Thursday, May 28, 2020

“Don’t Take Dietary Health Supplement…”

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I have another beef to pick with both the media and mainstream medicine. There were two recent studies in the news that require further comment. In the February edition of the Journal of the American Medical Association (JAMA), a study was published concerning the Women’s Health Initiative1.

The study

When this story hit the news people were astounded. Even my daughter, who rarely cares about such matters, called me for an explanation of the seemingly-negative outcome. If you look at the details of this study, it’s quite obvious. First, the mean dietary fat decrease was rather modest at only 8.2 percent. However, when you look at what fats were reduced, on average, saturated fats were decreased by a measly 2.9 percent, and good fats, such as monounsaturated fats, were likewise decreased by about 3.3 percent. Increase in fruits and vegetables was only a little more than one serving per day and for grains, only a half serving a day. (Keep in mind the grains may have been refined and actually detrimental!) While lowering saturated fat can obviously have beneficial effects, good fats (mono-unsaturated), were likewise decreased, basically cancelling out any potential benefit.

It involved over 48,000 post-menopausal women between 50 and 79 years old. Women were randomly assigned to make changes in diet or to continue with their usual dietary intake. Intensive behavior modification within the dietary-change group was designed to reduce average dietary fat intake from 37 percent to 20 percent of total calories, while increasing fruit and vegetable intake to five servings a day and grains to at least six servings a day. It should be noted that the women managed to reduce dietary fat intake to about 24 percent on average the first year, but it climbed to about 29 percent as the study proceeded. The study lasted for approximately eight years. By year six, the average dietary fat intake was decreased by 8.2 percent in the intervention group versus the comparison group. Furthermore, the intake of fruits and vegetables increased by a little over one serving a day and grains by about a half a serving a day. The results of this rather monumental study were that dietary changes had no significant effect on the incidence of coronary heart disease or stroke.

Almost in small print, it was noted that “trends toward greater reductions in cardiovascular heart disease risk were observed in those with lower intake of saturated fat or trans-fat or higher intakes of fruits/vegetables.” Folks, that’s the bottom line! For women who actually made a real change to their diets, decreasing bad fats (saturated and trans-fats) and really increasing intakes of fruits and vegetables, there was actual reduction in cardiovascular heart disease. Yet, the message the media portrayed is that changing your diet doesn’t seem to have any effect on cardiovascular risk. Where is the outcry from mainstream medicine? There should be doctors basically saying this study (which incredibly cost over $400 million of our tax money) was completely flawed and a TOTAL waste of time. It’s hard to believe that intelligent people in the media and in mainstream medicine could get this so wrong.

In a related matter, another study was just published in the February edition of The New England Journal of Medicine regarding glucosamine and chondroitin sulfate2. In this study, over 1,500 patients with symptomatic osteoarthritis of the knee were randomly assigned to receive 1,500 mg a day of glucosamine sulfate, 1,200 mg chondroitin sulfate daily, a combination of these two nutrients, 200 mg of Celebrex® or placebo for 24 weeks. The groups were stratified regarding severity of knee pain from mild versus moderate to severe. The study indicated that the placebo group had symptomatic improvement by a hard-to-believe 60 percent, while the percentage of people with symptomatic improvement on glucosamine and chondroitin sulfate was approximately 67 percent, compared to the Celebrex® group (which had symptomatic improvement by about 70 percent). For those with moderate to severe pain at baseline, the combination treatment with glucosamine and chondroitin sulfate was 79 percent improvement versus 54 percent improvement with placebo. Authors concluded that glucosamine and chondroitin sulfate, alone or in combination, did not reduce pain effectively in the overall groups with osteoarthritis of the knee.

So what’s my beef with this study?

First, you should note that the difference between the Celebrex® group and glucosamine/chondroitin group is only 3 percent, although that 3 percent difference was said to be statistically significant. I wonder about the matter of a 60 percent response rate in the placebo group, a number far higher the typical response of about 30 percent to 35 percent. Also, there’s no adjustment in dosing of glucosamine and chondroitin. Quite clearly, heavier patients require larger daily doses for effectiveness. Finally, the authors of the trial and the media, for that matter, gloss over the fact that the glucosamine and chondroitin combination in patients with moderate to severe pain showed higher statistical significant improvement compared to placebo and the FDA-approved drug to treat arthritis.

No wonder people are so confused!

There are studies published in reputable journals that are flawed or in some way misrepresented in conclusion or by the media. It would certainly be a shame if people stopped taking glucosamine and chondroitin based on this study. There have been dozens of other studies in very reputable journals showing clear benefit for these nutrients for healthy joint function and even to repair damage.

As an interesting aside to this, I noted a recent article in Reuters indicating that a fast food burger or monster sandwich or bag of nutritional-nothing from the vending machine at work causes you to become sluggish after lunch and lose productivity. The article indicated that the global cost in lost productivity could amount to billions of dollars a year. A health revolution can happen, and must happen, for the financial well-being of this country. It’s estimated that in the next few years, one out of every five dollars spent in the U.S. will be for health care, a number typically two or more times that compared to other countries. Remember, there are over 40 million people in this country who have no health insurance whatsoever.

Supplementation

Aside from improving your diet, starting an exercise program and reducing stress, a good multi-vitamin is essential. I also strongly recommend fish oil containing omega-3 essential fatty acids (EPA and DHA) at about 2,000 mg per day for everyone, except those on blood thinners, as a way to maximize health. Look for a pharmaceutical grade, molecularly distilled, standardized to about two times the EPA and DHA than your average fish oils because that’s what I’ve seen work time and again now.

Also, I recommend berry supplements that provide high levels of beneficial antioxidants.

And for those of you with joint issues please don’t abandon your glucosamine and chondroitin sulfate. If you are not getting the desired effects, consider increasing your dose, adding omega-3 fatty acids for their anti-inflammatory effects along with MSM, turmeric, Ester-C® and other nutrients that can help maximize joint health and overall health.

If you’re as frustrated as I am with the media, I certainly would like to hear from you, and I recommend that you call local newspaper, television and radio stations to share the other side of the story (the truth). In fact, I give you permission to forward this, print this, copy this, etc. to provide this information to the ill-informed reporters.

References:

  1. Barbara V. Howard; Linda Van Horn; Judith Hsia; JoAnn E. Manson; Marcia L. Stefanick; Sylvia Wassertheil-Smoller; Lewis H. Kuller; Andrea Z. LaCroix; Robert D. Langer; Norman L. Lasser; Cora E. Lewis; Marian C. Limacher; Karen L. Margolis; W. Jerry Mysiw; Judith K. Ockene; Linda M. Parker; Michael G. Perri; Lawrence Phillips; Ross L. Prentice; John Robbins; Jacques E. Rossouw; Gloria E. Sarto; Irwin J. Schatz; Linda G. Snetselaar; Victor J. Stevens; Lesley F. Tinker; Maurizio Trevisan; Mara Z. Vitolins; Garnet L. Anderson; Annlouise R. Assaf; Tamsen Bassford; Shirley A. A. Beresford; Henry R. Black; Robert L. Brunner; Robert G. Brzyski; Bette Caan; Rowan T. Chlebowski; Margery Gass; Iris Granek; Philip Greenland; Jennifer Hays; David Heber; Gerardo Heiss; Susan L. Hendrix; F. Allan Hubbell; Karen C. Johnson; Jane Morley Kotchen. Low-Fat Dietary Pattern and Risk of Cardiovascular Disease: The Women’s Health Initiative Randomized Controlled Dietary Modification Trial.JAMA. ;295:655-666.
  2. Daniel O. Clegg, M.D., Domenic J. Reda, Ph.D., Crystal L. Harris, Pharm.D., Marguerite A. Klein, M.S., James R. O’Dell, M.D., Michele M. Hooper, M.D., John D. Bradley, M.D., Clifton O. Bingham, III, M.D., Michael H. Weisman, M.D., Christopher G. Jackson, M.D., Nancy E. Lane, M.D., John J. Cush, M.D., Larry W. Moreland, M.D., H. Ralph Schumacher, Jr., M.D., Chester V. Oddis, M.D., Frederick Wolfe, M.D., Jerry A. Molitor, M.D., David E. Yocum, M.D., Thomas J. Schnitzer, M.D., Daniel E. Furst, M.D., Allen D. Sawitzke, M.D., Helen Shi, M.S., Kenneth D. Brandt, M.D., Roland W. Moskowitz, M.D., and H. James Williams, M.D. Glucosamine, Chondroitin Sulfate, and the Two in Combination for Painful Knee Osteoarthritis. N Engl J Med. Vol. 354:795-808.
Nathan
Writes in the lane of nutrition and natural treatment.

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