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Ground Hog’s Day at The New York Times: Supplements Edition

I did a short and sweet post the other day highlighting what I thought was a pretty good list: 11 Universal Truths in Nutrition That People Actually Agree on. I mentioned one minor quibble, and hit the publish button before calling it a day. But . . . there was one item on the list that I had a bigger issue with, but didn’t have the energy to make a Federal case out of. Number eight: Supplements Can Not Compensate For an Unhealthy Diet

I don’t think the statement goes far enough. There has been an avalanche of studies in recent years that show harm from or ineffectiveness of supplements, and yet the message never seems to sink in. It seemed like an opportunity to do another Groundhog’s Day post and a google search did not disappoint.

Beginning in 1998, but concentrated in the last six years, there has been a torrent of negative reporting in The New York Times on vitamin supplements. A handful of studies come up multiple times, but they are robust studies and the smaller ones never seem to end. Bear in mind, included in all the grim news, there were studies that did show benefit, but they tended to relate to people with existing health conditions. In that light, I’d say it makes sense to avoid supplements unless your doctor prescribes them. Even then, I’d want to see the research.

Seems a lot easier just to eat a few more fruits and vegetables.
Screen Shot 2014-04-12 at 8.16.09 PMTaking Too Much Vitamin C Can Be Dangerous, Study Finds | Jane Brody | 9 April 1998

But the British researchers, chemical pathologists at the University of Leicester, found in a six-week study of 30 healthy men and women that a daily 500-milligram supplement of vitamin C had pro-oxidant as well as antioxidant effects on the genetic material DNA. The researchers found that at the 500-milligram level, vitamin C promoted genetic damage by free radicals to a part of the DNA, the adenine bases, that had not previously been measured in studies of the vitamin’s oxidative properties.

Disappointing News on Vitamin E and Selenium | Tara Parker-Pope | 28 October 2008

The SELECT trial, which stands for the Selenium and Vitamin E Cancer Prevention Trial, was studying whether selenium and vitamin E, either alone or in combination, could lower a man’s risk for prostate cancer. More than 35,000 men were taking part, making it one of the largest and best studies of a vitamin or supplement.

But the National Cancer Institute announced Monday that the trial, which was scheduled to end in 2011 after seven years, is being halted early. A review of the data shows no benefit in using the supplements to prevent prostate cancer. In addition, slightly more users of vitamin E were getting prostate cancer, and slightly more selenium-only users were developing diabetes.


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11 Universal Truths in Nutrition That People Actually Agree on

This kind of health reporting usually drives me nuts, but it’s actually a pretty good list. I think it’s pretty accurate in terms of listing things that are uncontroversial, even broadly agreed upon.

1. Artificial Trans Fats Are Extremely Unhealthy
2. Whole Foods Are Better Than Processed Foods
3. Getting Enough Omega-3 Fatty Acids is Important
4. Added Sugar is Unhealthy
5. Green Tea is a Healthy Beverage
6. Refined Carbohydrates Should be Minimized
7. Vegetables Are Healthy Foods
8. Supplements Can Not Compensate For an Unhealthy Diet
9. Olive Oil is Super Healthy
10. Optimal Health Goes Beyond Just Nutrition
11. The Best Diet (or “Way of Eating”) For YOU is The One You Can Stick to

One quibble. The evidence on olive oil and green tea is pretty solid, but it’s solid on lots of fruits and vegetables, why single them out?

The biggest thing that I’d add Americans need to eat more green vegetables. After cutting sugar consumption, I think that would be the biggest single improvement you could make in the American diet.

Kale, collards, chard, spinach, arugula all make a great excuse to eat more bacon. So what’s holding you back?

PS I only read the list, not the explanations, so I offer no warranty on the quality of their justifications. I really do hate that kind of reporting.

Sodium Recommendations, Ground Hog’s Day and The New York Times

A new study finds bad news for those following CDC recommendations on sodium intake.

” A new study published in the American Journal of Hypertension finds evidence that the average daily sodium intake of most Americans is actually associated with better health outcomes than intake levels currently recommended by the CDC and major health departments, which are now being viewed by many in the scientific community as excessively and unrealistically low.

The study, “Compared With Usual Sodium Intake, Low-and Excessive-Sodium Diets Are Associated With Increased Mortality: A Meta-Analysis,” concluded that 2,645 – 4,945 mg of sodium per day, a range of intake within which the vast majority of Americans fall, actually results in more favorable health outcomes than the CDC’s current recommendation of less than 2300mg/day for healthy individuals under 50 years old, and less than 1500 mg/day for most over 50 years. This study was a combined analysis of 25 individual studies, which measured results from over 274,683 individuals. “

I’ve seen some people surprised by this, but for anyone following the issue and how it is reported it isn’t surprising, instead you feel more like Bill Murray in Ground Hog’s Day. [Editor: Warning: selective quotes ahead]

Gina Kolata writing in the The New York Times, May 14, 2013:

In a report that undercuts years of public health warnings, a prestigious group convened by the government says there is no good reason based on health outcomes for many Americans to drive their sodium consumption down to the very low levels recommended in national dietary guidelines.

Those levels, 1,500 milligrams of sodium a day, or a little more than half a teaspoon of salt, were supposed to prevent heart attacks and strokes in people at risk, including anyone older than 50, blacks and people with high blood pressure, diabetes or chronic kidney disease — groups that make up more than half of the American population.


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Bariatric surgery may be about metabolic health rather than limiting consumption

The Los Angeles Times reports on the results of a new study of the benefits of bariatric surgery”

The study randomly assigned 150 overweight and obese people with Type 2 diabetes to one of three groups. Those in the control group had their diabetes managed with medications and daily blood-glucose monitoring. They also received intensive counseling about diet and exercise, including regular weigh-ins to monitor their progress. After three years, they had lost an average of 9.5 pounds.

The second group in the trial got Roux-en-Y gastric bypasses, in which the stomach is reshaped and relocated to divert most food past much of the lower intestine, where nutrients and calories are largely absorbed. The third group got a procedure called sleeve gastrectomy, which staples some 80% of the stomach closed, creating a banana-shaped tube where once a large pouch existed. Patients who had surgery received intensive medical management and lifestyle counseling as well.

Three years later, those who had the Roux-en-Y bypass had lost an average of nearly 58 pounds, and those who had sleeve gastrectomy lost an average of 47 pounds.

More importantly, Schauer said, the patients in the surgery groups were much more likely to have their diabetes under control — 58% of those who had Roux-en-Y and 33% of those who had sleeve gastrectomy were able to stop taking diabetes medications. Only 5% of patients in the control group achieved the same endpoint after three years, and none were able to discontinue medications completely.

In addition, study volunteers who had gastric bypass whittled their daily number of blood pressure and cholesterol-lowering medications from 2.73 to 0.96, on average. And subjects who had sleeve gastrectomy reduced their average number of cardiovascular medications from 2.18 to 1.35 three years later.

The medication tally for the control group didn’t budge.

Sadly, the report does not discuss the possible mechanism(s) responsible for this result. The theory behind bariatric surgery was that it would work simply by restricting the volume of food that the patient could consume. It turns out that it seems to be driven more by the way it resets metabolic health in general and insulin sensitivity in particular.

Once he was awarded funding, Brady began collecting fat samples from bariatric surgery patients with the help of a research assistant. The samples were collected two weeks before the surgery, and then again two weeks after the surgery.

“We added varying dosages of insulin to the samples to test the sensitivity, to create a dose-response curve,” Brady said. “And what we found that there was a huge increase in both insulin sensitivity and responsiveness just two weeks after the procedure.”

Brady found that these results could be reproduced in each patient undergoing a Roux-en-Y or duodenial switch.

Bariatric surgery seems to ‘reboot’ fat cells so that they do their job properly, absorbing and retaining the lipids,” Brady said. “However, there are likely to be more subtle molecular and metabolic differences between the two procedures. This is something we’re hoping to examine in a larger study.”

It would be great to see the conversation about type 2 diabetes and obesity shift further away from the overeating paradigm to a metabolic health paradigm.

Annals of Bad Health Reporting: Diet Soda Edition

Josh Bloom in Science 2.0 sets things straight:

The Iowa group studied 60,000 middle-aged women over a ten-year period. Data were accumulated from questionnaires—a notoriously unreliable method of data gathering. But this isn’t a tiny fraction of the problem.

At the end of the study period the group took a look at the health of women who did, and did not drink diet soda. Lo and behold! Of women who drank two or more diet drinks per day, 8.5 percent had some sort of heart disease. But, for women who either drank fewer or no diet drinks that number was only 7 percent. Uh-oh. Smoking gun?

Not even close. Because buried at the bottom of the article is what is really going on: The women who drank more diet soda were less healthy to begin with. They were more likely to be overweight, to smoke, and to have high blood pressure than the other group.

So, let’s correct the headline a bit: “Sick People are More Likely to Die.” Accurate headline, but it won’t sell many papers.

I pray to the gods that there is a special circle in Hell for health reporters.