[ed note: Michael Jorrin is longtime medical writer who has been sharing his thoughts with our readers as “Doc Gumshoe” for several years (he’s not a doctor, I gave him the name). He generally covers medical and health news and sometimes health promotions and hype, but he rarely opines about investments or specific stocks. All of his past commentaries can be seen here]
The key word there is “responses” – not answers, but responses. Many of the comments from the Gumshoe Literati are in the form of specific questions – what’s the correct dose of a specific supplement to achieve a particular result? The answer to such a question – coming from Yr Obt Svt at any rate – would be “I haven’t the foggiest.” But I can and will respond. Your questions and comments set my mind to wondering and pondering and exploring, and I’m happy to expose the inner workings of my little grey cells to you all. And, needless to say, to expose my conclusions, tentative as they may be, to your shrewd appraisal.
Niacin as a treatment for elevated cholesterol?
One such comment, which I replied to briefly in the comments thread, was this:
“What did you think about the quote in the N Y Times (about a decade ago?), where the President of the college of cardiology states that the absolutely best drug for cardiovascular disease is Niacin (aka: Nicotinic acid), because it raises “good” HDL, lowers “bad” LDL, & lowers Triglycerides, as no statin can do?”
My reply did not satisfy the reader, particularly my noting that niacin had fallen out of favor as a treatment option for elevated cholesterol. He commented that “fallen out of favor” is not science, and mentioned other potentially beneficial effects of niacin/nicotinic acid which, to be frank, I had never heard of. This prompted some sleuthing.
In previous pieces, I have tried to present a kind of summary of the history of the management of heart disease related to arterial obstruction.
Hardening of the arteries, or arteriosclerosis, had been observed for a really long time – many centuries – but it was only in the early 20th century that it became associated with cardiovascular disease. In the first decade of the 20th century, the stuff that was deposited in the artery walls, and in some cases also clogged the lumen of the arteries, was identified as cholesterol, although some calcium was also deposited in artery walls. The term “arteriosclerosis” was gradually replaced by “atherosclerosis,” which pinned the blame on fat. The emphasis on cholesterol as the culprit is about a century old, but for most of that time, clinicians didn’t have any effective means of dealing with cholesterol or atherosclerosis.
The initial focus, quite reasonably, was to try to manage cholesterol by dietary means – that is, by restricting foods that were highest in cholesterol. Unfortunately, with regard to the population in general, this approach does not work. The principal reason for the failure of this approach is that we, along with most animals, have an excellent capacity for synthesizing cholesterol (cows make it out of grass). That capacity, after all, is necessary for our survival, since cholesterol is an essential component of most body tissues (bones excepted) and is also essential to the synthesis of the hormones on which we depend for body functions. So we make at least 80% of the cholesterol in our systems, and take in perhaps 20% as cholesterol in our food; therefore, lowering dietary cholesterol just doesn’t do the job.
Therefore, the medical community looked around for drugs that might have the effect of lowering cholesterol, and in the mid-1950s niacin was the first one found to have that property. Up to then, niacin, also termed Vitamin B3, had been known as an essential factor in preventing pellagra, a disease caused by deficiency of niacin/ B3 in some people’s diet.
Niacin lowers levels of LDL-cholesterol and VLDL-cholesterol, as well as lowering triglycerides and increasing HDL-cholesterol levels. The principal drawback of niacin as treatment for elevated blood lipids is that many patients find it quite difficult to tolerate niacin at the dosing levels necessary to effect the desirable changes. Many or most patients experience severe flushing, which can be accompanied by severe and persistent itching anywhere in the body. This has greatly affected adherence to treatment with niacin – that’s to say, patients try it, but find that they can’t stick to it.
There are other cholesterol-lowering options other than statins. Fibrates tend to have a beneficial effect on VLDL, and in particular, on triglycerides. Their effects on LDL and HDL are variable. Bile acid sequestrants tend to lower total cholesterol and LDL and produce small increases in HDL. Omega-3 fatty acids may be useful in persons whose lipid imbalance is primarily a matter of elevated triglycerides; these need to be taken in very large doses.
Unfortunately, neither niacin nor these alternatives lower C-reactive protein, which is a marker for systemic inflammation. Inflammation is thought by many to be the key factor in arterial disease, resulting in what’s called vulnerable plaque. It’s this plaque that breaks apart, dispatching the little blood clots that can cause deadly damage to lungs, brain, or heart. But statins do lower the specific type of C-reactive protein associated with vulnerable plaque.
And statins produce significantly larger reductions in both total cholesterol and LDL than those other agents; at high doses, statins can lower LDL levels by as much as 60%. Their effect on HDL levels is much smaller. The effectiveness of statins (HMG-CoA reductase inhibitors) in inhibiting cholesterol synthesis in the liver began to be understood in the 1970s, but it was not until the mid-1990s that it was clearly demonstrated in a large, well-controlled clinical trial, that statin treatment had a direct effect in reducing the mortality of persons with elevated cholesterol who had established heart disease. The trial in question, published in 1994, was the famous 4S trial (Scandinavian Simvastatin Survival Study), which enrolled patients with existing coronary heart disease and baseline mean total cholesterol of 261 mg/dL, and reduced coronary death by 55% at 5.4 years.
That was when treating elevated cholesterol with niacin “fell out of favor.”
It’s certainly the case that many people have problems with statins, specifically, muscle aches, or in the most severe cases, actual destruction of muscle tissue, called rhabdomyolysis. This last condition is exceedingly rare; in the neighborhood of ten cases per million statin prescriptions.
A recent review in Lancet weighing the efficacy of statins against the risk of side effects concluded that the harms of statin treatment have been greatly overestimated. For example, a reduction in LDL-cholesterol of 77 mg/dL, such as might be achieved with a 40 mg dose of a statin such as atorvastatin (Lipitor) would prevent major vascular events in about one out of ten patients, while it might result in fewer than one in a hundred new cases of diabetes, and fewer than one in a thousand hemorrhagic strokes. The authors pointed out, however, that those adverse events are not necessarily caused by statin therapy, noting, for example, that persons with elevated cholesterol are more apt to develop diabetes whether or not they are treated with statins. To sum up, the benefits hugely outweigh the harms.
This is not to say that recent algorithm-based guidelines that result in prescribing statins to another billion people or so, primarily based on their age, would not also result in unnecessary treatment for lots of those people, some of whom would likely experience adverse effects. The recommendations for such broad treatment remind me of a proposal in the UK, some years back, to put everybody over the age of 40 or so on a daily pill that combined a couple of different antihypertensives, aspirin, a statin, and I forget what else. That’s EVERYBODY – no questions, no medical examination, no tests. The idea was it wouldn’t hurt most people, and it would prevent some heart disease and strokes, and it would save a lot of money. Fortunately, the proposal didn’t take wing.
To go back to niacin for just another moment, this chemical has other presumed benefits, including, perhaps, that schizophrenia is due to a niacin deficiency, much as pellagra is due to a niacin deficiency, and might be corrected with niacin supplementation. Whether this theory is borne out in practice or not has little to do with niacin being preferable to statins for management of elevated cholesterol. The crux of the matter is the dose. To have any effect on cholesterol, the necessary niacin dose is far larger than the amount needed to correct a deficiency.
Niacin has been classified as a vitamin precisely because it is present in the normal diet and is essential for life. Vitamins as a group have little in common except for that simple characteristic. Most people get enough of the vitamins they need in the food they eat, but the difference between vitamins and other supplements is that a number of serious health conditions have been strongly linked to vitamin deficiencies, and giving vitamins to people with those health conditions addresses the problem efficiently. The origin of the word “vitamin,” by the way, is “vita” (Latin, “life”) plus “amines”; it was originally spelled “vitamine” due to the mistaken belief that niacin was an amine. In 1920 the error was pointed out, and the spelling was changed to the present form, without the final “e.”
What about co-enzyme Q10?
Co-Q10, as it is called, comes in for a great deal of speculative discussion. There are a lot of boosters, some detractors, and, certainly, quite a few skeptics, among whom I count myself. It’s an antioxidant, and as such is among the favorite supplements of the contingent that believes that oxidative stress is one of the health arch-villains. It is a factor in the conversion of food into energy, and it also has some anti-clotting capacity.
The comment in the Doc Gumshoe piece that I entitled “Thanksgiving Leftovers” came from a reader who reported hearing the head of cardiology at the Mayo Clinic say that he would take Co-Q10 in preference to a statin. I wonder about when exactly that happened, and also about the context. But it is true that Co-Q10 is promoted – or should I say “presented?” – by many as being a useful supplement in many cardiovascular conditions, including elevated cholesterol and high blood pressure. It may also help control diabetes and prevent migraines, and because it’s active in metabolism, it may boost energy and help deal with fatigue.
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Unfortunately, the evidence for these beneficial effects is thin, and in some cases, contradictory. The absence of solid evidence should not necessarily be taken as evidence of absence of benefit, however. The question is open, subject to confirmation – or rejection – by well-conducted clinical trials.
I recognize that the phrase “well-conducted clinical trials” is certain to raise hackles in the Gumshoe contingent that is solidly in the supplements camp. Their argument, which has merit, is that clinical trials with enough statistical weight to convince the likes of the medical establishment, the FDA, and Yours Truly, are exceedingly expensive, and that pharmaceutical outfits with the necessary capital are simply not going to pour a billion and a half bucks into demonstrating the benefits of a supplement that they cannot possibly patent and make any money from. This is true in a general sense, but that doesn’t mean that Co-Q10 hasn’t been the subject of considerable clinical scrutiny. A quick PubMed search turns up 630 published papers about Co-Q10, and from what I could see, none of them confirm its efficacy with any confidence. By no means did I examine all of these papers, but I looked at titles and read many abstracts. It was clear that the effects of this agent were being discussed in a speculative manner, and caveats were the rule.
The chief argument against Co-Q10 as a statin replacement is the possibility of a number of drug interactions, including with other cholesterol-lowering drugs (statins, fibrates), antihypertensives (beta-blockers), and antidepressants. What Co-Q10 appears to do is accelerate the elimination of those drugs, reducing their concentration and effectiveness.
My guess is that interest in Co-Q10 will remain high and that scientists will continue to try to figure out whether, and exactly how, it might convey substantial benefit in clinical use. When that happens, you can bet that a pharmaceutical company will tinker with the molecule or the formulation, patent it, and go ahead with whatever they need to do to turn it into a profitable product.
Carnosine to prevent cataracts?
Another reader asked whether I could report on the amount of carnosine needed to prevent cataracts. I had no idea even whether carnosine would prevent cataracts, let alone how much was necessary, but I decided to take a peek. By the way, this reader strongly suggested that my sources were, um, too narrow. Here’s what he said:
“I agree Michael Jorrin writes and derives conclusions from a very selective and limited perspective of available research.
For example, would you like longer or shorter telomeres? I want longer telomeres. Tell me Mr. Jorrin, which foods and food supplements will lengthen them and the correct dosage.
Or, how much Carnosine would it take to reduce formation of cataracts? Research suggests 1,000 mg per day. How much of what foods would that be, and wouldn’t it be easier and cheaper to supplement?”
When sleuthing about the anti-cataract potential of carnosine, it doesn’t take more than a few minutes before the name of M. A. Babizhayev comes into prominence. He is a Russian scientist who holds the patent on eye drops containing one form of carnosine, N-acetylcarnosine (NAC). The eye drops are sold as Can-C, and they are the most prominently-promoted of the several eye drops sold to prevent cataracts.
There appears to be at least some substance behind the claim that carnosine can prevent or at least delay cataracts. One of the factors that contributes to the formation of cataracts is the oxidation of lipids in the lens, and carnosine is active as an antioxidant. Another of the carnosine forms, L-carnosine, may inhibit glycation, in which glucose binds with lipids. The antioxidant properties of the L-carnosine form are minor, but inhibiting glycation in the eye may have some effect in delaying the formation of cataracts, especially in persons with poorly controlled diabetes. Thus, some eye specialists recommend L-carnosine for diabetic patients.
Dr Babishayev holds L-carnosine in low regard, instead emphasizing the potential of his own patented carnosine compound, NAC. Even so, his most recent paper (BBA Clin. 2016 Apr 19;6:49-68) is far from a confident assertion of the efficacy of NAC in preventing cataracts. It’s more of an exploration of the mechanisms through which NAC might prevent or delay cataracts, specifically the effects of reactive oxygen species on mitochondrial activity.
The Royal College of Ophthalmologists in the UK has taken a look at carnosine for cataract prevention and turned thumbs down – the evidence so far does not support the claims for efficacy or safety. More research is needed, especially by workers who do not hold patents on carnosine supplements.
The general view among the community of eye doctors is that the best way to prevent cataracts is to wear sunglasses, not smoke, and eat a normal diet including fruits and vegetables containing natural antioxidants. When people develop cataracts, which many people inevitably will, surgical treatment is straightforward and has a very high success rate.
Some readers will say that OF COURSE the Royal College of Ophthalmology is not going to go along with an inexpensive supplement that will prevent cataracts, because they want their patients to develop cataracts so that they can perform the surgeries that they depend on to maintain their luxurious town houses on Belgrave Square and their fox-hunting properties in Sussex. For my part, I wonder what Dr Babishayev’s country estate looks like?
… and what about telomeres?
In case you forgot, telomeres are short repetitive DNA sequences at the ends of chromosomes whose function seems to be to protect the chromosomes as cells divide; in themselves they don’t code for anything, they’re just little protective bumpers. Telomeres naturally get shorter as people age, contributing to chromosome damage. So, protecting telomeres is thought to be an excellent means of slowing the aging process. An analysis based on the Nurses’ Health Study, carried out by Brigham and Women’s Hospital and the Harvard Medical School, reported that adherence to the Mediterranean diet (fruits, vegetables, nuts, legumes, unrefined grains, olive oil, fish, and, yes!, wine) helps preserve telomeres.
The study, very carefully carried out and published in the British Medical Journal in December 2015 followed 4,676 women in the Nurses’ Health Study and assessed their adherence to the Mediterranean diet on a 9 point scale. Each increase of 1 point on this scale corresponded to about 1.5 fewer years of telomere aging. A 3 point score on the Mediterranean diet adherence scale corresponded to about 4.5 fewer years of telomere aging, which is similar to the difference between smokers and non smokers, and between inactive and active women (that is, smokers and inactive women had about 4.5 years more telomere aging). The largest single cohort in the study, 1201 women, had a score of greater than 6, equivalent to about 9 fewer years of telomere aging.
Whether this works out to be 9 additional years of life has yet to be determined, but it’s clearly a good sign!
And, by the way, the only significant correlation was between the Mediterranean diet overall and telomere length. Individual components of the diet did not yield significant correlations.
So, to the reader quoted above, and to Gumshoe Nation at large, my best answer to the question is that I do indeed want to protect my telomeres, and the best way I can come up with to attain that goal is to (more or less!) follow the Mediterranean Diet. For dinner tonight I am having a fish stew consisting of haddock, shrimp, several vegetables sautéed in olive oil, a salad, whole grain bread, and a nice Pinot Grigio.
A tuberculosis vaccine as a cancer treatment
This was more a suggestion than a question. It came from an Irregular, many of whose comments have led me down interesting paths. This one in particular was a familiar path, for reasons that I will explain, but one which led to fascinating prospects.
The tuberculosis vaccine is the bacillus Calmette-Guérin (BCG) vaccine, certainly one of the most widely-used vaccines in the world. Two French scientists, Albert Calmette and Camille Guérin were tinkering with the tuberculosis bacillus and accidentally found a way to greatly dial down the severity of its infectiousness. It would elicit an immune response, but not result in the clinical disease, thus making it a potential vaccine. That, as you remember, is the modus operandi for creating any vaccine – an inactivated or attenuated pathogen that creates immunogenicity in the host.
Calmette and Guérin started working on the tuberculosis bacillus in the early years of the 20th century, and along about 1920 they started using it in humans with some success. The discovery that the BCG vaccine was effective in treating cancer took another 30 years or so. A seminal paper in 1963, “The Clinical Use of BCG Vaccine in Stimulating Host Resistance to Cancer,” (Phillip J, Cancer 1963;5:387-400) pointed to the essential mechanism of the BCG vaccine. The vaccine itself does not attack cancer cells; instead it somehow recruits the host’s immune system to attack the cancer cells.
The particular cancer for which BCG is most frequently used is bladder cancer. It happens that about 25 years ago, I worked on a continuing medical education program on this subject, so when I saw the comment pointing to recent developments on the BCG front I was ready to jump on it.
That comment led me to a paper, published just two weeks ago, which pointed to the mechanism whereby BCG stimulates trained immunity (Arts RJ, Cell Rep 2016;17:2562-2571). The process itself leads into the thickets of an area of research that it arousing a great deal of interest. This field is relatively new. It is called epigenetics.
The term “epigenetics” describes factors that are not part of the genetic material itself, but can exert changes in its activity. Recent research demonstrates that changes in the activity of genes can be triggered by agents external to the DNA strands themselves, but within the capsule containing the DNA strands, which are tightly wound around proteins called histones. In turn, the histones are organized into tight clusters called chromatins. The full DNA double-helix, consisting of 146 to 147 base pairs of DNA, would be over 2 meters long extended to its full length, but the diameter of the chromatin is about one 6-millionth of a meter.
In the case of the BCG vaccine, changes in histones have been identified that modify certain immune cells called monocytes. In turn, the monocytes induce changes in cell metabolism that support the immunogenic characteristics of the BCG vaccine.
Scientists have been working on ways of editing DNA with the idea, for example, of creating a strain of sterile mosquitoes that would essentially cause a whole mosquito population to become extinct, as a way of controlling the Zika outbreak. However, it has generally been thought impossible to change the genetic material in midstream so as to effect changes in the immune system during the course of an infection or after a disease has set in. Targeting histones and chromatins through external agents can affect the activity of the genetic material without changing the DNA itself, therefore epigenetic modifications could be useful midstream.
An anticancer agent that employs epigenetics is panobinostat (Farydak, from Novartis), which was approved by the FDA in early 2015 for the treatment of multiple myeloma patients who have received at least two prior treatments. Treatment with panobinostat increased progression-free survival in such multiple myeloma patients from about 6 months to about 11 months. The specific mechanism of panobinostat is that it reverses the inactivation of enzymes that would normally attack cancer cells, in effect restoring the innate cancer-killing capacity of healthy cells.
There are currently 137 clinical trials listed as recruiting, underway, or completed, that investigate epigenetic factors in a number of cancers. These include breast cancer, pancreatic cancer, non small cell lung cancer, ovarian cancer, a number of lymphomas, esophageal cancer, lung cancer, thyroid cancer, brain tumors, colorectal cancer, leukemia, and castration-resistant prostate cancer.
It appears that the changes that Calmette and Guérin effected on the tuberculosis bacillus were epigenetic changes – changes to the chromatin that did not affect the DNA of the bacillus, but did modify its capacity to transmit active tuberculosis. They had no idea of what they were doing, only that they were working with a highly infectious pathogen in the hopes of achieving a good result, a la Pasteur. They knew nothing about DNA or about histones and chromatin. But they experimented, kept an eye on the results, and moved forward when they saw something good was happening.
That is often the way forward in medical research, and it applies not only to the bacillus Calmette-Guérin, but perhaps to some of the other interventions we discussed in this Doc Gumshoe episode. Maybe tinkering with Co-enzyme Q10 or carnosine will effect epigenetic changes that transform these substances into miracle drugs. There are Calmettes and Guérins out there still, and the likelihood is that we have not seen the end of great and valuable discoveries.
* * * * * * * * *
Well. I only got to about half of the interesting comments that you sent my way. I will resume sleuthing after the holidays – put my nose to the grindstone, or whatever they call it. Your comments are valuable, especially when they stir me to performing calisthenics with the contents of my noggin. Even the slings and arrows are welcome, such as when someone suggests that I must be in the pay of the Pharmaceutical Cabal. (My excellent wife, when I mentioned that particular comment, chortled and said, “Well, we could use the moolah!”)
I am greatly looking forward to the holidays & I wish you all the joys of this season of merriment and cheer! Best to all, Michael Jorrin (aka Doc Gumshoe)
I’m looking for income & looking to start a portfolio of mlps. In particular I like DM & MMP.
Suggested reading on this subject is ” The Great Cholesterol Con” The truth about what really causes heart disease and how to avoid it. by Dr. Malcolm Kendrick
Carnosine and leucine are promoted as natural food amino acids that facilitate healing injured tissues and to suppress aging via a variety of organ repairs, perhaps by accelerating stem cell formation. Please let us know your opinion regarding these claims.
I am specifically interested in D-leucine and L-carnosine as a natural food additive to reduce or eliminate seizures.
“Omega-3 fatty acids may be useful in persons whose lipid imbalance is primarily a matter of elevated triglycerides; these need to be taken in very large doses.”
Only the omega-3 fatty acids (EPA and DHA) from marine algal oils (via fish, or now directly from extracted algal oils) have this effect. ALA, an omega-3 fatty acid from land plants (flaxseed is the most-hyped source), does not produce this effect. Cheap and readily-available ALA passed off as having the same effects (anti-inflammatory, etc) as EPA and DHA is one of the bigger scams employed by the food industry and is still going strong, with flaxseed or its oil added to everything from margarines to muffins along with a proclamation of “Contains Omega-3!” on the label.
Btw, the other issue (besides flushing) with high-dose niacin is potential liver damage.
What about the Japan study that showed people with higher cholesterol (250 range) lived longer than those with lower cholesterol? Just so happened the 94 study was funded by makers of Lipitor. Isn’t there some important research out there regarding the case against the under 180 numbers?
Michael, the reason you are accused of being in league with Big Pharma is because your articles are incomplete and in some instances are lacking in balance. You sometimes appear to just reproduce Big Pharma marketing. I would suggest you revisit the actual statin studies and look at absolute risks instead of the misleading relative risks you champion. You should also review the all-cause mortality data for a more complete risk-reward picture.
WRT CoQ10, evidence is not “thin”. There are many study references on PubMed as to the benefits – are you also aware that Merck already possesses a patent (from 1990) combining a statin and CoQ10 but have never produced such a drug.
Finally, turmeric (curcumin) has been advanced as an inexpensive and highly effective agent to preserve and regenerate telomeres, in addition to a myriad of other health benefits.
Interesting piece, after reading the following I really thought this was going somewhere. ” In the first decade of the 20th century, the stuff that was deposited in the artery walls, and in some cases also clogged the lumen of the arteries, was identified as cholesterol, although some calcium was also deposited in artery walls. The term “arteriosclerosis” was gradually replaced by “atherosclerosis,” which pinned the blame on fat. The emphasis on cholesterol as the culprit is about a century old, but for most of that time, clinicians didn’t have any effective means of dealing with cholesterol or atherosclerosis.” I think from my personal research that the medical profession was barking up the wrong tree when it concluded that cholesterol was the prime culprit in heart disease and consequently statin’s have been over-prescribed. After I was placed on statin’s by my doctor I did some personal research on them and came to the conclusion that the treatment had more negatives and highly probable side effects that outweighed any potential benefit.
Two things in particular that influenced me were the potential of triggering diabetes, (which I was already diagnosed as having) but even more important was the fact that Co-enzyme Q-10 was essential to the beating of the heart and statins specifically interfered with the bodies natural ability to produce Q-10 which convinced me to stop taking statin’s, which I did and very quickly felt better. I am happy to say that through dietary means alone and taking Q-10 as a supplement I have able to reduce my insulin injections to twice a day from 4 times and half the original dosage.
When I confronted my doctor about the contradiction of prescribing statins to supposedly protect my heart when in fact it was a potential threat to my heart function he more or less shrugged his shoulders saying “all drugs have side-effects” showing no interest in learning about safe natural methods to deal with a problem. They are simply trained to prescribe drugs that interfere with the natural processes of the body.
Further research has me convinced that the culprit really is calcium that clogs the arteries and causes high blood pressure. The answer to that appears to be Vitamin K2 that directs calcium to the bones where it belongs rather than accumulating in arteries. A key researcher reporting on that phenomenon has been Brad Lemley of Laissez Faire and NO I do not believe that the average person gets adequate vitamins, minerals and enzymes from food without supplementation. This is a medical doctor promoted myth and drugs are no substitute for good nutrition. The Standard American Diet is indeed “SAD” easily determined by the huge number of people who are obese, which is really a symptom of poor nutrition, too many calories from junk food and not enough fresh fruits and vegetables with high nutritional content. Most health problems are solvable by intelligent changes in lifestyle. (which is why so many of the major causes of death are quite rightly dubbed “lifestyle diseases” the problem being that it is much easier to get the average person to take a pill than it is to educate them on the lifestyle/dietary changes they need to make to enjoy good health.
Myron, with all due respect to your research and strongly-held beliefs, it is not a myth that ordinary natural foods contain adequate essential nutrients for the great majority of people, and the reason that MDs say so is because they are told that by Registered Dietitians who in turn were taught thus in their training by taking nutrition courses at real universities, and those courses always employ serious nutrition textbooks and (ideally) profs who have advanced degrees in nutri. science, and the textbook authors and profs were in turn informed by real actual published papers in real actual scientific journals where it has been made abundantly clear over decades that ordinary foods in a varied diet are, in fact, adequate sources of essential nutrients. The myth is that they aren’t. This isn’t rocket science, but it is nutrition science. Furthermore, and rather unexpectedly, current evidence suggests that vit/min supplements do not provide much, if any, health benefits in the great majority of people who are otherwise well. In the case of statin-inhibited synthesis of CoQ10 (which, btw, is not considered a vitamin), taking a supplement may well provide a benefit…assuming that the ingested CoQ10 is actually absorbed from the small intestine into the bloodstream and manages to be distributed to all bodily tissues.
Yes Dave, it is possible to obtain all necessary nutrients from ordinary foods, providing they were grown in healthy soil with an adequate availability of trace elements, which is not true when grown with chemical fertilizers. the problem is that most people do NOT eat the ideal diet to begin with that would make that even possible. The person who lives on food from fast food restaurants, whether they prefer hot dogs, hamburgers or pizza washed down with soft drinks are not getting all the nutrients they need for proper metabolism and nutrition.
Likewise people whose meals at home are primarily based on processed and fractionated rather than whole foods, usually eat white flour, breads and pasta, white rice (germ removed) nitrate laced prepared meats instead of fresh are likewise likely to be nutritionally deficient and lacking adequate fiber etc. to say nothing of ingesting a myriad of chemicals in the forms of preservatives, artificial, colours and flavours etc.
The simple truth Dave is that MD’s are bombarded with far too much pharmaceutical industry propaganda that is profit centered rather than health centered and actually receive very little training in nutrition. They may learn from dietitians who have better training but even they are influenced by the alliance between the food processing industry and the pharmaceutical industry.
Your right, I don;t trust either one to act in my best interests as a consumer, I prefer to grow the majority of my fruits and vegetables organically without artificial chemical fertilizers and untouched by poisonous pesticides and herbicides etc, I want my meats, eggs dairy products from animals raised on a healthy natural diet and without hormones etc. I am happy to pay a little extra for higher quality food such as free range chickens fed flax seed for increased omega 3 content in their eggs for just one example.
Myron, the ALA omega-3 from land-based plants such as flax is the wrong omega-3. It is not comparable, effect-wise, to EPA and DHA which are derived from marine algae. Your fears about RDs are, imo, unwarranted, as are your worries about the nutritional adequacy of normal American foods. Of course hyper-processed foods (sugars, oils/margarines, protein powders, etc) are lacking in most essential nutrients unless the nutrients are replaced (as is partially the case for white flour and white rice, and the other essential nutrients can be found in other foods), but a varied diet of normal unprocessed or modestly-processed foods readily available in the non-organic section of typical grocery stores is adequate in its provision of essential nutrients.
People who do not go out of their way to “eat organic” or scrupulously avoid white flour/rice AND who maintain a healthy weight by not overeating AND who stay physically fit routinely live to advanced old age here in the US of A. And btw, obesity is entirely possible to achieve and maintain eating only Very Healthy Foods. It’s the calories, after all.
Well said Myron. As usual.
I vote for Myron over Dave S.
Dave S position seems more theoretical than reality. Nearly all of my friends and close relatives (e.g. similar genetic material ) almost to the man and woman, have a variety of Cancers, heart bypasses, replaced Knees, hips, Pacemakers, prostate problems, high blood pressure, taking drugs that provide a variety of miserable side effects. Some are already dead. All are (or were) clean -living, church going, exercising normal diet just Like Dave S. says, and followed Dave’s “advice.”
But I and my 91 year old Dad have none of these problems, and are not on any meds. For many years we have taken a variety of Supplements mentioned here, and then some. We eat the same diet as everyone else, but they, Like Dave don’t take supplements.
Bottom line. Myron- You are right on. But as for Dave S., there is a lot of research that supports supplementation as a way to optimize better health. You could learn.
One more thing: and this is more philosophical.
Research of this nature isn’t exact, as everyone is genetically different.
I only have one go at this life. If I miss something that research indicates may have been beneficial, that loss may be permanent. No going back.
The fatal heart attack that may have statistically been avoided with COQIO and other supplements isn’t going to be of much value retroactively from Dave’s “advice” – it’s too late.
So take advantage of every opportunity/option for better health while you can. You have only one shot.
Russ,
Please provide the links to said research. The actual scientific research I have seen and studied on this subject supports Dave S’s position. I congratulate you and your dad on your health but two data points based on anecdotal evidence, do not, a scientific study make. Where there have been studies that utilize the gold standard of peer reviewed, double blinded methods, that are admittedly expensive to conduct, no statistical benefit from taking supplements has been consistently proven, with the exception of Vitamin D. Most of the rest of the supplements have been found to have little benefit for the general population, though there are certain conditions based on deficiencies, where they obviously have benefits based on replacement of the chemical that is deficient. Worse yet, there has been significant research that has shown the vendors of these supplements often have poor quality control mechanisms to ensure that the buyer is getting what they paid for. Often, the advertised concentration of the supplement is not what is sold, with compounds being both over and under what is on the label. Sometimes, the compounds are not even there at all. It has been proven too, that over consumption of many supplements can be harmful which makes it all the more important to know what you are ingesting.
Good nutrition is essential to good health and I have yet to meet a doctor who doesn’t agree with that. Every nutritionist I have spoken to on this matter tells me that supplements are unnecessary if your diet is adequate. So let’s be careful to award facts to people like Myron i.e. “Bottom Line. Myron- You are right on,” when you are really just speaking opinion. If you want to further argue your point, I ask you to provide the links that support the research you allude to. I would be willing to bet, the research is of poor quality, that is not peer reviewed, and that is funded by the outfits who sell the supplements.
To Longonlife.
You’ve missed my point. I’m not the research but the probable beneficiary of a vast amount coming from universities and clinics all over the world.
Of course I can compare old blood tests with new ones and also feel improvement over time. But I am not the research- a subtle difference.
You ask for reference? Where does one start from maybe 10s of thousands of abstracts?
The short answer for me is LEF.Com. I trust their staff to review approximately 3,000 abstracts per month, to derive indications that support a particular supplement that may be of value.
Everyone wants a simple answer, but it’s not that simple.
In the end I, like Myron, can benefit from all that.
The government, JAMA and many others review research abstracts.
What I want is someone to put it all together; analyze and identify corroborative trends and indications from many different sources.
The purpose is to identify a critical mass of data supporting the safety and efficacy of something that will advance health outcomes. It’s hardly ever just one study. Some studies seem more indicative than others, of course, depending how they are constructed.
I suggest you start with the easily understood book “The China Study” by Colin Campbll. I’ll list the references from one chapter (Chapter 5 on heart disease) so you can see how condensed it is. Chapter 5
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Thanks Gillio, unfortunately there is a never ending battle between creationists who believe in an all wise Creator who made man from the dust of the earth and all the plants and herbs that are designed to pull those nutrients from the ground from which man was made and offer a wide variety of tastes, aromas, coluurs that in most cases are clues to their nutrient content for man to enjoy. In fact my Amplified Bible has a footnote on Gen 1:29 that outlines the ideal diet for man that says precisely that, in other words the Creator designed the Universe to provide everything that man needs in natural foods to maintain good health and long life. People lived for hundreds of years on an original natural foods diet BEFORE man thought he knew better than his Creator and polluted the air and water and in the pursuit of profit mined the soil stripping it of earthworms, a natural soil aerator bringing trace minerals from the subsoil to the surface and enriching the soilwith their castings. To-day most soil farmed commercially is depleted of essential nutrients and would produce very little if not force fed with chemical fertilizers and laced with poisonous chemicals to destroy the various pests and fungus that would normally decimate unhealthy, nutritionally inadequate produce of all kinds, which is what we end up with in the commercial markets.
This is not theory, my late father in the 50’s sold a highly successful John Deer dealership and bought a 200 acre farm considered one of the best in the district, spent tens of thousands on purebred Shorthorn cattle and the first few years we had no end of problems from cows aborting to scours in calves, the vet practically lived at our place. Dad;s brother had introduced him to Rodale publications on organic farming and he vowed that he would farm without chemicals or go broke trying. It took a few years of green manuring, (crops like sweet clover and rye plowed down) plus copious amounts of greensand (natural potash fertilizer with trace minerals), and natural rock phosphate before that depleted soil was again teeming with earthworms and producing healthy crops that were the envy of all the neighboring farmers. Best of all, no more sick animals so we learned from that and drastically changed our diet when I was in my teens, and likewise having been a sickly child, paralized briefly after a diptheria shot to robust health never taking a sick day in my working life and playing hockey until I was 72, and never once visited a medical doctor or filled a prescription.. I studied nutrition, reading dozens of books and raised 5 healthy children none of whom were ever inoculated for anything (because of my personal experience) after reading the now unfortunately out of print book, The Poisoned Needle by Eleanor McBean. The children ALL had no cavities into their 20’s in spite of my wife and I BOTH having a mouthful of rotten teeth as teenagers and YES, we both ate a pretty standard diet equivalent to the average consumer to-day, so you would have a pretty hard time convincing me that good nutition based on fresh natural foods don’t make a difference.
Agnostics and atheists on the other hand rely on so called science and the wisdom of man to replace the wisdom of recorded scripture instead of listening to the wisdom of Daniel who in captivity told the Babylonian King’s chef to just give them water to drink and Pulse (legumes) to eat instead of all the rich dainties of the Kings table and in just days it was obvious they were healthier and had more energy than those fed from the King’s table.
Another way to regenerate CoQ10 in our bodies is to eat a lot of greens and getting sunlight exposure.
http://nutritionfacts.org/video/how-to-regenerate-coenzyme-q10-coq10-naturally/
It’s all about diet, a crappy diet and all the pills will not help.
As Dr. McDougall states (it’s the food !)
Thank you for the link.
I should have added that in both men & women over the age of 70; there appears to be little to no evidence of benefit from Statins. More importantly, Over the age of 70 “the higher the cholesterol level, the higher the age at death ( longer lifespan). While correlation never proves causation (including in the case of patentable pharma products), most essential (hormones, etc…) biochemicals decline with age, which does not apparently lead to better quality of life, which I believe to be of value…
Isn’t it said that you cannot have a polite discussion about religion, politics and supplements?
I’ve been taking Max-Q10, Seven Tummeric/Curcumin and I’m now thinking of adding AL-3 for deep fat removal. Any thoughts as to any benefits or am I wasting my time? Also I’ve been hearing about alkaline water and the benefits but question if there truly is any benefit?
Backoffice, I think you’re wasting your time. Docs who sell such products from websites are exactly as trustworthy as trading/investment gurus with websites who claim to have a simple and foolproof way to turn a small grubstake of $5000 into as much as $79,654.34 in the next 6 months. If you assume they’re all charlatans you’ll almost always be right. And if there ever IS a simple miraculous fix for intra-abdominal fat that actually works (and it will very likely come from biomedical researchers rather than from a doc to Hollywood stars), EVERYONE will know about it, esp. your physician, and a Nobel prize will be awarded to the discoverer(s). I wouldn’t hold my breath for such a fix, but meanwhile, do what you can to lose the belly fat: eat fewer Cals than you spend in order to lose weight, and work up a serious sweat as often as you can with aerobic exercise.
And forget alkaline water. Just eat plant foods if you want alkalinity. Potassium does it. It will likely not be life-changing.
Dear Doc G.
Regarding Co-enzyme Q-10 (“ubiquinol”): I have never heard of co-enzyme Q-10 being useful in fighting cholesterol and promoting coronary health. I have encountered frequent references to the need for statin patients to take co-Q10 to counter some of the unwanted consequences of using statins.
I am doing this from memory and I am NOT a biochemist, so please feel free to correct any meaningful inaccuracies in my account. As I recall, statins do their thing by interrupting a chemical cycle in the liver that produces the cholesterol that finds its way into our arteries (the mevalonate cycle ). Unfortunately, the step that produces our cholesterol is near the beginning of this cascade of some 200 chemical reactions reactions, meaning that our use of statins to control cholesterol creates a lot of unnecessary ‘collateral damage’ downstream. And one of the the final events in this now-disrupted cycle is the production of co-enzyme Q-10. As I understand it, this enzyme is crucial in the production of the molecule ATP, which plays the vital roll of transporting energy from the cells’ mitochondria into the larger cell body.
Now, what would YOU expect to happen if you took a drug that suppressed the enzyme that is crucial to cellular energy transport? And, indeed, it is common for statin patients to complain of lack of energy, sudden weight gain, and loss of libido.
As your column implies, ‘atherosclerosis’ is appearing more and more to be an inflammatory disease rather than a disease of ‘excess lipids.’ Statins are at best a blunt-instrument approach to reducing the inflammation that lies at the root of coronary artery disease. And I am confident that in the not-too-distant future, medicine will come to view our use of statin drugs as a barbaric practice, akin to bloodletting in its precision and efficacy.
I think that chromosomes usually have more than 147 base pairs!
Correct – about two billion, as I remember. I was thinking of particular DNA groups that were affected by epigenetics through that particular drug. Thanks for pointing out by blunder, MJ.
What do you think of this study’s results bilberry extract and the reduced incidence, after 3 months of supplementation, of macular degeneration and cataracts in senescense-accelerated OXYS rats?
oops, forgot to include the link.
https://www.ncbi.nlm.nih.gov/pubmed/16075680
Postscript:
http://umm.edu/health/medical/altmed/condition/cataracts has some cautions on taking bilberry – not for people with low blood sugar or pressure or for people on Warfarin or with blood clots, or pregnant or breastfeeding women.
What about combining Coq-10 with a statin for better results?
While the Doc is just discovering the age old collusion between Big Pharma and Medical Establishment, others have bonded ahead towards reversing aging using gene therapy. Check out http://bioviva-science.com/
Hi doc,
re cholesterol/inflamation, statins etc in your latest, most interesting article,….did you perhaps include serrapeptase in your heart ailments/arterial blockages investiations/research? I think you would find your analysis/comments would go a lot further! Great to read your postss, keep up the good work! Thanks, qmike
I thought your comment on COQ10 having negative interactions with statins, beta blockers and anti-depressants quite interesting. I take a statin and anti-depressants – primarily as a migraine preventative yet my doctors told me that I should take COQ10 because it would help keep my cholesterol controlled and my blood pressure down. They didn’t mention anything about migraines and neither my cardiologist nor my neurologist are particular fans of supplements. I have been taking it for several years now and there does not seem to be any adverse effect – my cholesterol is being controlled and my migraines have decreased but that is primarily due to other medicine I am taking to help with significant, debilitating chronic pain.