Four Good Reasons to Take a Multivitamin

I do not know how many times I have been asked the question "why should I take a multivitamin?" - but today I am going to share some of the answers with you. This blog post started off as one on immunity. I have had a lot of people asking me lately what they can do to boost their immunity. They seem surprised when I mention taking a daily multivitamin. The following list is by no means an exhaustive list of reasons why you should take a multivitamin, but I think it is some good reasons.

1. Experts agree that we don't get enough nutrition from our food. In the perfect world, all your essential vitamins and minerals would come from the foods you eat every day. You would eat a nutrient dense, modest calorie diet, not worry about weight gain, and feel confident that food was meeting your needs. That is not the world we live in. There is more data than I can cite that clearly shows our diets (even those of us who watch what we eat carefully) tend to be nutrient poor. More often, they are calorie rich AND nutrient poor, which is why we simultaneously have increasing obesity and poor nutrition. In 2001, researchers from the Harvard School of Public Health writing in the New England Journal of Medicine said the following:  "Given the greater likelihood of benefit than harm, and considering the low cost, we conclude that a daily multivitamin makes sense for most adults. Substantial data suggests that higher intakes of folic acid, vitamin B6, vitamin B12, and vitamin D will benefit many people, and a multivitamin will ensure adequate intake of other vitamins." (1)  The following year, researchers from Harvard Medical School, wrote in the Journal of the American Medical Association: "Most people do not consume an optimal amount of all vitamins by diet alone.  Pending strong evidence of effectiveness from randomized trials, it appears prudent for all adults to take vitamin supplements." (2)
2. Taking a multivitamin is good for immunity.  There has been a great deal of research looking at the the use of basic nutrition in the form of a multivitamin for preventing infection and improving immunity.  The vast majority of studies have been done in the over-65 population, because nutritional status tends to decrease and community acquired infections (like the flu and pneumonia) tend to increase and become more deadly as we age.  The findings are almost 100% positive.  Again, far too many studies to cite, but if you search Google Scholar for "multivitamin and immunity" you'll find plenty of good reading material.  What about in the non-elderly?  In a study published in 2003, researchers gave a daily multivitamin to adults aged 45-64 and found that the rates of infection and days of lost work were significantly less in those taking a multivitamin compared to those taking a placebo. (3)  
3. Taking a multivitamin may help you to control your appetite.  Two studies published in November 2007 in the British Journal of Nutrition indicate that taking a multivitamin and mineral supplement may assist in weight management. The first study reported on a survey of survey of 267 men and 320 women aged 20 to 65. (4) The survey found that in men regularly taking a dietary supplement weighed less, had less body fat, and lower BMI than those who did not. Women reported similar results, as well as generally reduced appetite.  In the second study, obese patients were placed on a low calorie diet and either given a multivitamin or placebo. (5) While both groups lost weight equally, those taking the multivitamin reported significantly reduced hunger both between and after meals.  What should this tell us? Our metabolism is driven by nutrients - vitamins and minerals are the cofactors that make all the reactions work. When we lack these nutrients, things just don’t work as well. Moreover, a basic reason we eat is to get the nutrients we need. When the body doesn’t get enough of what it needs, one thing it does is make you feel hungry so you will eat more to get those nutrients.
4. It might make your cells younger.  Let's face it, most of us either want to stay young or be younger.  Most of the focus these days on "anti-aging" is on cosmetic procedures.  You can lift, inject, color, and tighten whatever you want, but that does not change anything but what you see in the mirror.  Research published earlier this year from the National Institute of Environmental Health Sciences found that the cells of multivitamin users were biologically younger than those of non-users. (6) As we age, a piece of DNA called a telomere that resides at the end of your chromosomes gets shorter.  When the telomere is finally "consumed" the cell dies (a process called apoptosis).  Thus telomere length is often looked at a a measurement of cellular age.  This particular study looked at the cells of 586 women aged between 35 and 74.  Multivitamin users had, on average, telomeres that were 5% longer than those of non-users of the same age.

Even if you think you eat really well, taking a multivitamin is a sensible health insurance policy for most adults.  I also think it's a good idea for kids, but perhaps we will leave that for a separate blog post.  I think the hardest thing for most people who have never supplemented before is simply getting started and making this part of your routine.  Here are two ideas to help you get in the habit of taking a vitamin.  First, put them where you will see them every day.  Inside your medicine cabinet is usually not that place.  I suggest setting the bottle of multivitamins by your toothpaste or on the desk in your office (or one in each place).  Second, set a reminder for yourself.  Most of us carry a PDA or cell phone these days.  Set a daily alarm to chime at the time when you want to take your vitamins.  You probably won't need to do this forever, but it can be a great tool when you are trying to make this a new habit.

In Health,


Dr. Jacques


References:
(1) Willett WC, Stampfer MJ. Clinical practice. What vitamins should I be taking, doctor?  N Engl J Med. 2001 Dec 20;345(25):1819-24.

(2) Fletcher RH, Fairfield KM.  Vitamins for chronic disease prevention in adults.  JAMA 2002; 287:3127-312. 

(3) Barringer TA, Kirk JK, Santaniello AC, Foley KL, Michielutte R. Effect of a multivitamin and mineral supplement on infection and quality of life. A randomized, double-blind, placebo-controlled trial.  Ann Intern Med. 2003 Mar 4;138(5):365-71.

(4)(5) G.C. Major, E. Doucet, M. Jacqmain, M. St-Onge, C. Bouchard, and A. Tremblay. Multivitamin and dietary supplements, body weight and appetite: results from a cross-sectional and a randomised double-blind placebo-controlled study. Br J Nutr. 2007 Nov 1;:1-11

(6) Xu Q, Parks CG, DeRoo LA, Cawthorn LM, Sandler DP, Chen H.  Multivitamin use and telomere length in women. Am J Clin Nutr. 2009 Jun;89(6):1857-63.

Hoodia for Weight Loss

When I put out a call for ingredients that people wanted more information about I was not expecting to get questions on Hoodia. In the world of natural products for weight loss, ingredients come and go - there is always a "hot" trend" - and Hoodia really hit that status 3 or 4 years ago.

Nonetheless, I got more requests to talk about Hoodia than anything else, so here we go.

First, some history. Hoodia, primarily the species Hoodia gordonii, is a traditional plant of Southern Africa. The San people of the Kalahari Desert would eat this plant to ease thirst and hunger when they were traveling, and short on readily available food sources. Literature also suggests that the San found Hoodia to be helpful for indigestion and other mild GI complaints.

In the 1960s, the Council for Scientific and Industrial Research (CSIR) took an interest in Hoodia and other indigenous plants for their possible medicinal properties. CSIR later contracted with a British pharmaceutical company called Phytopharm LTD to continue the investigation of Hoodia as a drug for appetite suppression. Phytopharm isolated a compound called p57, which they felt was the active ingredient responsible for the appetite-suppressing qualities of the plant. They licensed this to pharmaceutical giant Pfizer in 1998. Pfizer dropped the product after early clinical trials for vague reasons. Reports/rumours later circulated that the levels of Hoodia required to suppress appetite in rats and dogs was extremely large and produced severe liver damage. It may have also caused kidney damage. (You can read about that here, but remember, most of this is not validated: Hoodia Report from Fatnews)

Take two. After the failed attempt with Pfizer, whatever the reasons, Phytopharm entered into a contract with Unilever. Unilever was researching p57 as an addition to its popular SlimFast line of diet products. After 4 years of research, Unilever followed Pfizer and dropped p57 in late 2008. The publicity following this split often quoted executives from Unilever as saying that "clinical study concluded that Hoodia could not meet Unilever’s safety and efficacy standards." (read more here: Hoodia Finds Life After Unilever)

But wait, you ask, Hasn't Hoodia been available as a dietary supplement for years?? Yes it has. Concurrent to all this negotiation over the patented p57 (this patent expires in 2017, by the way), the natural products industry (reeling from the loss of Ephedra in 2004) jumped all over Hoodia as a traditional weight loss ingredient - and this created another set of problems.

Hoodia has long been acknowledged by the Convention on International Trade in Endangered Species (CITES), as a fragile species. It is apparently slow growing and hard to harvest. When it began to boom in popularity two things happened: 1) you had a lot of plant poaching - literally people stealing the herb to sell - and 2) you had a lot of product showing up here in the US that probably was not Hoodia at all (read more about fake Hoodia here: Fake Hoodia Fears Easing as Market Stabilizes). Fortunately, for the past few years, this seems to be improving. Methods for farming Hoodia have improved as have methods for identifying the genuine ingredient.

So what is the good news? Those who have practiced traditional herbal medicine will tell you that when you take a plant that has had a long history of being used for "condition x", try to isolate a chemical out of it and then expect the same results, you may not get what you are looking for. There are many great examples of this such as hypericin from St John's Wort and lobeline from Lobelia inflata. The San people ate whole Hoodia, not p57. But you can't patent the plant...

So if you are going to use Hoodia as part of your weight management strategy, you are actually likely to be better off with the whole plant extracts that are present in dietary supplements and not the isolated p57 - at least until if/when research proves otherwise. Also if you are going to take Hoodia, take a certified product - for example Naturex's HoodiaPure® - or others with CITES certification.

In Health,

Dr. Jacques

Omega-3 Updates

It seems like omega-3 fatty acids are competing with vitamin D for "most famous nutrient" award this year. There has been so much research published this year on these nutrients that it's almost more confusing for the public.

There have been several newsworthy pieces on omega-3 fats lately that have generated enough email to my in-box that I think they are worth blogging about.

1) In this study - Plasma n-3 polyunsaturated fatty acids are negatively associated with obesity - published in the British Journal of Nutrition, researchers examined blood levels of omega-3 fats in 124 people of varying body mass index (BMI). They found that, in general, people with higher BMIs (those who weighed more) had lower levels of omega-3 that those with lower BMIs. Most of the questions I have received are from people who want to know if this studying is saying that taking more omega-3 will cause you to weight less. There is no data yet to support that. However, there are other profound health benefits of these fats that make including them in your diet or taking them in a supplement worthwhile. Keep in mind that an average serving of salmon can have 2 or more grams of omega-3 - so those in the very high fish intake group may have been getting levels well above those shown to be health-supportive.

2) A study (Long-chain omega-3 fatty acids, fish intake, and the risk of type 2 diabetes mellitus) that hit the news more recently followed the health of 195,204 US adults for 14 to 18 years. Part of what researchers tracked was intake of fish and other sources of essential fatty acids. During the course of the study, 9380 people developed type 2 diabetes. Intake of fish and other essential fats was not associated with a reduced risk for developing diabetes. Actually, the highest intakes of fish (5 times or more per week), were associated with a 20% INCREASED risk. The researchers called this "modest". I do not call that modest. There is other research indicating that in those with diabetes or at risk for diabetes high intakes of omega-3 may elevate blood sugars. I think that until we know more, we should caution people against high intakes if omega-3 fats, and encourage the modest intakes that are associated with so many health benefits.

3) This leads me to the final story on this topic. A new review published in the Journal of the American College of Cardiology looked at studies involving approximately 40,000 people. They concluded that overwhelming evidence suggests that for prevention of heart disease, everyone should take 500 mg per day of omega-3 fatty acids as EPA and DHA (eicosapentanoic acid and docosahexanoic acid - the omega-3s from fish). For those with a known risk for heart disease, they suggest a higher dose of 800 to 1000 mg/day is well-supported by research. To read more on this review, click here: Omega-3 review: Half a gram needed for heart benefits.

So the conclusions for now:
Omega-3 fatty acids are important for good health. They have been shown to support the health and development of the brain and the eye, and we know they modulate inflammation, benefit the skin, joints, hormone balance and more. It does not, however, appear that they help you lose weight - but you never know what future studies might show. Levels of 500 to 1000 mg are appropriate for those who are looking to prevent heart disease. Very high intakes seem to increase the risk for diabetes - so until we know more, go for moderation. My final added advice - if you are relying on fish as your main source of omega-3, please seek clean sources. Fatty fish like salmon and tuna are often contaminated with pesticides, herbicides, and heavy metals that accumulate in your body and are truly harmful. Here is a great list of fish rated by average mercury levels: NRDC Fish List

In Health,

Dr. Jacques

Vinegar for Weight Loss

I get a lot of questions about natural ingredients for weight loss. One thing that I will do with this blog is review as many of them as I can with a particular focus on reviewing the available research. Apparently, there was a recent piece that appeared on WebMD about cider vinegar for weight loss. I have had several questions on this since the article appeared. (To read the original piece, click here.)

Apple cider vinegar has been touted as a cure-all for everything from digestive ailments to rheumatism. Hippocrates, the “Father of Medicine” reportedly gave it to patients as a healing tonic in 400 BC. To the best estimates of modern-day herbalists, apple cider vinegar first appeared in weight loss remedies in the 1970s – although modern proponents claim that this was the secret weight loss cure of Ancient Egypt. The secret recipe that started the modern-day trend was a blend of Apple Cider Vinegar, kelp (seaweed), lecithin, and vitamin B6. The story was that the lecithin emulsified fat, iodine in the kelp increased thyroid function (speeding up metabolism), B6 somehow metabolized the freed fat, and the vinegar would then breakdown or dissolve the fat and accelerate metabolism. Other theories have tied weight loss benefits of Apple Cider Vinegar to increased detoxification or improved pH.

Is there any actual evidence that Apple Cider Vinegar can help you lose weight? Not much. I did find a study done in Egypt in 2001 that showed that mice given a high dose of Apple Cider Vinegar for 4 weeks had significant weight loss compared to those on a controlled diet. However, the vinegar-eating mice also had pretty significant damage to their livers, stomachs, and small intestines – including erosion of the lining of the stomach and intestines (ie, ulcers) and changes in the cells of the liver. Not good for the mice. The study that was discussed in the WebMD article was also done in mice fed a diet high in vinegar for 6 weeks. They did not lose weight, but researchers reported that the vinegar "inhibited the accumulation of body fat." So what we really have to date is some less than spectacular data in mice.

Somehow, people always want to take these kinds of animal studies and transform them into the next great miracle cure for obesity. So what about studies in humans? A small study conducted in 2005 on 12 adults found that subjects who consumed 2 tablespoons of vinegar with a meal of bread reported less hunger after their meal. The same researcher later conducted a study in 13 adults and found when subjects used an oil and vinegar dressing with a meal of potatoes, they had lower post-meal blood sugars and a healthier insulin response. Finally, one study from 2004 gave a dose of 2 tablespoons of vinegar to 15 adults before lunch and dinner for 4 weeks. Compared to placebo, the vinegar group lost an average of 2 pounds over 4 weeks.

While these small trials are interesting, they do not look at big enough numbers to be significant and they do not address other issues of health. I have found one case report of a woman who suffered an acid burn in her esophagus from taking Apple Cider Vinegar tablets - she apparently did not lose weight. As part of the follow up to that case, investigators tested many products and found that some of them were so acidic (containing acetic acid levels over 20%) that they were in the range that the Consumer Product Safety Commission considers poisonous to humans.

Overall, Apple Cider Vinegar has some very good and valid uses. You can use it in salad dressing, it makes a great addition to marinades or to tenderize meat, you can clean gold jewelry with it, and you can use it as a natural weed killer in your garden. But as a weight loss agent, it has not yet been shown to be effective, and it could be harmful. Future more rigorous studies in humans might show doses that have both good safety and health benefits. For now, proceed with caution.

References:

Mohamed el-OA, Mohamed SM, Mohamed KA. The effect of cider vinegar on some nutritional and physiological parameters in mice. J Egypt Public Health Assoc. 2001;76(1-2):17-36.

Hill L. L., Woodruff L. H., Foote J. C., Barreto-Alcoba M. Esophageal Injury by Apple Cider Vinegar Tablets and Subsequent Evaluation of Products. JADA; 105(7): 1141-1144 (July 2005).

Ostman E, Granfeldt Y, Persson L, et al. Vinegar supplementation lowers glucose and insulin responses and increases satiety after a bread meal in healthy subjects. European Journal of Clinical Nutrition, 2005;59;983-988.

Leeman M, Ostman E, Bjorck I. Vinegar dressing and cold storage of potatoes lowers postprandial glycaemic andinsulinaemic responses in healthy subjects. European Journal of Clinical Nutrition, 2005

Johnston CS, Kim CM, Buller AJ. Vinegar improves insulin sensitivity to a high-carbohydrate meal in subjects with insulin resistance or type 2 diabetes. Diabetes Care, 2004;27:281-282.

Welcome

Welcome to my blog. Those who have known me throughout my life would never call me a person of small opinions, but I never thought I would feel inspired to share them in this way. Sometimes, however, something us moves us to action, and that happened to me recently. Let me explain.

I am a doctor of naturopathic medicine. I have had private practice, but have spent most of the past decade in the dietary supplement industry speaking, writing, formulating, and more. I have become very passionate about this industry, it's people, and the ability of good people and good products to affect change. Yet for all the good in this industry, there is ample bad. We have far too many examples of deceptive advertising, products laced with drugs, and other unsavory problems. For these reasons and more, I and others have championed continued industry improvements regulating advertising, labeling, and manufacturing.

So here is what happened to me recently. I got a "friend" request on Facebook from a medical school classmate. That's usually a very nice thing because I have lost track of many of my classmates and I generally like hearing about their lives and how they are doing. I accepted the request and left a nice note on my colleague's wall to say hello. The following day my own page was suddenly inundated with posts from this doctor promoting "miracle" weight loss products and denouncing bariatric surgery. Sigh. (Another thing to know about me is that I have spent the past eight years working in the bariatric surgery industry and serving on the board for the non-profit Obesity Action Coalition.) In a matter of moments my "friend" had managed to fill my page with deceptive advertising for products and offend all the weight loss surgery patients I am connected to at the same time.

So I lost a friend and gained some motivation. I know a lot about natural medicine. And I can use this knowledge for good. The driving force behind this blog is to talk about natural products, diets, and related subjects and look at them with a critical eye. If I can make one person healthier and one person safer, I'll feel pretty good about doing this. I think every consumer of natural products should be able to have a way to understand their safety, their efficacy, the reality behind the claims - good and bad. Because it's fun for me, I might also comment on current health topics and news as well. You may even get a recipe or a book review from time to time.

To get you started, here are a couple of other related pieces I have written:

1. Nutritional Mythology - this is a piece discussing false advertising claims for weight loss products in the dietary supplement industry. This was written for WLS Lifestyles Magazine.
2. Selecting a Weight Management Program - this is a nicely related piece on finding a good weight management program that recently appeared in the OAC Magazine.

Enjoy. Leave comments. Suggest topics.

In Health,

Dr. Jacques