Tag Archive for: supplementation

The Bottom Line on Preschoolers, Probiotics, and Gastroenteritis

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“These studies are likely to have significant impact towards eliminating use of medications that don't seem to work.”

That’s a quote from a physician interviewed by NPR who wrote a commentary accompanying the two research papers on probiotic use for gastroenteritis or GE (1). I think it perfectly illustrates the fallacy of the pharmaceutical model of research on nutrition and its impact on health:

Nutrients are not medications.

They may come in pill form, they can be administered like medications, but they’re nutrients nonetheless.
Questions About the Studies
The . . .

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Did Probiotics Help Preschoolers with Gastroenteritis?

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The use of probiotics to stop diarrhea and vomiting for preschoolers with gastroenteritis (GE) was studied in two major studies published in the New England Journal of Medicine. In the U.S. study, 55 of the 468 subjects who got the probiotics had scores of nine or greater on the scale while 60 of 475 in the placebo group has scores of nine or greater for the two weeks after the study began. This was a 20-point scale and the higher the score, the worse the GE symptoms. No significant differences.

In the Canadian study, 108 of the 414 subjects in the probiotics group and 102 of the 413 subjects in the placebo group had scores of nine or greater for the two weeks after the study began. Again no significant differences were found.

This led both research groups to conclude that the probiotics used in the studies were ineffective in preventing negative GE outcomes compared to those who received the placebo.

The press releases and follow-up interviews were much harsher in their criticism of probiotics. One of the study leaders concluded that “These two probiotics did not work. They should not be used for GE.” I would emphasize “period!” was implied. But is that true? If you’re a regular Memo reader, I’ll bet you have an idea where this is going; I’ll explain on Saturday.

What are you prepared to do today?

Dr. Chet

 

References:
1. N Engl J Med 2018; 379:2015-2026. DOI: 10.1056/NEJMoa1802597.
2. N Engl J Med 2018; 379:2002-2014. DOI: 10.1056/NEJMoa1802598.

 

Preschoolers, Probiotics, and Gastroenteritis

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Estimates are that close to two million preschool children will be taken to the emergency room for vomiting and diarrhea every year; the term generally used is gastroenteritis (GE). Two research groups, one from the U.S. and one from Canada, conducted studies to see if probiotics would have any impact on the course of GE from the time of the ER visit for at least two weeks after. Here’s what they did.

Researchers in Canada recruited close to 900 children and researchers in the U.S. had close to a thousand; all the children had symptoms of GE. The subjects were randomly assigned to a placebo or experimental group. The subjects in the experimental groups were given a five-day course of probiotics; the Canadian group used two strains and the U.S. used one strain. The subjects were then tracked to see whether there was a difference in the severity of the GE between those kids getting the placebo and the ones getting probiotics. Both research groups used the same GE symptom scale to monitor the severity of the GE.

Did the probiotics have any impact on the severity of the GE? We’ll check out the results on Thursday.

What are you prepared to do today?

Dr. Chet

 

References:
1. N Engl J Med 2018; 379:2015-2026. DOI: 10.1056/NEJMoa1802597.
2. N Engl J Med 2018; 379:2002-2014. DOI: 10.1056/NEJMoa1802598.

 

Classic: Vitamin Dumb

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As Paula and I visit our son and his wife this week, I’m choosing what I call Dr. Chet’s Classics. This one from 2010 illustrates two points. First, mega-dosing vitamins and minerals can have consequences that someone might not expect, and “if some is good, more has to be better” is not a good idea unless there’s a genetic or other reason. Second, even with the best intentions, researchers sometimes don’t use their heads when designing research studies.

Researchers reported in JAMA on the effects of vitamin D on fractures and falls in a group of over 1,500 women over 70. The results were surprising in that the vitamin D group had more falls and more fractures than the placebo group. Well, maybe not so surprising.

Remembering to take medications as well as supplements is a problem. So how did the researchers choose to address that issue? Give the women a year’s worth of vitamin D once a year.

That’s right. They gave these subjects 500,000 IU vitamin D once a year. I was almost rendered speechless—500,000 IU? What in nature would give them a model to follow? If you spend all day in the sun without sunblock, your body shuts down the production of vitamin D automatically; that’s why you can’t overdose on D from the sun. But this was oral intake; in what universe did these researchers think this was a good idea? Would they give someone a year’s supply of cholesterol-lowering medication or pain medication in one dose per year just because the subjects might not remember to take their meds every day? And what earthly good would that do?

In an editorial in the same issue, the authors suggested that medical professionals examine how vitamin D is administered, and that maybe administering 50,000–100,000 IU doses isn’t such a good idea.

Do ya think?

Taking up to 10,000 IU vitamin D3 is safe and 2,000-6,000 IU per day is a good goal. But this study illustrates that there’s no need to megadose. Doing that is like taking vitamin Dumb.

What are you prepared to do today?

Dr. Chet

 

Reference: JAMA. 2010;303(18):1815-1822.

 

Why You Need to Supplement

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The author of the opinion article in JAMA recommended that physicians make their patients aware of the research that questions the effectiveness of supplementation, hence his title “Negligible Benefits, Robust Consumption” (1). In making that recommendation, he gives the precise reason why that’s a bad idea. As I said Thursday, the answer can be found in the data used in the original article in JAMA about supplementation use in the U.S. (2).

While the JAMA article focused on supplementation, it also included data on food . . .

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Supplements: No Benefits?

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The opinion piece in the journal article was titled “The Supplement Paradox: Negligible Benefits, Robust Consumption” (1). The author is a well-respected physician who has written often about what he feels are the problems in the dietary supplement industry. He used the article I talked about Tuesday as a basis for his latest thoughts. Why would supplement use stay the same when research demonstrates that there are little to no benefits?

He raised three points. First, he suggests that people haven’t heard about the negative studies. I would debate that based on the questions I get about science . . .

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Changes in Supplement Use

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I take dietary supplements, and so do most of the people I know. We’re not alone. Using data from the NHANES data in 1999 and 2012, researchers compared how many people used supplements and what type of supplements they used (1).

Close to 38,000 subjects were included in the study. The percentage of people using supplements remained fairly stable over the time span at 52%; what changed was the types of supplements people took. Multivitamin-multimineral (MVMM) dropped 6% from 37% to 31%. There were some increases: vitamin D supplementation (other than from MVMM) increased from 5.1 . . .

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