Fishy Research

This seems to be the week of omega-3 oil publications. First there was a PATHETIC study whose authors claimed they had proved that O-3 supplements increase prostate cancer. http://jnci.oxfordjournals.org/content/early/2013/07/09/jnci.djt174.abstract. A boat load of scientists responded in the harshest terms, suggesting the author was trying to get attention (“the work of a junior professor”) and wondering how such a worthless study got published (“I have no idea how this study got accepted for publication”). The study contradicted previous research but only because of it’s bad design and the investigators’ truly horrible interpretation. It does seem that they were quite beyond their depth, purposefully hoping to grab attention or using ephemeral data to tout a predetermined conclusion. The nature of the study design could sometimes identify an association between factors but it can never prove causation. This study was far too poorly designed to even prove an association. One very simple and obvious point was that they did not determine where the omega-3 in the blood of their subjects came from (food or supplements). However, without that fundamental bit of information, the lead author was quoted “We’ve shown once again that the use of nutritional supplements might be harmful”. Sources of the oil could be crucial factor. Toxic contamination of fish and some supplements is a problem.Environmental toxins (especially dioxins and pesticides) have been linked to prostate cancer. This was just one of many overlooked confounders. Heavy tobacco and alcohol intakes appear to lead to more aggressive prostate cancer. In their data, smoking and alcohol both lowered the risk. Their research seems have been conducted in “opposite land”. The difference in blood levels between the highest and lowest groups was so small that the food the subject ate that day would change their grouping. The overall levels were so low that, if projected, the typical levels found among people living in countries where fish is most widely consumed (Scandinavia, Japan) would cause huge elevations in prostate cancer rates. That is not at all what we see. Other research has found 60-80% reduction in prostate cancer rates.The second study showed the importance of another fundamental issue overlooked by authors of the first. http://www.ncbi.nlm.nih.gov/pubmed?term=Garc%C3%ADa-Hernández%20VM%5BAuthor%5D&cauthor=true&cauthor_uid=23863036. This study, published in the International Journal of Food Science and Nutrition on July 18, compared the effects of different fish oil supplements on cholesterol and triglyceride levels. People think of omega-3 oils as “anti-inflammatory”. That is reasonable. The counterbalance to “anti-inflammatory” or “anti-oxidant”. Oxidization is sort of biochemical rust. Cancer and heart disease are among the health problems...

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...