Tag Archive for: supplement

Gas Station Heroin

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I have to admit that I’d never heard the headline’s words strung together like that until I read about the banning of several products that contained an anti-depressant called tianeptine, which is approved in some countries (not the U.S.) as a prescription drug for the treatment of depression. It is a tricyclic antidepressant; in some cases, it has a mood elevator effect. I can’t confirm that it is a high similar to fentanyl as claimed in some articles. While the products have been pitched as dietary supplements, they most definitely are not.

Here are three rules to follow when considering a dietary supplement:

  • Know the active ingredient you’re looking for, whether it’s a vitamin, mineral, herb, or other supplement like glucosamine. If you’re not sure, don’t make an impulsive purchase because a friend recommended it.
  • Check the label for a certification from a legitimate testing company like NSF or the USP, the two most prominent certification companies.
  • Most important, don’t buy dietary supplements from convenience stores or gas stations. What are you thinking? That area around the cash register can be a minefield of promises from energy to libido. Don’t fall for it!

The Managing Pain webinar is a week from tomorrow. Reserve your spot for the live webinar; spaces are limited and going fast. I hope to see you live. I’m ready to teach!

What are you prepared to do today?

        Dr. Chet

More Taurine, Longer Life

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The researchers next step was to supplement the diet of several species with taurine to see if the lifespan of various species would be increased. While they didn’t include humans in the study (we live too long), they did note in other studies that some factors related to aging declined with taurine supplementation.

Taurine supplementation significantly increased the lifespan of worms, mice, and rhesus monkeys, but researchers didn’t determine the originating mechanism involved in the protective process. Certainly, genes have to be impacted in some way, but the only conclusion they could make is that supplementing with taurine extended the lifespan of the species tested.

Combine that with the decline that occurs with aging in humans and the associated increase of degenerative conditions, and it appears that taurine is critical for improving human health as well decreasing some of the manifestations of aging.

Increasing Taurine Intake

The only real question is the best way to increase taurine levels. Would there be any downside to taking a taurine supplement? Or should we focus on increasing the protein in our diet, specifically the animal protein? Here’s something else to consider before we get to that point: one of the characteristics of aging is a decrease in protein intake. There’s no reason that I could find for that to happen. It just does.

I think it should be a combination of both sources. Protein intake should be increased once a person reaches 50 to at least one gram per kilogram body weight. That would mean it would be roughly half a person’s body weight in grams. If you weigh 200 pounds, you should probably get 100 to 120 grams of protein per day. It may be prudent for those over 70 to exceed that amount, not just for the taurine but also to stem the loss of muscle mass. It may require a concerted effort to eat that much protein.

Let’s turn to taurine supplementation. Taurine is typically offered in 500 milligram capsules. When you look at the research, the amount used in studies ranges from 500 milligrams per day up to six grams per day. A couple of studies lasted at least six months long. Taurine supplementation seems safe.

Starting with one gram of taurine per day for a minimum of 60 days is a good place to begin. Depending on where you began, you may or may not feel anything, so you can increase the amount. Or you may find it’s having a profound effect on you because it impacts so many different organ systems in the body, and you may decide to hold the line.

How about your diet? What foods contain taurine? The highest taurine levels would be found in shellfish, eggs, soy products, and liver as well as—surprise, surprise—energy drinks if you want to use them. But don’t forget, all animal protein will count because it will have the two primary amino acids that taurine is made from: methionine and cysteine.

The Bottom Line

Is taurine the fountain of youth? No. But it’s one of many strategies we can use to age well. Living long is not good enough. Living well longer should be our goal. Increasing taurine levels is another step in aging with a vengeance.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.science.org/doi/10.1126/science.abn9257

Taurine’s Effects on Aging

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A recent research paper examined the amino acid taurine and its connection to aging; in fact, the title of the research paper is “Taurine as a Driver of Aging.” It was published in the journal Science in June 2023; it’s open access if you’re interested in reading the article itself.

Taurine is a sulfur-containing amino acid that can be made from the amino acids methionine or cysteine metabolism. It plays a role in several essential body functions, such as regulating calcium levels in certain cells, manufacturing bile salts, balancing electrolytes in the body, and supporting the development of the nervous system. There is one more way that taurine may benefit us: taurine appears to be important in mitochondrial health as well. And when you think mitochondria, think energy.

In the first part of the study, the researchers examined taurine levels at various ages during the lifespan of several species. They looked at mice, macaques, worms, yeast, and human beings. The results were absolutely clear: as these species got older, the taurine levels decreased substantially. While all species had other metabolic functions going on, the stark drop in taurine certainly appeared to be related to the decline of many body systems.

But how do you test that? You supplement the diet of the particular species with taurine. That’s what the researchers did, and I’ll tell you what happened on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.science.org/doi/10.1126/science.abn9257

Exploding Gallbladders: Just the Facts

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Let’s take a look at the actual case study on the exploding gallbladder and figure out what’s relevant and what’s conjecture—by all parties.

The Case Study

The paper was the result of a close examination of the medical information gathered when a 69-year-old man went to the emergency room at SUNY Brooklyn Medical Center with a perforated gallbladder. There were three parts to the paper:

  • The introduction focused on curcumin and its potential for causing issues in people with gallbladder disease.
  • The second described the treatment plan for the patient, mostly antibiotics and pain relievers.
  • Finally, a review laid the groundwork for why curcumin caused the perforation in the gallbladder.

The reason? Curcumin may increase the strength of the contractions in the gallbladder duct as it moves bile. A large stone was blocking the duct, so curcumin caused the pressure to buildup in the gallbladder and boom: explosion! Well, perforation, but you get the idea.

The Problem

There was no evidence to show that curcumin directly contributed to the gallbladder issues. What was also in the case study but not considered was that the patient had a history of gallstones. He was also taking five medications for hypertension, high cholesterol, and an enlarged prostate.

The writers of the case study were a medical student and a nephrologist (a kidney specialist). Based on published information, neither was an expert in the digestive system. It appears to have been conjecture on their part as to the cause of the gallbladder perforation. The comments on food and supplement oversight, while referenced, did not demonstrate any understanding of the FDA’s oversight of food and supplements; they’re not controlled as pharmaceuticals are, but both the FDA and FTC have control over the claims they can make. The amount of curcumin used by the patient was within the standard range for use of the supplement.

The Bottom Line

I can’t fault the writer for the Daily Mail; writers sometimes tend toward the sensational, and an exploding gallbladder is a perfect fit. The physicians and the article reviewers should have realized the faults in the analysis. Could a gallbladder explosion have been possible? Yes, but without accounting for the current status of the patient’s disease and considering pharmaceutical interactions of the meds the patient was taking, they used the “Ready, Fire, Aim” approach to assess what might have happened. We might expect that from reporters with no health background but not from medical professionals.

They were right about one thing. More research on interactions between food, herbs, and pharmaceuticals is necessary—but that isn’t news.

What are you prepared to do today?

        Dr. Chet

References:
1. http://bit.ly/3KikdPv
2. American Journal of Medical Case Reports, 2022, Vol. 10, No. 12, 311-313

Exploding Gallbladders!

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Health Memo readers frequently forward health-related articles to me to ask my opinion; I read them all and respond to the sender if asked. Combined with my health news feeds, I read a lot about health—opinions about health, that is. I’m going to share a couple with you in the next few Memos and—wait for it—give you my opinion about whether what is being said is accurate, and more important, meaningful.

Let’s begin with curcumin, a very popular dietary supplement and a component of the herb turmeric used in cooking. It’s generally used as an anti-inflammatory for a variety of conditions, including joint health. The health headline in the Daily Mail implied that a 69-year-old man’s gallbladder exploded due to the interaction of the gallstones in his gallbladder with the high doses of curcumin he was taking. The Daily Mail seems to focus on celebrity news more than other types of news, but that doesn’t mean we can ignore the story.

The Daily Mail article was based on a case report published in a journal focused on just such case studies. The reporter took language from the paper that suggested that supplements avoid the regulatory process, creating a set of circumstances that could be potentially dangerous, as in this case. It also suggested that adverse reports with supplements are not reported. Is that all true? More importantly, what are the implications of such an article? I’ll let you know on Saturday.

What are you prepared to do today?

        Dr. Chet

References:
1. http://bit.ly/3KikdPv
2. American Journal of Medical Case Reports, 2022, Vol. 10, No. 12, 311-313

When Supplements Aren’t Absorbed

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If you take any type of dietary supplement, you want to make sure that you’re getting the active ingredient whether that’s turmeric, the mineral iron, or omega-3 fatty acids. The problem is that whether in its natural form in food or put into dietary supplements, nutrients can be difficult to absorb. In addition, the same holds true for pharmaceuticals as well. Here are some of the reasons why:

  • Taking supplements with food is important for nutrient absorption. If they’re fat-soluble, they need fat present to be absorbed. That’s problematic if someone takes the supplement without food or is on a low-fat diet.
  • I seem to always talk about increasing fiber in the diet, and we should, but fiber can interfere with the absorption of some nutrients. It may be the increased transit time or some form of mechanical blockage, but it happens.
  • Finally, gut health may also impact the absorption of nutrients. Lack of enzymes, too acidic or too alkaline, or lack of a healthy microbiome can also impact nutrient absorption.

All is not lost; the pharmaceutical and supplement industries have been working on ways to help deliver more active ingredients. I’ll cover those on Saturday.

What are you prepared to do today?

        Dr. Chet

Research Update on Fish Oil Supplements

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Researchers performed a meta-analysis of studies that examined EPA and DHA as dietary supplements to see if there was a reduction in CVD events and mortality. In this study, researchers included 40 studies with 135,267 participants. While they examined many different variables, including whether EPA was better than DHA and whether they could find the best combination or ratio, almost every analysis they ran demonstrated benefits for those who use fish oil supplements: a 13% decrease in the risk of a heart attack, a 10% decrease in any coronary heart disease event, and a 35% reduction in the risk of a fatal heart attack.

For me, the most significant finding was that there was a dose-response effect of taking fish oil supplements. In other words, CVD events decreased with higher intake of fish oil supplements.

The Problems with the Prescription Study

There were three issues with the EVAPORATE study I talked about in Thursday’s Memo. First, there was a significant loss of subjects. Most of the loss was in the experimental group, which reduced the number of subjects from 40 to 31.

Second, they did not compare the prescription fish oil with an equivalent amount of fish oil dietary supplement, whether it contained DHA or not, which seems to be a glaring omission to me.

Finally, the study was funded by the manufacturer; several of the researchers had a relationship with the pharmaceutical manufacturer as well. That doesn’t mean anything shady was going on, but it does put in question the conclusions that can be drawn about the significance of the entire clinical trial.

The Problem with the Fish Oil Supplement Study

The primary problem with the fish oil supplement study is that it was a meta-analysis. Even though that method is becoming popular, and even though by all accounts the researchers tried their best in selecting the correct studies for inclusion, there’s always the specter that they may have left out some studies. To their credit, they re-ran the analysis without several of the clinical trials and did get slightly different findings. However, it did not change the outcomes related to heart attacks or coronary heart disease events.

The study was funded by Global Organization for EPA and DHA Omega-3s. Just as with the pharmaceutical study, there’s an inherent bias implied. In both cases though, if the funding organizations didn’t sponsor the research, who would? There are only so many research dollars available, and many dollars are being siphoned off to fund urgent COVID-19 studies.

The Bottom Line

I think that these studies establish that fish oil is beneficial to reduce CVD events and reduce disease progression. Because there appears to be a dose-response relationship to fish oil and the reduction of CVD risk, the higher amount of fish oil a person takes, up to four grams, the better the potential outcomes.

Which one is better: prescription versus supplements? Until there’s a study that directly compares prescription fish oil to fish oil supplements, I don’t believe it matters; both studies we reviewed demonstrate benefits. The key is that if you have been diagnosed with CVD, you should take fish oil. Talk it over with your physician first and then get going. Your heart will love you for it. And don’t forget to eat better and move more as well.

What are you prepared to do today?

        Dr. Chet

References:
1. European Heart Journal (2020) 00, 1–8 doi:10.1093/eurheartj/ehaa652
2. https://doi.org/10.1016/j.mayocp.2020.08.034

Research Update on Probiotics and Adult Allergies

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Researchers recruited a total of 95 adults, ages 19 to 65, with allergic rhinitis for a double blind, randomized, placebo-controlled clinical trial; all the subjects were from two hospitals in South Korea. They were not allowed to take their usual medication to treat seasonal allergies.

In the experimental group, 47 subjects received the probiotics, and 48 subjects were in the placebo group. The probiotics used in the study was a novel blend called NVP-1703. The variables the researchers selected to track were markers associated with the immune response such as IgE and interleukins. They also tracked the symptoms of the subjects by having them complete daily diaries noting responses such as sneezing, itching, nasal congestion, runny nose, etc. The subjects also took standardized written allergy questionnaires.

The researchers found significant positive changes in the questionnaire assessment from baseline through weeks one, three, and four between the probiotic group and the placebo group. The IgE levels and serum IL-10 levels were significantly improved between the probiotic and the placebo group.

The improvement in questionnaire results meant that the subjects that were taking the probiotics saw their allergy symptoms decrease. By assessing the immune responses, they saw that somehow the probiotics stimulated the production of IgE and IL-10. Both of those allow the immune system to control symptoms associated with allergic rhinitis.

The researchers concluded that this blend of probiotics could be beneficial to treat seasonal allergies; I’m not sure I would go that far since the study contained fewer than 100 subjects. I would say that it was nice progress, although there’s still more to do. But if you have allergies, taking your probiotics regularly may be helpful for your allergy symptoms as well as all the other benefits.

What are you prepared to do today?

        Dr. Chet

Reference: Nutrients 2020. 12: 1427-41.; doi:10.3390/nu1205142

Will a Jellyfish Extract Help You Remember?

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For this week’s Memos, I’m reviewing products I get asked about frequently, all products that seem to have a large online or television presence. I’m going to review the base research on the product, and then you can decide whether you want to use it or not.

One of the most prevalent television commercials at this time is for a product called Prevagen, a dietary supplement whose tag line is “Improves Memory.” Prevagen contains an extract called apoaequorin from a type of jellyfish that appears to be well researched; however I found only a single clinical trial on the use of apoaequorin and memory. The 90-day trial of 211 subjects aged 40 to 91 showed no significant differences on a variety of cognitive tests between the placebo group and those using apoaequorin. However when a sub-group of subjects who were concerned about memory were tested using the AD8 test, there were statistically significant differences. When accounting for the actual differences in the reported percentages, the differences did not seem significant in the real world.

The product does appear to be safe in standardized toxicology tests on animals. Beyond that, there doesn’t seem to be any clear benefit for supplement use at this time because of the limited clinical research. It should not harm you, but it’s up to you to decide if the small chance it will help is worth your investement.

What are you prepared to do today?

        Dr. Chet

Reference: Adv Mind Body Med. 2016 Winter;30(1):4-11.

2018’s Worst Most-Read Paper

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In March of last year, the Journal of the American Medical Association published a viewpoint written by two experts in public health titled “Vitamin and Mineral Supplements. What Clinicians Need to Know”; it was one of the nutrition papers most read and most shared last year. The only problem is that clinicians really won’t find out much by reading it.

I’m going to pick one recommendation because everything after it won’t matter. The authors recommend that all clinicians recommend that patients get their nutrients from food. I absolutely agree with that. They go on to advise clinicians to tell their patients there’s no need to take any dietary supplements if they eat a healthy diet. That’s plain wrong.

We already know that over 90% of all adults do not get enough servings of vegetables, fruit, and whole grains every day—and it’s proven that food contains less nutrition than in the past—yet the authors did not recommend doing a nutrition analysis for the patient. With little to no information about the patient’s diet, clinicians are to tell their patients to eat a healthy diet, don’t take any supplements, and go on their way.

These are exceptional researchers; they know how poor the American diet is because they’ve done much of that research. To publish this opinion was incomplete in my opinion and thus it ranks as one of the worst papers of 2018. With almost a quarter million reads and shares passed along through social media and news feeds, millions read what they wrote, and it will influence millions. My opinion is that millions will be less healthy because they accepted these recommendations and dropped their nutrition insurance: their multivitamin and omega 3s and so on.

That doesn’t mean you take every dietary supplement that comes along. The rule is simple: know what supplements you take and more important, exactly why you’re taking them. And work on eating a healthier diet in 2019 as well.

What are you prepared to do today?

        Dr. Chet