Nutrients for Bone and Joint Health Interview

This interview was given to Whole Foods Magazine, excerpts were published in the February 2011 issue:

Despite evidence in recent medical journals, including several review studies calling for a far higher RDA and UL (upper limit) that would be five times the previous levels, the IOM held true to its conservative bent and raised the RDA and the UL; but only by 50% by only 100%, respectively . Observers are somewhat disappointed, but not really surprised. The most controversial part of the IOM committee’s report is that the only proven role for vitamin D is in bone and calcium metabolism, combined with its finding that most Americans already get enough for those benefits. That should come as news to researchers from Mayo Clinic operating under an NIH grant who recently reported that “Vitamin D insufficiency is common globally and in the United States. Approximately 25-50% of patients seen in routine clinical practice have vitamin D levels below the optimal range…” It also should be news to European regulators that recognize vitamin D’s beneficial effects on muscles, immunity, inflammation, cellular health, and reproduction. We recognize the new increased recommendations for vitamin D and the new higher safety recommendation, but believe that these numbers are insufficient to support vitamin D’s roles that go beyond calcium and bone health.

The need for joint and bone health nutrients in general increases with age. Aging also tends to reduce absorption of nutrients, forcing us to take higher amounts and better forms in order to assure adequate nutrition. The tendency of many seniors to cut back on meals, for reasons such as loss of taste or smell or interest in cooking, may also increase the need for supplementation of essential nutrients. The major joint and bone problems increase with age, and studies have shown the ability of relevant nutrients to maintain healthy bone and joint structures during these vulnerable times of life. Older customers that are more likely to take calcium supplements also tend to have diminished stomach acid available for digesting calcium from food and non-chelated (predigested) forms, so tend to do better with the predigested forms. These include calcium as citrate, malate, ascorbate, or bonded to specific amino acids; all are weak acidic sources that form a stable bond with the alkaline calcium and the resulting compound simulates the calcium complexes formed naturally during proper digestion.

While calcium and vitamin D are known for their role in bone and calcium metabolism, there are other nutrients necessary for bone health. These include silica, boron, magnesium, vitamins C and K, etc. protein. Comprehensive bone formulas include over a dozen nutrients, which are also available singly.

Children need to get sunshine, exercise, and a variety of calcium from food sources to ensure the body’s needs for bone health. If the child does not eat ample amounts milk and dark green leafy vegetables, they may need to complement the diet with appropriate dietary supplements.

Adults need to take care of their bodies and not impact the joints too much with hard exercises or excess weight. Support the joints nutritionally with glucosamine, vitamin C, a good multivitamin, and natural substances that modulate inflammation.

One should not neglect the long-term benefits of glucosamine to maintain joint distances that may otherwise erode, for example, while seeking fast-term temporary relief of aches and pains. By providing those products in both categories as well as overlapping combination products, we can supply a more holistic and sustainable nutritional joint support program.

Many of the Joint Structural Support Products contain varying amounts of glucosamine and/or chondroitin, as well as MSM, Hyaluronic Acid, and other well-known ingredients.

New evidence that many Americans don't get sufficient vitamin D!

These quotes are from an NIH-funded study at Mayo Clinic, just published by the the American Society of Hematology in its medical journal "Blood" (Shanafelt TD, et al. Vitamin D insufficiency and prognosis in chronic lymphocytic leukemia (CLL). Blood. 2010 Nov 3. PMID: 21048153). It suggests that 30-40% of the general population is deficient in vitamin D, and that this vitamin has a "central role" in the body beyond bone health:

"Vitamin D insufficiency is common globally and in the United States. Approximately 25-50% of patients seen in routine clinical practice have vitamin D levels below the optimal range, and it is estimated that up to 1 billion people worldwide have vitamin D insufficiency." 1-3

"Vitamin D has a central role in maintaining serum calcium and skeletal homeostasis as well as multiple other cellular effects including regulation of differentiation, proliferation, apoptosis, metastatic potential, and angiogenesis.5 Several reports now suggest low serum 25(OH)D levels may be associated with increased incidence of colorectal,6,7 breast,8,9 and other cancers.10 Consistent with these results, one population based, double-blind, randomized placebo-controlled trial found women who increased their daily vitamin D intake by 1100 IU reduced their risk of cancer by 60-77%." 11

"Consistent with the prevalence of hypovitaminosis D in the general population,1-3 30-40% of CLL patients in the two observational cohorts studied had vitamin D insufficiency."

These quotes cited the following references in the statements posted above:

1.Thomas MK, Lloyd-Jones DM, Thadhani RI, et al. Hypovitaminosis D in medical inpatients. N Engl J Med. 1998;338(12):777-783.
2. Holick MF. High prevalence of vitamin D inadequacy and implications for health. Mayo Clin Proc. 2006;81(3):353-373.
3. Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357(3):266-281.
5. Bikle D. Nonclassic actions of vitamin D. J Clin Endocrinol Metab. 2009;94(1):26-34.

6. Gorham ED, Garland CF, Garland FC, et al. Vitamin D and prevention of colorectal cancer. J Steroid Biochem Mol Biol. 2005;97(1-2):179-194.
7. Yin L, Grandi N, Raum E, Haug U, Arndt V, Brenner H. Meta-analysis: longitudinal studies of serum vitamin D and colorectal cancer risk. Aliment Pharmacol Ther. 2009;30(2):113-125.
8. Crew KD, Shane E, Cremers S, McMahon DJ, Irani D, Hershman DL. High prevalence of vitamin D deficiency despite supplementation in premenopausal women with breast cancer undergoing adjuvant chemotherapy. J Clin Oncol. 2009;27(13):2151-2156.
9. Chen P, Hu P, Xie D, Qin Y, Wang F, Wang H. Meta-analysis of vitamin D, calcium and the prevention of breast cancer. Breast Cancer Res Treat. 2009.
10. Garland CF, Gorham ED, Mohr SB, Garland FC. Vitamin D for cancer prevention: global
perspective. Ann Epidemiol. 2009;19(7):468-483.
11. Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP. Vitamin D and calcium
supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr. 2007;85(6):1586-
1591. 

Mayo doctor errs on dietary supplements

The following Letter to the Editor of the Chicago Tribune was written by Neil E. Levin, CCN, DANLA Chicago Tribune To the editor In your paper on Sunday January 21 a medical column by the Mayo Clinic made some factual errors. Dr. Textor stated that, regarding supplementation with the amino acid L-arginine to reduce blood pressure and the subsequent risk of stroke, “there is no evidence that either of these outcomes actually occurs in humans”. Not true! The Journal of Nutrition published a review of the scientific literature, done by a researcher at the Evans Department of Medicine, Cardiology Section, and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, which stated, “Numerous studies, though not uniformly, demonstrate a beneficial effect of acute and chronic L-arginine supplementation on EDNO production and endothelial function, and L-arginine has been shown to reduce systemic blood pressure in some forms of experimental hypertension.” Alternative Medicine Review published another review, reporting that, “Supplementation with L-arginine has been shown to restore vascular function and to improve the clinical symptoms of various diseases associated with vascular dysfunction.” A study published in that journal concluded, “This is the first study showing a moderate dose of sustained-release L-arginine can improve endothelial function and blood pressure.” Regarding strokes, the journal Nitric Oxide reported, “We performed a systematic review of published controlled studies of L-arginine (the precursor for NO) and NO donors in experimental stroke,” and concluded, “L-Arginine and NO donors reduced total cerebral infarct volume in permanent and transient models of ischaemia. Drug administration increased cortical CBF in permanent but not transient models.” This indicates that L-arginine and similar nutrients may reduce the risk of stroke damage. While not conclusive, this is published human clinical data that arginine may be useful to help manage hypertension and reduce the risk of strokes if used under a physician’s care, which is quite different from there being “no evidence” of these possible outcomes. Dr. Textor also erred in giving his opinion that dietary supplements are unregulated, stating that, “Because they are not officially considered drugs, supplements are not regulated by the U.S. Food and Drug Administration, so you don’t know what is actually contained in the products you’ve purchased.” As the agency’s name implies, the FDA does regulate foods – including dietary supplements as a specially regulated class of food – as well as regulating drugs and cosmetics. And the FDA has the statutory power to remove any adulterated or mislabeled drug, food or cosmetic from the marketplace. Check the FDA website and get a second opinion direct from the source. It is unfortunate that an otherwise fine medical column offering useful information about health strategies for hypertension was marred by the doctor giving inaccurate opinions about dietary supplements that are contradicted by information from scientific journals and government sources. Unfortunately, many people (including some health professionals and journalists) believe these myths about dietary supplements only because they are ignorant that a large body of evidence exists evidencing their regulation, safety and efficacy. Neil E. Levin, CCN, DANLA Board certified clinical nutritionist St. Charles, IL REFERENCES: Chicago Tribune, 1/21/07, From the Mayo Clinic: Don’t gamble on unproven blood pressure treatments, Section 13, page 8 http://www.chicagotribune.com/features/health/chi-0701210096jan21,1,4697775.story Gokce N. L-arginine and hypertension. J Nutr. 2004 Oct;134(10 Suppl):2807S-2811S; discussion 2818S-2819S. Review. PMID: 15465790 Boger RH, Ron ES. L-Arginine improves vascular function by overcoming deleterious effects of ADMA, a novel cardiovascular risk factor. Altern Med Rev. 2005 Mar;10(1):14-23. Review. PMID: 15771559 Miller AL. The effects of sustained-release-L-arginine formulation on blood pressure and vascular compliance in 29 healthy individuals. Altern Med Rev. 2006 Mar;11(1):23-9. PMID: 16597191 Willmot M, Gray L, Gibson C, Murphy S, Bath PM. A systematic review of nitric oxide donors and L-arginine in experimental stroke; effects on infarct size and cerebral blood flow. Nitric Oxide. 2005 May;12(3):141-9. Review. PMID: 15797842

Wrong TIME

Wrong TIME By Neil E. Levin, CCN, DANLA The Time article “State of Reliefs: HOW THE CONTROVERSIAL YET POPULAR SUPPLEMENT BUSINESS EMERGED IN UTAH” (10/1/06) mostly deals with MLMs (multi-level marketers) rather than other types of dietary supplement companies, but there are a few problems with the reporting. Time relies on quotes from notorious anti-supplement partisans who do not often admit to the peer-reviewed science of supplements: the Mayo Clinic and Dan Hurley. It is not even possible that Mr. Hurley's claim could be true ("the vast majority of supplements taken by Americans have been proven to be unsafe, ineffective or both"). If so, the FDA and the majority of companies that really do care about consumers' health would have already voluntarily or forcibly pulled them off the market. The mainstream dietary supplement industry's primary motivation is to provide safe, effective natural products, not to hurt or scam people. Most dietary supplement companies are science-driven and their labels and claims are scrutinized for accuracy and compliance with federal laws, such as the law (DSHEA) that the article falsely accuses of reducing FDA authority. Even the FDA itself denies this on their own website, as well as in the Congressional testimony of several FDA commissioners. DSHEA disallows any dietary supplement claims related to disease, so companies only offer documented structure-function claims as to how the supplements may affect the individual. These claims are submitted to the FDA for scrutiny and the agency has the power to ask for changes to these claims. The law also provides that any ingredient introduced to the market after October of 1994 must have a New Dietary Ingredient packet submitted to the FDA with evidence of safety, as well as allowing the FDA to set rules for good manufacturing practices, so the article's claim that DSHEA "released manufacturers from demonstrating that products were safe before being sold" is not quite accurate. In my personal opinion, Ephedra was only banned because of the FDA's misrepresentation of this herb’s safety record and an arbitrary dismissal of all of its proven benefits to produce a slightly negative risk/benefit ratio. (1,2) Rand Corporation researchers actually reported that up to 155 reported deaths possibly linked to Ephedra were contradicted by its own review of published Ephedra studies that found no deaths, strokes or any serious side effects reported from using the herb, yet the Time report only reports the association of Ephedra to these deaths, despite a complete lack of evidence of cause and effect. (3) The Rand report also stated that Ephedra, with or without caffeine, provided a statistically significant increase in short-term weight loss compared to placebo: about 2 pounds per month for up to 6 months, which contradicts the FDA's decision that Ephedra has only risks and no benefits. Several other review studies have also concluded that Ephedra is safe when properly used. (4,5) And while the Time article implies that an appeals court rejected the safety record of Ephedra ("Utah company Neutraceutical Corp. [sic] is still arguing that lower doses are safe, but in August the firm was overruled by an appeals court"). But the court did not really rule on whether or not the herb is safe because it was narrowly focused on the FDA's authority to implement DSHEA. To read the original Time article, click on this link: http://www.time.com/time/insidebiz/article/0,9171,1541294-2,00.html REFERENCES: 1. 21 C.F.R. Pt. 119, Final Rule Declaring Dietary Supplements Containing Ephedrine Alkaloids Adulterated Because They Present an Unreasonable Risk (Published February 11, 2004) (Effective April 12, 2004) available at http://www.fda.gov/ohrms/dockets/98fr/1995n-0304-nfr0001.pdf 2. Federal Register: February 11, 2004 (Volume 69, Number 28). 3. Shekelle PG, et al. Efficacy and safety of ephedra and ephedrine for weight loss and athletic performance: a meta-analysis. JAMA. 2003 Mar 26;289(12):1537-45. Epub 2003 Mar 10. PMID: 12672771 4. Morgenstern LB. Use of Ephedra-containing products and risk for hemorrhagic stroke. Neurology. 2003 Jan 4;60(1):132-5. Erratum in: Neurology. 2003 Mar 25;60(6):1055. PMID: 12525737 5. Soni MG, Carabin IG, Griffiths JC, Burdock GA. Safety of ephedra: lessons learned. Toxicol Lett. 2004 Apr 15;150(1):97-110. Review. PMID: 15068827