What Supplements Do I Take?

I get asked by many of my patients what supplements, if any, I take.  I preface any conversation with the classic parental advice of “do as I say not as I do,” and let my patients know that each individual has needs that are dictated by their circumstances.  I generally take supplements to be exactly that.  I feel that I am not getting enough of what I need of something to suit the lifestyle that I lead.  Generally speaking, if I lived in an area with fresh produce, grains and livestock, abundant fish and sunlight and if I took perfect care of body without any excesses, I would not take any supplements.  In the real world, here is my list:

1. Vitamin D₃ – The bulk of vitamin D gets created as pre-vitamin D through absorption of UV rays from the sun by the skin.  People at risk for vitamin D deficiency include those with minimal sun exposure, those who are obese or losing weight and people with issues of malabsorption.  In an ideal world I would live on an island with warm weather and plenty of sun exposure by spending much of my time outdoors throughout the year.  The reality is that I live in a northern city and spend most of my time indoors giving me minimal exposure to the sun for long stretches throughout the year.  There are clear links between vitamin D deficiency and multiple disease processes ranging from various forms or cancer to cardiovascular disease, metabolic bone disease and diseases involving the immune system.   A reminder: vitamin D is fat soluble, so take it with a fat-containing meal.

2. Omega-3/Fish Oil – These popular fatty acids have a healthy effect on brain function (particularly mood) and inflammation.  At high enough doses they can have powerful effects on depression and bipolar disorder that are comparable to traditional psychiatric medications.   Omega-3-fatty-acids also have an anti-inflammatory effect and can significantly lower triglyceride levels.  In an ideal world (on that island) my diet would consist of plenty of fish and would be low in unhealthy oils so this would not be necessary. 

3. Ginger – I take capsules of the whole root (not just isolated substances from within ginger that might have the wanted effect).  I take ginger for its anti-inflammatory effect.  This is not something that I recommend for all patients, but is useful for me in staying off of stronger, prescription strength anti-inflammatory medications that can be toxic to the kidneys particularly when taken frequently.  Without the chronic wear-and-tear of competitive sports, I probably would not bother with ginger.  Ginger tea, though, can be useful for nausea.  Cut up a bunch of fresh ginger root and boil it in water for 5 minutes.  Drinking a glass or two can have a relatively quick effect.

4. Tumeric – Again, I take the whole root in capsule form.   I am fearful of “anti-cancer” agents that are taken out of their natural environment.  While reported to have strong cancer-fighting properties, I take this herb (the primary ingredient in curry) for its anti-inflammatory effect. There appears to be an effect on the same enzyme as with the ginger.  Cultures that eat large amounts of turmeric in their diet also have low levels of certain types of cancer. 

5. Co-Q-10 – This enzyme (also known as Coenzyme Q) is produced by the body.  There is possibly some use for co-Q-10 in the management of heart failure patients.  Additionally, a recent meta-analysis suggested that blood pressure can be lowered by as much as 10 points when taking Co-Q-10 supplements, in addition to already reported positive effects on insulin resistance.   I originally took it to help with stamina in athletics.  I have not found a tremendous amount of data to back that up, but it is something that I continue to take given the personal response that I have other positive benefits associated with it including.  It should be noted that, since this is a natural substance produced in the body, the body might not produce as much when on it.  I have found that I feel a little shaky the first day after stopping it, so I tell my patients that either you are on it daily or not.  Some of my patients also find that they have a little bit of insomnia if they take it too late, so I recommend they take it in the morning. 

Sugar Again Linked to Cancer

A study discussed by MSNBC.COM and originally published in Cancer Research demonstrated that pancreatic cancer cells fed on different types of sugar have different reactions.  These cells were given both sucrose (table sugar made up of glucose and fructose) and fructose alone.  Each sugar had a different effect with fructose being directly responsible for cancer cell proliferation.  These fast-burning sugars seem to be feeding cancer cells – as opposed to starving them and letting your immune system naturally fend them off. 

Over the past couple of years I have had multiple patients who have come to me after being advised by oncologists or the nutritionists they recommend to keep up their caloric intake by any means necessary so that they do not lose too much weight while undergoing cancer treatment.  Two of them, including one with stomach cancer, were advised to consume ice cream regularly to achieve this goal.  I hope over time studies like these become commonplace enough that causative and curative aspects of nutrition and behavior are ultimately taken more seriously. For a while high-fructose corn syrup has been thought to cause harm in terms of obesity, diabetes and even cardiac disease.  This adds fuel to the fire by linking it even more closely with cancer.  Its continued inclusion in commercially processed foods, particularly those consumed by children, is largely a political issue that goes beyond basic health and nutrition. 

While long-term studies would have to be analyzed for the preventive effects of avoiding sugar (and certain types of sugar) consumption, there are certainly direct implications for cancer patients as they are given dietary recommendations during and after treatment.  This does not mean that going in the opposite direction of dietary harm – a bacon cheese burger without the bun – is any better for you.  Rather this study should be a friendly reminder to stay away from sugar, animal fats and all those things we are pretty sure are cause harm.  The bottom line at this point a balanced diet high in fiber, low in refined sugars and processed carbohydrates and unhealthy fats (particularly those found in animals) is still recommended.

To read the full MSNBC.com article, click here.

Can Calcium Supplements Cause Heart Attacks?

The British Medical Journal presented a meta-analysis conducted by a research group in New Zealand of 15 studies on calcium supplementation without vitamin D.  Calcium supplements are widely prescribed for the prevention and management of osteoporosis and have been shown to modestly reduce fracture risk in high risk populations.  This analysis, however, found an increase risk of heart attacks, vascular events and death with lone calcium supplementation.  The possible mechanism lies in the increased amount of calcium in the blood that might be adhering to arterial walls. 

The scariest findings?  While for every 1000 patients treated with calcium 26 fractures were prevented, 14 additional patients had heart attacks, 10 had strokes and 13 died.  Not exactly the type of trade-off many would make.  Combine these numbers with an association of increased prostate cancer risk in men with higher calcium intake and the concept of calcium supplementation might ultimately be overhauled. 

It should be noted, however, that these findings are not necessarily directly applicable to all patients.  First, the study excluded the use of vitamin D, which is generally given along with calcium.  Additionally many patients with osteoporosis who take calcium also take bisphosphonates that would effectively lower the amount of circulating calcium that would be available for deposition into blood vessels.  The bottom line is that if you are a man, you probably should avoid calcium supplements altogether and if you are a woman, you should take them if at high risk, but not without vitamin D and or bisphosphonates.

To read the full British Medical Journal report, click here.

What We Eat...It MIGHT Scare You, But WILL Make You Fat

Here is a breakdown from visualeconomics.com of what the average American consumes annually. There are times when people get righteous over eating one food versus another food that is out of proportion to their likely health values.  Nonetheless, this is an eye-popping review of what is being eaten…on average.  That means that statistically half of Americans should be consuming more than 1 gallon of soda per week or more than 29 pounds of French fries per year. 

The part that I found most interesting, though, was not the amazing amounts of caloric sweeteners and soda consumed annually as these notions have been made public for quite some time.  Rather the stunning amount of dairy that is eaten in relation to fresh produce (the heaviest food per serving that exists).  This in light of the fact that excessive calcium intake in males has been linked to prostate cancer (this might actually come from dairy consumption), and regular dairy products are loaded with cholesterol raising saturated fat.  Humans are the only species to consume dairy as adults.

The bottom line is that no single food pyramid has been created that has been proven to be the answer for all consumers.  That said, this should serve as a striking reminder to increase the amounts of produce and whole grains consumed while decreasing the amount of animal products, sweeteners and empty calories in attempt to maintain weight and health.

To see the full page from visualeconomics.com, click here.

You Need More Vitamin D…For Now

Vitamin D has been all the rage of late.  Here is a brief review from the New York Times.  Once considered strictly a regulator of calcium and bone mineralization recent findings suggest that vitamin D deficiency is associated with several types of cancer, cardiovascular disease, osteoarthritis, osteoporosis and immune system disorders, raising risk of infection, auto-immune diseases, including rheumatoid arthritis, multiple sclerosis and type-I diabetes. 

I have found that the overwhelming number of patients that I see have at least insufficient vitamin D levels, while at least half have vitamin D deficiency.  Those at highest risk are obese patients, patients with digestive disorders and, not surprisingly, people who work long hours at desk jobs without sun exposure (lawyers and investment bankers tend to have the lowest in my practice).  In fact, over the past year I have only seen a handful of patients not already taking supplemental vitamin D that meet the suggested 25, OH vitamin D level of 40 ng/ml.

My advice is to start at 1000 IU of vitamin D₃ daily to be taken with a meal (aiding the absorption of this fat-soluble vitamin).  For those at higher risk or whose vitamin D levels do not rise, I suggest 2000 IU or even more aggressive dosing for those severely deficient, although I have found that this moderate supplementation usually is sufficient.   This is not the first vitamin to gain public favor – vitamins A, C and E were popular not that long ago, although follow up studies on broad use of them as supplements in healthy individuals has yet to yield convincing evidence of their benefit.  For now, the association of vitamin D deficiency and disease is convincing.  Whether follow-up studies demonstrate efficacy of vitamin D supplementation in preventing and managing these diseases will ultimately guide recommendations. 

To read the full NY Times article, click here.