Liquid Chlorophyll as Sodium Copper Chlorophyllin

Chlorophyllin is a water-soluble analog of the green plant pigment chlorophyll. Liquid chlorophyll products containing chlorophyllin are a mixture of chlorophyll and copper. Chlorophyllin is produced by extracting natural chlorophyll from mulberry leaves (post silkworm feeding) or the traditional alfalfa source (which today is mostly genetically modified/GMO) and reacting the chlorophyll to copper. Today chlorophyllin is compliant with the USP monograph as Sodium Copper Chlorophyllin and is water-soluble; chlorophyll in plants is a fat-soluble substance. Solubilized chlorophyllin is dispersible and stable in water, unlike the original plant chlorophyll, making liquid chlorophyll products possible. 

It is best to test each lot of chlorophyll for identity, microbial burden (including pathogens), and heavy metals to assure product safety. The sodium content of chlorophyllin is negligible; about 9.5 milligrams per 100 gram serving.  

Chlorophyll as Sodium Copper Chlorophyllin can function as a free radical neutralizer and may help to support the body's detoxification processes. https://pubmed.ncbi.nlm.nih.gov/7788866/  and https://pubmed.ncbi.nlm.nih.gov/12628519/ 

Specifically, chlorophyllin ‘has potent antioxidant ability involving scavenging of various physiologically important ROS’ [reactive oxygen species]. https://pubmed.ncbi.nlm.nih.gov/11767414/ 

Chlorophyllin has been traditionally used as an internal deodorizer, both medically under FDA authorization (21CFR357.850) and as a dietary supplement, and it promotes cleansing and freshens breath. It has also been found to be a safe and effective detoxification agent suitable for use in individuals unavoidably exposed to dietary aflatoxins. https://pubmed.ncbi.nlm.nih.gov/12628519/ 

Do bioflavonoids enhance Vitamin C absorption?

Vitamin C absorption from the gut is governed by sodium content for active transport. For passive absorption throughout the length of the intestine the vitamin does not use a similar co-factor.

The bioflavonoids come into play after vitamin C has been absorbed and is in circulation.  This vitamin has a relatively short half-life and depends on other antioxidants to act as electron donors to 'reduce' oxidized vitamin C (dehydroascorbate) back into the antioxidant form (ascorbate; ascorbic acid).  Various antioxidants, including bioflavonoids and polyphenols in fruits, are typically used to provide that extra benefit.  So the recycling and longevity of vitamin C after absorption depends greatly on the presence of other antioxidants; including not only rutin and bioflavonoids but also alpha lipoic acid, glutathione, and numerous other antioxidants.

So there is a benefit to using a base, often called vitamin C complex, in a vitamin C formula, but not so much in the initial absorption as in the vitamin's retention and recycling for re-use over time.  The variety of antioxidant-related nutrients in the human diet is thought responsible for why humans can retain vitamin C between meals when we cannot manufacture our own from blood sugar at will, as most mammals can.

USDA Database for the Oxygen Radical Absorbance Capacity (ORAC) of Selected Foods, Release 2

The USDA recently removed its ORAC database listing values of antioxidant activity for various foods in test tube studies (in vitro). The reason given is that ORAC values don't necessarily translate directly into antioxidant activity in live humans (in vivo).

However, ORAC values do provide an indication of the antioxidant and polyphenol levels in the foods. Polyphenols have proven health benefits beyond their antioxidant activity (i.e. the green tea polyphenol EGCg stimulates metabolism). They also provide an indication of product freshness and ability to maintain freshness.

In the interest of  maintaining access to this data, I am providing a link to the database here. If it becomes inactive in the future, please contact me to send you a copy.

USDA Database for the Oxygen Radical Absorbance Capacity (ORAC) of Selected Foods, Release 2:
http://www.orac-info-portal.de/download/ORAC_R2.pdf

Espanol:
http://portalantioxidantes.com/orac-base-de-datos-actividad-antioxidante-y-contenido-de-polifenoles-totales-en-frutas/

For articles on this issue, please see:
http://www.ars.usda.gov/research/publications/publications.htm?seq_no_115=251105

http://www.ars.usda.gov/SP2UserFiles/Place/12354500/Articles/AICR07_ORAC.pdf

http://www.nutraingredients-usa.com/Industry/ORAC-has-ongoing-value-says-expert-as-USDA-removes-online-database

Is Resveratrol stable after exposure to air?

The question of whether the polyphenol Resveratrol will readily oxidize when exposed to air has been addressed scientifically. At the time of this relevant study (Prokop J, Abrman P, Seligson AL, Sovak M. Resveratrol and its glycon piceid are stable polyphenols. J Med Food. 2006 Spring;9(1):11-4. PubMed PMID: 16579722.), there were no published studies suggesting that Resveratrol was unstable, despite contrary claims being made by some. This study solidly confirmed Resveratrol's long-term stability under ambient handling and storage conditions for at least 4 years, as well as being stable for years even under more extreme "accelerated" storage conditions.


I can confidently report at this time that Resveratrol does not deteriorate when exposed to air and therefore does not require any special manufacturing processes that exclude oxygen. This has been confirmed by both this independent study published in a peer-reviewed journal and by stability studies performed on Resveratrol finished products by qualified scientists. Despite the assertion that Resveratrol requires special handling in oxygen-free conditions, we have seen no published data to support that claim.

Superfruits and ORAC value

A normal piece of fruit may have hundreds of ORAC units, a laboratory measure of antioxidant activity in a test tube. A “superfruit” may have tens of times higher antioxidant activity than our common fruits. Part of the reason for this is the environmental conditions of superfruits: some of them come from rainforests; others from more arid regions. It has been shown in studies that plants make antioxidants in response to environmental challenges such as droughts, variations in nutrient availability, competition with weeds, attacks by molds or bugs, lack of or excess sunlight, and other substandard conditions that are less common in modern chemical agricultural farming. This makes non-conventional crops more nutritious, especially in antioxidant nutrients like polyphenols that have only been compared to conventional crops for about a decade.

ORAC units, being a measure of test tube activity, may not be an ideal way to measure antioxidant potential in a food. However, it does give us a comparative measure of antioxidant compounds in various foods. The fact that these numbers may not accurately reflect their ability to act as antioxidants in the human body has become an issue, but until we get a better measure, or determine exactly which compounds measured by ORAC are used in what ways, this imperfect method still gives us a useful yardstick for nutritional density related to the foods’ antioxidant potential.

Naturally, numerous factors will affect the price and availability of superfruits including long supply chains, weather, transport costs, supply-and-demand, etc. Several superfruits are predicted to have an enduring market presence: Acai, Goji, Mangosteen, Noni, and Pomegranate. Maqui berries possess among the highest known ORAC value (Oxygen Radical Absorption Capacity) of any superfruit. Maqui berries are purple berries rich in anthocyanins.

It’s important to realize that rainforest fruits play a role in preserving tropical rain forests. If the indigenous people can make a living by harvesting wild fruit from mature trees, rather than finding it advantageous to clear cut to farm corn and soybeans, you can see that their vested interest would lie in protecting that forest from developers. Wildcrafted fruit would tend to be more nutritious in antioxidants than orchard-grown fruit, based on the results of comparative studies showing that environmental diversity protects and challenges the plants to produce protective phytochemicals that serve as human nutrients. Of course, these superfruits are not necessarily locally sourced, but they are extremely nutritious and do help to preserve the rainforests.

It’s important to note that the federal government refuses to recognize “structure-function” claims made on foods, which do not have DSHEA protections. You’ve probably heard that food companies touting the benefits of their own superfoods – cherries, fortified OJ, probiotics, pomegranate juice – have been targeted by federal agencies enforcing their rules that all food claims go through the tedious approval process of publishing in the Federal Register, etc. In this regard one can make more claims on a dietary supplement label – if properly documented – than on a food label.

Neil was interviewed about CoQ10 for a trade magazine

* How would you rate consumer awareness of the health benefits of CoQ10? Neil: There is actually a fair amount of consistently positive press on CoEnzyme Q10 (CoQ10), with a significant part of that because of this antioxidant nutrient’s role in cardiovascular and heart health. Many cardiologists recommend CoQ10 to their patients and popular books, such as by Dr. Sinatra, promote the healthful effects of CoQ10 to at-risk people. I would go so far as to suggest that CoQ10 has picked up some of the wide popularity as a heart nutrient that vitamin E had several years ago (but lost due to consumer confusion caused by unwarranted negative publicity). The fact that CoQ10 is so obviously safe, versatile, and useful has propelled it to a high place on the list of cardiovascular nutrients. * What is driving consumer interest in CoQ10 products? Neil: The multiple roles of CoQ10 in the human body make it uniquely useful in protecting cells and energizing essential processes such as heart action and immunity. Energy supports the constant pumping of the heart muscle, but also supports immune functions and antioxidant activity. Lack of energy is a common complaint heard by doctors, and active people need good sources of energy, so nutrients that promise to improve the energetics of the body are always in demand. In addition, new technologies to improve the historically poor absorption of CoQ10 have expanded the product category as prices have moderated, which is a perfect place for people selling CoQ10 to be in. Tell us more about CoQ10: Neil: Ubiquinol doubles as an antioxidant, and like other antioxidants the body can convert from one to the other and back again. Although Ubiquinol lacks much in the way of human clinical trials, supplemental Ubiquinone mostly converts to Ubiquinol during transport from the gut to the circulatory system. Ubiquinol is the primary form of the nutrient that circulates in the body. Ubiquinol converts to Ubiquinone to stimulate the production of cellular energy. CoQ10 is a fat-soluble nutrient and therefore should only be taken with meals containing significant amounts of fat. That has traditionally been the main limiting factor in absorption. Blending CoQ10 into an oily base to make softgel capsules is somewhat superior to dry capsules because a little oil is provided, but again there just isn’t enough oil in a capsule to make a big difference when the nutrient is not dissolved into the oil. When CoQ10 is completely dissolved into an oil, forming a crystal-free solution, it does make it several times more absorbable. But all oily solvents are not created equal! Some manufacturers use the synthetic chemical polysorbate 80 as the base and main ingredient in the softgel capsule, whereas others use only natural citrus or coconut oil fractions to do the same job because we prefer to have natural bases.

How Nutrition Affects Swine Flu (Influenza) and Immunity

Why are the Public Health authorities silent on the role of nutrition to protect us during an official national health emergency? Do they not know, or simply not care? Is either answer acceptable to citizens concerned about their health and wanting to get practical/real/fair/impartial information that we can utilize to help protect our families? Here's what the experts are not telling us:

• Did you know that if you had the seasonal flu vaccine last year it may make you more vulnerable to the swine flu this year? Vaccines create antibodies that actually make you more susceptible to other organisms, like viruses and bacteria. (Four Canadian studies reported by CBC News, 9/23/09)
• Did you know that side effects of vaccines can be minimized if there are adequate levels of vitamin D in the person? (Epidemic influenza and vitamin D. Epidemiol Infect. 2006 Dec;134(6):1129-40. Review.)
• Did you know that a lack of vitamin D makes people far more likely to have respiratory infections? (On the epidemiology of influenza. Virol J. 2008 Feb 25;5:29. Review.) Did you know that the virus itself can become less aggressive and less prone to mutating into more dangerous forms if a person has adequate levels of nutrients, especially antioxidants? (Host nutritional status: the neglected virulence factor. Trends Microbiol. 2004 Sep;12(9):417-23. Review.)
• Did you know that antioxidants, like selenium, not only reduce our vulnerability to getting influenza but also reduce the chances that it will progress into pneumonia! (Host nutritional status: the neglected virulence factor. Trends Microbiol. 2004 Sep;12(9):417-23. Review.)

Nutrients of interest to stroke victims

Sorry there's not much detail but this is a list that I made of nutrients that may be useful for someone who has had a stroke. I would suggest that you look each one up at a reputable online database, if interested. Of course, there are often difficulties at getting stroke survivors to take nutritional pills/caps; everything from swallowing to drug interactions. In no particular order: Vinpocetine Pycnogenol Nattokinase Rosemary Thyme Proline CoQ10 Phosphatidyl Choline Acetyl-l-carnitine vitamin E (all 8 tocopherols and tocotrienols) alpha-lipoic acid silymarin magnesium acetylcholine precursors: choline, PC, B5, huperzine

Swine Flu: Does Nutritional Status Aid Immunity?

Swine Flu: Does Nutritional Status Aid Immunity? By Neil E. Levin, CCN, DANLA A new health threat has arrived in our shrinking world: the swine flu. It is an organism for which there is no preventive vaccine; the commonly available flu vaccine does not include this strain, so offers no protection. Likewise, antibiotics target only bacterial strains so are useless to stop the viruses responsible for colds and flus. There are a couple of drugs (Tamiflu® and Relenza®) which are prescribed for those who have actually come down with the flu, and sometimes recommended for those who may come into contact with flu sufferers. However, they are expensive and typically work if you have one at home and take it at the first sign of illness. For example, the Tamiflu® website reports that, if taken within 48 hours of the first appearance of symptoms, adults may feel better about 1.5 days faster than patients who did not take it. When the avian flu (another Type A Influenza, the most common type) scare was around two or three years ago (remember SARS? Avian Flu? Bird Flu?), our family physician offered both my wife and me precautionary prescriptions of Tamiflu®, for which we would have had to pay about $200 out of pocket for a two person one-time supply. It wouldn’t be covered by insurance since we didn’t have an actual diagnosis of influenza. Besides that, there is a shortage and these drugs typically have a relatively short shelf life of only about a year. We respectfully declined the offer. While that is certainly an option for those who want to or need to pay to see a physician and get a prescription, and it may be covered by your insurance, it is not a practical option for most of us just wanting to improve our natural resistance to a known threat; and certainly not a cure. Besides, drugs have their own side effects (including shrinkage of the wallet) that should be noted by potential users. That’s precisely why they are controlled substances that are only available from medical professionals. What is the swine flu and what can we do to protect ourselves from it? According to Dr. Joe Bresee, Chief of the Epidemiology and Prevention Branch of the CDC (Centers for Disease Control and Prevention) Influenza Division, “Swine flu is a respiratory disease of pigs caused by Type A Influenza viruses. The symptoms of [swine] flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and [vomiting] associated with swine flu as well. There is no vaccine available right now to protect against swine flu. However, there are everyday actions that people can take to help prevent the spread of germs that cause respiratory illnesses like influenza. Take these everyday steps to protect your health. Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash can after you use it. Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective. Try to avoid contact with sick people.” Well, that is helpful, but only to a point. Also seemingly important is the fact that Americans who have come down with swine flu to date have had only one death - compared to well over a hundred Mexican deaths - and seem to have had contracted a much milder form of the illness than our unfortunate neighbors to the south. I speculate that the American diet, despite its known shortcomings, may in some ways still be superior in its content of some important nutrients to the average diet of many Mexican citizens, and perhaps support a better immune response. At the time of this writing though, only 20 of the 140 Mexican deaths attributed to pneumonia-like symptoms have actually been confirmed as the swine flu. No doubt new information will be coming in daily. But there are reportedly an estimated 36,000 deaths from the common flu every year, mostly the very old and the very young. After reviewing a number of scientific papers to assess the potential of foods and food supplements to improve our bodies’ natural response to the flu, there are a number of things that you and your physician may want to consider. In the battle to maintain healthy respiratory function and properly modulate immune response, natural nutritional substances can be helpful. Various vitamins, minerals, herbs and amino acids support optimal immune function and respiratory health. In fact, there is evidence that nutrient status of the host even affects the genetic expression of viruses; that is, an unsuitable environment (the well-nourished body) inhibits the ability of the virus to freely replicate and thrive. This is not a list of cures; it is a list of natural substances that have shown promise in improving survival or resistance to influenza as recorded in published studies. Those who want to support their immune system should investigate these with the knowledge and consent of your physician; physicians may want to note these natural products that may support the nutritional status of your patients. · AHCC In a recent study, supplementation with AHCC resulted in a dose-dependent increase in survival in mice in response to acute influenza infection (influenza A virus: avian flu, H1N1, PR8). · Andrographis paniculata has been shown in studies to support a healthy and balanced immune response by modulating the immune system’s production of immune cells (Interferon gamma (IFNg), Interleukin-2 (IL-2), and T-cells). Numerous clinical studies have demonstrated its ability to significantly increase cell-mediated immunity in response to stresses, such as those encountered during seasonal changes. · Astragalus (Astragalus membranaceous) is an Oriental herb well known for aiding the immune system. Astragalus has been shown in non-clinical studies to support a number of aspects of healthy immune function, including the enhancement of T-Cell and Natural Killer (NK) cell activity. Natural killer cells destroy unhealthy cells in the body virtually on contact. · Black Elderberry (Sambucus nigra) standardized extract may provide protection against oxidative stress and modulate inflammatory cytokines to protect respiratory function. Elderberry provides Vitamins A and C, as well as anthocyanins, which are potent free radical scavengers. Clinical and non-clinical studies have demonstrated Elderberry's immune-supporting properties. One article reported that, “Constituents of European elderberry neutralize the hemagglutinin spikes found on the surface of viruses, including flu viruses, preventing the viruses from piercing cell walls and replicating. European elderberry extracts also enhance immune function by increasing cytokine production.” It also reported that two randomized, double-blind, placebo-controlled clinical trials have shown that a European elderberry preparation “can inhibit influenza A and B viruses when given to patients within 48 hours of symptom development”. · Echinacea (Echinacea purpurea and Echinacea angustifolia) is well known for its immune modulating effects. E. purpurea extracts demonstrate significant immunomodulatory activities. “Among the many pharmacological properties reported, macrophage activation has been demonstrated most convincingly.” E. purpurea has been shown to have antiviral effects, with most studies looking at either rhinoviruses (colds) or herpes simplex virus type-1 (HSV-1). Its polysaccharides were able to exert an antiviral action on the development of HSV-1 disease when supplied prior to infection. Reductions in numbers of upper respiratory infections have been noted in several trials, but generally the differences in the large variety of commercial and non-commercial products studied have resulted in conflicting reports. However, a meta-analysis of previously published studies was published in the British medical journal The Lancet Infectious Diseases and concluded, “Published evidence supports echinacea’s benefit in decreasing the incidence and duration of the common cold.” · Garlic (Allium sativum) compounds have been shown to have some antiviral effects. For example, a compound called allitridin (diallyl trisulfide) has anti-human herpes virus (HCMV) activity via a mechanism associated with suppression of the virus’ gene expression. Other important and better known compounds include allicin and ajoene. Allicin has been shown to reduce the incidence of colds and flus. “Among the viruses which are sensitive to garlic extracts are the human cytomegalovirus, influenza B, herpes simplex virus type 1, herpes simplex virus type 2, parainfluenza virus type 3, vaccinia virus, vesicular stomatitis virus, and human rhinovirus type 2. · Larch tree (Larix occidentalis) polysaccharides (arabinogalactans) help to support healthy intestinal flora and aid healthy immune function. “They stimulate the immune system through the activation of phagocytosis, competitive binding of bacterial fimbrae, and the potentiation of the reticuloendothelial system's effects.” · Resveratrol, naturally occurring in grape vines, grape skins and red wine, improves immune response and down-regulates the activation and production of proinflammatory cytokines. · Selenium has been shown to help the immune system modulate inflammatory response in mice challenged with reactive agents. Animals deficient in the mineral had much poorer outcomes than those whose diets were supplemented with this antioxidant mineral. · Vitamin C (ascorbic acid, ascorbate) in divided doses supports immunity. Taking about 500 mg at a time enhances absorption and avoids a laxative effect possible at higher doses. In a two-year long controlled study, “vitamin C administration resulted in an 85-percent decrease in cold and flu symptoms compared to the control group”. In a controlled trial of 226 patients with influenza A, where about half received 300 mg of vitamin C daily: “Pneumonia was reported in two cases in the treatment group and 10 in the control group, while hospital stays for influenza or related complications averaged nine days in the vitamin C group and 12 days in the control group.” · Vitamin D (cholecalciferol, ergocalciferol) deficiencies have been associated with immune challenges (such as the flu) during the winter months when sunlight is not as able to produce the vitamin in our bodies. A deficiency can inhibit the body’s ability to maintain health and immunity. · Vitamin E (alpha-tocopherol) deficiencies have been shown to decrease immune response and increase inflammatory responses leading to possible tissue damage in the respiratory system. · Zinc is recommended for immunity. Use up to 30 mg per day for this use; higher doses could increase the need for copper. These statements have not been evaluated by the FDA. The information provided by this article is intended for scientific and historical reference only and is not intended to diagnose, treat, prevent or cure any disease. If you have been exposed to or think you may have flu or any disease, see a physician as soon as possible. Do not try to self treat swine flu or any other disease; influenza can be life-threatening. Please inform your physician before taking any food supplements if you take any medications or have a known medical condition. Read all product labels carefully and follow all directions and label cautions, and do not exceed the highest recommended servings. Neil E. Levin, CCN, DANLA is a board certified clinical nutritionist with a Diplomate in Advanced Nutritional Laboratory Assessment. He is a professional member of the International & American Associations of Clinical Nutritionists and serves on the Scientific Council of the national Clinical Nutrition Certification Board. 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Currier NL, Lejtenyi D, Miller SC Effect over time of in-vivo administration of the polysaccharide arabinogalactan on immune and hemopoietic cell lineages in murine spleen and bone marrow. Phytomedicine. 2003 Mar;10(2-3):145-53. Friel H, Lederman H. A nutritional supplement formula for influenza A (H5N1) infection in humans. Med Hypotheses. 2006;67(3):578-87. Epub 2006 Apr 18. PMID: 16624496 Beck MA. Selenium and vitamin E status: impact on viral pathogenicity. J Nutr. 2007 May;137(5):1338-40. Review. PMID: 17449602 Beck MA. Antioxidants and viral infections: host immune response and viral pathogenicity. J Am Coll Nutr. 2001 Oct;20(5 Suppl):384S-388S; discussion 396S-397S. Review. PMID: 11603647 Friel H, Lederman H. A nutritional supplement formula for influenza A (H5N1) infection in humans. Med Hypotheses. 2006;67(3):578-87. Epub 2006 Apr 18. PMID: 16624496 Nandi BK, Subramanian N, Majumder AK, Chatterjee IB. Effect of ascorbic acid on detoxification of histamine under stress conditions. Biochem Pharmacol. 1974 Feb 1;23(3):643-7. Johnston CS. The antihistamine action of ascorbic acid. Subcell Biochem. 1996;25:189-213. Johnston CS, Martin LJ, Cai X. Antihistamine effect of supplemental ascorbic acid and neutrophil chemotaxis. J Am Coll Nutr. 1992 Apr;11(2):172-6. Wintergerst ES, Maggini S, Hornig DH. Immune-enhancing role of vitamin C and zinc and effect on clinical conditions. Ann Nutr Metab. 2006;50(2):85-94. Carcamo JM, Pedraza A, Borquez-Ojeda O, Golde DW. Vitamin C suppresses TNF alpha-induced NF kappa B activation by inhibiting I kappa B alpha phosphorylation. Biochemistry. 2002 Oct 29;41(43):12995-3002. Kimbarowski JA, Mokrow NJ. Colored precipitation reaction of the urine according to Kimbarowski (FARK) as an index of the effect of ascorbic acid during treatment of viral influenza. Dtsch Gesundheitsw. 1967;22:2413-2418. [Article in German] Cannell JJ, Hollis BW. Use of vitamin D in clinical practice. Altern Med Rev. 2008 Mar;13(1):6-20. Review. PMID: 18377099 Cannell JJ, Zasloff M, Garland CF, Scragg R, Giovannucci E. On the epidemiology of influenza. Virol J. 2008 Feb 25;5:29. Review. PMID: 18298852 Cannell JJ, Vieth R, Umhau JC, Holick MF, Grant WB, Madronich S, Garland CF, Giovannucci E. Epidemic influenza and vitamin D. Epidemiol Infect. 2006 Dec;134(6):1129-40. Epub 2006 Sep 7. Review. PMID: 16959053 Beck MA. Selenium and vitamin E status: impact on viral pathogenicity. J Nutr. 2007 May;137(5):1338-40. Review. PMID: 17449602 Friel H, Lederman H. A nutritional supplement formula for influenza A (H5N1) infection in humans. Med Hypotheses. 2006;67(3):578-87. Epub 2006 Apr 18. PMID: 16624496 Arroll B. Non-antibiotic treatments for upper-respiratory tract infections (common cold). Respir Med. 2005 Dec;99(12):1477-84. PMID: 16291073

More evidence that antioxidant “dangers” are exaggerated (especially beta-carotene)

More evidence that antioxidant “dangers” are exaggerated (especially beta-carotene) By Neil E. Levin, CCN, DANLA In a study published in 2006, cancer researchers tested daily supplementation of 400 IU of vitamins E as alpha-tocopherol along with 50,000 IU (39 mg) of beta-carotene on 540 head and neck cancer patients for three years after treatment with radiation therapies. Due to safety concerns in previous trials (which I have repeatedly criticized in previous writings, for various reasons), the beta-carotene component was discontinued during the trial. During a median 6 ½ years of follow up, 179 of the patients died. The researchers concluded that high-dose vitamin E supplementation could be harmful to cancer patients, with a 38% increased risk for death. 1 This study has been associated with the hyperbolic warnings against antioxidant use for cancer patients. The same group of researchers published a 2007 study looking at the same group of 540 cancer patients treated by radiation to see if the antioxidant vitamins reduced the toxicity of the treatments. This report investigated the dietary intake, supplementation and plasma levels of beta carotene in the patients to look for correlations in outcomes, specifically acute adverse effects of the radiation therapy and cancer recurrence. A higher beta carotene dietary intake was associated with 39% fewer severe acute adverse effects, and higher plasma levels with 27% fewer severe adverse effects, from the radiation treatments. The researchers reported that, “This study suggests that a higher usual dietary beta carotene intake can reduce the occurrence of severe adverse effects of radiation therapy and decrease local cancer recurrence.” 2 This conclusion is at odds with fears of beta-carotene toxicity that have been massively publicized over the past 14 years. Now, in 2008, we have heard again from this same group of researchers continuing to review the data from the same group of patients. It turns out that the large increase in mortality in the patient group given antioxidants - reported in the 2006 study – was basically limited to those patients who smoked during their radiation treatments. In fact, there was no significant mortality increase in patients who only smoked before or after the course of radiation treatment, or for non-smokers. 3 This new information tells us that the general cautions about antioxidants should be limited to certain narrow conditions or situations, such as active smokers during therapy. This is good information, since we know that 40% of cancer patients actually die of malnutrition; that plasma levels of antioxidants are a far better measure of antioxidant status than supplement intake prescriptions or dietary recall surveys; and that antioxidants are synergistic with inter-related functions and should not be given separately. Now we also can point to numerous benefits of antioxidants in clinical studies that have been far overshadowed by the over-hyped negative conclusions of a relative few prominent-but-flawed studies reported by prestigious institutions, sometimes with NIH funding. I agree with those critics who insist that it should be considered scientifically inappropriate to use the drug model for nutrient research, because the nutrients already exist in the diet and in the body and are clearly impacted by other nutrients; as well as other variables, some of which are quite well known. By contrast, in a drug study a new, foreign chemical is being tested which should not already be present in the diet or the body, making toxicity a bigger issue while eliminating many of the variables that are inappropriately ignored in sensational-but-flawed nutrient studies that get so much media attention and so many undeserved citations in scientific journals. I have previously written about the use of antioxidants for cancer patients, as have others, with the common conclusion that most such warnings are overblown and that much of the published science has been favorable regarding those combinations of factors. REFERENCES

• Bairati I, Meyer F, Jobin E, Gélinas M, Fortin A, Nabid A, Brochet F, Têtu B. Antioxidant vitamins supplementation and mortality: a randomized trial in head and neck cancer patients. Int J Cancer. 2006 Nov 1;119(9):2221-4. PMID: 16841333
• Meyer F, Bairati I, Jobin E, Gélinas M, Fortin A, Nabid A, Têtu B. Acute adverse effects of radiation therapy and local recurrence in relation to dietary and plasma beta carotene and alpha tocopherol in head and neck cancer patients. Nutr Cancer. 2007;59(1):29-35. PMID: 17927499
• Meyer F, Bairati I, Fortin A, Gélinas M, Nabid A, Brochet F, Têtu B. Interaction between antioxidant vitamin supplementation and cigarette smoking during radiation therapy in relation to long-term effects on recurrence and mortality: a randomized trial among head and neck cancer patients. Int J Cancer. 2008 Apr 1;122(7):1679-83. PMID: 18059031

Beta-carotene risks over-stated

Beta-carotene risks over-stated By Neil E. Levin, CCN, DANLA A recent journal article pointed out the widely-reported danger of smokers using beta-carotene, a natural source (provitamin) of vitamin A, as part of their multivitamins. 1 In this meta-analysis the researchers have neglected to consider pre-existing dietary and serum levels of this nutrient, making their claim to control by placebo inadequate to properly isolate this variable. In fact, this failure to determine the effects of beta-carotene at a dose-dependent plasma level – and by neglecting to measure total beta-carotene intake along with the relevant synergistic antioxidants associated with it, as opposed to simply measuring supplemental intake - raises serious questions about the validity of these results. 2 There is also legitimate scientific debate over the use of trans versus cis forms of this provitamin that may affect the way it is used in vivo that dispute whether all forms are equal, which most studies simply do not address (including this meta-analysis). 3 Regarding beta-carotene safety little has been satisfactorily resolved, and the negative studies have been vigorously disputed for these and other reasons. For example, researchers have previously noted in the Journal of the National Cancer Institute that beta-carotene has been shown to not affect the risk of oxidative DNA damage in male smokers, despite its reputation as an antioxidant. But neither did the provitamin A prove to cause oxidative DNA damage. 4 It has become apparent to numerous observers that simply measuring supplementation of beta-carotene is not a good predictor of serum levels or of risk, and that a low level of total antioxidant intake may be a more valid marker in this regard. In fact, the dietary level of several antioxidants has been shown to be an independent predictor of plasma beta-carotene, especially in moderate alcohol drinkers. A recent study reports, “This may explain, at least in part, the inverse relationship observed between plasma beta-carotene and risk of chronic diseases associated to high levels of oxidative stress (i.e., diabetes and CVD), as well as the failure of beta-carotene supplements alone in reducing such risk.” 2 As the authors (Tanvetyanon, et al) of this current analysis have themselves noted, the Physicians Health Study compared the effects of taking 50 mg of supplemental beta-carotene (over 83,000 IU) every other day to a placebo in 22,071 US male physicians aged 40-84 and found no adverse health effects over a 12-year study period. 5 Likewise, the Women’s Health Study of 39,876 health professionals found no significant difference on lung cancer rates when looking at the effects of 50 mg of beta-carotene administered on alternate days over 2+ years plus a 4 year follow up period, using forms and dosing similar to the Physician’s Health Study to achieve very high serum levels of beta-carotene. 6 In a third study used in the current meta-analysis, The Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group (ATBC), an antioxidant study in Finland was halted early because of a widely reported small increase in cancer rates among male smokers taking beta-carotene that were only possibly linked to that nutrient. 7 Headlines associated this supplement with cancer risk. Despite objections that the study was flawed, beta-carotene use dropped. This study continues to be widely cited and believed, despite the researchers’ own statements that the results were most likely due to chance. A later analysis published in July 2004 took another look at that same Finnish smokers study’s data, but now taking into account total antioxidant intake, which should have cleared away some of the scientific controversy over beta-carotene. The smokers’ risk of getting lung cancer was inversely associated with total antioxidants in the diet, with more total antioxidants resulting in fewer cancers. 8 In this study a composite antioxidant index was generated for each of the 27,000 men over 14 years. The calculated amounts of carotenoids, flavonoids, vitamin E, selenium and Vitamin C were compared to actual lung cancer rates, with a clear result: a combination of antioxidants lowered lung cancer risk in male smokers. Properly reviewed, beta-carotene was not the culprit; low antioxidant status was the more relevant factor affecting cancer rates, and supplementation with a single antioxidant supplement simply failed to create enough improvement to avert deaths related to oxidative factors. Perhaps the supplementation with beta-carotene was simply a case of “too little, too late”, rather than a root cause of a slightly higher lung cancer rate in those smokers. It is notable that Tanvetyanon et al included the ATBC study but failed to even reference the later Wright et al study that largely refuted the alleged harms of beta-carotene shown in ATBC, which were shown to be more likely due to low levels of total antioxidant intake than to excessive beta-carotene intake. This later review of ATBC should be a cautionary tale concerning the lack of proper controls in nutrient studies, especially as compounded by the use of meta-analysis, and should have alerted the current authors to that all-too-common mistake in nutrient study design. Indeed, another large study has noted that high carotenoid intake, confirmed by measures of plasma, was associated with lower mortality rates among the elderly over a ten year period. 9 This model measured results of consuming both supplements and foods, not solely supplement input, and when combined with plasma levels should therefore be regarded as a far more robust type of science for measuring vitamin effects than a meta-analysis of simply supplementation. As in the long-term Physicians Health Study, there was no observable risk of lung cancer noted in this report. The fourth study used in the current meta-analysis used very high doses of both beta-carotene (30 mg, equal to 50,000 IU) plus 25,000 IU of pre-formed vitamin A. 10 These amounts are extremely high; the Upper Limit for vitamin A is 10,000 IU, though there is none for beta-carotene because of its historic safety record. The amount of beta-carotene used in the eye vitamins were high only because the authors selected solely formulas designed for eye health that typically provide more beta-carotene than ordinary multivitamins. This distinction is not clear in their calling such formulas “multivitamins”, because that name is typically given to full-spectrum formulas containing a full range of the essential vitamins with minerals, not system-specific formulas like those sold for eye health. Such formulas have proved to be beneficial in maintaining eye health and the combination of antioxidants have been stronger antioxidants than beta-carotene, which is potentially a pro-oxidant at times and could thus be used more safely – and effectively - in combination with other antioxidants. 11 Most importantly, the authors have not shown why they assume that “multivitamin” use would be associated with the supposed risks of beta-carotene used singly, even if those risks for the solo provitamin are assumed to be true. Nor have they adequately demonstrated the alleged dangers of taking eye formula supplements, or even the danger of lung cancer rates increasing in those taking mixtures of beta-carotene combined with other antioxidant nutrients. In the case of multivitamins most studies have shown overwhelmingly positive effects, such as one report evidencing reduced infections in nursing homes with vitamins over placebo (73% vs. 43%; P < 0.001). Intervention was with a multivitamin containing beta-carotene. Infection-related absenteeism was higher in the placebo group than in the treatment group (57% vs. 21%; P < 0.001). Perhaps most importantly, 93% of participants with diabetes mellitus reported an infection versus only 17% of those receiving supplements (P < 0.001). 12 These huge reductions in potentially serious infections among our elderly citizens should be measured against the relatively slight and mostly theoretical risk of increased lung cancer rates associated with beta-carotene supplementation. A study reported in the Journal of the National Cancer Institute looked at death rates in a population given multivitamins or other nutrients. 13 After supplements were given for 5.25 years in the general population trial of 30,000 people, significant reductions in total [relative risk (RR) = 0.91] and cancer (RR = 0.87) mortality were observed in subjects receiving beta-carotene, alpha-tocopherol, and selenium combined. The same researchers reported on a subgroup of 3,318 persons with esophageal Dysplasia (a precursor to esophageal cancer) that was given either a multiple vitamin-and-mineral supplement or a placebo for 6 years. In this portion of the trial, small reductions in total (RR 0.93) and cancer (RR = 0.96) mortality were observed but were not significant. In any case, no increase in cancer rates was noted in the group taking multivitamins; there was actually a possible small benefit in terms of reducing this risk. The participants getting the multivitamin took a daily beta-carotene capsule along with two multivitamin tablets. This was a group of subjects at high risk of getting throat cancer. 14-15 It is a leap of faith to assume that a single nutrient would have identical effects to a combination of nutrients without substantial supporting evidence, which is still lacking; confounded by conflicting evidence and multiplying variables in meta-analyses. Since nutrients are both synergistic and present in the diet, it is important to factor those known variables into a proper study design. All too often, researchers do not consider this fundamental difference between drug and nutrient research and unwittingly introduce extra variables that undermine their conclusions. 16 This current meta-analysis of 4 studies - only one of which unquestionably shows a slight increase in lung cancer risk but does not actually measure isolated beta-carotene risk; two others are well-designed and robust studies looking at serum levels of those taking a high dose of beta-carotene but show no increased risk in lung cancer rates, and the fourth has been largely shown to be moot by a later and more complete re-analysis of the data - does not support the hypothesis that beta-carotene increases rates of lung cancer and that multivitamins are therefore dangerous. Thus, there is no sound basis in the current review for suggesting that warning labels may be needed for multivitamins or eye health supplements containing beta-carotene along with other nutrients that have been shown in well-designed studies to help protect the eyesight – and independence - of our aging population. REFERENCES: Tanvetyanon T, Bepler G. Beta-carotene in multivitamins and the possible risk of lung cancer among smokers versus former smokers: a meta-analysis and evaluation of national brands. Cancer. 2008 Jul 1;113(1):150-7. PMID: 18429004 Valtueña S, et al. The total antioxidant capacity of the diet is an independent predictor of plasma beta-carotene. Eur J Clin Nutr. 2007 Jan;61(1):69-76. Epub 2006 Jul 12. PMID: 16835597 [Supported by the European Community IST-2001–33204 'Healthy Market', the Italian Ministry of University and Research COFIN 2001 and the National Research Council CU01.00923.CT26 research projects.] Andreas Schieber, Reinhold Carle. Occurrence of carotenoid cis-isomers in food: Technological, analytical, and nutritional implications. Trends in Food Science & Technology, Volume 16, Issue 9, September 2005, Pages 416-422 van Poppel G, Poulsen H, Loft S, Verhagen H. No influence of beta carotene on oxidative DNA damage in male smokers. J Natl Cancer Inst. 1995 Feb 15;87(4):310-1. PMID: 7707423 Hennekens CH, Buring JE, Manson JE, et al. Lack of effect of long-term supplementation with beta carotene on the incidence of malignant neoplasms and cardiovascular disease. N Engl J Med. 1996 May 2;334(18):1145-9. PMID: 8602179 Lee IM, Cook NR, Manson JE, Buring JE, Hennekens CH. Beta-carotene supplementation and incidence of cancer and cardiovascular disease: the Women's Health Study. J Natl Cancer Inst. 1999 Dec 15;91(24):2102-6. PMID: 10601381 The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. The Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group. N Engl J Med. 1994 Apr 14;330(15):1029-35. PMID: 8127329 Wright ME, et al. Development of a comprehensive dietary antioxidant index and application to lung cancer risk in a cohort of male smokers. Am J Epidemiol. 2004 Jul 1;160(1):68-76. PMID: 15229119 Buijsse B, et al. Plasma carotene and alpha-tocopherol in relation to 10-y all-cause and cause-specific mortality in European elderly: the Survey in Europe on Nutrition and the Elderly, a Concerted Action (SENECA). Am J Clin Nutr. 2005 Oct;82(4):879-86. PMID: 16210720 Omenn GS, Goodman GE, Thornquist MD, et al. Effects of a combination of beta carotene and vitamin A on lung cancer and cardiovascular disease. N Engl J Med. 1996;334:1150–1155. Bartlett H, Eperjesi F. Age-related macular degeneration and nutritional supplementation: a review of randomised controlled trials. Ophthalmic Physiol Opt. 2003 Sep;23(5):383-99. Review. PMID: 12950886 Liu BA, et al. Effect of multivitamin and mineral supplementation on episodes of infection in nursing home residents: a randomized, placebo-controlled study. J Am Geriatr Soc. 2007 Jan;55(1):35-42. Erratum in: J Am Geriatr Soc. 2007 Mar;55(3):478. PMID: 17233683 Blot WI, Li IY, Taylor PR, et al. Nutrition intervention trials in Linxian, China: supplementation with specific vitamin/mineral combinations, cancer incidence, and disease-specific mortality in the general population. J Natl Cancer Inst 1993:8ı:1483-92 Li JY, Taylor PR, et al. Nutrition intervention trials in Linxian, China: multiple vitamin/mineral supplementation, cancer incidence, and disease-specific mortality among adults with esophageal dysplasia. J Natl Cancer Inst. 1993 Sep 15;85(18):1492-8. PMID: 8360932 Blot WI, et al. The Linxian trials: mortality rates by vitamin-mineral intervention group. Am J Clin Nutr. 1995 Dec;62(6 Suppl):1424S-1426S. PMID: 7495242

Cardiovascular Health

Cardiovascular Health By Neil E. Levin, CCN, DANLA For a healthy cardiovascular system it is important to get plenty of nutrients over the whole range. B-Vitamins, for example, help to produce energy and to control metabolic processing, including the one that results in excessive levels of the inflammatory compound homocysteine. Homocysteine is a greater risk factor for cardiovascular risk than total cholesterol level. Antioxidants support each other, and clinical research indicates that total antioxidant status is more important than a single level of a single antioxidant nutrient. Antioxidants protect cholesterol from oxidizing, and also protect arterial surfaces from being damaged, leading to plaque formation and cholesterol “patches”. Minerals are also useful for cholesterol metabolism - especially chromium - also calcium, copper, and possibly magnesium and selenium. With the recent stories about obese children – some with Type-2 “adult-onset” diabetes - and with kids getting heart attacks in their teens, there is a growing awareness that cardiovascular health issues are not limited to middle aged men. Recent reports also point to the increased risk for women after menopause or who are on hormone replacement drugs, hammering the point home that age and gender are no longer rigid dividers of people into cardiovascular risk groups. That’s not to say that everyone is aware of these cardiovascular risk factors, but the risk categories in terms of age have certainly broadened dramatically in recent years. We have seen an increasing number of college-aged young men be afflicted by cardiac events at sports or training events, with some dying. Still, the risks do not seem as immediate to young adults with their heightened sense of immortality, especially young men. By the time men hit their 40s, there is an increased awareness of cardiac risks that keeps increasing throughout their lives. The young are mostly oblivious to health risks unless some event creates the beginnings of awareness that they may be at risk, such as a close relative suffering a cardiac event at an early age or a health scare. Unfortunately, these events seem to be increasing. Genetics, sedentary lifestyles, poor diet and obesity all make people susceptible to vascular problems. The emergence of hemorrhoids or any hint of varicose veins should be obvious indications of cardiovascular weakness at any age. Obesity and lack of stamina are also good indicators. Family health history is another consideration that should affect awareness. Circulation depends on body movement/exercise and requires an unobstructed blood flow through flexible blood vessels that have structural integrity. Collagen, elastin and supporting nutrients (proline, lysine, Vitamin C, Pycnogenol®, rutin) help to strengthen these tissues, while certain herbs (cayenne, garlic, horse chestnut, prickly ash extract, hawthorn extract) help to improve blood flow. Smoking and stress narrow the blood vessels, increasing the risk of forming clots or obstructions. Certain amino acids in the diet (arginine, citrulline) support NO (nitric oxide) formation that dilates blood vessels to reduce blood pressure and enhance blood flow to the peripheries. The presence of these components and modulators in the diet help to maintain cardiovascular health and vascular integrity. People should be eating a variety of fruits and vegetables, along with whole grains, in order to provide nutrients essential to the integrity of blood vessels. Products include beta sistosterol, vitamin C, Vitamin E, chromium, garlic, guar gum, Guggul extract, tocotrienols, policosanol, vitamins B1, B6, folate, B12, iodine, magnesium, selenium, potassium, carnitine, ginger, cayenne, hawthorn extract, CoQ10, lipoic acid, homocysteine regulators (B6, B12, folate, TMG), Policosanol, Red Yeast Rice Extract (plain or with CoQ10, alpha lipoic acid and silymarin), prickly ash extract, horse chestnut extract, butcher’s broom extract, grape seed extract, Pycnogenol® and rutin. However, other products are also helpful for cardiovascular health including gamma and delta tocotrienols, amino acids (taurine, carnitine, lysine, proline), Nattokinase (fibrin enzyme for supporting the body’s control of clotting), fish oil, and lecithin. Remember, you must take care of your heart and cardiovascular system if you expect them to take care of you for a lifetime!

Beta-carotene risks still unproven!

A recent journal article pointed out the widely-reported danger of smokers using beta-carotene, a natural source (provitamin) of vitamin A, as part of their multivitamins. 1 In this meta-analysis (as in common in such analyses) the researchers have neglected to consider pre-existing dietary and serum levels of this nutrient, making their claim to control by placebo inadequate to properly isolate this variable. In fact, this failure to determine the effects of beta-carotene at a dose-dependent plasma level – and by neglecting to measure total beta-carotene intake along with the relevant synergistic antioxidants associated with it, as opposed to simply measuring supplemental intake - raises serious questions about the validity of these results. 2 There is also legitimate scientific debate over the use of trans versus cis forms of this provitamin that may affect the way it is used by our bodies in vivo that dispute whether all forms are equal, which most studies simply do not address (including this meta-analysis). 3 Regarding beta-carotene safety little has been satisfactorily resolved, and the negative studies have been vigorously disputed for these and other reasons. For example, researchers have previously noted in the Journal of the National Cancer Institute that beta-carotene has been shown to not affect the risk of oxidative DNA damage in male smokers, despite its reputation as an antioxidant. But neither did the provitamin A prove to cause oxidative DNA damage. 4 It has become apparent to numerous observers that simply measuring supplementation of beta-carotene is not a good predictor of serum levels or of risk, and that a low level of total antioxidant intake may be a more valid marker in this regard. In fact, the dietary level of several antioxidants has been shown to be an independent predictor of plasma beta-carotene, especially in moderate alcohol drinkers. A recent study reports, "This may explain, at least in part, the inverse relationship observed between plasma beta-carotene and risk of chronic diseases associated to high levels of oxidative stress (i.e., diabetes and CVD), as well as the failure of beta-carotene supplements alone in reducing such risk." 2 As the authors (Tanvetyanon, et al) of this current analysis have themselves noted, the Physicians Health Study compared the effects of taking 50 mg of supplemental beta-carotene (over 83,000 IU) every other day to a placebo in 22,071 US male physicians aged 40-84 and found no adverse health effects over a 12-year study period. 5 Likewise, the Women’s Health Study of 39,876 health professionals found no significant difference on lung cancer rates when looking at the effects of 50 mg of beta-carotene administered on alternate days over 2+ years plus a 4-year follow up period, using forms and dosing similar to the Physician’s Health Study to achieve very high serum levels of beta-carotene. 6 In a third study used in the current meta-analysis, The Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group (ATBC), an antioxidant study in Finland was halted early because of a widely reported small increase in cancer rates among male smokers taking beta-carotene that were only possibly linked to that nutrient. 7 Headlines associated this supplement with cancer risk. Despite objections that the study was flawed, beta-carotene use dropped. This study continues to be widely cited and believed, despite the researchers’ own statements that the results were most likely due to chance. A later analysis published in July 2004 took another look at that same Finnish smokers study’s data, but now taking into account total antioxidant intake, which should have cleared away some of the scientific controversy over beta-carotene safety. The smokers’ risk of getting lung cancer was inversely associated with total antioxidants in the diet, with more total antioxidants resulting in fewer cancers. 8 In this study a composite antioxidant index was generated for each of the 27,000 men over 14 years. The calculated amounts of carotenoids, flavonoids, vitamin E, selenium and Vitamin C were compared to actual lung cancer rates, with a clear result: a combination of antioxidants lowered lung cancer risk in male smokers. Properly reviewed, beta-carotene was not the culprit; low antioxidant status was the more relevant factor affecting cancer rates, and supplementation with a single antioxidant supplement simply failed to create enough improvement to avert deaths related to oxidative factors. Perhaps the supplementation with beta-carotene was simply a case of "too little, too late", rather than a root cause of a slightly higher lung cancer rate in those smokers. It is notable that Tanvetyanon et al included the ATBC study but failed to even reference the later Wright et al study that largely refuted the alleged harms of beta-carotene shown in ATBC, which were shown to be more likely due to low levels of total antioxidant intake than to excessive beta-carotene intake. This later review of ATBC should be a cautionary tale concerning the lack of proper controls in nutrient studies, especially as compounded by the use of meta-analysis, and should have alerted the current authors to that all-too-common mistake in nutrient study design. Indeed, another large study has noted that high carotenoid intake, confirmed by measures of plasma, was associated with lower mortality rates among the elderly over a ten year period. 9 This model measured results of consuming both supplements and foods, not solely supplement input, and when combined with plasma levels should therefore be regarded as a far more robust type of science for measuring vitamin effects than a meta-analysis of simply supplementation. As in the long-term Physicians Health Study, there was no observable risk of lung cancer noted in this report. The fourth study used in the current meta-analysis used very high doses of both beta-carotene (30 mg, equal to 50,000 IU) plus 25,000 IU of pre-formed vitamin A. 10 These amounts are extremely high; the Upper Limit for vitamin A is 10,000 IU, though there is no official Upper Limit for beta-carotene because of its historic safety record. The amounts of beta-carotene used in the eye vitamins were high only because the authors selected solely formulas designed for eye health that typically provide more beta-carotene than ordinary multivitamins. This distinction is not clear in their calling such formulas "multivitamins", because that name is typically given to full-spectrum formulas containing a full range of the essential vitamins with minerals, not system-specific formulas like those sold for eye health. Such formulas have proved to be beneficial in maintaining eye health and the combination of antioxidants have been stronger antioxidants than beta-carotene, which is potentially a pro-oxidant at times and could thus be used more safely – and effectively - in combination with other antioxidants. 11 That being said, eye formulas with more milligrams of lutein than beta-carotene are probably better formulated than ones with very high beta-carotene because of their competition for absorption. Most importantly, the authors have not shown why they assume that "multivitamin" use would be associated with the supposed risks of beta-carotene used singly, even if those risks for the solo provitamin are assumed to be true. Nor have they adequately demonstrated the alleged dangers of taking eye formula supplements, or even the danger of lung cancer rates increasing in those taking mixtures of beta-carotene combined with other antioxidant nutrients. In the case of multivitamins most studies have shown overwhelmingly positive effects, such as one report evidencing reduced infections in nursing homes with vitamins over placebo (73% vs. 43%). Intervention was with a multivitamin containing beta-carotene. Infection-related absenteeism was higher in the placebo group than in the treatment group (57% vs. 21%). Perhaps most importantly, 93% of participants with diabetes mellitus reported an infection versus only 17% of those receiving supplements. 12 These huge reductions in potentially serious infections among our elderly citizens should be measured against the relatively slight and mostly theoretical risk of increased lung cancer rates associated with beta-carotene supplementation. A study reported in the Journal of the National Cancer Institute looked at death rates in a population given multivitamins or other nutrients. 13 After supplements were given for 5.25 years in the general population trial of 30,000 people, significant reductions in total [relative risk (RR) = 0.91] and cancer (RR = 0.87) mortality were observed in subjects receiving beta-carotene, alpha-tocopherol, and selenium combined. The same researchers reported on a subgroup of 3,318 persons with esophageal Dysplasia (a precursor to esophageal cancer) that was given either a multiple vitamin-and-mineral supplement or a placebo for 6 years. In this portion of the trial, small reductions in total (RR 0.93) and cancer (RR = 0.96) mortality were observed but were not significant. In any case, no increase in cancer rates was noted in the group taking multivitamins; there was actually a possible small benefit in terms of reducing this risk. The participants getting the multivitamin took a daily beta-carotene capsule along with two multivitamin tablets. This was a group of subjects at high risk of getting throat cancer. 14-15 It is a leap of faith to assume that a single nutrient would have identical effects to a combination of nutrients without substantial supporting evidence, which is still lacking; confounded by conflicting evidence and multiplying variables in meta-analyses. Since nutrients are both synergistic and present in the diet, it is important to factor those known variables into a proper study design. All too often, researchers do not consider this fundamental difference between drug and nutrient research and unwittingly introduce extra variables that undermine their conclusions. 16

This current meta-analysis of 4 studies - only one of which unquestionably shows a slight increase in lung cancer risk but does not actually measure isolated beta-carotene risk; two others are well-designed and robust studies looking at serum levels of those taking a high dose of beta-carotene but show no increased risk in lung cancer rates, and the fourth has been largely shown to be moot by a later and more complete re-analysis of the data - does not support the hypothesis that beta-carotene increases rates of lung cancer and that multivitamins are therefore dangerous. Thus, there is no sound basis in the current review for suggesting that warning labels may be needed for multivitamins or eye health supplements containing beta-carotene along with other nutrients that have been shown in well-designed studies to help protect the eyesight – and independence - of our aging population. REFERENCES:

1. Tanvetyanon T, Bepler G. Beta-carotene in multivitamins and the possible risk of lung cancer among smokers versus former smokers: a meta-analysis and evaluation of national brands. Cancer. 2008 Jul 1;113(1):150-7. PMID: 18429004
2. Valtueña S, et al. The total antioxidant capacity of the diet is an independent predictor of plasma beta-carotene. Eur J Clin Nutr. 2007 Jan;61(1):69-76. Epub 2006 Jul 12. PMID: 16835597 [Supported by the European Community IST-2001–33204 'Healthy Market', the Italian Ministry of University and Research COFIN 2001 and the National Research Council CU01.00923.CT26 research projects.]
3. Andreas Schieber, Reinhold Carle. Occurrence of carotenoid cis-isomers in food: Technological, analytical, and nutritional implications. Trends in Food Science & Technology, Volume 16, Issue 9, September 2005, Pages 416-422
4. van Poppel G, Poulsen H, Loft S, Verhagen H. No influence of beta carotene on oxidative DNA damage in male smokers. J Natl Cancer Inst. 1995 Feb 15;87(4):310-1. PMID: 7707423
5. Hennekens CH, Buring JE, Manson JE, et al. Lack of effect of long-term supplementation with beta carotene on the incidence of malignant neoplasms and cardiovascular disease. N Engl J Med. 1996 May 2;334(18):1145-9. PMID: 8602179
6. Lee IM, Cook NR, Manson JE, Buring JE, Hennekens CH. Beta-carotene supplementation and incidence of cancer and cardiovascular disease: the Women's Health Study. J Natl Cancer Inst. 1999 Dec 15;91(24):2102-6. PMID: 10601381
7. The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. The Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group. N Engl J Med. 1994 Apr 14;330(15):1029-35. PMID: 8127329
8. Wright ME, et al. Development of a comprehensive dietary antioxidant index and application to lung cancer risk in a cohort of male smokers. Am J Epidemiol. 2004 Jul 1;160(1):68-76. PMID: 15229119
9. Buijsse B, et al. Plasma carotene and alpha-tocopherol in relation to 10-y all-cause and cause-specific mortality in European elderly: the Survey in Europe on Nutrition and the Elderly, a Concerted Action (SENECA). Am J Clin Nutr. 2005 Oct;82(4):879-86. PMID: 16210720
10. Omenn GS, Goodman GE, Thornquist MD, et al. Effects of a combination of beta carotene and vitamin A on lung cancer and cardiovascular disease. N Engl J Med. 1996;334:1150–1155.
11. Bartlett H, Eperjesi F. Age-related macular degeneration and nutritional supplementation: a review of randomised controlled trials. Ophthalmic Physiol Opt. 2003 Sep;23(5):383-99. Review. PMID: 12950886
12. Liu BA, et al. Effect of multivitamin and mineral supplementation on episodes of infection in nursing home residents: a randomized, placebo-controlled study. J Am Geriatr Soc. 2007 Jan;55(1):35-42. Erratum in: J Am Geriatr Soc. 2007 Mar;55(3):478. PMID: 17233683
13. Blot WI, Li IY, Taylor PR, et al. Nutrition intervention trials in Linxian, China: supplementation with specific vitamin/mineral combinations, cancer incidence, and disease-specific mortality in the general population. J Natl Cancer Inst 1993:8ı:1483-92
14. Li JY, Taylor PR, et al. Nutrition intervention trials in Linxian, China: multiple vitamin/mineral supplementation, cancer incidence, and disease-specific mortality among adults with esophageal dysplasia. J Natl Cancer Inst. 1993 Sep 15;85(18):1492-8. PMID: 8360932
15. Blot WI, et al. The Linxian trials: mortality rates by vitamin-mineral intervention group. Am J Clin Nutr. 1995 Dec;62(6 Suppl):1424S-1426S. PMID: 7495242
16. Levin, N. Land of Confusion: How Poor Science and Misleading Media Coverage Create Public Confusion About How Dietary Supplements Affect Health. J App Nutr, Vol 55, No. 1, 2005 8-15

Should cancer patients take vitamins?

Regarding the article “Should cancer survivors take supplements?” (14:34 ET, Thu 21 Feb 2008, http://features.us.reuters.com/wellbeing/news/FA7141DA-E0B3-11DC-91C7-1D7C8A14.html), I had written a rebuttal to a letter in CA: the Journal of the American Cancer Society, addressing these issues. (1) It is available on the journal’s web page, posted after editorial review. I cite numerous studies in which dietary supplements were used with cancer therapies, with no apparent problems. Additionally, since 40% of cancer patients actually die of malnutrition, please consider that it is wise to try to devise strategies to nourish the patients…they can’t live solely on chemotherapy and radiation, or surgery. Soon after, a review article addressed the same issue, reaching a similar conclusion: it is possible to mix dietary supplements with cancer therapies, in many cases improving results, though the timing is important. “CONCLUSION: None of the trials reported evidence of significant decreases in efficacy from antioxidant supplementation during chemotherapy. Many of the studies indicated that antioxidant supplementation resulted in either increased survival times, increased tumor responses, or both, as well as fewer toxicities than controls; however, lack of adequate statistical power was a consistent limitation.” (2) Science Daily reported that, “There is no evidence that antioxidant supplements interfere with the therapeutic effects of chemotherapy agents, according to a recent systematic review of the use of antioxidants during chemotherapy, available in the May, 2007 issue of the peer-reviewed journal Cancer Treatment Reviews. In fact, they may help increase survival rates, tumor response, and the patient’s ability to tolerate treatment.” (3) REFERENCES: 1. Cancer patients may very well tolerate the use of certain dietary supplements http://caonline.amcancersoc.org/cgi/eletters/55/5/319#176 2. Block KI, et al. Impact of antioxidant supplementation on chemotherapeutic efficacy: a systematic review of the evidence from randomized controlled trials. Cancer Treat Rev. 2007 Aug;33(5):407-18. Epub 2007 Mar 23. Review. PMID: 17367938 [PubMed - indexed for MEDLINE] 3. Antioxidants May Aid Chemotherapy Patients. ScienceDaily. Retrieved February 22, 2008, from http://www.sciencedaily.com/releases/2007/04/070426132954.htm Neil E. Levin, CCN, DANLA http://www.honestnutrition.com/

Selenium Safety

Selenium Safety By Neil E. Levin, CCN, DANLA 9/21/07 My comments refer to “Effects of selenium supplementation for cancer prevention in patients with carcinoma of the skin. A randomized controlled trial. Nutritional Prevention of Cancer Study Group” 1 Giving high doses of a single antioxidant is contrary to the realities biology and nutrition. It is unfortunate that synergistic nutrients are tested individually, like drugs. This is a pharmaceutical practice, not human nutrition, and also shouldn’t imply that comprehensive mixtures of nutrients (like a multivitamin) would have the same effects. Additionally, giving these doses to sick patient populations typically results in the authors’ cautions that their results are not applicable to the general population. Still, this disclaimer is routinely ignored in the significant portion of the media that tends to sensationalize the results in headlines or brief televised “health segments”. Antioxidants are synergistic and simply don’t work in isolation. In fact, high doses of single antioxidants have been shown to create imbalances, in vivo, and may even backfire. I consider these cases to be a fault of the study design and a lack of understanding of the scientific field, not a defect of the nutrient being studied. This report was primarily a study of patients with skin cancers, with a increase in self-reported Type 2 diabetes found during a “secondary analysis”. This means that strict elimination of various factors and strict screening of patients was not completed in relation to this unexpected outcome, and that researchers relied primarily on patients’ anecdoctal reports of being diagnosed with diabetes during the trial. This raises issues of undiagnosed cases of diabetes at the start of or during the trial, since even a few missed diagnoses could have (admittedly) reduced or eliminated the significance of the results. Admittedly, “detailed information on unmeasured risk factors at baseline, such as family history of diabetes, body fat distribution, and physical activity, are lacking.” This expands the variables far beyond those accounted for in the study design, which was really looking at cancer recurrences. (More on that later.) Other concerns with this report: • Only Caucasians were included in the patient population; almost all participants in the NPC trial were non-Hispanic white persons. Three-quarters of participants were men. • Patient compliance was also self-reported, limiting validity of the data. • Selenium is not an antioxidant commonly associated with glucose metabolism, so its selection is a bit odd, though in some past studies the mineral has given some indications that it may be useful. However, its close association with vitamin E, and the lack of data on coinciding use of that and other antioxidants, raises more questions than answers. Selenium was used in a study primarily looking at its effect on cancer, with good reason based on past science, and with self-reported diabetes only noticed as varying between the groups incidentally. • The “risk for type 2 diabetes did not differ between treatment groups within the top tertile of BMI” (Body Mass Index, indicating the most overweight people). This strongly indicates another possible variable and alternative explanation, reducing the validity of the implication that selenium alone was the cause of the increased diabetes self-reports. • A well known, name-brand selenium supplement was changed for a different one late in the study, without explanation. • High-selenium yeast products may not work the same as selenomethionine, the most popular type of selenium supplement currently sold. And yeast itself is considered to be a good dietary source of selenium and other nutrients, yet yeast was the placebo. • The population was consuming more than the Daily Value of selenium in their diet, so this was not a particularly selenium-deficient group before supplementation. And since they had all had previously diagnosed skin cancer, it appears that significant other factors, especially antioxidant synergies, were lacking in this patient group. The researchers admit that, “we cannot rule out the role of chance in our findings.” In other words, they admit that their report doesn’t really prove anything. In fact, in the original trial, the focus was on selenium and cancer. What were those results? Selenium alone so successfully reduced cancer incidences and cancer mortality that the study was halted early because a lack of selenium was so clearly associated with higher incidences and deaths from cancer. “Primarily because of the apparent reductions in total cancer mortality and total cancer incidence in the selenium group, the blinded phase of the trial was stopped early. No cases of selenium toxicity occurred. CONCLUSIONS: Selenium treatment did not protect against development of basal or squamous cell carcinomas of the skin. However, results from secondary end-point analyses support the hypothesis that supplemental selenium may reduce the incidence of, and mortality from, carcinomas of several sites.” 2, 12 Regarding the editorial about selenium and diabetes published in the same edition of the journal Annals of Internal Medicine, negative comments were made about the general safety of antioxidant supplements. 3 I dispute that “randomized, controlled clinical trials have shown that ß-carotene and vitamin E supplements, which were widely believed to be safe, increase mortality and morbidity”. The choices, increasing variables, and manipulation by statistical models in meta-analyses are often questionable. In this report, prediabetic symptoms were not even considered as a variable. Buijsse noted that high carotenoid intake, confirmed by measures of blood levels, was associated with lower mortality rates among the elderly over a ten-year period, countering the claim that ß-carotene dangers are proven. 5 The Miller meta-analysis 9, cited as proof of vitamin E’s dangers, was heavily criticized in published responses, and its conclusions were NOT replicated when the same data was re-analyzed (Hathcock) 7. It should therefore not be cited as proof of the vitamin’s danger. Another meta-analysis cited reported that antioxidant vitamins may increase death rates. But the authors did not determine a dose-dependent or cause-and-effect relationship between antioxidants and deaths (from all causes) of study participants. The researchers pooled 68 published trials, excluding 405 published studies with no deaths reported. Too wide a range of potencies (Vitamin A 1333 IU - 200,000 IU, vitamin E 10 IU to 1000 IU), and durations (28 days to 12 years) were lumped together. 4 The editorial statement, “No dietary supplement, including selenium, has proven useful so far for the prevention of cardiovascular disease or cancer in the general U.S. population,” is questionable. The Alpha-Tocopherol, Beta- Carotene Cancer Prevention (ATBC) Study published by the National Cancer Institute demonstrated a 32% reduction in prostate cancer incidence in response to daily alpha-tocopherol supplementation. 8, 10 The Women’s Health Study (JAMA) reported a significant 24% reduction in cardiovascular death with supplemental vitamin E. 11 The NIH reports, “Taking a daily supplement containing 200 mcg of selenium … significantly reduced the occurrence and death from total cancers. The incidence of prostate cancer, colorectal cancer, and lung cancer was notably lower in the group given selenium supplements.” 13 Yet the Annals editorial suggests lowering consumption below the Daily Value (70 mcg) used in multivitamins, far below the current official upper limit of 400 mcg. 13 On the contrary, the Lewin Group reports that the use of antioxidants could save the vision and independence of many senior citizens, saving billions of dollars in healthcare costs. 6 REFERENCES: 1. Stranges S, et al. Effects of long-term selenium supplementation on the incidence of type 2 diabetes: a randomized trial. Ann Intern Med. 2007 Aug 21;147(4):217-23. Epub 2007 Jul 9. Summary for patients in: Ann Intern Med. 2007 Aug 21;147(4):I14. PMID: 17620655 [PubMed - indexed for MEDLINE] 2. Clark LC, Combs GF Jr, Turnbull BW, Slate EH, Chalker DK, Chow J, et al. Effects of selenium supplementation for cancer prevention in patients with carcinoma of the skin. A randomized controlled trial. Nutritional Prevention of Cancer Study Group. JAMA. 1996;276:1957-63. 3. J. Bleys, A. Navas-Acien, and E. Guallar. Selenium and Diabetes: More Bad News for Supplements. Ann Intern Med, August 21, 2007; 147(4): 271 - 272. 4. Bjelakovic G, et.al. Mortality in Randomized Trials of Antioxidant Supplements for Primary and Secondary Prevention: Systematic Review and Meta-analysis. JAMA 2007. 297(8):842-857 5. Buijsse B, et al. Plasma carotene and alpha-tocopherol in relation to 10-y all-cause and cause-specific mortality in European elderly: The Survey in Europe on Nutrition and the Elderly, a Concerted Action (SENECA). Am J Clin Nutr 2005;82:879–886. 6. DaVanzo JE, et al. An Evidence-Based Study of the Role of Dietary Supplements in Helping Seniors Maintain their Independence. The Lewin Group Inc. January 20, 2006 7. Hathcock JN, et al. Vitamins E and C are safe across a broad range of intakes. Am J Clin Nutr. 2005 Apr;81(4):736-45. Review. PMID: 15817846 8. Weinstein SJ, et al. Serum alpha -Tocopherol and gamma-Tocopherol in Relation to Prostate Cancer Risk in a Prospective Study. J. Natl. Cancer Inst. 2005 97: 396-399; doi:10.1093/jnci/dji045 9. Edgar R. Miller, III, MD, PhD; et al. High-dose vitamin E supplementation may increase all-cause mortality, a dose response meta-analysis of randomized trials. Annals of Internal Medicine. 4 January 2005 | Volume 142 Issue 1 10. Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study Group. The effect of vitamin E and beta-carotene on the incidence of lung cancer and other cancers in male smokers. N Engl J Med 1994;330:1029 –35. 11. Lee IM, et al. Vitamin E in the primary prevention of cardiovascular disease and cancer: the Women's Health Study: a randomized controlled trial. JAMA. 2005 Jul 6;294(1):56-65. PMID: 15998891 12. Combs GF Jr, Clark LC, Turnbull BW. Reduction of cancer risk with an oral supplement of selenium. Biomed Environ Sci. 1997 Sep;10(2-3):227-34. PMID: 9315315 13. Dietary Supplement Fact Sheet: Selenium. Office of Dietary Supplements • NIH Clinical Center • National Institutes of Health. http://ods.od.nih.gov/factsheets/selenium.asp

My review of studies supporting the use of aromatherapy to reduce symptoms of aging

http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003150/frame.html Aroma therapy is the use of pure essential oils from fragrant plants (such as Peppermint, Sweet Marjoram, and Rose) to help relieve health problems and improve the quality of life in general. The healing properties of aroma therapy are claimed to include promotion of relaxation and sleep, relief of pain, and reduction of depressive symptoms. Hence, aroma therapy has been used to reduce disturbed behaviour, to promote sleep and to stimulate motivational behaviour of people with dementia. Of the three randomized controlled trials found only one had useable data. The analysis of this one trial showed a significant effect in favour of aroma therapy on measures of agitation and neuropsychiatric symptoms. More large-scale randomized controlled trials are needed before firm conclusions can be reached about the effectiveness of aroma therapy. Aroma therapy for dementia. Cochrane Database Syst Rev. 2003;(3):CD003150. Review. PMID: 12917949 http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=9672344&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus RESULTS: Eight randomized, controlled trials were located. Collectively they indicate that peppermint oil could be efficacious for symptom relief in IBS. A metaanalysis of five placebo-controlled, double blind trials seems to support this notion. In view of the methodological flaws associated with most studies, no definitive judgment about efficacy can be given. Peppermint oil for irritable bowel syndrome: a critical review and metaanalysis. Am J Gastroenterol. 1998 Jul;93(7):1131-5. PMID: 9672344 In aromatherapy, grapefruit is used to treat depression and induce euphoria, whereas lavender is beneficial in reducing stress and relaxing the mind. This raises the possibility that stimulation with grapefruit or lavender may influence the activity of sympathetic nerves. Mechanism of changes induced in plasma glycerol by scent stimulation with grapefruit and lavender essential oils. Neuroscience Letters, Volume 416, Issue 3, 18 April 2007, Pages 241-246 The antimicrobial and antioxidant properties of essential oils have been known for a long time, and a number of investigations have been conducted into their antimicrobial activities using various bacteria, viruses and fungi. A common feature of plant volatiles is their hydrophobic nature, and studies addressing the mode of antimicrobial action of such compounds generally point to the cell membrane as primary target (Stammati et al., 1999). Recent studies have shown that essential oils of oregano, thyme, clove and cinnamon are among the most active in this respect. Chemical analysis of these oils has shown the constituents to be principally carvacrol, thymol and eugenol and their precursors...Essential oils—their antimicrobial activity against Escherichia coli and effect on intestinal cell viability. Toxicology in Vitro, Volume 20, Issue 8, December 2006, Pages 1435-1445 Symptoms of tiredness, lack of muscle co-ordination and dysarthria, and difficulty in maintaining attention in elderly people may be wrongly labelled as part of the ageing process and so ignored. If adequate sleep can reduce these symptoms and restore therapeutic activity, it is of enormous value to elderly people in retaining their independence and quality of life. Safe promotion of sleep without daytime lethargy is needed. In order to test the hypotheses that Essential Oil of Lavender has a sedative effect, and that the resultant sleep promotes therapeutic activity, a pilot study was arranged with acutely ill elderly people. This was followed by a more detailed trial with long-term patients. The results show a positive trend towards improvement with lavender. The value of lavender for rest and activity in the elderly patient. Complementary Therapies in Medicine. Volume 4, Issue 1, January 1996, Pages 52-57 These findings clarify that lavender and rosemary enhance FRSA [free radical scavenging activity] and decrease the stress hormone, cortisol, which protects the body from oxidative stress. Smelling lavender and rosemary increases free radical scavenging activity and decreases cortisol level in saliva. Psychiatry Research Volume 150, Issue 1, 28 February 2007, Pages 89-96 A general feature of these various antioxidant parameters measured was that their activities remained higher in rats whose diets were supplemented with thyme oil, suggesting that they retained a more favourable antioxidant capacity during their life span. Dietary supplementation of thyme (Thymus vulgaris L.) essential oil during the lifetime of the rat: its effects on the antioxidant status in liver, kidney and heart tissues. Mechanisms of Ageing and Development. Volume 109, Issue 3, 8 September 1999, Pages 163-175 Symptoms of tiredness, lack of muscle co-ordination and dysarthria, and difficulty in maintaining attention in elderly people may be wrongly labelled as part of the ageing process and so ignored. If adequate sleep can reduce these symptoms and restore therapeutic activity, it is of enormous value to elderly people in retaining their independence and quality of life. Safe promotion of sleep without daytime lethargy is needed. In order to test the hypotheses that Essential Oil of Lavender has a sedative effect, and that the resultant sleep promotes therapeutic activity, a pilot study was arranged with acutely ill elderly people. This was followed by a more detailed trial with long-term patients. The results show a positive trend towards improvement with lavender. The value of lavender for rest and activity in the elderly patient. Complementary Therapies in Medicine. Volume 4, Issue 1, January 1996, Pages 52-57 Aromatherapy can be a useful addition to self-care especially in managing stress and minor self-limiting conditions. Caring for the wounded healer—nurturing the self. Journal of Bodywork and Movement Therapies. Volume 10, Issue 4, October 2006, Pages 251-260 The goal of this study was to investigate the impact of the essential oils of orange and lavender on anxiety, mood, alertness and calmness in dental patients. Two hundred patients between the ages of 18 and 77 years (half women, half men) were assigned to one of four independent groups. While waiting for dental procedures patients were either stimulated with ambient odor of orange or ambient odor of lavender. These conditions were compared to a music condition and a control condition (no odor, no music). Anxiety, mood, alertness and calmness were assessed while patients waited for dental treatment. Statistical analyses revealed that compared to control condition both ambient odors of orange and lavender reduced anxiety and improved mood in patients waiting for dental treatment. These findings support the previous opinion that odors are capable of altering emotional states and may indicate that the use of odors is helpful in reducing anxiety in dental patients. Ambient odors of orange and lavender reduce anxiety and improve mood in a dental office. Physiology & Behavior. Volume 86, Issues 1-2, 15 September 2005, Pages 92-95 In this review we detail the current state of knowledge about the effect of lavender oils on psychological and physiological parameters and its use as an antimicrobial agent. Although the data are still inconclusive and often controversial, there does seem to be both scientific and clinical data that support the traditional uses of lavender. Biological activities of lavender essential oil. Phytother Res. 2002 Jun;16(4):301-8. Review. PMID: 12112282