Conventional physicians are not always known for their open-mindedness about natural therapies, such as nutritional and herbal supplements. However, in light of good scientific research, they cannot keep their eyes closed to the benefits.
Results of a new research study were presented at the 2013 annual meeting of the American Society of Clinical Oncology that showed a new supplement led to significant lowering of prostate specific antigen (PSA) levels in prostate cancer patients. This was a randomized placebo-controlled trial, which is considered the highest level of scientific evidence available in the medical world. The supplement, called Pomi-T, is a combination of well-known cancer fighting botanicals, including turmeric, green tea, broccoli, and pomegranate.
This study examined 203 men who had been treated for prostate cancer, but had a relapse of elevated PSA. Half of the subjects were randomized to receive Pomi-T, and half received a placebo. After six months, the botanicals group had a 63.8% lower increase in PSA versus the placebo group. They were also three times as likely to have stable or even lower than baseline PSA levels versus the placebo group. Furthermore, there were no significant side effects from the supplement.
The medical community, which historically has been skeptical, if not downright antagonistic, towards nutritional supplements, heralded this research for two important reasons. Firstly, the design and quality of the supplement was closely monitored. This is important, since many off-the-shelf supplements are questionable in terms of their quality and purity. Secondly, this study was well designed, and had enough subjects to draw good statistical conclusions. Many times, when you read about "clinical research" on a supplement manufacturer's website, this is based on a handful of subjects, with no placebo control.
Remember, too, that any supplement is an addition to a healthy lifestyle: good diet and regular exercise. But if you are dealing with prostate cancer, this supplement looks like a good fit. If you can't find it, you can find supplemental forms of each of the components; just be sure to get standardized products from reputable manufacturers. When it comes to cancer, don't bet your life on the cheap stuff off the shelf at Wal-Mart.
2013 Annual Meeting of the American Society of Clinical Oncology. Abstract 5008. Presented June 3, 2013.
Monday, June 17, 2013
Monday, June 10, 2013
Fish Oil is Dead... or Is It?
If you're a patient or a regular reader of my articles, you know that one supplement that I often recommend is fish oil -- a good source of omega-3 fatty acids. These fats are essential to our health, because our bodies cannot make them from any other type of fat. The many benefits of omega-3 fats include:
- Cardiovascular health benefits
- Immunomodulation
- Anti-inflammatory effects
- Psychological and behavioral health improvement
- Improved bone density
A large study published recently in the New England Journal of Medicine (1) has called into serious question the well-established cardiovascular benefits of fish oil. Italian researchers divided a group of over 12,000 subjects into two groups: one received 1 gram of omega-3 fats from fish oil per day, the other 1 gram of placebo (olive oil). These were high-risk patients: people with multiple cardiovascular risk factors such as high cholesterol, type 2 diabetes, or even established atherosclerosis. The outcome? After 1 year, there was no difference in the rates of death, non-fatal heart attack, or stroke between the two groups.
What are we to conclude from this? The sound-bite headlines trumpet "Fish Oil is Worthless!" Some eminent cardiologists agree. But let's peel back the layers, and examine the flaws in this otherwise large and impressive study.
- Dose. 1 gram of omega-3 fats is not a high dose at all, especially in this population of high-risk patients. For my patients with any cardiovascular risk factors, I recommend 1.5-2.5 grams of omega-3 fats per day. And remember, a 1 gram (1000 mg) fish oil softgel only contains about 300 mg of omega-3s. For cardiovascular health, 5-8 softgels per day are required. An alternative would be to take a concentrated form of fish oil, or to use liquid cod liver oil. I take about 2 teaspoons of cod liver oil daily, which supplies around 2.5 grams (2500 mg) of omega-3s.
- Quality. There is a wide variability in the quality of fish oil products. A pharmaceutical-grade form is best, which is screened for impurities, and has less chance of being rancid. The form used in the study is not specified.
- Lab Values. One of the main ways that omega-3 fats benefit the cardiovascular system is by lowering triglyceride levels -- data about patients' triglyceride levels were not included in the study. Also, how well were the diabetic patients maintaining blood sugar control? Poorly controlled blood sugar is a major risk factor that a little fish oil won't overcome.
- Choice of "Placebo." A placebo (inactive pill) is necessary in research studies to compare to the active intervention, to account for the fact that people's expectations about receiving care can have a strong therapeutic effect. This is know as the placebo effect. But is olive oil a good choice as an inert comparison? There is a mountain of research about the cardiovascular benefits of the Mediterranean Diet, whose foundation is daily olive oil use. Just a few weeks ago, I wrote about the PREDIMED study, which found that an olive oil-supplemented Mediterranean diet resulted in a 30 percent decreased risk of cardiovascular disease.
- Other Benefits of Omega-3 Fats. Now granted, the list of other benefits was not being looked at in this study, but some commentators really threw the baby out with the bathwater on this point. Cardiologist Eric Topol, MD, called fish oil a "no-go," a "nada effect," and even "implores" his patients to stop taking it. Really? That's quite an exercise in ignoring the large body of research on fish oil for multiple body systems.
As always, I urge you to look past the headlines, and consider the whole research picture. Don't throw out your fish oil on the basis of this one flawed study.
Monday, June 3, 2013
I Have a Gut Feeling They're on to Something.
You know you're mostly not human, right?
When you count the microorganisms living in your gastrointestinal tract, skin, and respiratory tract will, there are ten times as many bacterial cells as human cells in your body. We are ecosystems, rather than single organisms. If 20th century nutrition was the discovery of vitamins, proteins, carbohydrates, and other nutrients, 21st century nutrition will be the study of how nutrients affect those 90% of nonhuman cells within us.
These friendly bacteria (also known as normal flora or probiotics) play an important role in our gastrointestinal health, allergies, normal immune system functioning, and maintaining a normal body weight. Some intriguing early animal studies found that probiotics could even decrease symptoms of depression. In the June issue of the journal Gastroenterology, researchers at UCLA published the first study showing a direct effect of probiotics on the human brain. And no, this does not mean that people were shoving yogurt into their ears.
Researchers divided a group of 36 healthy women into three subgroups: the first received two servings of yogurt with probiotics daily; the second subgroup received non-fermented milk products; and the third subgroup received no special foods.
After four weeks, these women underwent psychological testing while in a functional MRI (fMRI) -- an imager that examines real-time brain activity, rather than just taking a static image. The probiotic subgroup showed significantly reduced activity in brain areas associated with emotional variability and pain. Translation? Probiotics made them less moody!
The importance of this study is that it proves that gut bacteria can have a direct impact on human brain functioning, specifically in the areas of emotions and pain perception. It did not examine what the exact mechanism of action is. We also have to be a bit cautious with this study, because these were healthy volunteers, with no gastrointestinal or psychological disorders.
Nevertheless, this just adds another piece of evidence that indicates that tending to the complex "rain forest" within us, with fermented foods and lots of dietary fiber, is probably more important than taking high doses of any single nutrient.
Tillisch K et al. Consumption of Fermented Milk Product With Probiotic Modulates Brain Activity. Gastroenterology June 2013; 144(7):1394-1401.
When you count the microorganisms living in your gastrointestinal tract, skin, and respiratory tract will, there are ten times as many bacterial cells as human cells in your body. We are ecosystems, rather than single organisms. If 20th century nutrition was the discovery of vitamins, proteins, carbohydrates, and other nutrients, 21st century nutrition will be the study of how nutrients affect those 90% of nonhuman cells within us.
These friendly bacteria (also known as normal flora or probiotics) play an important role in our gastrointestinal health, allergies, normal immune system functioning, and maintaining a normal body weight. Some intriguing early animal studies found that probiotics could even decrease symptoms of depression. In the June issue of the journal Gastroenterology, researchers at UCLA published the first study showing a direct effect of probiotics on the human brain. And no, this does not mean that people were shoving yogurt into their ears.
Researchers divided a group of 36 healthy women into three subgroups: the first received two servings of yogurt with probiotics daily; the second subgroup received non-fermented milk products; and the third subgroup received no special foods.
After four weeks, these women underwent psychological testing while in a functional MRI (fMRI) -- an imager that examines real-time brain activity, rather than just taking a static image. The probiotic subgroup showed significantly reduced activity in brain areas associated with emotional variability and pain. Translation? Probiotics made them less moody!
The importance of this study is that it proves that gut bacteria can have a direct impact on human brain functioning, specifically in the areas of emotions and pain perception. It did not examine what the exact mechanism of action is. We also have to be a bit cautious with this study, because these were healthy volunteers, with no gastrointestinal or psychological disorders.
Nevertheless, this just adds another piece of evidence that indicates that tending to the complex "rain forest" within us, with fermented foods and lots of dietary fiber, is probably more important than taking high doses of any single nutrient.
Tillisch K et al. Consumption of Fermented Milk Product With Probiotic Modulates Brain Activity. Gastroenterology June 2013; 144(7):1394-1401.
Wednesday, May 15, 2013
More Good News for the Mediterranean Diet
For years, the standard nutritional advice for cardiovascular disease prevention has been to follow a low-fat diet. This is still the official recommendation of the American Heart Association. However, more and more evidence is pointing to the fact that it may be the quality, not quantity, of the fats we consume that is good for our hearts.
A few weeks ago, I wrote about a new study showing that detrimental effects of red meat consumption on our gut bacteria. This could be one of the keys that links higher risk of cardiovascular disease to hiding meat intake. The Mediterranean diet, which is low in meat, has just gotten some new support for its effectiveness in primary prevention of cardiovascular disease. The Mediterranean diet is definitely not low in fat; it just relies more on different types of fat than the standard American diet (S.A.D.). Instead of high levels of animal-based saturated fats from meat and dairy, the Mediterranean approach relies more on the healthful unsaturated fats in nuts and olive oil.
This new study from Spain, called PREDIMED (1), differs from previous research, in that it was a randomized controlled trial, involving over 7000 older men and women without any established cardiovascular disease. This means that the investigators assigned a different diet to different groups of subjects -- either Mediterranean, or the AHA low-fat diet. Most previous research was a retrospective -- that is, it looked at people's dietary habits in the past, based on recall or diet diaries.
The exciting finding from PREDIMED is that the Mediterranean diet, with a special focus on either olive oil or nuts, resulted in about a 30% lower risk of heart attack, stroke, or cardiovascular death compared to the low-fat approach. Perhaps surprisingly, there are no studies of similar quality to support the benefits of a low-fat diet. This recommendation of the AHA could be classified as a medical myth.
Dr Ramón Estruch, one of the lead researchers in this study, summarized his recommendations this way:
1. Estruch R, Ros E, Salas-Salvadó J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 2013; DOI:10.1056/NEJMoa200303.
A few weeks ago, I wrote about a new study showing that detrimental effects of red meat consumption on our gut bacteria. This could be one of the keys that links higher risk of cardiovascular disease to hiding meat intake. The Mediterranean diet, which is low in meat, has just gotten some new support for its effectiveness in primary prevention of cardiovascular disease. The Mediterranean diet is definitely not low in fat; it just relies more on different types of fat than the standard American diet (S.A.D.). Instead of high levels of animal-based saturated fats from meat and dairy, the Mediterranean approach relies more on the healthful unsaturated fats in nuts and olive oil.
This new study from Spain, called PREDIMED (1), differs from previous research, in that it was a randomized controlled trial, involving over 7000 older men and women without any established cardiovascular disease. This means that the investigators assigned a different diet to different groups of subjects -- either Mediterranean, or the AHA low-fat diet. Most previous research was a retrospective -- that is, it looked at people's dietary habits in the past, based on recall or diet diaries.
The exciting finding from PREDIMED is that the Mediterranean diet, with a special focus on either olive oil or nuts, resulted in about a 30% lower risk of heart attack, stroke, or cardiovascular death compared to the low-fat approach. Perhaps surprisingly, there are no studies of similar quality to support the benefits of a low-fat diet. This recommendation of the AHA could be classified as a medical myth.
Dr Ramón Estruch, one of the lead researchers in this study, summarized his recommendations this way:
"People should know that the Mediterranean diet is a diet healthier than others and should know the key components of this food pattern. The plan should be to increase the intake of the key foods (vegetables, fruit, nuts, fish, legumes, extra virgin olive oil, and red wine in moderation), also increase the intake of white meat, and decrease the intake of red and processed meat, soda drinks, whole dairy products, commercial bakery goods, and sweets and pastries."
He continued: "To achieve a score of 14 in the 14-item adherence scale to traditional Mediterranean diet [laid out in a supplemental appendix in the paper] is more or less impossible, but to upgrade two to three points in this score is enough to reduce your cardiovascular risk by 30%."
1. Estruch R, Ros E, Salas-Salvadó J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 2013; DOI:10.1056/NEJMoa200303.
Monday, April 29, 2013
Just Say NO to High Blood Pressure!
It has long been known that compounds known as nitrates have
a beneficial effect for the cardiovascular system. The most common example of this is
nitroglycerin, a drug that is used for angina (chest pain due to spasm of blood
vessels). Nitrates are transformed by
bacteria in the mouth to nitrites, which are then converted in the blood into
nitric oxide (NO). NO relaxes blood
vessels, which can lower blood pressure.
In addition to pharmaceutical nitrates, attention has been
focused recently on whole foods sources of nitrates. Two studies took a look at the effects of
beetroot juice on blood pressure. In
2012, Australian researchers (1) found that consuming beetroot juice
significantly lowered systolic blood pressure for up to 6 hours, compared to
placebo. Beets are a good source of
nitrates, which the body can convert into NO.
But 500 g of beetroot juice is quite a bit. Some clever Brits (2) therefore compared drinking
liquid beetroot juice to consuming a special beetroot enriched bread. They found that both were equally effective
in lowering blood pressure, and the bread may be more palatable. Furthermore, in their study, they noticed that the blood pressure lowering benefits persisted for 24 hours.
One caveat to keep in mind is that both of these studies
were performed with healthy subjects.
However, eating more vegetables is definitely good for your health anyway,
so increasing your beet intake is a good idea if you're trying to lower your
blood pressure. You can also look at
other vegetables that are high in nitrates, such as radishes, carrots, and
lettuce. And don't forget the blood pressure lowering benefits of chocolate for dessert!
1. Coles, L and Clifton, P. Effect of beetroot juice on lowering blood pressure in free-living, disease-free adults: a randomized, placebo-controlled trial. Nutr J. 2012; 11: 106.
Monday, April 22, 2013
Red Meat and Heart Health: The Gut Bacteria Connection
There's been a lot of debate over the years as to whether or not red meat consumption increases our risk of developing heart disease. In the past, much of the research has focused on the high levels of saturated fat and red meat, and their impact on blood cholesterol levels. A new study just published this month in Nature Medicine suggests a new mechanism: the difference in the type of gut bacteria between meat eaters and non-meat eaters. A nice summary of the study was discussed recently on the National Public Radio show, Science Friday.
The main focus of this new study is a compound called L-carnitine, which is found in abundance in red meat. The intestinal bacteria found in omnivorous humans (compared to vegetarians or vegans) are more likely to metabolize L-carnitine into a compound called trimethylamine-N-oxide (TMAO). High levels of TMAO accelerate the process of atherosclerosis.
The findings of this study are consistent with the well-known pattern of the Mediterranean diet, which places a great emphasis on plant-based foods, and recommends red meat only once or twice per month (see the pyramid diagram below). The Mediterranean diet is the pattern of eating among people in Italy, Greece, and other Mediterranean regions, that has been associated with protection against chronic disease, and greater lifespan. This study has generated considerable outrage and debate, especially among proponents of high-meat diets, such as the Paleo diet. However, there is much more research about the health benefits of a Mediterranean eating pattern.
Once again, we're just beginning to scratch the surface of the importance of the ecosystem living in our intestinal tract. I recently reported that the normal flora living in our gut can have an influence on obesity and weight loss. If the first hundred years of nutrition research has focused on identifying nutrient compounds, deficiency conditions, and toxicity, then the next hundred years could be looking more at the effects of normal flora on our health.
Intestinal microbiota metabolism of L-carnitine, a nutrient in red meat, promotes atherosclerosis.
The main focus of this new study is a compound called L-carnitine, which is found in abundance in red meat. The intestinal bacteria found in omnivorous humans (compared to vegetarians or vegans) are more likely to metabolize L-carnitine into a compound called trimethylamine-N-oxide (TMAO). High levels of TMAO accelerate the process of atherosclerosis.
The findings of this study are consistent with the well-known pattern of the Mediterranean diet, which places a great emphasis on plant-based foods, and recommends red meat only once or twice per month (see the pyramid diagram below). The Mediterranean diet is the pattern of eating among people in Italy, Greece, and other Mediterranean regions, that has been associated with protection against chronic disease, and greater lifespan. This study has generated considerable outrage and debate, especially among proponents of high-meat diets, such as the Paleo diet. However, there is much more research about the health benefits of a Mediterranean eating pattern.
Once again, we're just beginning to scratch the surface of the importance of the ecosystem living in our intestinal tract. I recently reported that the normal flora living in our gut can have an influence on obesity and weight loss. If the first hundred years of nutrition research has focused on identifying nutrient compounds, deficiency conditions, and toxicity, then the next hundred years could be looking more at the effects of normal flora on our health.
Intestinal microbiota metabolism of L-carnitine, a nutrient in red meat, promotes atherosclerosis. Nature Medicine doi:10.1038/nm.3145.
Published online
Monday, April 15, 2013
Coffee: Pain Reduction, Weight Loss, and More
For decades, it's been a given in natural health circles that coffee is a no-no. It's commonly one of the first things that people are asked to give up when going on a detox program, or any other recommendations for improving their health. Over the past decade or so, though, evidence has been mounting that there are actually many health benefits for that morning cup of joe.
One of the latest findings is that coffee may help to reduce pain. In 2012, Norwegian researchers found that coffee drinkers reported about a 25% lower pain score than non-coffee drinkers in a simulated office work environment. This difference was true whether participants had chronic pain or not.
Other benefits that have been reported for coffee in recent years include:
One of the latest findings is that coffee may help to reduce pain. In 2012, Norwegian researchers found that coffee drinkers reported about a 25% lower pain score than non-coffee drinkers in a simulated office work environment. This difference was true whether participants had chronic pain or not.
Other benefits that have been reported for coffee in recent years include:
- decreased risk of endometrial cancer, Parkinson's disease, Alzheimer's disease, and type 2 diabetes
- enhanced muscle growth
- assistance with weight loss (with green coffee bean extract)
The research on green coffee extract for weight loss was a small human trial, involving only 16 subjects. Doses used were in the range of 700 to 1000 mg per day. However, the results were striking, and so far, and this supplement seems safe. It is inexpensive, and worth a try for a few months.
The main benefits of coffee seem to be related to its phytonutrient content-- those health promoting compounds found in plants that have antioxidant and other beneficial effects on the human body. These benefits seem to hold true whether the coffee contains caffeine or not. So if you're concerned about caffeine, due to its acute blood pressure raising effects, or its detrimental effects on sleep, you can drink decaf, and still enjoy the preventive medicine aspects of coffee.
One last thing to keep in mind: many of the health benefits of coffee can be counteracted if you add a lot of milk and sugar to it. The high saturated fat and empty calories would be more than enough to outweigh the phytonutrient effects.
For me, I'll be enjoying my cup of black half-caf in the morning all the more.
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