

A drink or two a day raises long-chain omega-3 fatty acid levels

Helmut Beierbeck — Fri, 12 Dec 2008 23:24:00 GMT

You probably know that moderate alcocol consumption — one daily drink for women and two for men — protects your heart (1). People who regularly drink a modest amount of alcohol are healthier than teetotalers or heavy drinkers. It was thought that the alcohol (ethanol) itself was responsible for these health benefits. Its cardioprotective effect was attributed to improvements in insulin sensitivity and HDL ("good" cholesterol) levels (1).

A new study suggests yet another way in which moderate drinking may benefit your heart — it increases omega-3 polyunsaturated fatty acid levels (2). European investigators asked 1604 men and women from Belgium, England and Italy, 26 to 65 years of age, to recall their dietary intakes over the course of one year. An analysis of their answers showed that

In women, alcohol consumption raised EPA and DHA levels in plasma as well as in the membranes of red blood cells
In men, only EPA plasma and red blood cell levels increased with alcohol use; there was no corresponding DHA increase.
Only wine increased fatty acid levels; beer and hard liquor had no such effect.

EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) are the major omega-3 polyunsaturated fatty acids in cold-water fish and fish oils.

The fact that only wine raises long-chain polyunsaturated fatty acid levels suggests that factors other that alcohol may be responsible. Polyphenolic compounds like resveratrol are obvious candidates.

Remember that these heart health benefits are only observed with regular moderate alcohol use — about one drink per day for women and two for men. An occasional drink has no noticeable health benefit. At the other extreme, excessive drinking is obviously a major health hazard. All things in moderation.

Cheers

Sources:

O′Keefe JH, Bybee KA, Javie CJ. Alcohol and cardiovascular health. The razor-sharp double-edged sword. J Am Coll Cardiol 2007;50:1009-1014.
http://content.onlinejacc.org/cgi/reprint/50/11/1009.pdf
di Giuseppe R, de Lorgeril M, Salen P et al. Alcohol consumption and n-3 polyunsaturated fatty acids in healthy men and women from 3 European populations. Am J Clin Nutr 2008;
[Abstract]

What is Orthomolecular Medicine?

Helmut Beierbeck — Tue, 28 Oct 2008 21:40:00 GMT

In my post "Flu shots for the elderly — a waste of time and money?" I mentioned the Orthomolecular Medicine News Service. This news service provides regular health-related reports from a website called orthomolecular.org, a site dedicated to Therapeutic Nutrition Based Upon Biochemical Individuality (1). It is managed by an organization called The Center For The Improvement Of Human Functioning International. This is one of the best websites on health and nutrition that I have come across.

It has an editorial board consisting of scientists and medical doctors
Its articles are professionally written, yet understandable by the non-expert
New articles are emailed to you as they become available, and the service is free
Past articles are archived and also freely accessible on their website
They don′t inundate you with a daily stream of drivel

You can sign up for their reports at orthomolecular.org. It′s well worth it!

What is orthomolecular medicine?

The term orthomolecular medicine was introduced by the late Linus Pauling in his 1968 article Orthomolecular Psychiatry (2). Orthomolecular.org defines it like this:

"Orthomolecular medicine describes the practice of preventing and treating disease by providing the body with optimal amounts of substances which are natural to the body."

Many diseases are manifestations of nutritional imbalances or deficiencies. Doctors practising orthomolecular medicine aim to uncover these deficiencies and correct them. Drugs may suppress symptoms in these cases, but only the correction of the underlying problem, by dietary changes or supplementation, offers any real hope for a recovery.

As Dr. Abram Hoffer puts it:

"Orthomolecular treatment does not lend itself to rapid drug-like control of symptoms, but patients get well to a degree not seen by tranquilizer therapists who believe orthomolecular therapists are prone to exaggeration. Those who′ve seen the results are astonished."

Sources

Orthomolecular.org. Therapeutic Nutrition Based Upon Biochemical Individuality.
http://www.orthomolecular.org
Pauling L. Orthomolecular Psychiatry. Varying the concentrations of substances normally present in the human body may control mental disease. Science 1968;160:265-271.
http://www.sciencemag.org/cgi/content/abstract/160/3825/265

Flu shots for the elderly — a waste of time and money?

Helmut Beierbeck — Mon, 27 Oct 2008 23:21:00 GMT

"Flu Shots For The Elderly Are Ineffective". That′s the headline of an Oct. 23, 2008 release from the Orthomolecular Medicine News Service (1). The article picks up on a Sep. 2, 2008 report in the NY Times which claimed that "Doubts Grow Over Flu Vaccine in Elderly" (2).

"A growing number of immunologists and epidemiologists say the vaccine probably does not work very well for people over 70, the group that accounts for three-fourth of all flu deaths." (2)

The evidence for and against the flu shot′s effectiveness

Flu shots are effective if you believe the results of dozens of observational studies carried out over the last forty years or so. These studies seemed to show that flu shots cut the risk of dying in winter from any cause by almost 50% and reduced the need for hospitalization by nearly 30%. It should be pointed out that unambiguous evidence is hard to come by in this field, since doctors rarely confirm influenza with lab tests.

The only randomized placebo-controlled trial to date, a study published by a Dutch group in 1994, found that the vaccine prevented the flu in about 57% of patients in their sixties. For patients past seventy the rate dropped to just 23% — a far cry from 50%, but still better than nothing.

A 2005 article, on the other hand, painted quite a different picture. That paper pointed out that, even though the percentage of elderly getting an annual flu shot more than tripled from 1980 to 2001, there was no corresponding drop in the death rate. The authors concluded that the flu probably causes just 5 - 10% of all winter deaths in the elderly.

Now a new 2008 Lancet article questions the interpretation of earlier findings. These authors suggest that the very decision to get vaccinated simply sets healthy seniors apart from the sick and frail. They theorize that healthier and health-conscious patients are more likely to take the initiative to get a flu shot. Seniors who may have trouble taking care of themselves, and who might have led a less than healthy lifestyle, might simply not get to a doctor′s office for the shot. In other words, lower influenza rates in the vaccinated may have little to do with the vaccine′s effectiveness; seniors who bother to get vaccinated may simply be healthier to begin with.

Needless to say, this view isn′t universally shared by the health care community. Proponents of immunization maintain that any reduction in the number of influenza cases has to be welcome, even if there is no sound evidence that this reduction is due to the flu shot. Doubters, on the other hand, simply see this attitude as a triumph of marketing over science.

Why would flu shots be ineffective?

First, there are some 200 to 300 different influenza virus strains, but the vaccine usually contains antigens of only a few. Preparing vaccines for the coming flu season is an annual guessing game. More often than not the vaccine doesn′t contain antigens of the most virulent strains.

Secondly, our immune system weakens with age; older adults do not respond as well as younger people to vaccines. For example, elderly patients may need as much as four times the amount of antigen for the same immune response as people under forty.

Thirdly, flu shots and other vaccines have harmful side effects. The Vaccine Adverse Effect Reporting System (VAERS) of the U.S. Food & Drug Administration (FDA) receives around 11,000 serious adverse reaction reports per year. Serious reactions are defined as death, life-threatening illness, hospitalization, or disability resulting from a vaccine. The FDA admits that in all probability only about 10% of adverse reactions are reported. The U.S. National Vaccine Information Center puts that ratio at only 3%.

In addition, the elderly take more medications than younger people. Combined with an already weakened immune system and potential vaccine side effects, the risk of adverse reactions can only grow with age.

What can you do to protect yourself?

Whether or not you decide to get the flu shot, you should do everything you can to strengthen your immune system. As the article from the Orthomolecular Medicine News Service puts it:

"Is there an available alternative? Yes, there may be: give the elderly more nutrients, rather than more needles. Older people often have inadequate diets. With ageing and illness, their bodies′ need for vital nutrients goes up, yet frequently their intake actually goes down." (1)

and

"Over-reliance on vaccinating the elderly ignores their fundamental problems of poor diet and vitamin/mineral deficiencies. These are underlying reasons for a susceptible immune system. Supplemental nutrition is the "other" immune system booster. It is time to use it." (1)

The authors point out that high doses of vitamin C have been shown to reduce the frequency and severity of influenza. Vitamin D and the minerals selenium and zinc have also been found effective. I would add that a number of soluble fibers are known to strengthen the immune system as well.

The nutritional approach shouldn′t just be seen as a replacement for immunization. Even an effective vaccine still requires a functioning immune system. A vaccine presents the patient′s immune system with a weakened or dead virus. The immune system responds to that viral preparation in exactly the same way as it does to the real thing. By trial and error, the adaptive immune response develops antibodies and memory B cells against the viral strains it encounters; this process may take several days.

The difference between the live virus and the vaccine — and the idea behind vaccination — is that during that delay the real virus multiplies furiously and may overwhelm the patient, whereas the weakened or dead strain cannot. If the vaccination worked, the patient′s immune system is fully prepared to react immediately when it encounters the live virus.

So, do everything you can to strengthen your immune system, whether you decide to get a flu shot or not!

Sources

Flu Shots For The Elderly Are Ineffective. Orthomolecular Medicine News Service, Oct. 23, 2008, and references therein.
Doubts Grow Over Flu Vaccine in Elderly. Goodman B. NY Times Sep. 2, 2008.