Category Archives: Supplements

Do Supplements Work for Osteoarthritis?

Steve Parker MD

Does running promote osteoarthritis. Probably not.

Science Based Medicine has a new article on supplements for osteoarthritis pain. A snippet:

“Based on their review, the authors do not recommend omega-3 fatty acids, vitamins D and E, willow bark extract, collagen hydrolysate, glucosamine, chondroitin, combinations of glucosamine and chondroitin, and rose hip. Based on the review, Boswellia serrata extract and pycnogenol appear to demonstrate the most clinically important effects. They also note that while curcumin and MSM demonstrated clinically important effects, the quality of that evidence was low.”

Furthermore…

“The authors conclude that those with osteoarthritis those that are enthusiastic about using supplements, short-term trials of the pycnogenol, curcumin, Boswellia serrata extract, or MSM could be attempted, and should be discontinued after 4-6 weeks if no obvious benefits are noted. Importantly, drug-supplement interactions are not always well understood or well documented, and any supplement should be used with caution (and preferably, consultation with their pharmacist) if being combined with prescription or non-prescription drugs. There is also the very real concerns about supplement quality and batch-to-bath consistency, which complicates evaluations of risk, and determining whether or not they work.”

The SBM writer (Scott Gavura, a pharmacist) also points out the benefits of ongoing exercise, appropriate weight loss, and topical nonsteroidal anti-inflammatory drugs (e.g., diclofenac). IIRC, there’s good evidence that topical capsaicin also helps with the pain.

Source: Supplements for Osteoarthritis – Evaluating the Evidence – Science-Based Medicine

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Is There a Role for Magnesium Supplementation in Type 2 Diabetes?

Not the magnesium used in the study at hand

I hadn’t thought so until I read about an experiment published in 2003. Now I’m wondering.

The study was done in northern Mexico and all participants were taking glibenclamide, a sulfonylurea known as glyburide in the U.S. Importantly, study participants had low blood magnesium levels at the outset.

So if you’re not a hypomagnesemic Mexican taking glibenclamide, results may not apply to you.

Nevertheless, results were impressive. Compared to the control group, magnesium supplementation…

  • reduced insulin resistance
  • fasting glucose was 144 mg/dl (185 in controls)
  • Hemoglobin A1c was 8% (10% in controls)

The experiment lasted 16 weeks and the specific form of magnesium used was magnesium chloride solution.

Maybe we should be checking magnesium levels more often. BTW, magnesium supplements are difficult for our bodies to absorb. I know of at least three magnesium compounds: oxide, citrate, and chloride. There are probably others. Degree of absorption varies from one to the other. Adding a supplement on top of kidney impairment could cause toxicity.

The researchers conclude:

Oral supplementation with MgCl2 solution restores serum magnesium levels, improving insulin sensitivity and metabolic control in type 2 diabetic patients with decreased serum magnesium levels.

Source: Oral Magnesium Supplementation Improves Insulin Sensitivity and Metabolic Control in Type 2 Diabetic Subjects | Diabetes Care

 

Book Review: P.D. Mangan’s “Best Supplements for Men”

Death in a bottle?

Best Supplements for Men: for more muscle, higher testosterone, longer life, and better looks was published in 2017 so should still be up to date. I have the paperback but it’s also available as a Kindle e-book. Per Amazon.com’s rating system, I give it five stars (I love it).

*  *  *

My favorite sentence in this book is, “If you don’t eat, exercise, and sleep right, the health effects of adding any supplement may be minimal to non-existent.” That sets an honest tone. Also in favor of integrity is that the author doesn’t offer Mangan-branded supplements for sale.

I like this book and learned a lot from it. I’ve benefited by reading the author’s tweets and blog (Rogue Health and Fitness) for several years. He’s smart and, I believe, honest.

The author supports his assertions with numerous scientific references, organized by chapter at the back of the book. If he cites a study done in mice, he tells you. Human studies admittedly carry more weight.

Have you wondered if protein supplements and creatine are good for muscle strength and energy? Does magnesium increase testosterone levels? Does berberine have beneficial health effects? The answers are here.

The author gives good advice regarding calcium supplements that even most physicians don’t know about.

Great recommendations on food.

No book is perfect, and this one is no different. It has no index. So if you’re curious about turmeric or supplements that control diabetes, you have to scan the whole book. My copy didn’t include references for chapter 11. Page numbers for chapters in the index didn’t match the actual chapter starts. My least favorite sentence in the book was something about Dr. Joseph Mercola being a trustworthy source of health information; he is not (search “mercola” at ScienceBasedMedicine.org).

Again, I like this book, learned much from it, and recommend it to men. If you’re taking lots of supplements now, read this book to find out if they help, harm, or are only good for making expensive urine.

Steve Parker, M.D.

PS: Some personal notes from my reading. Many of the cited studies are “association”-type evidence  rather causation. Berberine may help reduce blood sugars in diabetics just as well as metformin. Creatine: Yes, for muscle growth and strength. Magnesium 700 mg/day increases testosterone. Mag oxide may be worthless due to poor absorption. Mangan likes mag citrate but Lexicomp says it’s no better than oxide; absorption “up to 30%.” Citrulline: Yes, for ED, and may help with HTN. DHEA 50 mg/day increases testosterone in men by 50%, but only in men over 70. During fat weight loss, whey protein helps prevent muscle loss. MCT oil may also help (e.g., cook with coconut oil). ASA 81 mg/day seems to prevent some cancers in folks over 55, especially colorectal cancer.

Dementia risk increased with calcium supplements in women with cerebrovascular disease

He's not worried about adequate dietary calcium

He’s not worried about adequate dietary calcium

The paleo diet is relatively low in calcium content. So is that a reason to take a calcium supplement? Probably not. Calcium supplements are problematic. They may increase the risk of heart attacks. They may raise the odds of premature cardiac death in men. High calcium consumption increased the risk of death in Swedish women.

MedicalNewsToday has a brief report on dementia in women with cerebrovascular disease and calcium supplements:

“Calcium supplements may increase the risk of developing dementia in senior women with cerebrovascular disease, finds a study published in Neurology, the medical journal of the American Academy of Neurology.

Women who took calcium supplements were twice as likely to develop dementia.Cerebrovascular diseases are conditions caused by problems that affect the blood supply to the brain. The four most common types of cerebrovascular disease are stroke, transient ischemic attack (TIA), subarachnoid hemorrhage, and vascular dementia.”

Source: Dementia risk increased with calcium supplements in certain women – Medical News Today

Artificial Sweeteners and the Paleoista

Did you know babies under one year of age shouldn’t be given honey?  I saw that warning on a honey container recently and didn’t know why.  Honey may contain bacterial spores that cause botulism in the wee ones.

A pinch of salt helps reduce bitterness in coffee

Paleo diet aficionados can satisfy a sweet tooth with honey or fruit.  Unfortunately for people with diabetes, those items can spike blood sugars too high.  Honey, for instance, has 17 grams of carbohydrate in one tablespoon (15 ml), which is more carb than in a tablespoon of white granulated table sugar.

Most diabetics eating paleo-style will need some limit on consumption of honey and fruit.  Or they could take more diabetes drugs to control blood glucose elevations.  Again, unfortunately, we don’t know the long-term health effects of most of our diabetes drugs.

How about getting a sweet fix with artificial sweeteners?  Paleo purists would say “fuggedaboudit.”  In theory, that’s fine.  But many paleo followers with diabetes won’t forget about it.  They’ll use artificial sweeteners, aka sugar substitutes.

If you’re gonna use ’em, think about stevia.  It’s derived from a natural source, the leaves of a plant in South America.  Admittedly, our forebears in eastern Africa wouldn’t have had access to it 50,000 years ago.  After the plant has been processed, it’s certainly a highly refined product going against the grain of the paleo movement.  Furthermore, one of the stevia market leaders in U.S. (Truvia) is mixed with erythritol.  To help you feel better about the erythritol (a sugar alcohol), note that it is found naturally in some fruits.  Another stevia commercial product in the U.S. is Pure Via.

Dietitian Brenna at her Eating Simple blog reviewed sugar impostors in January, 2012.  She favored stevia over the others, at least for non-diabetics who were tempted.  Brenna also linked to a Mayo Clinic review of artificial sweeteners.

Note that sugar alcohols like erythritol have the potential to raise blood sugar levels.  They shouldn’t raise it as much as table sugar, however.  With regard to sugar alcohols, Dr. Richard K. Bernstein urges caution, if not total avoidance.  Use your meter to see how they effect you.

If you’re in the habit of using one or two teaspoons of honey to sweeten tea or coffee, you’re blood sugar levels should be more stable and manageable if you use stevia instead.  Dr. Bernstein gives the green light to stevia powder or liquid, along with saccharin tablets or liquid, aspartame tablets, and sucralose tablets, acesulfame-K, and neotame tablets.  Stevia is the only one close to “natural.”

Steve Parker, M.D.

Do We Need Supplements Because Our Soils Are Depleted?

In my recent review of The Blood Sugar Solution, I noted the numerous supplements recommended by Dr. Mark Hyman: between 11 and 16 supplements.  And one of those supplements is a multivitamin/multimineral supplement that has 20 or so different components.

One reason we need the supplements, according to Dr. Hyman, is because the soils in which we grow food over the years has been depleted of minerals and other basic plant building blocks.

I know one doctor who told his patients the same thing while selling them over-priced supplements straight from his office.

So is there any truth to the “soil depletion” argument for supplements?

Not much, if any, according to Monica Reinagel.  She reviewed the topic in 2010 at her Nutrition Diva blog: http://nutritiondiva.quickanddirtytips.com/are-fruits-and-vegetables-getting-less-nutritious.aspx.  I trust Monica.  In the same article, you’ll find links to her opinion on whether organic vegetables are healthier and worth the cost.

I’ve not done a comprehensive review of the soil depletion issue myself.   It’s quite a difficult area to research; try it and you’ll see.  The Soil Science Society of America, founded in 1936, sounds like a great place to find the answer.  No such luck.

The U.S. is a huge country with lots of different soil types and usage histories.   Soils in one field may be depleted in certain components whereas the field across the road may be quite rich.  Soils are not static.  Farmers are always making amendments to the soil, either with fertilizers or other additives, or by rotating crops.

Wouldn’t you think farmers, whether small family units or huge corporate enterprises, would do what’s necessary to keep their soils productive?

Another way to look at soil depletion would be to look at the nutrient content of the plants and animals that depend on soil for life.  The U.S. Department of Agriculture did that in its 2004 publication, “Nutrient Content of the U.S. Food Suppy, 1909-2000.”  This paper includes 10 vitamins and nine minerals.  For the boring details, see   http://www.cnpp.usda.gov/publications/foodsupply/foodsupply1909-2000.pdf.   Some excerpts:

Levels for most vitamins and minerals were higher in 2000 than in 1909.

Levels for vitamin B12 and potassium were lower in 2000 than in 1909, but over the series, met or exceeded current recommendations for a healthy diet….

The authors attibute lower potassium availability to lower consumption of plant foods, especially fresh potatoes.  I’m increasingly interested in the possibilty that low potassium consumption may contribute to heart disease and premature death.  But that’s a topic for another day.

I’m skeptical about claims of widespread soil depletion in the U.S. as a cause of food supply degradation.  Supplement sellers are sure to disagree.  To be sure you’re getting the nutrients you need, eat a wide variety of foods.

Steve Parker, M.D.

PS: The American Council on Science and Health has a brief article on whether everybody needs a multivitamin/multimineral supplement.

New research is questioning the benefits of taking supplemental vitamins and minerals, suggesting that, for the general population, such supplements may actually pose more risks than benefits.

Click for the full article: http://www.acsh.org/factsfears/newsid.3067/news_detail.asp

PPS:  Oregon State University’s Linus Pauling Institute published a long article on the multivitamin/multimineral supplement issue.  It seems fairly balanced to me.  The Institute notes the 2006 National Institutes of Health assessment that we have insufficient evidence to recommend either for  or against such supplementation (Annals of Internal Medicine, 145(5), 2006: 364-371).  Nevertheless, the Linus Pauling Institute recommends supplementation as “insurance.”  You know, just in case.

Right Diet Preserves Brain Function and Size

mp9004223691.jpgThe journal Neurology reports that the proper diet seems to help prevent age-related brain shrinkage and cognitive decline.

From the press release:

People with diets high in several vitamins or in omega 3 fatty acids are less likely to have the brain shrinkage associated with Alzheimer’s disease than people whose diets are not high in those nutrients, according to a new study published in the December 28, 2011, online issue of Neurology, the medical journal of the American Academy of Neurology.

Those with diets high in omega 3 fatty acids and in vitamins C, D, E and the B vitamins also had higher scores on mental thinking tests than people with diets low in those nutrients. These omega 3 fatty acids and vitamin D are primarily found in fish. The B vitamins and antioxidants C and E are primarily found in fruits and vegetables.

So the dietary pattern linked to preservation of brain size and function in this study is: high omega-3 fatty acids and vitamins B, C, D, and E. I don’t know if study participants were getting these nutrients from supplements or from food or a combination. (I haven’t read the full article.)

To find foods high in the aforementioned nutrients, you can use NutritionData’s Nutrient Search Tool.

Note that the time-honored Mediterranean diet is also associated with lower rates of dementia and slower rate of age-related mental decline.

I previously reported that a supplement cocktail of three B vitamins slowed the rate of brain shrinkage.

Steve Parker, M.D.

Reference: Bowman, G.L., et al. Nutrient biomarker patterns, cognitive function, and MRI measures of brain aging. Neurology. doi: 10.1212/WNL.0b013e3182436598

h/t to Randall Parker at FuturePundit