 A 2016 Frontline special was highly critical of the vitamin and supplement industry, pointing out that it is largely unregulated, that supplements are not proven to be useful, and that some people have become quite ill or even died due to a supplement they were using.
I actually agree with much of what they discussed on the show. The only thing I thought was a strange omission (given the topic) is that they never mentioned that we do have some independent third party testing for supplements, through ConsumerLab and LabDoor. Frontline also downplayed the known benefits of vitamins and herbs. For example, they never mentioned that in a 2012 research paper, 14,641 male physicians were randomized to receive a multivitamin or placebo, and followed over 10+ years. The group that took the vitamin had an 8% reduction in cancer. So vitamins may be poorly regulated but they are worth looking into. Moreover, contrary to Dr. Offit's assertion that most of us are getting enough vitamins, the US Department of Agriculture freely admits that most Americansdo not consume sufficient quantities of many vitamins. Right at the top of the list, only 46% of Americans consume enough vitamin A. 13% consume enough vitamin E. So, do you need to take vitamin supplements? How will you figure this out? CLARITY IS POSSIBLE I would like to help bring some clarity to the situation. That would take writing a book of course, but here are a few thoughts. I come at this from a very strict conventional medicine background. I practiced as a conventional family physician for 20 years (1987-2008) and during that time did not use or recommend any preventative vitamins. When I “discovered” functional medicine, I decided to suspend disbelief and try the supplements recommended by Dr. Mark Hyman in The Ultramind Solution. I was really amazed to feel that they were helping me (that was not a scientific observation, but an intuitive one). I then joined a group of physicians who were all to some extent transitioning from conventional to functional medicine, and we formed a “lab group” so we could share our experiences with the myriad of new and unusual tests that we saw being used by alternative medical providers. Which ones were reliable? We really wanted to know. Having followed a flawed recipe for health during our time in conventional medicine, we were quite determined to figure out how to provide the best care for our patients. WHAT ARE ALL THESE PILLS OUT THERE FOR? I see five basic types of pills sold without a prescription:
RELIABLE TESTS First there are some substances for which there are reliable tests. These include coenzyme Q10, vitamin D, vitamin B12 (though you need to check a methylmalonic acid, the B12 level is not sufficient) and other B vitamins (measured indirectly using the serum homocysteine – not perfect, but if too high, you know you need them – usually). The reason to test and treat for these is that insufficiency either causes fatigue and difficulties with the immune system, or may cause a number of problems in the future. The most important issue is prevention of Alzheimer’s Disease. This is such a long latency disease that our main focus is prevention (though it can sometimes be reversed with a functional medicine approach). Proper vitamin levels may not be sufficient for prevention, but they provide some insurance. There’s a few more nutrients I can test for reliably, including zinc, iron, selenium, and essential fatty acids, including long-chain fatty acids (omega 3s, omega 6s, arachidonic acid, etc.) and short chain fatty acids (made by beneficial bacteria). Cholesterol is another nutrient we can measure. LDL cholesterol, often called “bad cholesterol”, is actually the building block for many critical structures: cell walls, myelin sheath for nerve cells, and steroid hormones like estrogen, testosterone, progesterone, cortisol, vitamin D and thyroid hormone. So how “bad” can it be? Well, there are many sizes of LDL, and it can be in a normal state, or an oxidized or glycated state, and each of these sizes and states matter to cardiovascular health. We can measure all these, and it’s not expensive, but it is often not done. LESS RELIABLE TESTS There are nutrients one can only hope to get a good handle on: these include vitamins A, C, E, and magnesium. It seems you can best measure these indirectly, by looking at levels of certain metabolite levels (body substances), or at damaged cell structures, like lipid peroxides and the level of 8-OH-deoxyguanosine, a cancer predictor. UNRELIABLE TESTS Finally there are nutrients that we really can’t measure. For example, there are many tests for iodine but none are reliable indicators of deficiency or sufficiency. I used to like the serum iodine but now I am not sure it’s the best way to go. Experts in the supplementation field recommend a careful trial of iodine rather than testing. Many tests attempt to quantify beneficial bacteria and I am not sure we are really getting a good picture from them. The situation is so complex, some won’t grow in culture, and the techniques for detecting them are imperfect. In research, arrays of beneficial bacteria seem to have a tantalizing story to tell but in individual patients, I can only make out very broad generalities. I actually like to look at their output (the short chain fatty acids they synthesize) better than their presence or absence. Calcium levels are available but they tell us more about abnormal hormonal conditions or dangerous cancer side effects than about dietary calcium sufficiency. Whether calcium sticks to bone or not seems to depend more on just about everything else: fruits and vegetables in the diet, level and type of exercise, gluten sensitivity, etc. Calcium is also important for cardiovascular health, and it is true that if you consume no dairy and few vegetables, you are likely to be deficient. GAMING THE SYSTEM I use just a few herbs because to me they are in the same general way of thinking as medications. They may be better suited to our body than manufactured chemicals, They may sometimes accomplish what medications can’t. But in general, they are not a root-cause solution. I use some herbs that help reduce the impact of stress while someone is recovering from a long series of stressful events that have impacted the functioning of the adrenal glands. But along with these, I use stress reduction practices and tools to change how we respond to what bothers us. I use turmeric or a combination of anti-inflammatory herbs to try to get someone off anti-inflammatory medications which can cause intestinal permeability (and a vicious circle of inflammation). I’m sure some people need to stay on turmeric, in certain situations where damage will not completely resolve. I use red yeast rice when the harmful type of LDL cholesterol won’t resolve in spite of reasonable efforts with a functional medicine approach. There are many natural substances one can use to alleviate symptoms while we attempt to heal the underlying systems: inositol, N-acetyl cysteine, acetyl-l-carnitine, alpha lipoic acid, and many, many more. So many in fact that this is a significant problem with the first phase of functional medicine treatment: having to take so many pills. The goal is to get to a final minimum, or even to stop taking them altogether. VITAMINS FOR HEALTHY PEOPLE If you have no symptoms, no fatigue, no digestive issues, no joint pains (my three favorite symptoms to reverse!), no autoimmune disease, no strange neurological sensations, no mood or mind issues – should you still take a preventive vitamin? There are two things you can do to answer this question:
DO VITAMINS/SUPPLEMENTS CONTAIN WHAT THEY CLAIM? Here’s one last problem, in fact they sometimes don’t contain what they claim to contain. If you see a functional medicine provider, she will in fact tell you her favorite brands. Ask how she knows: does she read ConsumerLab or LabDoor? These are third party testing organizations that try to find out what is in vitamins and supplements, and whether they may be contaminated with lead (which can be a problem for herbs, for example). If you are on your own, you may have to get a subscription to ConsumerLab just long enough to figure out a specific set of vitamins and supplements. MY FAVORITES Well, my favorite types (because my favorite may depend on the condition):
CONCLUSION Why would Frontline present a documentary with such frightening headlines? Will supplements make you sick? If you avoid performance enhancers and get advice from a provider you trust, or use the resources that exist for assessing the adequacy and safety of vitamins and supplements, you would likely come out ahead. It’s not dangerous, but it does take some work to figure out. On the other hand, I hate to say it, but pharmaceutical companies have been trying to get the supplement industry regulated so they can take over. One problem they face is that the medications they promote themselves have very high rates of adverse effects: in 2009, the Drug Abuse Warning Network calculated that 50% of nearly 4.6 million drug-related emergency room visits were attributed to adverse reactions to medications taken as prescribed!! Dr. Paul Offit (interviewed on the Frontline documentary) is well aware of this, as his own Rotavirus vaccine is known to cause a very dangerous condition called "intussusception." But he is essentially employed by a pharmaceutical company that funds the “chair” he sits in and the Institute he created, and perhaps prefers to talk about the side effects of vitamins rather than the side effects of pharmaceuticals. We need to be careful what regulations are put in place, or only well-funded Big Pharma will be able to sell vitamins. The problem is that some of these pharmaceutical companies have a long history of hiding research findings and promoting their products without following regulations. So, yes, we need to fix the system we have, but let's be smart about it. REFERENCE Gaziano J, Sesso HD, Christen WG, et al. Multivitamins in the Prevention of Cancer in Men: The Physicians' Health Study II Randomized Controlled Trial. JAMA. 2012;308(18):1871-1880.
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AND OTHER REASONS TO BUY ORGANIC
Should you eat organic? Should you choose organic meat, or fruits and vegetables? Are the “clean fifteen” OK to buy “non-organic”? It’s hard to answer these questions without a point of reference. What are your goals? How did you come to adopt these goals? What are the underlying questions? We have grown used to inexpensive food (compared to other nations) to the point that our household budgets are dependent on it. However, there are many reasons to make a change, and not only for the most heavily contaminated “dirty dozen” crops. Here are some of the reasons to prioritize organic food: 1. Organic food is better for your health. We finally have a study that followed 35,000 Danish women through pregnancy. Women who ate mostly organic foods had half the chance that their baby boys would be born with a birth defect called hypospadias. This defect involves the development of male reproductive organs, which are sensitive to the hormone disrupting effect of many pesticides. 2. Organic food is the moral thing to do: we have solid research indicating that children of farmworkers, and children in farm areas, are affected by the pesticides we use on our food. If there were less such food, these impacts would be lessened. Our choices affect others’ lives. 3. Healthier farm children translate into lower health bills for our nation, and improved school scores, and hopefully an improved workforce. ADHD, for example, can lead to increased rates of low school achievement, drug use, truancy, and arrests. We should all care about outcomes for farm children. 4. Pesticides are affecting our environment: actually, few disagree on this point. Do we think that the destruction of our environment will never impact our own health and happiness? Of course it does. We are part of this ecosystem. For example, if bees become extinct, our food supply will be threatened. We should boycott all products raised with the use of neonicotinoid pesticides. Now. The world needs bees, we can’t afford to wait for scientists and businessmen to agree. 5. The old saying that “the dose makes the poison” is now believed to be false in many cases. You shouldn’t believe anything you read that relies on this argument. Unfortunately, many chemicals that affect our hormones work more powerfully in small doses than large. How can this be? Simple. These chemicals interact with receptors in our bodies. The receptors adjust to the level of chemical in the environment. If there is a low level, they accept the chemical and become affected by it. If there is a high level, they inactivate and stop becoming affected. Many chemicals were initially tested at high doses because we were looking for cancer-causing potential. Once they were found to be hormone mimics, the rules changed. They must be shown safe all over again, and many simply haven’t been tested. 6. Our regulatory agencies never thought that the effects of chemicals would pile up on top of one another. They somehow thought that if each chemical is at a safe level, then the food is safe to consume. But the truth is that the effects of chemicals add up on top of one another, even if they act on different biochemical pathways. It seems prudent to avoid chemicals where we can, even if their individual levels are deemed safe. 7. I sometimes see journalists make the argument that vegetables already contain toxins, which occur naturally to deter predators, and therefore we don’t need to be worried about small amounts of man-made pesticides. But I don’t understand: if plants, which we must eat to get our vitamins and phytonutrients, already contain toxins, then why add to the toxins they contain by eating vegetables with pesticides? IS THERE A SAFE AMOUNT? The basic question is whether there exists an amount of poison that is the minimum amount to cause any effect at all. Is there a threshold below which it doesn’t matter in any way that you swallowed a bit of poison? As described above, levels of chemicals are additive (and sometimes worse than additive), and thus we really have no idea of the final effect of the mixtures we may be exposed to. It also depends on the effect you are considering. If you worry about acute poisoning, meaning death within the week, there is definitely an amount that is safe. If you worry about getting leukemia and dying, there is an amount but it’s much lower. For example, mothers who use pesticides in their home up to a year before the birth of a child have children with a measurably higher risk of getting leukemia. If you are trying to measure subtle changes in personality, or in intelligence, or behavior, then there often is an even lower limit of acceptable toxin. Over time, we have lowered the allowable limits of lead for example, because of being better able to measure the brain damage caused by small amounts of lead. First we used IQ, later we used reading scores. You may say, what is the importance of this subtle behavior change? I may never notice the difference even with my kids. That may be true, but from the point of view of the country as a whole, if all the kids are a little more hyperactive, then thousands more kids will be actually “diagnosed” with ADHD, and thus many more will be taking medication and requiring follow up. It’s as though there were thousands of children on the cusp of being considered hyperactive, and this extra small amount of pesticide pushed them over the edge and into a “diagnosable” category. The same happens with developmental delay, or autism, or anxiety and depression. Many illnesses are a matter of degree. BETTER DEFENSE There is yet another concern. Some children have slower defenses than other kids when it comes to getting rid of these chemicals. A standard dose accumulates and will lead to symptoms they may never have had if they were a faster “detoxifier”. Doctors don’t test detoxifying capacity or efficiency. There is no way to know except after the fact, when neurological damage has occurred. In one recent case (the case of Heather Poling), the courts ruled that a young girl acquired autistic behaviors due to a vaccine she received, because she had a genetic defect that left her vulnerable to this. We wish we had ways to detect all such children ahead of time, but we don’t. We understand the pathways in only a small number of children. We see that many children with autism actually seem to regress like this girl, but we don’t understand the sequence of neurological events very well at all. So we can’t say what “caused” it, but chemicals known to be neurotoxins at a specific dose, while okay for most, may be very harmful for a few. There is no doubt that disabilities, specifically learning and behavior disabilities in children, are on the rise. The chance of having a child with autism is about 1 in 50 at this time. Autoimmune diseases, asthma, eczema, and allergies are also on the rise, including severe food allergies. Even for adults, neurological diseases are on the rise, such as Parkinson’s disease, which has a proven link to pesticide use. HOW DO WE DECIDE In the face of neurological damage rising nationwide, would you choose to give your kids neurotoxins, in any amount? In the face of increasing immunological abnormalities, would you choose to give them immune system toxins? What if you have one of the children with the genetically slow detoxification pathways? What is unfair in this country is that so few children have access to clean nutritious food, and that not all children are safe from harmful farm practices. Let’s right this! If all of us who can afford it insist on clean food, we will have more clean farms, and cheaper clean food. This will allow even more people to be able to afford clean, tasty, healthy food. This is how you correct an injustice. Our main agricultural outputs include corn, soy, and wheat. The first two are controlled by a single corporation that happens to be a pesticide manufacturer, and whose publicly expressed goal is the control of the entire food supply. Massive government subsidies flow to this type of agriculture. In turn, the largest corporations fund our universities and direct the public conversation on the need for artificial inputs in order to grow affordable food. Careful studies have shown, however, that we don’t need chemical agriculture. In fact, given climate change and yields under unpredictable weather conditions, small-scale organic agriculture is what we need to turn to in the decades to come. This is the time to transition to organic food as a nation: for our health and that of our kids’, and our neighbors and their kids’; for our environment and for our future as a species on this planet.  In November 2014, California researcher Dale Bredesen reported on a therapeutic program he used to successfully reverse cognitive decline (see link at bottom of article). He reported on 10 patients who were enrolled in this program. Six of his 10 patients had discontinued work due to memory issues, but after following his program, they were able to return to work. All patients but one improved on objective measurements, as well as subjectively. Several months after the publication of this article, there are now about 45 patients and the results continue to be encouraging. A research study with 200 patients is being launched by MUSES Lab.
This therapeutic program is based on a multifaceted approach. It contains the following components: o The patients’ diet was optimized by minimizing carbohydrates and inflammatory foods o A 12 hour fast was instituted each night o Stress was reduced using a personalized approach o Sleep was optimized, including treating sleep apnea where needed o Exercise was increased o Brain stimulation was added in the form of software such as Posit o Blood tests were used to optimize B and D vitamin sufficiency, and zinc to copper ratio o Vitamin E, selenium, NAC, alpha-lipoic acid, coQ10 were added o Anti-inflammatory herbs were used for patients with high levels of inflammation o Thyroid hormone was balanced o Gastrointestinal function was improved o Herbs and other substances that improve cognition were recommended o Building blocks for brain cell communication were provided (Citicoline, DHA, etc…) o Heavy metals were tested and reduced where appropriate This program is very exciting because there are no medications presently that are truly effective in preventing decline, let alone reversing it. It may seem strange that this hasn't made headlines: but what brand new medical therapy ever does? First, there is Step 1: a small group of patients are convinced to try a new approach. If this works well, then, in Step 2, more patients are enrolled. Eventually, we get to Step 3: the drug company funds a large trial costing millions of dollars, researchers tally and publish the findings and gradually, the treatment is adopted by medical providers. The process normally takes about 15-20 years. But here we are on Step 1. We have a group of patients who have met with resounding success. How do we get to Step 3: what deep pockets will fund this type of approach? The treatment is time-consuming and demanding, but it does NOT pose a health risk. I see no reason not to consider it. Most importantly, the program makes a lot of sense from a functional medicine perspective: we need to identify and correct all the underlying causes of inflammation, because inflammation disturbs mitochondria (energy transducers in your cells) and in turn that causes the brain to function very poorly. Then we need to use all the tools we have: we have research showing that exercise helps mitochondria a little bit; we know overnight fasting helps them a bit too; we know the supplements used in this program work a little bit; and we know a lot of people with Alzheimer's or Parkinson's or multiple sclerosis, or epilepsy, or depression and anxiety for that matter--benefit from the low-carb diet. What Dr. Bredesen's approach does that is new is that it combines a large number of these interventions. He explains it thus: "If you had a roof with 17 holes in it, would you want just a single one fixed? Would that be satisfactory? So we fix all 17 holes, that is why there are so many components to this program." I am very excited to put this to the test. I am sticking very close to Dr. Bredesen's successful recipe: first I do a functional medicine consultation, to uncover all the likely sources of inflammation and identify all the possible nutrient deficiencies. At baseline, we get brain function tests so we have a score to compare to in 3 months when we re-test. Then, step by step, week by week, we add one or two components as tolerated. The visits can be brief, and follow up can be as frequent as you like. Within 3 months, with any luck at all, your life will be transformed. If you wonder whether this is for you, you can use an online tool to see how your brain function compares to that of other people your age. You can take brain tests on Lumosity for example. If you want to read the article for yourself, here's the link: Bredesen, D.E. 2014. Reversal of Cognitive Decline: A Novel Therapeutic Approach. Aging 9(7): 707-717  Yet another study is reported today that casts doubt on the value of supplementing vitamin D. Subjects were given either 400 iu daily or 50,000 iu twice a week. No difference in outcome was seen. I am going to agree with them for one minute here: I would not use either one of these options. However, it boggles the mind that we are still so unsophisticated in our analyses of vitamin D. I present here a summary of studies that DID find a benefit. Since randomized studies of supplementation have not found harm, it seems the choice is whether to take a risk (that appears very small so far) to get an advantage as detailed below. MAIN TAKEAWAY POINTS:
For this review, I have focused on randomized controlled trials of vitamin D supplementation. Vitamin D supplementation in general, without regard to condition or level, generally reduces all-cause mortality (Chowdhury et al, 2014) and improves pregnancy outcomes (Sablok, 2015). The most obvious benefit of vitamin D supplementation is for people whose vitamin D is below 20 ng/mL. In my opinion, this group makes it worthwhile to screen everyone with a vitamin D level, as supplemented patients will experience fewer bone fractures, less injury from falls, better tooth retention, better sleep and well being, less overall pain, less cardiovascular disease, less asthma and COPD, less influenza, fewer colds, and less pneumonia (see Table 1). If people already have certain medical conditions, raising vitamin D using supplements will help them to have better outcomes with Hepatitis C treatment, to have less joint pain (with rheumatoid arthritis), less neuropathy (with diabetes), less pain (with fibromyalgia), better glucose control (with gestational diabetes), lowered insulin resistance (teenagers with prediabetes), less eczema, and fewer episodes of otitis media (for children prone to otitis) (see Table 2).   One study compared gene expression in people with low vs. normal vitamin D levels. They found 66 genes expressing differently between the two groups. In vitamin D deficient subject, supplementation corrected the expression of these genes (Hossein-nezhad et al, 2014).
The expression of several immunological markers was improved in a group of patients with multiple sclerosis supplemented to a average level of 50 ng/mL (Terrier et al, 2012). In many cases, research has not shown a benefit to attaining levels above 35 ng/mL, and there are concerns that there may be adverse consequences of excessive vitamin D supplementation. However, it is hard to draw firm conclusions in that regard. Few research subjects attain levels much above 35 ng/mL, making it difficult to find statistically significant differences above that level. The studies showing associations between high vitamin D levels and certain illnesses do not involve a randomized controlled comparison of people taking different doses of vitamin D. This introduces the possibility that there are other reasons people with high vitamin D levels sometimes have higher fracture risk (Bleicher et al, 2014), more Type 1 diabetes (Gorham et al, 2012) or higher risk of cardiovascular disease. For certain conditions, a vitamin D level above 40 ng/mL is the most beneficial (Munger et al, 2006). In fibromyalgia, maximum benefit was found when patients were supplemented to levels exceeding 48 ng/mL (Wepner et al, 2014). Some neurologists (Gominak et al, 2012) claim that it is necessary to supplement patients to levels of 60-80 ng/mL to correct sleep problems, including sleep apnea, and levels above 80 ng/mL may offer additional advantages in autism (Cannell, personal communication; Perlmutter—in his book, Grain Brain). Some people have genetics that result in lower vitamin D levels (Wang et al, 2011). These variants are near genes involved in cholesterol synthesis, hydroxylation and vitamin D transport. There are also inborn errors of vitamin D metabolism, some of which can be overcome with vitamin D supplementation (Malloy et al, 2010). Some people also have genetics that impair the hydroxylation of 25 OH vitamin D to the active form 1, 25 OH vitamin D. It is tempting to hypothesize that these are the patients who get more benefit from very high levels. Mitochondria are involved in this conversion, raising the possibility that mitochondrial dysfunction also impacts need for high levels of 25 OH vitamin D (See Perfect Health Diet website). Vitamin D supplementation as a single 300,000 iu dose can also be used to treat primary dysmenorrhea (Lasco et al, 2012). I would love to find research support for an ideal level being in the 50ng/mL, or the 70-80+ range. This is frequently recommended in functional medicine, but does not appear well supported, and certainly not by randomized controlled studies of supplementation. Please comment if you have studies to support aiming for such a high level! REFERENCES Al-Shaar L1, Nabulsi M, Maalouf J, El-Rassi R, Vieth R, Beck TJ, El-Hajj Fuleihan G. Bone. 2013 Oct;56(2):296-303. Effect of vitamin D replacement on hip structural geometry in adolescents: a randomized controlled trial. Amestejani M, Salehi BS, Vasigh M, Sobhkhiz A, Karami M, Alinia H, Kamrava SK, Shamspour N, Ghalehbaghi B, Behzadi AH. J Drugs Dermatol. 2012 Mar;11(3):327-30. Vitamin D supplementation in the treatment of atopic dermatitis: a clinical trial study. Arregbesola et al. J Epidemiol Community Health Serum 25-hydroxyvitamin D3 and the risk of pneumonia in an ageing general population. (huge connection with deficiency; when sufficient, no added benefit). Asemi Z & Maryam Karamali &Ahmad Esmaillzadeh .Diabetologia 2014 Effects of calcium–vitamin D co-supplementation on glycaemic control, inflammation and oxidative stress in gestational diabetes:a randomised placebo-controlled trial Belenchia AM, Tosh AK, Hillman LS, Peterson CA.; Am J Clin Nutr. 2013 Apr;97(4):774-81. Correcting vitamin D insufficiency improves insulin sensitivity in obese adolescents: a randomized controlled trial. Bleicher K1, Cumming RG, Naganathan V, Blyth FM, Le Couteur DG, Handelsman DJ, Waite LM, Seibel MJ. J Bone Miner Res. 2014 Sep;29(9):2024-31. U-shaped association between serum 25-hydroxyvitamin D and fracture risk in older men: results from the prospective population-based CHAMP study. Bitetto D1, Fabris C, Fornasiere E, Pipan C, Fumolo E, Cussigh A, Bignulin S, Cmet S, Fontanini E, Falleti E, Martinella R, Pirisi M, Toniutto P. Transpl Int. 2011 Jan;24(1):43-50. Vitamin D supplementation improves response to antiviral treatment for recurrent hepatitis C. Camargo CA Jr, Ganmaa D, Frazier AL, Kirchberg FF, Stuart JJ, Kleinman K, Sumberzul N, Rich-Edwards JW. Pediatrics. 2012 Sep;130(3):e561-7. Randomized trial of vitamin D supplementation and risk of acute respiratory infection in Mongolia. Chowdhury Rajiv, Kunutsor Setor, Vitezova Anna, Oliver Williams Clare, Chowdhury Susmita, Kiefte-de-Jong Jessica C et al. Vitamin D and risk of cause specific death: systematic review and meta-analysis of observational cohort and randomised intervention studies BMJ 2014 Columbo M, Reynold A Panettieri2 and Albert S Rohr1Allergy, Ashtma and Clinical Immunology 2014 Asthma in the elderly: a study of the role of vitamin D; Forman JP1, Scott JB, Ng K, Drake BF, Suarez EG, Hayden DL, Bennett GG, Chandler PD, Hollis BW, Emmons KM, Giovannucci EL, Fuchs CS, Chan AT Hypertension. 2013 Apr;61(4):779-85. Effect of vitamin D supplementation on blood pressure in blacks. Gominak SC1, Stumpf WE. Med Hypotheses. 2012 Aug;79(2):132-5. doi: 10.1016/j.mehy.2012.03.031. Epub 2012 May 13. The world epidemic of sleep disorders is linked to vitamin D deficiency. Gorham, ED & C. F. Garland & A. A. Burgi & S. B. Mohr & K. Zeng & H. Hofflich & J. J. Kim & C. Ricordi. Diabetologia 2012 Lower prediagnostic serum 25-hydroxyvitamin D concentration is associated with higher risk of insulin-requiring diabetes: a nested case–control study (another U shaped curve, T1DM) Greene DA1, Naughton GA. Osteoporos Int. 2011 Feb;22(2):489-98. Calcium and vitamin-D supplementation on bone structural properties in peripubertal female identical twins: a randomised controlled trial. Hossein-nezhad A, Spira A, Holick MF. PLoS One. 2013;8(3):e58725. Influence of vitamin D status and vitamin D3 supplementation on genome wide expression of white blood cells: a randomized double-blind clinical trial. Hong Q, Xu J, Xu S, Lian L, Zhang M, Ding C. Rheumatology (Oxford). 2014 Nov;53(11):1994-2001. Associations between serum 25-hydroxyvitamin D and disease activity, inflammatory cytokines and bone loss in patients with rheumatoid arthritis. Huang W1, Shah S, Long Q, Crankshaw AK, Tangpricha V. Clin J Pain. 2013 Apr;29(4):341-7. Improvement of pain, sleep, and quality of life in chronic pain patients with vitamin D supplementation. Krall EA, Wehler C, Garcia RI, Harris SS, Dawson-Hughes B.Am J Med. 2001 Oct 15;111(6):452-6. Calcium and vitamin D supplements reduce tooth loss in the elderly. Lasco A, Catalano A, Benvenga S. Improvement of Primary Dysmenorrhea Caused by a Single Oral Dose of Vitamin D: Results of a Randomized, Double-blind, Placebo-Controlled Study. Arch Intern Med.2012;172(4):366-367. Malloy PJ, Feldman D. Genetic Disorders and Defects in Vitamin D Action.Endocrinology and metabolism clinics of North America. 2010;39(2):333-346 Marchisio P1, Consonni D, Baggi E, Zampiero A, Bianchini S, Terranova L, Tirelli S, Esposito S, Principi N.Pediatr Infect Dis J. 2013 Oct;32(10):1055-60. Vitamin D supplementation reduces the risk of acute otitis media in otitis-prone children. (took kids over 30ng/dl, using 1000 iu vitamin D, to prevent ear infections) Martineau AR et al. Lancet Respiratory Medicine 2014. Vitamin D3 supplementation in patients with chronic obstructive pulmonary disease (ViDiCO): a multicentre, double-blind, randomised controlled trial (only people who start out deficient improve, about 2000 iu daily is enough; they attain about 35 ng at most by the time they are done) Munger KL, Levin LI, Hollis BW, Howard NS, Ascherio A. JAMA. 2006 Dec 20;296(23):2832-8. Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis. Shehab D.a · Al-Jarallah K.a · Abdella N.a · Mojiminiyi O.A.b · Al Mohamedy H. Medical Principles and Practice 2015 Prospective Evaluation of the Effect of Short-Term Oral Vitamin D Supplementation on Peripheral Neuropathy in Type 2 Diabetes Rizzoli R, Boonen S, Brandi ML, Bruyère O, Cooper C, Kanis JA, Kaufman JM, Ringe JD, Weryha G, Reginster JY. Curr Med Res Opin. 2013 Apr;29(4):305-13. Vitamin D supplementation in elderly or postmenopausal women: a 2013 update of the 2008 recommendations from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Sablok A1, Batra A, Thariani K, Batra A, Bharti R, Aggarwal AR, Kabi BC, Chellani H. Clin Endocrinol (Oxf). 2015 Feb 14. Supplementation of vitamin D in pregnancy and its correlation with feto-maternal outcome. Terrier B, Derian N, Schoindre Y, Chaara W, Geri G, Zahr N, Mariampillai K, Rosenzwajg M, Carpentier W, Musset L, Piette JC, Six A, Klatzmann D, Saadoun D,Patrice C, Costedoat-Chalumeau N. Arthritis Res Ther. 2012 Oct 17;14(5):R221. Restoration of regulatory and effector T cell balance and B cell homeostasis in systemic lupus erythematosus patients through vitamin D supplementation. Urashima M, Segawa T, Okazaki M, Kurihara M, Wada Y, Ida H. Am J Clin Nutr. 2010 May;91(5):1255-60. Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren. Uusi-Rasi K, Patil R, Karinkanta S, et al. Exercise and Vitamin D in Fall Prevention Among Older Women: A Randomized Clinical Trial. JAMA Intern Med. Published online March 23, 2015. Wang et al (very large group). Lancet. 2010 Jul 17;376(9736):180-8. Common genetic determinants of vitamin D insufficiency: a genome-wide association study. Wepner F, Raphael Scheuer, Birgit Schuetz-Wieser, Peter Machacek, Elisabeth Pieler-Bruha, Heide S. Cross, Julia Hahne, Martin Friedrich Pain 2014 Effects of vitamin D on patients with fibromyalgia syndrome: A randomized placebo-controlled trial (this group attained a level of 48 ng or more; pain resumed 6m after supplementation stopped) Wepner F, Raphael Scheuer, Birgit Schuetz-Wieser, Peter Machacek, Elisabeth Pieler-Bruha, Heide S. Cross, Julia Hahne, Martin Friedrich Arthritis Research and Therapy 2012. Effects of vitamin D on patients with fibromyalgia syndrome: A randomized placebo-controlled trial. 7/30/2015 8 Comments Why I am a germophile The dictionary defines “germophobe” as “a person who fears physical contact with germs and is therefore obsessed with cleanliness”.
Given what we know now about the fact that there are 10 bacterial cells to each human cell in our bodies, this seems like strange behavior indeed. How can you even focus on the germs outside when there are so many germs inside? Yet, germophobes are very common. A recent entertaining blog contrasted “germophile” and “germophobe”, insisting that one was not better than the other. But should we choose consciously? Is one better than the other? What would “better” mean in this case? Of course from my point of view as a functional medicine physician, “better” means free of illness, and full of vitality and a sense of well-being. If that is the goal, I think “germophile” wins. WE SPREAD GERMS INSTINCTIVELY The thing that I find most relevant to thinking about this question, is how many of our automatic and most treasured behaviors involve maximizing the transfer and spreading of germs. From the first moment of life, which, if we are lucky, involves a short trip down the birth canal, it’s all about getting as many germs as we possibly can. Breast milk is full not only of germs, but of germ “landing docks”, that allow germs to take residence in the baby’s intestine. Breast milk is also full of certain substances the baby cannot digest. They are solely for feeding the bugs that begin to inhabit the baby—letting them go hungry would be a disaster! Of course that is just the start. For some reason, I was overwhelmingly driven to kiss my babies over and over again. I touched them a lot and I have to say, I didn’t bathe them daily because they just didn’t seem dirty to me. Many of our other behaviors (kissing in general, shaking hands, touching, hugging) also seem aimed at sampling the environment and each other, and becoming maximally colonized with germs. Babies are notorious at mouthing everything within their reach. Is this really because the mouth is another “sense organ” to them, or is it because they are busily and systematically putting together an extensive germ collection? Read just a bit of the latest science on the gut-brain connection and you will learn that gut bacteria impact brain development and our responses to stress later in life. Even certain parasites are favorable to the brain. I am becoming a bigger and bigger fan of germs. To be honest, I am in awe of what they do for us. WE RELY ON BACTERIA DNA in the human cell comprises about 20,000 genes. Each gene is the blueprint for a protein that will then carry out a function within the cell or in another part of the body. However, the human organism requires about 500,000 to a million different proteins to function. Where do they come from? Some have hypothesized that the 20,000 human genes mix and match and combine bits of each other to become half a million different proteins. Others have argued that this is not the case: we get the vast majority of our cellular-level tools from bacteria. Each bacteria only has a few thousand genes. So the goal, clearly, is to collect as many different bacterial strains as possible as quickly as you can. Babies are especially well-suited for this. They have a “weak” immune system, so as not to kill off germs right away: the germs get the benefit of the doubt. As we get older, we still have a compulsion (or brilliant adaptation) to keep sampling: we touch things, then touch our face or somehow put fingers in the mouth. There could be a way that this helps us cope with what our environment requires of us: detoxification, absorption or manufacture of vitamins, immune system training and performance, connection with other human beings. We know bacteria influence or perform these functions. There could be more: we could be adapting to different threats: savanna vs. forest, tide pools vs. mountaintops. I’m deeply intrigued. And in turn, we impact our environment bacteriologically in exquisitely specific ways: each finger has its specific bacterial signature. What purpose does that serve? GUT BIOME DIVERSITY Now that we are measuring the gut biome (collection of all bacterial DNA within a human being), we know that within the body, about 99 genes are of bacterial origin for each 1 human gene. This is due to the large variety of bacteria we possess. The diversity of bacterial species within the gut is reported as a measure of robust gut health. When we observe indigenous cultures, we find that they do outrageously “germy” things, like let a carcass fester in the sun before consuming certain animals. All traditional cultures have a typical fermented food. Some will only consume certain foods if they have been fermented. We also notice that their rates of allergies, asthma, autoimmune disease, obesity, diabetes and most cancers are or were lower than ours. We think this is all related to gut biome diversity. Our laboratory animals may also be too sterile and may not represent how life really means to proceed. Rat cages are routinely sterilized, and their food, if you think about it, is typically entirely processed. Perhaps they represent what it would be like for us if we lived like that. GUT AND PSYCHOLOGY The most exciting findings recently are in psychobacteriology (I made that up, I don’t think they have a name yet). Most of our nervous system is in the gut. Most of our immune system is there too. It is where the action is, clearly. Bacteria make substances that are recognized by our nervous system. Researchers have found that bacteria in the gut communicate with our brains using the vagus nerve, that links the intestinal area with the brain. They help us be calm, resourceful and connect better with others. They may control appetite and food choices. In turn, all of the above influences our immune system function. I’m starting to think that germs make us better people—healthier, more connected with each other, more adaptable, and more relaxed. I think the vast majority of bacteria are helpful, and we should re-examine each one of our assumptions about killing them. There is a minimum of sanitation that prevents important infectious illnesses but by and large, we have gone overboard. So I am a germophile. VIDEO VERSION here:   What is your opinion about gluten? How have you come to your conclusions? As a functional medicine physician, I find most articles I read in the popular press incomplete. I would like to share what I have learned in my journey from conventional doctor to functional medicine physician.
The basic statistic is this: 1% of Americans have celiac disease, a well-established autoimmune disease. An additional 5-6% of Americans may have non-celiac gluten sensitivity (NCGS), which has very recently been recognized as a real illness by gastroenterologists. Both celiac disease and NCGS can have symptoms that have nothing to do with the gut. So, why are 10-30% of Americans (depending on the survey) trying to reduce the gluten in their diets? Are most of them fools? A new disease First let me point out that until 2011, most gastroenterologists refused to believe that gluten could cause stomach cramps in patients without celiac disease. That is barely 4 years ago. Now many admit that they were missing a lot of people with NCGS. Could they be missing something else? What will they admit to in another 4 years? Would you prefer to get healthier now, or would you like to wait? I understand the strong drive to prevent our patients from falling prey to expensive scams. I understand our hesitation to recommend a diet that has not been “proven” safe. I also understand that we worry that patients will neglect some other treatable condition and instead do diet experiments we believe are doomed to fail. So I think physicians who don’t believe so many people should be gluten-free have good intentions. I also know that American agriculture has a strong vested interest in maintaining (increasing, really) our collective consumption of wheat products. And American processed food manufacturing and food retailing has a similar strong vested interest. In the setting of powerful conflicts of interest, mainstream media does not serve us well. Here is my point of view As a doctor, I see sick people. I don’t see well people because they don’t seek me out. Out of the sick people I see, many have a problem with gluten. As a quick review, gluten is a protein found in wheat, barley, rye and in contaminated oats. It contains another protein called gliadin, which seems to be the one to cause problems. Types of problems with gluten Here’s some of the problems my patients are having, in order of increasing difficulty to diagnose: o Some people have wheat allergies. When they eat wheat, they get a stuffy nose, or they break out in hives. This is diagnosed with a simple blood test for Wheat IgE. o Many people have a problem with processing carbohydrates (40% or more, actually). This may show up in the blood as a high Hemoglobin A1C (over 5.6%). People with this problem can easily demonstrate to themselves, by using an inexpensive glucometer (freely available on Amazon) that a meal consisting of cereal, or sandwich, or pasta, results in elevated blood sugar (as opposed to a salad, or a meal consisting of only lean protein plus broccoli). o Some people have celiac disease. They have the genetics that put them at risk (positive DQ2 or DQ8 genes) and in addition, they have a positive transglutaminase (tTg) IgA antibody, endomysial antibody or deamidated gliadin antibody. Note that testing only for the tTg is not enough to rule out celiac disease. In addition to blood testing, gastroenterologists recommend an intestinal biopsy to officially call it celiac disease, but some argue that positive antibodies are sufficient to recommend a gluten-free diet. o Some patients have a problem tolerating lectins, which are also in beans and some other foods. A possible test for lectin sensitivity is the wheat germ agglutinin antibody test. o Some people have a problem with FODMAPs. These are components (fermentable carbohydrates) abundant in certain foods (including wheat) that cause bloating in susceptible individuals. There is a hydrogen breath test that may or may not help with detecting this. o Some people react to breakdown products of gluten and dairy called gluteomophins and casomorphins. I am not sure these can be measured outside of research labs. o Some people have non-celiac gluten sensitivity (NCGS). At this time, this is a condition without clear diagnostic criteria. If you say that you feel better off wheat, that makes you a candidate. There are tests for anti-gliadin antibodies, but they are not universally accepted by conventional medicine. There are also biopsy findings but most people with gluten sensitivity do not undergo intestinal biopsies. The test I use is from Cyrex Laboratories. It finds more people with anti-gliadin antibodies than any other test. You will see the figure of 3-5% of people having NCGS. This is when you test all the patients in a gastroenterology practice. If you take people with joint pains, or people with balance problems, or people with autoimmune disease, or people in my practice, you will find a different percentage--sometimes lower, sometimes much higher. Why do I take patients off gluten? Taking people off gluten is one of my most common initial dietary changes. Here’s why I do it, and why this makes all the articles you read by science journalists who have consulted with conventional medical sources incomplete. I take anyone off gluten who has significant inflammation. How do I know they have inflammation? I learned that from reading research studies about the medical conditions I treat. Most people who haven’t felt well for months or years (my specialty is chronic illness) have inflammation. In any given person with a health complaint, I actually have to prove it’s not a factor. It is my job to improve this aspect of the immune system in all my patients. It’s the only way I can hope to reverse illness without the use of drugs. Why is gluten a problem for inflammation? First, gluten causes increased intestinal permeability in everyone temporarily. For some, this is repaired before the next dose of gluten. For others, it’s not. Leaky gut will cause leakage of large poorly digested proteins from the gut into the bloodstream, and basic immunology tells us that these tend to elicit an immune response (i.e. inflammation). In addition to this, some people are exquisitely sensitive to some undigested proteins from specific foods. Leaky gut also allows gut bacteria to leak into the bloodstream, and these bacteria have a substance on them called lipopolysaccharide (LPS), which is also a strong immune system stimulant (i.e. inflammatory). It has been hypothesized that a healthy gut microbiome may minimize the issues with intestinal permeability. However, as we well know, our microbiomes have been weakened by our environment and our customs (such as hygiene and antibiotics). Second, wheat products tend to take the place of healthier products in our diet. They present a number of drawbacks, including the fact that they have a high glycemic index, and the fact that they don’t have as many vitamins and phytonutrients as do fruits, vegetables, seeds and nuts. If you replace your cereal/bread/pasta with a “gluten-free” version, you will not see much of a difference in your nutrient intake. However, this is not what I recommend. Gluten-free products are processed foods, and thus of little use to any person who is trying to overcome a serious medical problem. If you replace your breakfast cereal with a smoothie full of fresh produce, your lunchtime sandwich with a big colorful salad, and your evening noodles or pizza with healthy protein and a vegetable stir-fry—then you will indeed reap the rewards of a healthier diet. Third, changing your diet changes your beneficial bacteria. As they are in charge of your immune system, of making vitamins for you, of breaking down toxins or causing inflammation, changing them is often beneficial in changing your symptoms. Traditional vs. updated The controversy about gluten relates to the different ways in which patients with chronic illness are viewed in the conventional vs. the alternative medicine model. In the conventional model, we seek a single cause—an infectious agent, an injury, a genetic predisposition. In the alternative model (or more precisely in this case, the functional medicine model), the “terrain” or underlying weakness of the individual is the most important factor: the microbiome modulates genetics to create inflammation that results in disease. Gluten acts almost like a litmus test that reveals significant inflammation and gut microbiome weakness. These preconditions exist before gluten is added but worsen with the addition of gluten. Thus, many people find that they feel better when they transition from a standard diet to a high nutrient, gluten-free diet. The controversy about gluten might simply be related to our shifting understanding of the underlying drivers of health and disease.  In functional medicine, we talk a lot about the term “root-cause resolution”. What does it mean though? How do you know that you are tackling the root cause of your illness? When I go online to see what people are saying about functional medicine, I see that they seem confused by the term “root cause”. They say that all medicine is oriented to finding the cause of your concerns and resolving it. For example if you go in to see a doctor and you complain of urinary discomfort, they will look for an infection, or some other cause, and treat you accordingly. Are they right? Is all medicine “root cause” medicine? Well it depends if your illness is acute (has lasted only a short time) or chronic. If your illness is chronic, such as a rising blood pressure that has now exceeded the threshold for “abnormal”, your doctor will check a blood test, recommend you eat less salt, and put you on a medication. That is because conventional medicine considers that hypertension is most often “idiopathic”.  IDIOPATHIC Idiopathic is a Greek word meaning “sickens itself”, from (idio-, self, and –pathic, illness). Hypertension sickens itself. That is absurd, of course. So in medical school I refused to use that word, and substituted another Greek word, “cryptogenic”, which means that the origin (-genic) is hidden (crypto-). To practice root cause medicine you begin by believing that there’s a good chance you can find the hidden origins of diseases that conventional medicine believes are “cryptogenic.” The reason root-cause medicine is so valuable is that if you can find the root cause, you stand a better chance to reverse the illness (not just manage it). So if a patient comes in with joint pains, and he or she gets ibuprofen, or curcumin, if that is all that gets done, this is not “root cause” medicine. The patient didn’t have a curcumin deficiency. The patient will be more comfortable on curcumin, but if you are practicing functional medicine, you will not stop there. LOOK FOR A CAUSE You will target inflammation and there are many ways to do that. You will take a full history, to see how this pain came about, and that will give you a clue as to whether you should try first to change the diet, teach stress reduction, recommend rest or exercise, or target something more obscure like coenzyme Q10, leaky gut, thyroid problems, insulin issues, heavy metals, and so on. Once you find, say, leaky gut, you still have not found the root cause. Why does he have leaky gut? This could be a variety of things from diet to stress, to poor probiotics. And if it’s stress, what is the root cause of that? You have to consider your patient’s early life history, and investigate perhaps trauma work or therapy. So, how do you know when to stop looking for underlying causes? How do you know you are dealing with a root cause? I’ve made up an acronym to remind me of the main root causes that may not have deeper underlying causes: G-FLAT  G stands for Genetics, and Germs.
FLAT are events, or external inputs: Food, Life events, Actions and Toxins “Genetics” may include for example MTHFR: by giving people with a slow variant of the MTHFR gene a surplus of folate (sometimes through food, sometimes with supplements) we compensate for a genetic problem. We only have a few genes we know how to bypass, but we can help the body modify the expression of hundreds of genes by targeting inflammation genes with lifestyle or nutraceuticals (even better, according to recent research, with both). “Germs” refers to causes like Lyme disease and chronic viruses that can be participants in patients’ chronic conditions. External inputs are the most common issues. They include the following: - “food” includes inflammatory food, like too many grains, meat, or salt - “life events” includes trauma, either psychological or physical - “actions” includes lack of sleep, repetitive motion, lack of exercise - “toxins” include processed foods, and environmental toxins Of course, illness arises from the interaction of these factors, but first we have to strip the situation down to these essential elements, and then devise a plan of action. It may take many steps to uncover the root cause, and you really want a motivated patient and a patient and persistent provider. So make sure you go all the way to G-FLAT! This past month has seen an onslaught of highly damning research results on the most fundamental tools of conventional medicine. It has left me wondering what is left for doctors to do that will help more than harm?
ANTACIDS ARE NOT SAFE Medscape, a highly read conventional medical newsfeed, reports that the most popular article of the month among readers was the one reporting that proton pump inhibitors (PPIs) were linked to a rise in heart attacks. PPIs are medications like omeprazole (Prilosec), pantoprazole (Protonix), dexlansoprazole (Dexilant), esomeprazole (Nexium) and lansoprazole (Prevacid). They are prescribed for a variety of complaints, especially acid reflux and indigestion. Millions of people are on these medications, sometimes for decades. It can be very hard to stop these medications, because stopping them may cause rebound heartburn (though I have my tricks). How do PPIs cause heart attacks? Scientists are not sure, but it could be because we need the acid in the stomach for a number of reasons, and one of them is to use a substance made by mouth bacteria and turn it into a very important substance called nitric oxide, that protects blood vessels. Far fetched, but, it’s only a start. IBUPROFEN IS NOT SAFE Today the FDA put out a warning that NSAIDs, well-loved drug category reducing pain and inflammation, also likely increase heart attacks and strokes. This category includes ibuprofen (Advil, Nuprin, Motrin), naproxen (Aleve, Naprosyn), and many others. Almost everyone has at least tried something from this category, or taken it for a week or more to manage an injury, and millions take it most days to manage chronic pain. So what are doctors supposed to do with patients’ pain? Interestingly, the regular use of NSAIDs can cause heartburn, and I have often seen patients started on PPIs because of their NSAID, sometimes preventatively. I am not looking forward to the study about what the combination does to your heart attack risk. In case you thought you would turn to acetaminophen (Tylenol), remember that it worsens asthma and impairs detoxification by reducing your levels of glutathione. It has also been connected to asthma development in babies and to ADHD in the children born to women who used it during pregnancy. All of these are associations, but they are not reassuring. STATINS ARE NOT SAFE What about statins? Everyone should be on one, right? Well they cause diabetes. They were thought to cause a little diabetes, but it turns out they cause more diabetes than originally thought. So how is it that they can still be beneficial? After all, another study this month tells us that a significant number of patients have a sudden decline in cognitive function after starting statins. Researchers are not sure if this is a real effect of the drug or some sort of research distortion, but it sure could be real. DIABETES IS WORSE THAN WE THOUGHT, EVEN WELL-TREATED Yesterday saw the publication of a study showing that diabetics have an accelerated decline in cognitive function, even when treated. So maybe those people who had heart attacks and were placed on statins are living longer but living with cognitive decline? AND LET’S NOT FORGET This month the Cochrane Collaboration, a highly respected European group that reviews research on therapy and prevention, declared that there was no good evidence that water fluoridation prevents dental caries. This is the same group that pointed out that influenza vaccination is probably not worthwhile for the vast majority of people. And more recent research suggest that whooping cough vaccination (not lack of vaccination) is a cause of disease resurgence. Does this leave anything for the average doctor to do that will actually work, and won’t make the patient worse? How about preventative tests that aim to detect cancer? CANCER IS NOT AS WE THOUGHT This week, we also had the report on an enormous study comparing breast cancer incidence and mortality across US counties with high and low mammography rates. If mammography saves lives then the counties with high mammography rates would have had fewer breast cancer deaths, and fewer larger tumors. But that is not the case. Mammograms do find many more small cancers, but these may not be cancers that would have become noticeable over time. We know this because counties with a high rate of mammography did not have a lower rate of large tumors. Therefore mammograms do not prevent small tumors from turning into large tumors. Nor did counties with high mammography rates have lower breast cancer mortality. So mammograms do not save lives. But these counties did have higher breast cancer incidence rates. So really all mammography does is cause more women to have to undergo cancer treatment. Overall, lives are not saved. I am NOT talking about false positive scares. This is full-fledged chemotherapy, lumpectomy or mastectomy and/or radiotherapy; and then more medications like tamoxifen; and long-term side effects like heart failure and cognitive decline from chemo and immune system anomalies from radiotherapy. THE PRICE TO PAY FOR PEACE OF MIND It appears that what really happened is that some women gained reassurance at the expense of other women going through a diagnosis of breast cancer (either invasive breast cancer or DCIS), and undergoing dangerous chemotherapy and disfiguring and painful removal of a body part. Women that were going to die, died anyways (the mortality didn’t change). UNLESS-- what we are seeing is a lot more real breast cancer than before—but no one is admitting to that. The following concept is now gaining favor: that cancer does not always proceed from small to large in predictable fashion. I know it makes no sense but it is true: cancer sometimes starts small and explodes very fast. Sometimes it starts small and regresses back to nothing. Sometimes it progresses the way we used to think, from small to large to widespread. HERE’S WHAT I THINK The concept of better living through chemistry is backfiring. Chronic disease prevention through surgery will also not work. There’s that devil once again, in the details. The idea that you could continue with your previous lifestyle, the one that brought on the heartburn, joint pain or headache, high cholesterol (which may not even be harmful cholesterol) or high glucose, or maybe even cancer—the idea that a pill could make it just fine to continue with that lifestyle—that has turned out to be WRONG. Doctors can’t save you from a symptom without giving you a disease, which may be worse. What we need to do is to find and fix the underlying cause. For some people, it’s not a choice they made. The underlying cause is toxins, or immune dysfunction, or multigenerational trauma. Help may be available for them too. There are worthwhile trade-offs to be found, there is trauma therapy, and immune support. But for others who have space to improve their lifestyle, to eat healthier, sleep more, exercise more, stress less, focus more on meaning, purpose, community, love, and service, it will actually NOT be very hard to sidestep antacids, anti-inflammatories, statins, and whatever is on those rows and rows of shelves at the drugstore—and diabetes, strokes and heart attacks, and in many cases even cancer. The work we do to resolve heartburn or reflux, joint pains, headache, cholesterol and glucose issues is the same work that studies suggest leads to a long and healthy life. INDEED, ALL CAUSE MORTALITY IS SHARPLY REDUCED WITH FRUITS, VEGETABLES, EXERCISE and MEDITATION. A study from 2012 shows an 8-fold reduction in all-cause mortality in the participants who ate more than 5 portions of fruit and vegetables daily and who were in the fittest subset. A separate study showed a 40% reduction in all-cause mortality with meditation. I would love to see the study that combines diet, exercise and meditation. And the study that further measures the effect of having a strong sense of mission, and a good close-knit group of family or friends. The skills and practice of functional medicine have helped me squarely focus on the promotion of wellness. My goal is to continue to learn efficient and effective ways to guide my patients to optimal health through natural means. REFERENCES FOR THE SKEPTIC—bring to your physician and have a conversation! Proton Pump Inhibitors and Cardiovascular health http://www.scientificamerican.com/article/certain-heartburn-drugs-linked-to-increased-risk-of-heart-attack/ NSAIDS and cardiovascular health http://www.fda.gov/Drugs/DrugSafety/ucm451800.htm#collapseSix Statins risk for diabetes—March 2015 http://www.sciencedaily.com/releases/2015/05/150507145328.htm Statins affect memory http://www.ncbi.nlm.nih.gov/pubmed/26054031 Water fluoridation not proven to prevent cavities http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010856.pub2/abstract Influenza shots probably not worthwhile in most people http://www.cochrane.org/CD001269/ARI_vaccines-to-prevent-influenza-in-healthy-adults Whooping cough vaccination spreads disease http://www.sciencedaily.com/releases/2015/06/150624071018.htm Mammography and cancer rates in US counties http://archinte.jamanetwork.com/article.aspx?articleid=2363025 Fruit and vegetable intake, physical activity, and mortality in older community-dwelling women. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3639003/ |
Blog AuthorDr. Myrto Ashe MD, MPH is a functional medicine family physician. Archives
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