Thursday, November 29, 2007

My second letter to Reader's Digest about vitamins

Subject: Re: Vitamin Hoax Thank you for your reply. But your statement that "supplements are unregulated" is completely untrue, and is contradicted by the FDA itself on its own official Web page [“FDA regulates dietary supplements under a different set of regulations than those covering "conventional" foods and drug products (prescription and Over-the-Counter).”]. Are your experts completely unfamiliar with the Dietary Supplement Health and Education Act prohibiting new dietary ingredients without FDA pre-approval and regulating adulterated products and label claims, the Serious Adverse Event reporting act passed last year, the mandatory federal current Good Manufacturing Practices (cGMP) that are now being implemented requiring quality controls and identity testing of ingredients, and currently operational GMP-audited manufacturers? That inflammatory falsehood is exactly the kind of media myth that evidences bias or abject misunderstanding. You have represented a misguided opinion as fact, when it is clearly contradicted by official records of the FDA, FTC and the Congressional Record in both law and regulations. As a watchdog for clinical studies that are misrepresented or poorly done, it is obvious to me that your writers cherry-picked negative studies that were heavily criticized, some contradicted by more robust data or not able to be replicated, and some done with very sick people where the results were admittedly not applicable to healthy populations. Many scientists simply fail to understand the topic of nutrition, thinking that nutrients should be taken just like drugs: in isolation and in high potencies to treat disease in their studies. That is pharmaceutical medicine, not basic human nutrition, which is an all-too-common mistake that creates a lot of confusion when applied to the moderate dietary supplements used by ordinary people to enhance their vitamin-starved modern diets. Using examples of potential side effects from taking amounts far above commonly available supplement potencies as the main reason to avoid taking them entirely is intellectually dishonest, in my opinion, when no one was actually suggesting that everyone take those mega dose amounts in the first place. When you say that, “Food (especially locally farmed food) is the only way to get your vitamins that's absolutely proven to be safe and effective”, you are only partially right. I am a nominee to the Illinois Local and Organic Food Task Force, on a slate approved by the state Department of Agriculture, so I do understand your point and empathize. But you forget the tens of thousands of people affected annually by food poisoning. This makes vitamins orders of magnitude safer than food, especially fresh foods, and are thus more deserving of your praise for safety and efficacy. You also seem to forget that vitamins are regulated as a special, highly regulated food category by the federal government (by law), and not as drugs. If it is so 'easy' to "get what you need from food" then why does your own report admit that only 3% of us get the minimal nutrient levels from our diet? That really disproves this tired old mantra, doesn't it? It is pure institutional bias that prevents the NIH from recommending multiple vitamins, when even the mainstream medical journal JAMA has done so years ago. If you remember (I do), it took the federal government 20+ years to endorse the use of folic acid to fortify foods denatured of that essential vitamin, during which entire time the evidence was already strong that it could prevent birth defects; with a request in to the Nixon administration that it was time to take action. The March of Dimes recommended this fortification long before the government finally caved in (during the Clinton administration!), but meanwhile thousands of children were born each year with potentially preventable and predictable birth defects while waiting for the perpetually elusive 'more conclusive evidence'. But there never seems to be enough evidence when we're talking about dietary supplements. Even a multiple vitamin taken by the mothers should have been enough to spare these children, but the government still to this day won't fully act to protect people's health by recommending that the 97% of us not eating even minimally right take a simple and safe daily multivitamin, as many doctors already recommend. Are we so set on forcing people to eat right, when they clearly won't, that we should all just pretend that taking a multivitamin as nutritional 'insurance' is somehow fundamentally wrong? In good conscience, I can't do that. I know better. And so do most Americans, who have opted to take vitamins and do so without much risk. Perhaps you haven’t noticed the reports that our food supply has dramatically dropped in nutritional value over the past half century due to factors such as chemical farming, less nutritious plant varieties, changes in storage and handling, etc? The nutritional content of U.S. fruits and vegetables has declined over the past 50 years, according to a researcher at the University of Texas. Cited in an article by Scripps Howard News Service, biochemist Donald Davis said that of 13 major nutrients in fruits and vegetables tracked by the Agriculture Department from 1950 to 1999, six (protein, calcium, phosphorus, iron, riboflavin and vitamin C) all showed noticeable declines. Declines ranged from 6% for protein, 20% for vitamin C, and 38% for riboflavin. [February 2006, official meeting of the American Association for the Advancement of Science in St. Louis, MO] Data from the Department for the Environment, Food and Rural Affairs (DEFRA) showed that, between 1940 and 1991, trace minerals in UK fruits and vegetables fell by up to 76 per cent, and United States Department of Agriculture (USDA) figures showed similar declines. [McCance and Widdowson 1940–1991, The Composition of Foods, 1st to 5th editions, published by MAFF/RSC] [Mayer AM, 1997, ‘Historical changes in the mineral content of fruits and vegetables’, in Lockeretz W (ed.), Agricultural Production and Nutrition, Tufts University School of Nutrition Science and Policy, Boston, MA, p 69–77. See also British Food Journal 99(6), p207–211] [Bergner P, 1997, The Healing Power of Minerals, Special Nutrients and Trace Elements, Prima Publishing, Rocklin, CA, p 312] Neil E. Levin, CCN, DANLA

Friday, November 16, 2007

A Tale of Two Studies: Vitamin E - Food vs Supplements

Vitamin E: Food vs Supplements Here is an illustration of the apparent contradiction between whether food sources of vitamin E are better to prevent prostate cancer than supplemental vitamin E sources: Two large studies, both published in the same technical journal at the same time, seem to reach contradictory results as to whether supplemental vitamin E is valuable in relation to prostate cancer. But are they both equal and contradictory? Actually, one is far more rigorous, and thus presumably more valid, than the other. In the first one (Serum and Dietary Vitamin E in Relation to Prostate Cancer Risk <1>), definite and large benefits were shown for supplemental alpha-tocopherol vitamin E, but not for food sources (containing mostly gamma-tocopherol). In the second one (Supplemental and Dietary Vitamin E Intakes and Risk of Prostate Cancer in a Large Prospective Study <2>), only food sources containing gamma-tocopherol were effective, but not supplemental vitamin E as alpha-tocopherol. A closer look reveals that the first study responsibly looked at serum levels and food plus supplemental vitamin E intake, then related that data to prostate cancer rates over up to 19 years afterward. This study's conclusion was that, "In summary, higher prediagnostic serum concentrations of alpha-tocopherol, but not dietary vitamin E, was associated with lower risk of developing prostate cancer, particularly advanced prostate cancer." The second study looked only at questionnaires related to subjects' intake of vitamin E from food and supplements at the start of the 5-year study, then compared the number of cancers over a 5-year period to data obtained from that questionnaire. The incubation period for cancers is estimated to be in the decades, rarely a period of 5 years or less. That, along with the lack of any data on serum antioxidant status and the use of a questionably reliable survey to determine intake of vitamin E from food or supplements, makes the second report far less meaningful than the first one. Don’t get me wrong, I am not against food sources of nutrients and routinely recommend vitamin E sources containing gamma-tocopherol, along with the full range of tocopherols and tocotrienols. But when preliminary or sketchy science is all-too-often reported as if it’s definitive when it’s really not, and when it is contradicted by better science, I am compelled to put things into a more realistic perspective. The measurement of serum levels in the body, along with careful reporting of a nutrient’s intake from various sources, is much more compelling than relying on a questionnaire that may be done by memory. It is well-known among nutritionists that daily food diaries are notoriously different than weekly food surveys done by memory recall, which almost always seem to conveniently forget the junk food, snacks and extra calories. A cancer study lasting nearly 4 times as long is also far more compelling than a shorter one because it will be more likely to encompass the cancer’s incubation period and allow for the development of symptoms that will allow detection. As the National Cancer Institute reports: “Prostate cancer often does not cause symptoms for many years.” <3> The use of supplemental alpha-tocopherol is supported by other reputable studies. For example, The Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study demonstrated a 32% reduction in prostate cancer incidence in response to daily alpha-tocopherol supplementation. <4> Levels of Vitamin E above 100 IU daily are associated with decreased risk of coronary heart disease and certain types of cancer, as well as enhancement of immune function. These increased vitamin E intakes (100 I.U. and above) are considerably above levels obtainable from diet alone. <5-7> In the case of supplemental vitamin E, the results for prostate cancer in the more rigorous, better designed and better implemented study shows that it is more beneficial for prostate health than only food sources of vitamin E, which also tend to be much weaker amounts (often far below 100 IU daily, with Americans’ typical intake being only around 9.5 IU (6.4 mg) of alpha-tocopherol, below the RDA of 22.5 IU (15 mg). <8-9> This indicates our general need for supplemental vitamin E, unless by some miracle we all suddenly decide to eat wholesome natural foods containing a lot more vitamin E. But in the meantime, it would be nice if these studies were put into perspective so we could accurately assess their value to our health habits. Unfortunately, media coverage of negative reports, especially regarding vitamins, tends to drown out the positive ones, even when the good news is backed by studies with better design and implementation. In this case, supplemental vitamin E was the clear winner over the abysmal amounts in our diet, which ideally should be increased to healthy levels. REFERENCES: 1. Weinstein, SJ, et al. Serum and Dietary Vitamin E in Relation to Prostate Cancer Risk. Cancer Epidemiol Biomarkers Prev 2007 16: p. 1253-1259 2. Wright, ME, et al. Supplemental and Dietary Vitamin E Intakes and Risk of Prostate Cancer in a Large Prospective Study. Cancer Epidemiol Biomarkers Prev 2007 16: p. 1128-1135 3. National Cancer Institute’s Web site 4. 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 Mar 2;97(5):396-9. PMID: 15741576 5. Bauernfeind, J. Tocopherols in Foods. In: Vitamin E: A Comprehensive Treatise. Marcel Dekker, Inc., New York and Basel, pp. 99-167, 1980 6. Horwitt, M.K. The Promotion of Vitamin E. J. Nutr. 116:1371-1377, 1986 7. Weber, P., Bendich, A. and Machlin, L.J. Vitamin E and Human Health: Rationale for Determining Recommended Intake Levels. Nutrition 13:450-460, 1997 8. Ervin RB, Wright JD, Wang CY, Kennedy-Stephenson J. Dietary intake of selected vitamins for the United States Population: 1999–2000. Advance data from vital and health statistics; no 339. Hyattsville, Maryland: National Center for Health Statistics. 2004 9. Vitamin E, Office of Dietary Supplements • NIH Clinical Center • National Institutes of Health

Natural Controversies

On Thursday, November 8, 2007 I began writing the book, "Natural Controversies". The intention is a consumer-friendly referenced guide with specific examples of how to navigate sensational reports and conflicting claims about natural products and therapies. On November 15, I registered that title as a website name, temporarily pointing it to this blog (until the book is finished and the webpage can properly showcase it).

Wednesday, November 07, 2007

Letter sent to Reader's Digest in response to The Vitamin Myth (11/07)

Myths about Vitamin Dangers While “The Vitamin Myth” did responsibly quote experts refuting some negative reports emphasized in the article, the overall tone was sensationalist and negative, greatly exaggerating supposed risks. Vitamins may be among the safest substances known, typically causing no deaths in any given year. The article emphasized heavily-criticized single reports in preference to more rigorous published research contradicting the alleged dangers (for example, of vitamin E), a common media error. Megadoses far above levels commonly consumed were highlighted as reasons why we should not take vitamins, with confusing potencies listed for oil-soluble vitamins by weight rather than by the consumer-friendly IU measurements. The lack of specific disease benefits was presented as the only reason not to take certain vitamins (“Vitamin C: There’s no conclusive evidence that it prevents colds, heart disease, cataracts or cancer.”), reflecting an expectation and bias not shared by many nutrition experts. Any such disease claims are regulated as “drug claims”, which are prohibited for vitamins. Were you really that hard up to find 10 reasons not to take vitamins? Nutrients are not drugs, may require synergies with other nutrients for best effect, and may be misrepresented by the conclusions of review studies that combine dissimilar protocols. Even your article admits that only 3% of us get the minimal amounts of vitamins and minerals from our diet, making supplementation essential for virtually every American.