Research Update on Probiotics and Healthy Skin

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There has been so much research on probiotics published that it’s hard to keep myself informed, and you as well. This week I’ll summarize three recent studies on probiotics. Let’s begin with research on probiotics and skin conditions.

Researchers examined the effects of three strains of probiotics on skin inflammation in mice: two strains of lactobacillus and one strain of bifidobacterium. Three groups of mice were given one of the probiotics for two weeks while two control groups were given a placebo. After two weeks, the skin of four groups of mice was chemically exposed to an irritant to cause inflammation while the fifth group was exposed to a control chemical.

The researchers examined both blood and skin of the mice for indicators of inflammation after seven days of exposure. The markers for inflammation were lower in the groups who took the preventive probiotics than either of the positive or negative controls. While this was a small study on mice, it did demonstrate that probiotics helped reduce the skin response to chemical irritation. This may be the first step in identifying a probiotic that could help conditions such as atopic dermatitis in the future.

Keep taking a wide-spectrum probiotic, especially if your skin has been less healthy than you want it to be. If you have a teen with skin problems, probiotics may make a big difference. Another research update on Thursday.

What are you prepared to do today?

Dr. Chet

 

Reference: Beneficial Microbes, 2018; 9(2): 299-309.

 

Quality Manufacturing: Own It

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The most important trait of a quality manufacturer of dietary supplements is to own as much of the process as possible: farms to grow plants, laboratories to test all components of the supplements, scientists to base formulations on the latest research, manufacturing facilities for the products, and elements of the distribution process. As I said, no company can process every nutrient that may go into a supplement but the more they control, the better the oversight.

The problem will always be the lack of control. As control decreases, the probability of tainted supplements increases. Anyone, and I really mean anyone with the money, can put together a formula for supplements and find a manufacturer that will make it. The ingredients can be organic and natural or they can be the cheapest available. That person can also find a warehouse to store it and another company to distribute it, especially in these days of Internet shopping. Anyone can start selling his own formulations for supplements within a week to a month.

Lack of ownership isn’t necessarily a bad thing; we can’t begin with the premise that everyone is out to cheat everyone by cutting corners. But while someone might be an excellent nutritionist with a great idea for a supplement of some sort, they’re not necessarily an expert in the entire process of manufacturing. That could result in problems with the finished product that were unseen due to a lack of expertise.

In this week’s Memos, I’ve covered a simple way to assess the manufacturers of supplements. The only thing you have to do is ask the right questions before you buy. That protects you and your family.

What are you prepared to do today?

Dr. Chet

 

Quality Manufacturing: Independent Testing

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Let’s continue our look at how quality manufacturers could prevent tainted products. In-house testing is important, but all work should be verified by an independent testing company. There are several labs that perform such services such as NSF and USP. There are three important services they can perform:

  1. Inspect the facility to make sure the manufacturing process complies with FDA Guidelines for dietary supplements known as Good Manufacturing Practices.
  2. Verify the quantities of nutrients in the products listed on the product labels.
  3. Check for the presence of contaminants of all types.

It seems simple enough. Why don’t all manufacturers use independent testing companies? One of the reasons is cost: it’s not inexpensive, and it also must be continuous. But the trademark of a quality manufacturer is independent testing of the manufacturing facilities and dietary supplements they make.

We’ll finish this up on Saturday with one of the most important traits of a quality manufacturer.

What are you prepared to do today?

Dr. Chet

 

Quality Manufacturing: Establish Rules

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Last week’s Memos were about supplements that were tainted with pharmaceuticals. What can manufacturers do to insure their products are not tainted? Mistakes can always happen, but what can be done to get those errors as close to zero as possible? That’s what we’ll cover this week.

Let’s begin with this premise: no manufacturer of dietary supplements grows every plant they use or makes every vitamin in their supplements. There’s nothing wrong with that because the growth and production of supplements is so complex. However, there are two things that a manufacturer can require from their vendors.

First, that they follow specific guidelines in the growth of plants: what type of seeds, what type of organic herbicides, how the plants must be harvested, and on and on. Following guidelines would also be required of outside companies who make vitamins and process minerals.

Second, all vendors’ products would be tested for contaminants upon arrival before any final products are made. If they do not meet the guidelines, the shipment is rejected.

Monitoring the quality of ingredients is the first step in making sure a dietary supplement contains untainted ingredients. I’ll cover another in Thursday’s Memo.

What are you prepared to do today?

Dr. Chet

 

Tainted Supplements: Buyer Beware

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There was a big problem with the papers that were published in JAMA and the resultant media headlines: the authors and commentator lumped the tainted products into a single category of dietary supplements and categorized these questionable manufacturers and their tainted products with all manufacturers of dietary supplements. That was simply wrong, and people in health news know better. There will always be unscrupulous companies out to make a quick buck and laughing all the way to the bank.

Some of the tainted products are still on the market today. Most are available only online, and their websites contain no information about the company who makes them or how they were made. They might simply be the same product sold under different names; there’s no way to tell.

The everyone-in-the-pool approach used by the authors reflects an underlying belief that the FDA should give approval to every dietary supplement. There are healthcare professionals who don’t like supplements of any kind. With this kind of news, they make the leap that all supplements are equal, and thus all require more restrictive oversight to stem the tide of tainted supplements. That’s just foolish. Quality manufacturers that want to continue to be in business follow the rules set out by the FDA for dietary supplements. Fly-by-night companies won’t, no matter what the laws say.

Buyer Beware

The articles do raise an important concern: how do you know whether the products you’re buying are made by a reputable manufacturer or not? After all, you’re going to be putting them in your body. Do your homework, just as you might do with any other consumable product. Check out the company online to the extent you can. The more information you can find, the better. If there’s not much info, consider that a red flag.

But how do you know what to look for? I’ll cover that in next week’s Memos, so make sure you don’t miss them.

What are you prepared to do today?

Dr. Chet

 

References:
1. JAMA Network Open. doi:10.1001/jamanetworkopen.2018.3337.
2. JAMA Network Open. doi:10.1001/jamanetworkopen.2018.3329.
3. FDA Database: http://bit.ly/2Pyq0B3

 

Which Products Were Tainted?

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The logical concern is this: what products were on the list of supplements that made up all those headlines? There were over 700 products on the FDA list of tainted products, so I think there’s a better way to ask the question: what were the categories of products?

1. Sexual performance was the overwhelming leader.
2. Weight loss was second.
3. Muscle building also made the list.

The problem with the sexual performance products was that they contained actual Viagra, Cialis, or one of the other medications used for erectile dysfunction. The weight loss products contained a pharmaceutical that has been taken off the market because of side effects. Most of the problematic muscle-building products contained anabolic steroids. When people take these types of medications pitched as dietary supplements without knowing what’s in the product, the potential for unexpected consequences is substantial and could threaten their health.

I reviewed the entire list of supplements on the FDA list and found no products—not one—offered by a reputable company. No multivitamins. No antioxidants. No herbals such as echinacea.

Here’s the bottom line: these were not dietary supplements, they were pharmaceuticals that skirted the FDA regulations for pharmaceutical and over-the-counter drugs and the FTC rules for honesty in advertising. But that’s not what the paper’s authors and the commentator said. We’ll finish this on Saturday.

What are you prepared to do today?

Dr. Chet

 

References:
1. JAMA Network Open. doi:10.1001/jamanetworkopen.2018.3337.
2. JAMA Network Open. doi:10.1001/jamanetworkopen.2018.3329.
3. FDA Database: http://bit.ly/2Pyq0B3

 

Tainted-Supplement Headlines

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I’d like you to read these three headlines, stop, and identify the first thought that comes to your mind:

“Hundreds of Supplements Are Tainted With Hidden Pharmaceutical Drugs”

“Hidden Drugs and Danger Lurk in Over-the-Counter Supplements, Study Finds”

“Supplements Often Tainted by Hidden Drugs”

No matter what supplements you’re taking, the thought “I wonder what’s really in my supplements?” must have passed through your mind, even just for a second. I know my readers were thinking that. Should you be concerned? Will that multivitamin or B complex you’re taking contain something dangerous?

That’s the takeaway from these headlines about a paper published in the JAMA Network Open journal (1). The article had a corresponding commentary criticizing the FDA for dereliction of duty in not seeing that these products were removed from the marketplace. (2).

There are some important lessons here and this is the first one: while numerous publications called this a study, it was not. A few scientists reviewed the FDA website that listed tainted products marketed as dietary supplements; the FDA had sent warning letters to the manufacturers to stop selling the products. The authors grouped them by category of product type and then spent eight pages talking about them. According to the paper, they did nothing else—no other investigation or analysis.

The type of products that made the tainted products list wasn’t surprising if you closely follow health news. I’ll tell you what they are on Thursday.

What are you prepared to do today?

Dr. Chet

 

References:
1. JAMA Network Open. doi:10.1001/jamanetworkopen.2018.3337.
2. JAMA Network Open. doi:10.1001/jamanetworkopen.2018.3329.
3. FDA Database: http://bit.ly/2Pyq0B3

 

Vitamin D: Stay the Course

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Let’s finish this look at the recent paper on vitamin D (1). As you could read in Thursday’s Memo, they included some curious studies in their review. Let’s take a look.

Mixed-Purpose Studies

Have you ever eaten leftovers? Sure. Did you take all the different leftovers—the spaghetti, the fried rice, the mashed potatoes and gravy—mix them together in a stew or smoothie, and eat them? Probably not. And that’s the primary problem with this review paper: too many different types of studies.

There were enough papers using very high doses of vitamin D administered orally to the elderly that could have been combined. There certainly were enough studies to use only 800 or 1,000 IUs that could have been combined.

It is not the statistics; it’s the physiology and biochemistry. There’s going to be a difference in how the body utilizes 100,000 IUs at one time versus 1,000 IU every day for 100 days. That has to be acknowledged as a possibility. That it wasn’t illustrates a typical problem in these types of studies.

The Pharmaceutical Model

The real weakness of the studies that were included in this review was that the vitamin D was used as a treatment for a disease rather than as a nutritional supplement. What gets lost in translation is that in several studies where vitamin D was used to address low vitamin D levels in the elderly with and without fractures, there was actual improvement in bone-mineral density.

It begs the question: why would you give astronomical doses to healthy people? That’s what they did in communities of elderly residents. Their intentions were good (they wanted to try to prevent fractures and falls), but it’s a lousy approach. Would you give someone a one-month dose of a blood pressure medication? You could kill them. If you’re going to use a vitamin that has robust uses in the body, you have to respect it. They considered it a nutrient, but used it as a drug.

The only issue that I could find with the high doses of vitamin D is that for some reason, they were associated with an increase in falls. That seems inexplicable to me, but it was a consistent observation at high doses of vitamin D. The only reason I would consider it suspect was that in most studies included in the review paper, people self-reported falls. Still, it was there.

The Bottom Line

The overall problem with this review of vitamin D is that the authors considered only a single factor; bone building is dependent on a variety of nutritional factors that were never considered. Most of all, the great majority of the studies didn’t consider the role of exercise: fewer than five of the 81 studies gave any mention to exercise. In order for bones to grow and recover, they must be stressed on a regular basis. There’s no way to come to the conclusions the authors did without that data.

While researchers looked at only a single factor involving the musculoskeletal system, the immune and nervous systems can still benefit from vitamin D even if bones don’t benefit as much as some supplements promise. Vitamin D has also been shown to help mental health and depression. Some day nutrition research will be done correctly, but it wasn’t served very well by this paper or the studies that were included. I found no reason to stop taking vitamin D as a supplement. In fact, it’s time to increase your dosage as the days get shorter and your sunlight exposure decreases.

What are you prepared to do today?

Dr. Chet

 

Reference: DOI:https://doi.org/10.1016/S2213-8587(18)30265-1.

 

A Potpourri of Research on Vitamin D

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Scientists try to follow some strict guidelines when they select studies to be included in a meta-analysis. With that in mind, here’s some of what I found in reviewing the studies. Remember, they were looking at fractures, falls, and bone-mineral densities.

  • The length of the studies ranged from as short as eight weeks to as long as seven years. The most popular study length was one year, second was two years.
  • Most of the studies focused on the elderly. Falling and fractures are obvious concerns for that population. But they also included papers on post-parathyroidectomy patients of all ages, renal transplant patients, and young patients that were HIV positive where falling and fractures were not obvious consequences of the age group.
  • For the most part, they selected studies with vitamin D taken via oral supplements. But they also used cod liver oil, with and without vitamin D, as well as intramuscular injections.
  • This one was just simply puzzling. The range of vitamin D administered to the subjects was as low as 400 IU and as high as 600,000 IU in a single dose. Some gave oral vitamin D at 100,000 IUs four times per year, injections of 300,000 IU and 600,000 IU, and one study administered 300,000 IU in a single oral dose.

You don’t have to have any type of scientific degree to see the problem with the apples-and-oranges selection of the studies. Competent scientists may be able to account for differences statistically to do the analysis, but they can’t account for the varying physiological impacts on the subjects.

I’ll finish this up on Saturday.

What are you prepared to do today?

Dr. Chet

 

Reference: DOI:https://doi.org/10.1016/S2213-8587(18)30265-1.

Update: Vitamin D’s Health Effects

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With all the political headlines last week, an important health headline could have been overlooked. A group of scientists published a paper suggesting vitamin D doesn’t prevent fractures and falls or help increase bone-mineral density, and they recommended that it not be used for that purpose. I’m a strong believer that vitamin D is one of the fundamental supplements we should take, so I took a close look at this paper.

Typically I call this a Research Update, but I’m intentionally not calling it that this time because there’s no new research in this paper. This was a research review paper that included a re-analysis of prior research, some 81 studies. That’s a meta-analysis, a statistical technique that has risen in popularity in the past 10 years. In fact, it really only included research published since 2014, the last time some of these authors did the exact same analysis. Based on the prior research of the statistician involved who was the lead author, I have to believe the math is correct.

The problem is in the selection of the studies. I did something I don’t always do. I examined almost all of the abstracts of the 81 papers that were used in the meta-analysis. It was tedious to say the least. To be blunt, I don’t understand how some of the papers were selected. On Thursday, I’ll give you the run down on the research review part of the paper.

What are you prepared to do today?

Dr. Chet

 

Reference: DOI:https://doi.org/10.1016/S2213-8587(18)30265-1.