Tag Archives: supplements

Trust Me, I’m a Doctor: You Don’t Want Macular Degeneration

Remember...peanuts aren't nuts, they're legumes

Remember…peanuts aren’t nuts, they’re legumes

I saw an optometrist a few months ago for a new eyeglass prescription and mentioned that age-related macular degeneration (ARMD or AMD) runs in my family. ARMD is the leading cause of adult blindness in the West.

The optometrist suggested I start taking eye vitamins to help prevent ARMD. Popular eye vitamin preparations around here are Ocuvite and I-Caps. He said a multivitamin like Centrum might be just as effective.

Steve Parker MD, eye chart, eye exam

Macular degeneration is the opposite of this: blacked-out or fuzzy vision in the center, clearer at the periphery

UpToDate.com, a source I trust, says that supplements for prevention probably don’t work and are not recommended. Which means Centrum would be just as effective: i.e., none of them work.

Instead, UpToDate recommends regular exercise, not smoking, and relatively high consumption of leafy green vegetables, fruits, fish and nuts. Although they didn’t mention it by name, the traditional Mediterranean diet provides all of those.

On the other hand, if you already have macular degeneration (wet or dry), UpToDate recommends these supplements (probably based on the AREDS-2 study):

  • vitamin C 500 mg/day
  • vitamin E 400 mg/day
  • lutein 10 mg/day
  • zeaxanthin 1 mg/day
  • zinc 80 mg/day (as zinc oxide)
  • copper 2 mg/day (as cupric oxide)

An reasonable alternative for non-smokers and never-smokers is the standard AREDS formula. It’s the same as above except it substitutes beta carotene for lutein or zeaxanthin. You can buy both formulations over-the-counter in the U.S. pre-mixed so you don’t have to swallow a handful of pills, just one.

I was in a supermarket yesterday checking out eye vitamins and noted that Bausch and Lomb’s AREDS-2 formula costs about $10/month.

I’m not taking these supplements for now. I taking the diet, exercise, and non-smoking route.

Steve Parker, M.D.

Paleo Pioneer S. Boyd Eaton’s Personal Lifestyle

African Savanna

African Savanna

Dr. Eaton (M.D.) spoke at the last Ancestral Health Symposium about his own diet and exercise program.  He’s 74-years-old and has been following his paleo lifestyle for 30 years.  In this video, Dr. Eaton looks quite fit and is obviously mentally sharp.

He talks about a “weak form” of the paleo diet that would include relatively small amounts of whole grains (e.g., shredded wheat) and dairy (e.g., skim milk).  He doesn’t proscribe beans.  He limits saturated fat, but enjoys red wine.

Dr. Eaton also discusses a “strong form” diet that would cut out the dairy, grains, and probably alcohol.  This is for those with certain diseases of modern civilization, such as high blood pressure, coronary artery disease, metabolic syndrome, adverse blood lipids, etc.  He didn’t mention diabetes specifically, but I bet he would include it in the list.

He has an impressive daily exercise program that probably takes at least an hour, with weight training on machines plus an aerobics (stationary bike and swimming).

Dr. Eaton supplments with a multivitamin/multimineral (showed a picture of Centrum), EPA/DHA, and fiber (especially soluble fiber).

The video is only 20 minutes long and well worth a look.

Steve Parker, M.D.

h/t Melissa McEwen. (Melissa has the impression the Eaton partakes of whole grains and dairy.  I didn’t hear that in the video but may have missed it.)

 

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.

Book Review: The Blood Sugar Solution

A few months ago, I read The Blood Sugar Solution: The UltraHealthy Progam for Losing Weight, Preventing Disease, and Feeling Great Now!  Published in 2012, the author is Dr. Mark Hyman. I give it three stars per Amazon’s rating system (“It’s OK”).  Actually, I came close to giving it two stars, but was afraid the review would have been censored at the Amazon site.

♦   ♦   ♦

The book’s promotional blurbs by the likes of Dr. Oz, Dr. Dean Ornish, and Deepak Chopra predisposed me to dislike this book.  But it’s not as bad as I thought it’d be.

The good parts first.  Dr. Hyman favors the Mediterranean diet, strength training, and high-intensity interval training.  His recommended way of eating is an improvement over the standard American diet, improving prospects for health and longevity.  His dietary approach to insulin-resistant overweight/obesity and type 2 diabetes includes 1) avoidance of sugar, flour, processed foods, 2) preparation of your own meals from natural, whole food, and 3) keeping glycemic loads low.  All well and good for weight loss and blood sugar control.  It’s not a vegetarian diet.

The author proposes a new trade-marked medical condition: diabesity. It refers to insulin resistance in association with (usually) overweight, obesity, and/or type 2 diabetes mellitus.  Dr. Hyman says half of Americans have this brand-new disorder, and he has the cure.  If you don’t have overt diabetes or prediabetes, you’ll have to get your insulin levels measured to see if you have diabesity.

He reiterates many current politically correct fads, such as grass-fed/pastured beef, organic food, detoxification, and strict avoidance of all man-made chemicals, notwithstanding the relative lack of scientific evidence supporting many of these positions.

Dr. Hyman bills himself as a scientist, but his biography in the book doesn’t support that label.  Shoot, I’ve got a degree in zoology, but I’m a practicing physician, not a scientist.

The author thinks there are only six causes of all disease: single-gene genetic disorders, poor diet, chonic stress, microbes, toxins, and allergens.  Hmmm… None of those explain hypothyroidism, rheumatoid arthritis, systemic lupus erythematosis, tinnitus, migraines, irritable bowel syndrome, Parkinsons disease, chronic fatigue syndrome, or multiple sclerosis, to name a few that don’t fit his paradigm.

Dr. Hyman makes a number of claims that are just plain wrong.  Here are some:
– Over 80% of Americans are deficient in vitamin D
– Lack of fiber contributes to cancer
– High C-reactive protein (in blood) is linked to a 1,700% increased probability of developing diabetes
– Processed, factory-made foods have no nutrients
– We must take nutritional supplements

Furthermore, he recommends a minimum of 11 and perhaps as many as 16 different supplements even though the supportive science is weak or nonexistent.  Is he selling supplements?  You betcha!

After easily finding these bloopers, I started questioning many other of the author’s statements.

I was very troubled by the apparent lack of warning about hypoglycemia (low blood sugar).  Many folks with diabetes will be reading this book.  They could experience hypoglycemia on this diet if they’re taking certain diabetes drugs: insulin, sulfonylureas, meglitinides, pramlintide plus insulin, exenatide plus sulfonylurea, and possibly thiazolidinediones, to name a few instances.

If you don’t have diabetes but do need to lose weight, this book may help.  If you have diabetes, strongly consider an alternative such as Dr. Bernstein’s Diabetes Solution or my Conquer Diabetes and Prediabetes.

In the interest of brevity, I’ll not comment on Dr. Hyman’s substitution of time-tested science-based medicine with his own “Functional Medicine.”

Steve Parker, M.D.