Is Vitamin D Good for the Heart or Not?

Based on much recent research linking low levels of vitamin D to increased risk of heart disease, this is something I measure in all of my older patients.  If low, supplementation is simple, cheap, and can effectively raise those levels back up.  This is especially important at this time of year, since the sun is not strong enough to produce any vitamin D from skin exposure at our latitude.

A recent study in the Journal of Clinical Endocrinology & Metabolism (1) looked at the question of whether or not supplementing with vitamin D can change cardiovascular risk.  This was one of the first actual placebo-controlled clinical trials to examine the question.  Half the participants got vitamin D3 (a good quality form of vitamin D), and the other half got placebo.  At the end of the study, they examined cardiovascular risk markers, such as blood cholesterol, blood pressure, and C-reactive protein, and found no significant difference between the groups.  The conclusion?  Quoting from the New York Times:

“The study actually shows that vitamin D does not protect you against heart disease,” said Helen M. Macdonald, a senior lecturer at the University of Aberdeen in Scotland, who led the study. “That’s not what people want to hear, but it’s true.”

Now hold on a minute.  The researchers are making a huge assumption:  that the risk markers of cholesterol, C-reactive protein, etc., are synonymous with heart disease.  The thinking is that if something (in this case vitamin D) does not affect those traditional risk markers directly, there is no impact on heart disease.   However, it is well known that a significant percentage of heart disease and heart attacks occur in people with normal cholesterol levels and blood pressure.  Perhaps vitamin D is an independent risk factor -- that is, it could protect against heart disease without changing those other parameters.

The way to  really tell this for sure experimentally would be to use actual cases of heart disease as the end point of vitamin D supplementation.  This study was a good first step, but the error in logic on the part of the researchers is glaring.  In the meantime, I'll keep checking blood levels of vitamin D on my patients over age 40 as part of an overall cardiovascular risk assessment, using the naturopathic principle of "Treat the whole person."

1.  Vitamin D₃ Supplementation Has No Effect on Conventional Cardiovascular Risk Factors: A Parallel-Group, Double-Blind, Placebo-Controlled RCT.  Published online before printAugust 3, 2012, doi:10.1210/jc.2012-2126
The Journal of Clinical Endocrinology & Metabolism, October 1, 2012 vol. 97 no. 103557-3568

Natural Medicine Myth #3: Systemic Candida

This is a continuation of my series (in no particular order) on misperceptions in the field of natural medicine.  My previous articles focused on policosanol and cinnamon.

In the 1980s, a medical doctor by the name of William Crook published a book called The Yeast Connection.  The gist of it is that many symptoms of fatigue, joint pain, depression, etc., are the result of by-products of yeast overgrowth in the body.  Eating a diet that starves the yeast (eliminating sugar and refined grains) can therefore resolve these symptoms.  Sometimes anti-yeast medications may be required also.

Is yeast real?  Of course -- Candida albicans, the main yeast species that Dr. Crook refers to, is part of the normal flora of our intestinal tract in small amounts.  When there is an overgrowth of candida, it can cause gastrointestinal (GI) bloating, indigestion, and constipation or diarrhea.  Overgrowth in the genital tract cause those annoying vaginal yeast infections; candida from the GI tract can serve as a reservoir for recurring infection.  And indeed, waste products produced by candida in the GI tract can be absorbed and cause more widespread symptoms in the body.

So why am I calling this a myth?  The problem is with misperceptions surrounding candida:

1. You can diagnose candida overgrowth from a symptom questionnaire.  There are many, many problems in the body that can lead to fatigue, joint pain, etc.  Doing a stool test to check for yeast, or a urinary organic acid test to check for yeast by-products, are the only ways to know for sure that intestinal candida is the culprit.  In that case, specific anti-yeast therapies (pharmaceutical or natural) may be needed.  However, doing a "cleanse" for candida or parasites without evidence is most likely a waste of effort.
2. "Whole-body candida."  Some folks get the impression that candida is growing throughout the bloodstream or other parts of the body, besides the GI or genital tracts.  This only occurs in severely immunocompromised conditions, such as AIDS.  The by-products from yeast might be high in the bloodstream, but not the organisms themselves.
3. You need to avoid all yeast and mushrooms on an anti-candida diet.  Candida is part of the fungus kingdom -- a completely separate branch of life from plants, animals, and bacteria.  However, it is only one species.  Baker's yeast is a completely different species (Saccharomyces cerevisiae), and mushrooms are of many other different species.  Avoidance of everything in the fungus kingdom is akin to saying that because you are allergic to cats, you need to avoid elephants, trout, ladybugs, bald eagles, and everything else in the animal kingdom.  One particular yeast -- Saccharomyces boulardii -- is even considered a powerful probiotic (beneficial organism) that helps boost our immune response (1,2). 
4. You need to kill all candida in the body in order to be cured.  This is a well-nigh impossible task.  All of us have some candida in the GI tract, along with hundreds of other species of microorganisms.  Our normal flora is more like a complex rainforest ecosystem, rather than the one or two species present in a probiotic supplement.  The key is in the balance, and making sure that there isn't overgrowth of candida.

Now you might be thinking, "OK then, Mr. Smartypants, then why do I feel so much better on the anti-candida diet?"  Look at the foundation of it again:  eliminating sugar and refined grains (white flour).  Now compare that to any of a number of other diets (Atkins, South Beach, Paleo, blood type diet, etc.).  What do they all start with?  Eliminate sugar and refined grains.  Each then goes on to an elaborate set of specific rules, and reasoning behind it.  But maybe it all boils down once again to the fact that this approach cuts out most of the junk food in the Standard American Diet (S.A.D.), and replaces it with nutrient-dense whole foods.  Of course you're going to feel better!  This approach gives your body the bioavailable vitamins, minerals, and phytonutrients it needs.  It also eliminates the blood sugar and insulin roller coaster brought about by these refined, high glycemic index foods.  

Before jumping on an extreme diet, take a look at whether or not you're even getting the recommended five to nine servings of fruits and veggies per day.  It's always easier to add things into our diet first, than to take things out.

1.  Systematic review and meta-analysis of Saccharomyces boulardii in adult patients.  World J Gastroenterol. 2010 May 14;16(18):2202-22.

2.  Interaction of Saccharomyces boulardii with intestinal brush border membranes: key to probiotic effects?  J Pediatr Gastroenterol Nutr. 2010 Oct;51(4):532-3.

Natural Medicine Myth #2: Cinnamon

Starting with last week's article about policosanol, I have been outlining five of the most common misperceptions I encounter in the field of natural medicine, and examine some more effective alternatives.

Myth #2:  Cinnamon controls blood sugar (or even "cures" diabetes).
T'ype 2 diabetes and "pre-diabetes" (insulin resistance) are on the rise in the U.S., thanks to the prevalence of junk food, and an increasingly sedentary lifestyle.  These conditions involve a breakdown of the body's ability to regulate blood sugar, so that it goes too high.  High blood sugar itself may not sound very threatening, but it basically puts aging on fast-forward, dramatically increasing the risk of heart disease, kidney damage, and vision and nerve problems.  Recent research even suggests that blood sugar at the high end of the "normal" range represents a significant risk factor.

Folks in the natural health field emphasize (or should emphasize) specific diet and exercise changes as the foundation to diabetes prevention and treatment.  We also, when necessary, recommend nutritional supplements to help bring down high blood sugar levels.  One of the most popular in recent years has been cinnamon, since it is safe, commonly available, and has been shown effective in lowering levels of hemoglobin A1c (HbA1c, the blood test for 3-month average blood sugars).  I often recommended this to patients myself, until some recent clarification from my colleague, Jacob Schor, ND, of Denver Naturopathic Clinic.  A recent meta-analysis (a study of studies) showed that cinnamon does indeed lower HbA1c to a statistically significant extent (1).

Huzzah!  So what's the problem?  A closer look at the data shows that the average effect of cinnamon was a 0.09% decrease in HbA1c.  Clinically, this is barely a dent in blood sugar.  "Statistically significant" just means that the math panned out.  By comparison, studies showed that weight loss and regular exercise can drop HbA1c three times as much as cinnamon (2).  Berberine, an extract from various herbs such as Oregon grape route, barberry, and goldenseal, taken at doses of 500 mg, three times per day, lowered blood sugar twenty-two times as much as cinnamon (3).

If you are having blood sugar problems, or are already diabetic, don't rely on cinnamon to control it (for pity's sake, don't use some of the research as an excuse to reach for a cinnamon roll!).  It's a great spice, but not great medicine.

1. Akilen R, Tsiami A, Devendra D, Robinson N. Cinnamon in glycaemic control: Systematic review and meta analysis. Clin Nutr. 2012 May 12.
2.   Nilsen V, Bakke PS, Gallefoss F. Effects of lifestyle intervention in persons at risk for type 2 diabetes mellitus - results from a randomised, controlled trial. BMC Public Health. 2011 Nov 25;11:893.
3.  Yin J, Xing H, Ye J. Efficacy of berberine in patients with type 2 diabetes mellitus. Metabolism. 2008 May;57(5):712-7.

Top 5 "Myths" in Natural Medicine

As a doctor of naturopathic medicine, I have years of experience and training to respect the vis medicatrix naturae, or healing power of nature.  This is foundational to our approach to health.  I also have a background in science, and know that it is important to examine natural methods of health care to see if they are valid and effective.

That is why (though it might be dangerous to step on some toes) I like to clarify common misperceptions:  My goal is to help patients be as healthy as possible, not to be wedded to a particular idea.  Therefore, over the next few articles, I will present five common myths I often encounter, in no particular order.

Myth #1: Policosanol is a good alternative to cholesterol-lowering medication.
Policosanol is an extract of the sugar cane plant that made big news about ten years ago, with studies showing it was very effective at lowering blood cholesterol levels (1).  The nutritional supplement industry responded with a deluge of policosanol products.  However, much of that early research was conducted in Cuba, the source of the sugar cane--the raw material for policosanol production.  Follow-up studies conducted on larger populations, showed little to no clinically significant cholesterol-lowering effects of policosanol (2, 3).  Even though this well-designed research was published in 2006, policosanol sales continue to this day.  More recent research from 2011 (4) found that even a form of policosanol modified to make it better absorbed from the gastrointestinal tract failed to make a significant dent in cholesterol levels.  Some recent studies showing benefits used policosanol in combination with red yeast rice and berberine, two natural compounds that have been proven time and again to be effective in lowering cholesterol.  It's highly likely in these studies that the policosanol could have been left out, without affecting the results.

With all this evidence against policosanol, why are sales still so brisk today?  Well, in the midst of bashing the evil of Big Pharma companies, we sometimes forget that supplement companies are businesses, too, driven by market forces.  As long as there's a demand for policosanol (based on those biased studies from 10-15 years ago), they'll keep selling it.  Sorry, folks--supplement companies are not selfless crusaders for health; they're driven by the profit motive.  It's the American way.

I stopped recommending policosanol in 2006, in favor of much more effective treatments.  I also like to remind patients that high cholesterol is not a disease; it's a risk factor for cardiovascular disease (CVD).  I put the emphasis on lifestyle factors for CVD prevention, and look at modifying other risk factors too (such as high-sensitivity C-reactive protein and blood levels of vitamin D).

Next Time:  Cinnamon for blood sugar control

1.  Policosanol: a new treatment for cardiovascular disease?  Altern Med Rev. 2002 Jun;7(3):203-17.

2.  Effect of policosanol on lipid levels among patients with hypercholesterolemia or combined hyperlipidemia: a randomized controlled trial.  JAMA. 2006 May 17;295(19):2262-9.

3.  Comparative lipid-lowering effects of policosanol and atorvastatin: a randomized, parallel, double-blind, placebo-controlled trial.  Am Heart J. 2006 Nov;152(5):982.e1-5.

4.  Modified-policosanol does not reduce plasma lipoproteins in hyperlipidemic patients when used alone or in combination with statin therapy.  Lipids. 2011 Oct;46(10):923-9. Epub 2011 Jul 8.