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Information, Deception and Perspective
Commentary by Ralph Campbell, MD
(OMNS Sept 7 2018) An ancient Roman governor famously asked, "What is truth?" To find the truth is notoriously difficult, and when you do find it, to be certain you've found it is also difficult. So I congratulate all seekers reading the Orthomolecular Medicine News Service looking to find an honest source of nutrition knowledge. My initial license to practice medicine was issued in 1947. I am continually learning. We all have the same goal.
In the medicine-vitamin controversy, each side has plenty of statements to make. But how do we determine what is true? We have to be able to trust the source, which is not so easy whenever there is monetary profit dimming the light on the subject. It is now (finally) the law that authors of studies, including nutrition studies, must disclose financial support. In medical studies, the law is pretty well abided; perhaps not so well in nutrition studies. In either case, if the study sounds like a promotion or advertisement, the money trail should be followed.
Information or just more advertising?
Learning that our government agencies entrusted with our health and safety, such as the Food and Drug Administration (FDA) and Environmental Protection Agency (EPA) are influenced by lobbyists and are not always trustworthy is disheartening. Certainly, when contemplating the use of a prescription drug, a doctor should make clear to patients both the potential and the drawbacks (side effects) of a drug before prescribing. Unfortunately, many times doctors can't give appropriate advice about nutrition supplements, since few of them have the time or interest to keep up with of the latest information about nutritional medicine. So, you computer wizards, go online and see for yourself. At the very least, prepare for your next conversation when your doctor prescribes a drug for you. The last advice given in a TV ad for a drug is, "Ask your doctor about so and so." When you check out "so and so" on the internet, or listen carefully to the fast spoken words in the ad, you might be surprised to learn of a dire warning that could even include "occasional death." No thanks!
Leaving out nutrition is deception
Drug advertising has always been deceptive. Recently it has gotten more so, because that remains an effective way to promote sales. The aim is to make the target audience feel more on a par with the doctor by the use of technical acronyms. Added to this, the prospective user is familiarized with lab test acronyms. For instance, advertising for empagliflozin (Jardiance), a glucose-lowering drug, tells of its ability to lower the A1C. All we need to know about A1C is that high levels are bad; we do not need to get into the details that hemoglobin A1C levels are formed from glucose combining with hemoglobin (the protein in red blood cells that carries oxygen). Measuring it is a good way of monitoring glucose levels over a longer term. The drug is prescribed when "proper diet and exercise to control high blood sugar are not enough." If only the prospective drug user viewing the advertisement could learn the truth: it is usually possible to prevent or reverse type 2 diabetes by proper diet, exercise, and adequate doses of vitamin and mineral supplements. [1-4]
So many side effects
Another glucose-lowering drug, dapagliflozin (Farxiga) has nearly the same side effects list, making me believe that the manufactures may collaborate to comply with the law and to avoid the chance of a lawsuit. Before listing the side effects, they note that doctors recommend the drugs because the benefits outweigh the risks. Here are the risks: frequent urination, dizziness or light-headedness. Interesting grouping in that frequent urinating usually is due to high glucose levels, while dizziness and light-headedness are often symptoms of hypoglycemia (the medicine is working too well). The list continues: urinary tract infection, kidney problems (less urine and edema), nausea/vomiting, abdominal pain, trouble breathing, may act as a diuretic and promote yeast infections (again, problems of too much glucose in the urine that may indicate the drug is not doing its job). I can't comprehend this last statement: the drug "doesn't usually cause hypoglycemia, but if used with another glucose-lowering drug, it might." Overuse of a glucose-lowering drug is certain to produce hypoglycemia. Last of all, as with many drugs, it may cause the signs and symptoms of angioneurotic edema, dismissed casually with "call your doctor immediately." However if you can't reach him or her or find another way to receive an adrenalin shot in very short order, this could turn out to be your one and only (and last) drug reaction. Most of us consider death as one mighty serious side effect.
One more illustration of misleading information accompanies rivaroxaban (Xarelto), an anticoagulant. This new drug, as with many others, came on the market as soon as the old standby, warfarin, became generic. The superiority of the new compared with the old is emphasized. The claim is that rivaroxaban inhibits a coagulation factor other than vitamin K, as warfarin does. That mysterious coagulation factor is "factor Xa," a protease enzyme in the coagulation pathway that requires vitamin K for its synthesis. Efficacy of anticoagulants is measured by the prothrombin time. In the case of warfarin, the prothrombin time could be controlled by removing vitamin K from the diet (a poor choice), enforcing a diet with a constant low level of vitamin K (a difficult choice), or simply altering the dose of the drug (a better choice). This new drug, lacking a long track record, should be monitored like any other. Usually, the manufacturer carefully describes the new drug with scientific-sounding words, but universally, anticoagulants are called "blood thinners," allowing the public to hang on to one last legend. Actually, the only known thinner is water when it is drunk in toxic amounts. Since the medicine slows coagulation, an overdose will promote bleeding. You need to monitor your coagulation time with regular blood tests.
Naturally, drug ads don't mention that adequate doses of vitamin E (400-1200 IU/day) will slow blood clot formation and along with adequate doses of vitamin C (3000-6000 milligrams/day) and magnesium (300-600 mg/d) will help to keep blood vessels strong and elastic, thereby reducing the risk of developing diabetes, arterial plaque formation, heart attack, and stroke.[1-7] Much higher-than-RDA doses of vitamin supplements, including vitamin K, are considered helpful for long-term health. But until the drug industry develops replacements for vitamins C, E, and K and essential minerals that are deficient in the modern diet, I expect that drug profits will continue to be promoted by misleading ads.
Always check for yourself
Checking out alternatives requires discernment. Nutrition supplements are regulated by the FDA, as they state at their own website. https://www.fda.gov/food/dietarysupplements/ We surely don't want supplements regulated like drugs, with costs pushed through the roof. But naive free-wheeling can also get us in trouble. In evaluating a supplement I have not personally used, I do the following:
1) Make sure the manufacturer is trustworthy by checking its track record for both efficacy and safety. Consider contacting the company. http://www.doctoryourself.com/labels.html
2) See if the ingredients pass a test of common sense, with an adequate explanation of how they work for their intended use. http://www.doctoryourself.com/synthetic.html
3) If 1 and 2 are satisfactory, I try the supplement with a few well-informed patients whom I have carefully advised about what the supplement is supposed to do.
4) If steps 1 and 2 are OK but I am unable to do 3, I put this information in my mental storage unit, ready to get it out as more evidence of its worth comes forth.
Linus Pauling said, "Never put your trust into anything but your own intellect. You must always be skeptical - always think for yourself." Good advice.
(This commentary presents the opinions of the author and does not necessarily reflect the viewpoint of all members of the Orthomolecular Medicine News Service Editorial Review Board. OMNS allows equal time for dissenting opinions, which may be submitted to the Editor at the contact listed further below.)
1. Brighthope IE (2012). The Vitamin Cure for Diabetes. Basic Health Pub. ISBN-13: 978-1591202905
2. Dean C. (2017) The Magnesium Miracle. Ballantine Books, Second Ed. ISBN-13: 978-0399594441
3. Harding AH, Wareham NJ, Bingham SA, et al. (2008) Plasma vitamin C level, fruit and vegetable consumption, and the risk of new-onset type 2 diabetes mellitus: the European prospective investigation of cancer--Norfolk prospective study. Arch Intern Med. 168:1493-1499. https://www.ncbi.nlm.nih.gov/pubmed/18663161
4. Shargorodsky M, Debby O, Matas Z, Zimlichman R. Effect of Long-Term Treatment with Antioxidants (Vitamin C, Vitamin E, Coenzyme Q10 and Selenium) on Arterial Compliance, Humoral Factors and Inflammatory Markers in Patients with Multiple Cardiovascular Risk Factors. Nutr Metab (Lond) 7:55. https://www.ncbi.nlm.nih.gov/pubmed/20604917
5. Kurl S, Tuomainen TP, Laukkanen JA, et al. (2002) Plasma Vitamin C Modifies the Association between Hypertension and Risk of Stroke. Stroke 33:1568-1573. https://www.ncbi.nlm.nih.gov/pubmed/12052992
6. Schürks M, Glynn RJ, Rist PM, et al. (2010) Effects of Vitamin E on Stroke Subtypes: Meta-Analysis of Randomised Controlled Trials. BMJ 341:c5702. https://www.ncbi.nlm.nih.gov/pubmed/21051774
7. Ames BN. (2010) Prevention of mutation, cancer, and other age-associated diseases by optimizing micronutrient intake. J Nucleic Acids. 2010:725071. https://www.ncbi.nlm.nih.gov/pubmed/20936173
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