Exercise Is Medicine

A recent review of studies comparing exercise as medicine to prescription medication got some attention, but it deserved more. One of the authors (John Ioannindis) is the “god” of such critical analyses. A few years ago, there was even an interesting article about him in the Atlantic Magazine. Imagine that, a researcher as pop star! A 2005 article he wrote, Why Most Published Research Findings Are False, was a landmark for medicine. My favorite comment in that article was: Moreover, for many current scientific fields, claimed research findings may often be simply accurate measures of the prevailing bias. He likes to “stir the pot”, but thoughtfully. So, when Dr. Ioannindis’ name is on an article, the medical community pays attention. The recent exercise review confirms my career-long approach to medicine. It has taken FAR too long, but I am enjoying another victory dance with the appearance of this article. What was so cool about it? What make me so overjoyed? Soak in this sentence from the abstract: Although limited in quantity, existing randomised trial evidence on exercise interventions suggests that exercise and many drug interventions are often potentially similar in terms of their mortality benefits in the secondary prevention of coronary heart disease, rehabilitation after stroke, treatment of heart failure, and prevention of diabetes. That’s “mortality”, i.e. “life or death”. So, exercise is as good or better than drugs at saving people’s lives. Exercise is medicine. That is awesome! However, the life-enhancing power of exercise is not factored into that. Exercise is medicine, but it is also the best medicine. If you exercise, you are going to feel better and live longer. Other studies have shown that cancer patients live longer and better if they exercise. This recognition is powerful, but comprehending that exercise is medicine just scratches the surface. Exercise is only one of the essential health habits (much more about those in my upcoming book). From my experience, as well as studying the limited research we have on these habits, I can tell you that they are each powerful and, in combination, they change people’s lives like nothing else...

Vitamin D Is Too Good Not To Be True

Several years ago when I attended the first medical conference on vitamin D designed for clinicians, the limited data we had were very exciting. There was also many reasons to be skeptical and many were. It all sounded too good to be true they thought. Maybe higher vitamin D levels just told us who was already healthy. Instead of being sick and house-bound, they spent more time outside. The high vitamin D was not the cause of being well, it was the result. More complicated, time-consuming and expensive studies would have to be done to sort out the truth. Since then we have accumulated a great deal of research data. What does it show? Simply, the data shows that our high expectations about vitamin D were wrong. The highest expectations about vitamin D were actually too modest! At this point just about the only health outcomes that we can’t prove are influenced by vitamin D are the ones we have not measured yet. Study after study links diseases, syndromes, development and well-being to vitamin D. A few very recent discoveries follow: As we broaden our view to hunt down foreseen connections, more and more comes to light. For example, we have long been aware of a rising rate of premature onset of menses in little girls. There were many explanations including hormones in the food, rising rates of obesity and environmental hormone disrupting chemicals. Now we can add low vitamin D to the list of contributors. Vitamin D lowers the risk of ischemic stroke and diabetes. Low vitamin D is closely linked to vitiligo (patchy white skin) whether or not there is an autoimmune disease contributing to the vitiligo. Patients with hepatitis C are more likely to respond to drug treatment and get better if their D levels are higher. Black people with high blood pressure can lower it taking vitamin D but a dose of at least 2,000 iu is necessary and 4,000 iu/day (the highest they tested) is better. A paltry dose of 1,200 iu of D3 markedly reduced the symptoms of Parkinson’s Disease patients. Vitamin D appears to make prostate cancer cells less aggressive. Honestly, it is getting kind of boring. It is abundantly clear that optimizing everyone’s D level is a no-brainer, regardless of their health. Vitamin D is just plain GOOD. The end. I am interested in what we do not know and then, most importantly, what can be done about it. I want to help not just categorize. Diagnoses and labels...

Tastes, Vitamin Supplements and Wild foods

A controversial but prominent advocate of immunizations in the United States is now becoming a vocal critic of nutrition. In advance of his new book, which advertisements and reviews suggest is a diatribe against acupuncture, chiropractic, supplements, etc., he wrote an editorial for the New York Times espousing the harms of vitamin supplements. In the editorial he “cherry picks” studies to support his contention, leaving out others that contradict his view, and even neglecting to mention data in the studies he chose, which complicate the question. The first study he cites is an ancient one in the world of medical research. It was a 1994 investigation of male Finnish cigarette smokers. Back 15+ years ago, when this study was “new”, I often discussed it in my lectures to physicians. He wrote that those Finish male smokers who had taken beta carotene were more likely to die of lung cancer. That was true. Overlooked by those who read only the abstract, not the study itself, was that researchers discovered that smokers who had the highest blood levels of beta carotene at the beginning of the study were least likely to die of lung cancer, whether they took the supplement during the study or not. Doesn’t that then mean that beta carotene supplements cause cancer? No. My reading of the study then and supported by studies since then, was and is that male smokers should not take a synthetic beta carotene supplement by itself. Beta carotene is “beta” because there is an alpha, gamma, delta, epsilon and zeta carotenes as well. There are different forms of beta carotene as well. Considerable science accumulated over the last two decades fleshes out our understanding (at least if we take the time to read enough). Just as taking too little is not good, taking too much is bad. The form is important, just as is the context (ie,. taking a balance of nutrients). As you can tell, dietary studies are extremely prone to be as misleading as they are enlightening. Even when carefully done, nutritional research is notoriously unreliable. Design flaws are ubiquitous because we can’t control precisely what people eat for the decades required. Consequently, we need to think more broadly. One asset to understanding nutrition, as with so much else in medicine, is the study of evolutionary biology. Simply put, that is thinking carefully about how we got here. We have learned that the leafy diets of our primate relatives are surprisingly nutrient-rich. Little 10 pound chimpanzees get about 600 mg...

Tastes, Vitamin Supplements and Wild foods

A controversial but prominent advocate of immunizations in the United States is now becoming a vocal critic of nutrition. In advance of his new book, which advertisements and reviews suggest is a diatribe against acupuncture, chiropractic, supplements, etc., he wrote an editorial for the New York Times espousing the harms of vitamin supplements. In the editorial he “cherry picks” studies to support his contention, leaving out others that contradict his view, and even neglecting to mention data in the studies he chose, which complicate the question. The first study he cites is an ancient one in the world of medical research. It was a 1994 investigation of male Finnish cigarette smokers. Back 15+ years ago, when this study was “new”, I often discussed it in my lectures to physicians. He wrote that those Finish male smokers who had taken beta carotene were more likely to die of lung cancer. That was true. Overlooked by those who read only the abstract, not the study itself, was that researchers discovered that smokers who had the highest blood levels of beta carotene at the beginning of the study were least likely to die of lung cancer, whether they took the supplement during the study or not. Doesn’t that then mean that beta carotene supplements cause cancer? No. My reading of the study then and supported by studies since then, was and is that male smokers should not take a synthetic beta carotene supplement by itself. Beta carotene is “beta” because there is an alpha, gamma, delta, epsilon and zeta carotenes as well. There are different forms of beta carotene as well. Considerable science accumulated over the last two decades fleshes out our understanding (at least if we take the time to read enough). Just as taking too little is not good, taking too much is bad. The form is important, just as is the context (ie,. taking a balance of nutrients). As you can tell, dietary studies are extremely prone to be as misleading as they are enlightening. Even when carefully done, nutritional research is notoriously unreliable. Design flaws are ubiquitous because we can’t control precisely what people eat for the decades required. Consequently, we need to think more broadly. One asset to understanding nutrition, as with so much else in medicine, is the study of evolutionary biology. Simply put, that is thinking carefully about how we got here. We have learned that the leafy diets of our primate relatives are surprisingly nutrient-rich. Little 10 pound chimpanzees get about 600 mg...