NATURALLY DANGEROUS: Surprising Facts About Food, Health, and the Environment.
By James P. Collman, Professor of Chemistry, Stanford University
Chapter 3. Is the Health Food Store an Oxymoron?
© James P. Collman, 2003. All rights reserved
Many people search for natural remedies to treat or prevent chronic and acute illnesses. Few are effective, but one is well documented. Regular workouts do limit colds, reduce cancer, and ward off the ravages of aging. Recent, comprehensive epidemiological studies show that regular exercise, even brisk walks, enhances the body’s immune system and helps fight off viruses and bacteria. Studies have shown that regular workouts can reduce the incidence of diabetes by about 50%; of high blood pressure by 40%; reduce mortality and recurrence from breast cancer by up to 50%; lower the occurrence of colon cancer by more than 60%; can reduce depression; and even lower the risk of developing Alzheimer’s disease by nearly 40%. More exercise seems to be better. Greater benefits have been found for runners going over 30 miles per week and increased workouts by swimmers, cyclists, and other aerobic forms of exercise. One can literally run from Father Time, but eventually he will catch up, just later.
One of the underlying mechanisms seems to be that exercise helps retain “telomeres”, the tips of one’s DNA. When cells divide and replicate the long DNA strands, the telomere tip is snipped and becomes shorter. Eventually, this telomere becomes so short that the cell dies or enters a suspended state. The length of a cell’s telomere is a marker of a cell’s age and vitality; shorter telomeres indicate that a cell is old and tired. Cancer, aging, and a higher risk of death are associated with shortened telomeres. People who have exercised have longer and therefore younger telomeres than “couch potatoes” of the same age. At the molecular level exercise has an anti-aging effect, not perfect, but superior to those who do not exercise. This convincing evidence is thoroughly discussed and guidelines are presented in a recent article in the Wall Street Journal: January 5, 2010, page D1.
After a heart attack, therapeutic hypothermia (cooling) protects the brain. It has long been thought that if the heart stopped beating for more than six or ten minutes, the brain would be dead. Recent studies have shown that patients can be restored to health even after their heart has stopped beating for 20 minutes, perhaps even longer. Cardiac-arrest patients have been restored with most of their cognitive abilities intact, if they have been cooled by applying ice or other coolants to lower their body temperature by six degrees and then put into a drug-induced coma for about 24 hours before being warmed to normal temperature. This treatment is being introduced into many U.S. hospitals for patients brought in after suffering a heart attack. A cardiologist, Michael Mooney at the Minneapolis Heart Institute described patients who have been “stone-cold” out for at least 20 minutes and brought back to normal by this technique. This does not work in every instance, but more than 52% of a group of 140 patients have recovered, most to a normal state. Otherwise less than 10% would have survived. About 300,000 Americans suffer cardiac arrest outside a hospital every year so therapeutic hypothermia could save many lives. Cooling seems to prevent damage to the brain. “Cold blankets” or intravenous cool fluids are used, but thus far no drugs have been used to cool the body or maintain a cold state. The theory behind therapeutic hypothermia is that icing the body slows metabolism and protects the brain from some of the damage caused by restored blood flow in a revived person at normal temperature. (Wall Street Journal, October 6, 2009, page D1)
The Food and Drug Administration has warned consumers to avoid over two-dozen over-the-counter products marketed for weight loss. Some of these products are sold on the internet; others in "health food stores". Many of these materials are said to be "natural" or "herbal", but they often contain potentially dangerous, undeclared ingredients such as an anti-seizure medication and a suspected carcinogen. Some contain prescription drugs in amounts exceeding the maximum recommended doses. Using these products could endanger a person's health said the FDA. If a person has a problem with excessive weight, they are advised to see their physician. It is unclear whether the FDA has the power or the political will to remove these dangerous products from the market. This issue is at the heart of the message in Naturally Dangerous: natural does not mean safe. The federal law protecting herbs and supplements needs to be drastically reformed or repealed! (HealthDay 12/23/08)
Further epidemiological evidence shows the importance of vitamin D. A recent study of 253 births at a Boston hospital showed that women with low blood levels of vitamin D were nearly four times as likely to have an emergency C-section than other women who had normal vitamin D levels. Although this was a relatively small study, it did control for other variables and will probably pass the test of time. These findings might be explained by the association of vitamin D levels with muscle weakness and high blood pressure. Your author, who does not have a problem with pregnancy, has been taking 1000 international units of vitamin D from tasteless, colorless "D-drops" purchased over the internet from a Canadian company. These were recommended to me by a former Stanford premedical student, who is now an epidemiologist at the Harvard Medical School.
Large statistical, double-blinded trials have destroyed another myth: that selenium, vitamin E, and vitamin C prevent prostate cancer. The most surprising failure is selenium because past studies seemed to show that selenium did inhibit prostate cancer.
The current results are based on two large, well designed studies: one, known as SELECT by Scott Lippman at the M.D. Anderson Cancer Center in Houston, and the other, done by Harvard researchers.
The SELECT study involved more than 35,000 men and included Black men over 50 and men of other races over 55. The men were assigned to one of four groups: selenium, vitamin E, selenium and vitamin E, or a placebo. This study was ended early because there was no finding of efficacy. Recall that Black men are more susceptible to prostate cancer (but this may be from lower levels of vitamin D and less exposure to ultraviolet B from sunlight).
The Harvard study included nearly 15,000 male physicians over 50, who received vitamin E, vitamin C, or a placebo with an average follow-up period of 8 years.
These studies add to several other recent ones that fail to show any benefits of vitamins or supplements for prevention of cancer. But your author expects sales of these supplements to continue. (US News , Tuesday, December 9, 2008).
Evidence continues to accumulate that a natural substance, resveratrol, found in red wine improves the health of mice. Previously resveratrol was shown to reverse the effect of obesity in mice and to make them live longer. Now scientists have found that this chemical increases the endurance of mice. Mice given resveratrol double their ability to run on a treadmill before collapsing. These mice have energy-charged muscles and a reduced heart rate similar to a trained athlete, but without the benefit of training. The number of power cells, mitochondria, increased in mice fed resveratrol. Moderate amounts of resveratrol produced these effects in mice, but these doses could not be extrapolated to humans. No one could consume so much red wine. Some scientists studying resveratrol are taking capsules that contain extracts from red wine or from a Chinese plant, giant knotweed, which was listed in an encyclopedia of ancient Chinese medicines. But these extracts contain far smaller quantities of resveratrol than the mice were given. You can purchase such extracts at the "health food store", but there is no guarantee about the amounts or purity of the reseveratrol said to be in these tablets. Men are not mice, but more active compounds having these effects are being developed. Resveratrol is thought to activate a group of enzymes called sirtuins. (New York Times, November 17, 2006, page A16).
Females who derive from opposite-sex twin pairs (their twins are brothers) have unusual characteristics. Such females tend to be more aggressive, adventurous, and process special information like males. These mixed twin females also show the left-brain dominance that males typically manifest. Female co-twins also have less eating disorders than other females. Other differences have been observed, such as female co-twins being less likely to marry, or if married, to have children.
It is unethical to study human co-twins in utero, but related studies have been carried out with mice, confirming that the extra testosterone experienced by female co-twins could account for their unusual characteristics.
Other scientists believe that these behavioral differences might arise from the simple fact that female co-twins grow up with a twin brother. This possible behavioral influence was examined by an extensive study of Finnish birth, death, and marriage records from the pre-birth control period on the 18th and 19th centuries. For example it was possible to compare females who were born with a brother or sister twin, but subsequently were raised as singletons because the other twin died. These findings were the same when compared across social classes. Those studies showed the same differences in the behavior of female co-twins. (Science News, May 10, 2008, page 25)
Have you noticed that some grocery store shelves contain an array of nutrient-fortified soft drinks? Several major soft drink producers have come out with beverages containing vitamins and minerals; for example Coca-Cola Co., PepsiCo Inc., and Ardea Beverage Co. These enhanced, fruit-flavored drinks are usually sweetened, but contain fewer calories than typical soft drinks. Usually these fortified beverages are accompanied by health claims that skirt legal restrictions. Such fortified drinks cannot claim to cure diseases, but some of these tout benefits, such as “healthily manage your weight”, “improving seventh grader test scores”, “provide clarity and focus”, and “enhance physical endurance”, that seem doubtful. Are these fortified beverages safe? Probably, according to nutritionists. Excess water-soluble vitamins are excreted in the urine and are not harmful. Fat-soluble vitamins such as A, D, and E enter the digestive track more rapidly when taken in liquid form, but how much is absorbed depends on the amount of fat that is in the digestive tract at the time the drink is introduced. Higher amounts of vitamin A weaken the bones and can be dangerous, , but the amount in these fortified fruit-flavored drinks seems too little to be a worry. It is generally better to get one’s vitamins from a balanced diet, but the main harm from these enhanced beverages seems to be to your wallet. On the other hand, some nutrient-enhanced drinks also contain herbs such as Echinacea or St. John’s wort. Under some circumstances herbs can be dangerous (as discussed in Naturally Dangerous). I think it is outrageous that the latter are being promoted to children and teenagers. (The Wall Street Journal, July 24, 2007, page D1)
A small study involving 87 men averaging 79 years and 57 women averaging 68 was reported in the New England Journal of Medicine in October 2006. The men were divided into three groups and each group was tested with5 milligrams of testosterone, or 75 milligrams of DHEA, or a placebo. The women were divided into two groups; one was tested with 75 milligrams of DHEA or a placebo. The findings were sobering for those who believe these supplements are effective. Neither testosterone nor DHEA had a significant effect on body mass index, peak volume of oxygen consumed per minute, muscle strength, or insulin sensitivity. The latter is a measure of type II diabetes. Recall from Chapter 3, page 80, that DHEA levels in the body decline 20 fold in old age from the peak levels of youth. Because of the US dietary supplement laws, DHEA is sold in the US, but in no foreign countries, and its use is banned in many amateur and professional sports organizations. There was a small increase in bone density at the hip in men and in the forearm of women taking DHEA. Larger studies may be required before the government takes steps to ban these supplements. (New York Times, October 31, 2006, page D7)
Many theories about taking supplements turn out to be wrong when they are examined with a well-controlled study. On the basis of animal studies there had been a suggestion that selenium improves glucose absorption, but when selenium was examined to see if it would reduce the incidence of type 2 diabetes in humans, the opposite result was found. A randomized, double-blinded study of 1,250 people having an average age of 63 employing a placebo versus 200 microgram doses of selenium was followed over a 7.7 year period. Of those people who took selenium supplements 58 percent developed type 2 diabetes compared with 39 percent of those who took the placebo pills. Since most Americans obtain sufficient selenium in their diets, there seems to be no reason to take selenium supplements and this result suggests that it is unwise to take these. But others who favor dietary supplements might say that a single study does not give the final answer. (New York Times, July 10, 2007, page D6)
Since your body cannot absorb more than about 500 milligrams at a time (a Tums tablet contains 400 milligrams and multivitamin pills up to 300 milligrams), a person would have to take three or four tablets throughout the day to obtain the recommended 1,200 milligram daily dose. Vitamin D enhances calcium absorption so combining vitamin D supplements with calcium tablets makes sense. On the other hand, calcium interferes with bisphosphonate bone drugs such as Fosamax, and with some antibiotics. High fiber foods can decrease calcium absorption. Phosphoric acid salts such as those found in some dark colas interfere with calcium absorption. Caffeine and excess sodium promote the excretion of calcium in the urine. Because of these complications, it may be better to get your calcium from food (milk, cheese, yoghurt, and sardines for example) and keep up your level of vitamin D (preferably from strong sunlight). (Wall Street Journal, July 24, 2007, page D2)
The biology behind a widely-sold supplement, coenzyme Q10, also called ubiquinone or CoQ10, is well accepted, but it is uncertain whether taking this natural substance is wise; moreover it is uncertain whether CoQ10 should actually be classified as a vitamin. Most vitamins are said to be obtained from food in one’s diet and cannot be made in your body. Karl Folker, the director of the Institute for Biomedical Research at the University of Texas , has worked on CoQ10 for many years; he says that coenzyme Q10 should be called a vitamin and he reports that many heart patients are deficient in CoQ10. For this reason, Folker recommends that these individuals take CoQ10 as a supplement. A further complication and another possible reason that some patients should take CoQ10 is that the common heart drugs called statins aggravate CoQ10 deficiency because these drugs inhibit the body’s production of this vital substance. Recall that statins reduce cholesterol levels in the body and are recommended to prevent or to correct heart problems.
During respiration, CoQ10 is an essential ingredient in producing ATP, the “energy currency” in humans and other mammals. CoQ10 also serves as an antioxidant protecting the body from free radicals that are involved in aging and degenerative diseases.
Most vitamins function as coenzymes (they are an essential part of these enzymes), which are used to carry out necessary biochemical transformations. The majority of vitamins must be obtained from our diet, whereas CoQ10 is made in our bodies. Nevertheless this production of CoQ10 requires the presence of other vitamins: B2, B6, B3, folic acid, panothenic acid and vitamin C, all of which must be obtained from our diet. A deficiency of any one of these vitamins inhibits our internal production of CoQ10 leading to its deficiency. Many Americans, especially older people, are deficient in at least some of these required vitamins. CoQ10 levels usually peak after the age of 19 – 21 and then fall as we age. One study by Folkers found that 75% of a group of 132 patients undergoing heart surgery were deficient in CoQ10. Several cardiologists recommend that their patients take CoQ10 supplements, which cost about $40 per month, but other cardiologists are unaware of CoQ10 and do not recommend it to their patients. Others say that there are no large, double-blinded studies of CoQ10 showing efficacy and demonstrating safety and therefore they feel it is unwise to proscribe CoQ10 supplements (which can be purchased without a prescription in “health food stores”. Lacking a patent position, large pharmaceutical companies are not interested in funding such studies and marketing CoQ10, because there is no money to be made after such an investment. A few small studies seem to show efficacy and demonstrate its safety, but this “vitamin” is a sort of commercial and medical orphan. (material taken from an article written by Jack Challem in the 1994 March/April Natural Health magazine)
It has long been known that raw garlic can kill some bacteria; garlic is an antibiotic. A recent study has shown that cooked garlic can still kill bacteria, but it is less effective. Some of the antibacterial components in garlic apparently survive cooking, but these natural chemicals have not been identified. (Science News, June 10, 2006, page 366)
A traditional Chinese herbal medicine has been used for thousands of years to treat type 2 diabetes. Fruit from Gardenia jasminoides, also called cape jasmine, has been used to alleviate type 2 diabetes. Scientists have now learned that extracts from this plant inhibit a substance called uncoupling protein 2 (UCP2), which is thought to reduce the insulin that a patient's pancreas cells produce. Thus inhibiting UCP2 should relieve the symptoms of diabetes as has been demonstrated in lab animals. Two active compounds have been isolated from extracts of this plant, and one of them, a small molecule called genipin was shown to inhibit UCP2. Apparently the other compound also causes cells to release more insulin. This research conducted between scientists in the Beth Israel Deaconess Medical Center in Boston and in Nanjing University in China may lead to a new oral drug to treat type diabetes, but this would take several years to develop and pass through the various FDA requirements. This is a modern example of a principle given in Naturally Dangerous, that many modern medicines come from ancient remedies. (Science News, June 10, 2006, vol. 169, page 357)
Taking vitamin E supplements is falling out of favor as recent statistical studies have challenged the view that vitamin E prevents heart disease, Alzheimer’s disease, or cancer. Moreover, it seems that taking large daily doses (400 international units, IU) of vitamin E can actually do harm. Vitamin D is another quite another matter; a summary of previous statistical studies was published in 2005 in the American Journal of Public Health. This report concluded that taking Vitamin D supplements could reduce the incidence of several cancers: breast, colon, prostate, and ovarian. Other research indicates that vitamin D supplements may offer additional health benefits. For example, vitamin D is thought to help in building muscle strength and some scientists think that vitamin D may offer cardiovascular benefits, and protect against rheumatoid arthritis and other auto-immune conditions. This makes taking vitamin D supplements a bargain: these tablets cost only $0.05 a day!
In contrast to several other vitamins, it is better to take supplements of vitamin D rather than trying to obtain it from food or by exposure to the sun. Why? First of all, natural food sources of vitamin D are scarce: it is in fatty fish from cold ocean water such as bluefish, mackerel, and salmon but not in many other foods. Milk is supplemented with vitamin D to ward off deficiencies in children. Each cup of supplemented milk contains 100 IU of vitamin D. For most people the best source of vitamin D comes from the action of sunlight on their skin. Ultraviolet light (UVB – the light that can burn your skin – see page 200 in Naturally Dangerous) turns a cholesterol-like compound in the body into a precursor of vitamin D. There are several problems with getting sufficient sunlight to generate all the vitamin D that an individual needs. Too much sun, in the summer months, can cause sensitive people to get skin cancer, but dark-skinned individuals that are less sensitive to sunlight don’t pass enough UVB through their skin to produce enough vitamin D; for other individuals protect themselves with sunscreens, which filter out the required UVB. African Americans have only about half as much vitamin D in their blood than whites do. Location also counts. People living about latitude 37, just north of Richmond Virginia , don’t get enough sun-generated vitamin D. What about exposure to sunlight during the winter months, when there is not enough light? That is less of a problem because vitamin D is stored in fatty tissue so one can “bank” it from the summer for the winter. Because of the role of sunlight in generating vitamin D, it is interesting that some disease rates can be correlated with the latitude patients live in. For example, at higher latitudes there is a higher incidence of breast, colon, ovarian, and prostate cancers.
You can understand that getting enough vitamin D from the sun would be a problem for many individuals, so taking supplements, which are cheap and safe, is a good solution to vitamin D deficiency. The suggested upper limit set by The National Academy of Sciences, is 2,000 IU per day. Professor Walter Willett, chair of the Harvard School of Public Health’s nutrition department proposes that adults should get 800-1,000 IU of vitamin D per day. You can’t get this from eating fruits and vegetables, because plants don’t have vitamin D; you can’t drink enough milk or eat enough milk to get this much vitamin D. Thus, unless you live in the South and are frequently out in the sun, it is recommended to take vitamin D supplements, 400 to 600 ID, depending on one’s age (older people need the higher amounts). This is one supplement that appears to be beneficial. (Harvard Health Letter, volume 31, number 5, March 2006)
There is some dispute among endocrinologists about diagnosing under performing thyroids. But first I will define some basics about the thyroid gland and thyroid hormones.
The thyroid gland is found between the voice box (larynx) and the upper windpipe (trachea). The thyroid has two lobes connected by a narrow neck. The thyroid gland produces two important hormones, which are peptides that contain iodine atoms: thyroxine or T4 and triodothyronine or T3. These hormones are essential for life because they influence metabolism, growth, and development. Iodine is essential for life because it is needed to make these iodinated thyroid hormones. Iodine comes from water we drink and food we eat; either too much iodine from foods such as kelp (a kind of seaweed) or too little iodine from water or salt deficient in iodine, can make us ill. Enlargement of the thyroid gland is a condition called goiter, which may indicate a disease. Most thyroid diseases are the result of either too much thyroid hormone (hyperthyroidism) or too little thyroid hormone (hypothyroidism). The thyroid gland is influenced by additional hormones produced by two neighboring organs. The pituitary gland, located at the base of the brain, produces a thyroid-stimulating hormone, TSH. The hypothalamus, in the brain positioned just above the thyroid produces thyrotropin-releasing hormone, TRH. When levels of the thyroid hormones, T3 or T4, in the blood are low, these low levels are detected by the hypothalamus and the pituitary. This causes release of TRH, stimulating the pituitary to produce TSH. The increased level of TSH stimulates the thyroid to produce more thyroid hormone. Thus these three glands and their hormones are interconnected. When there is an imbalance resulting in too much TSH it causes the growth of thyroid cells and can lead to goiter.
Hypothyroidism is characterized by slow mental responses, physical performance, and other symptoms. In the U.S. hypothyroidism is thought to affect an estimated 13 million people, but the diagnosis of this disorder is controversial. Sub-clinical hypothyroidism has been defined by elevated levels of TSH, (between 4.5 to 10 milliunits per liter). Normal TSH levels are thought to be between 0.4 and 4.5. Now some physicians are arguing about whether they should treat patients with TSH levels as low as 2.5. Some of the physicians who say that patients with such low levels of TSH should be treated have been supported by manufacturers of a drug that is used to treat hypothyroidism, levothyroxine (called Synthroid, Levoxyl, and Unithyroid). These supporters of low TSH levels may have a conflict of interest. ( New York Times, November 8, 2005 , page D5)
The death of my 85 year-old former professor from an unusual brain disease caused me to look up the probable cause of his death: "Lewy Body Dementia", referred to as LBD or DLB. This incurable dimentia is often misdiagnosed as either Parkinson's (PD) or Alzheimer's (AD) disease, because DLB has some symptoms that are common to both PD and AD. These Lewy bodies were first described and related to dementia by Frederick Lewy in 1914. If you have never read about DLB, how common is this brain disease: more than you would guess. The frequency of DLB although uncertain because it is diagnosed by postmortem examination of the brain and after their death, many victims are not subjected to an autopsy. However, the result of autopsy studies that have been done in the U.S. indicate that 10-20% of all dementias and up to 40% of patients who died from AD actually had Lewy Bodies (LBs) in their brains that are characteristic of LBD. Presumably these patients had DLB. Autopsy studies in Europe and Japan indicate similar frequencies of DLB. Old and late-middle-aged patients, more often men than women, get DLB.
The Lewy bodies that characterize this dementia are malformed proteins in the brain, reminiscent of other malformed proteins that characterize AD and Mad-Cow Disease. In all cases the functions of the "normal proteins" is not well understood, nor is the mechanism by which their distorted forms develop in diseased patients. In DLB the Lewy body proteins are primarily comprised of a protein called alpha-synuclein, but its function is unknown. AD gets a lot of attention in the U.S. media, so it is surprising that the public hears little or nothing about DLB. How might PD or AD be distinguished from DLB? The symptoms of DLB include impaired balance and mobility, sometimes confusing DLB with PD. But a condition of resting tremor occurs less frequently in DLB compared with PD. Halucinations, visuospatial functioning, impaired cognition (patients can't balance their check-books) are common symptoms of DLB, but these can be confused with AD. A unique symptom of DLB is a sudden fluctuation in cognitive function with varying levels of alertness and attention. That is: one day a patient may not recognize a friend, nor be able to converse intelligently, but another day, the patient might return to a state of near normalcy. Such reversals may occur frequently. This distinctive symptom along with other subtle observations can sometimes be used to distinguish DLB from AD. On the other hand, there are no sensitive or specific blood or urine tests for DLB. The etiology (origin) of DLB is uncertain; familial cases are rare so it might not be genetic, but there may not be enough studies to know. The lipoprotein. ApoE4 that is over-represented in AD has not been observed in DLB, except when AD is present.
There is no effective treatment for DLB, although certain drugs have been suggested to offer limited relief. For example in some cases, acetylcholinesterase (AChE) inhibitors have been shown to relieve psychiatric symptoms in DLB, but like AD, DLB is incurable and deadly. You may hear more about DLB as further medical studies develop.
Theory doesn't always agree with reality; carefully done bio-statistics are what really count in assessing the possible benefits of medical protocols. As discussed in Chapter 3 in Naturally Dangerous, statistical studies of large populations have shown that high levels of a natural amino acid in the bloodstream: homocysteine correlate with the a risk of heart attacks and strokes. Naturally, some physicians suggested that patients with high homocysteine levels take a regimen of B-vitamins ®C folic acid, vitamin B12, and vitamin B6 because this combination of B-vitamins are known, through other statistical studies to lower the homocysteine levels in the blood. Sounds logical, doesn't it? This prophylactic B-vitamin treatment has been widely promoted. Now three large, well-designed studies have unequivocally shown that this B-vitamin regimen has no benefit in people who are at high risk for heart attacks or strokes. How good are these studies and what the explaination behind these new findings?
These three studies overall included 9,000 patients and involved double-blinded,"gold standard" placebos. The first a Canadian study involved 5,522 men and women 55 or older who had experienced a heart attack or had diabetes. These patients were monitored for five years. The second study, in Norway lasted three years and four months and involved 3,749 men and women ages 30 to 85, who had recently had a heart attack. The third study in the US involved 3,680 stroke patients, who were randomly assigned to take these B-vitamins. All three studies consistently and unequivocally support the conclusion that there is no measurable clinical benefit from treating patients who have had vascular disease with folic acid and vitamin-12 with or without vitaimin-B6.
What lies behind these unexpected results? The explanation is uncertain, but the one your author likes best is an analogy. When patients become ill, for example with an infection, they often manifest a high fever, but lowering that fever, with aspirin does not cure the infection and neither do the B-vitamins cure some underlying disease or inflammation, which is reflected by high homocysteine levels. Incidentally, all three of the above studies resulted in lowering homocysteine levels. (Gina Kolata, New York Times, March 13, 2006)
Herbal remedies are usually bases on flimsy scientific evidence, but are protected from regulation by the infamous 1994 Federal Law discussed in Naturally Dangerous. When these remedies are subjected to double-blinded tests, where neither the physician, nor the patient knows which is the alleged remedy or the placebo, the herbal treatment often fails. A modest double-blinded study of 225 men having prostate enlargement, were treated with an extract of the herb, saw palmetto (from the fruit of small palm trees), and a placebo, chosen to resemble “the real thing”. This study found no difference between saw palmetto and the placebo in improving enlarged prostate symptoms (diminished urine flow and frequent urination). More than 2 million American men now take saw palmetto to treat their enlarged prostate and urination problems; they are probably wasting their money, but this herb does not seem to have serious side effects. This study was published in the February 9 th issue of the New England Journal of Medicine. What should these 2 million men do? Perhaps nothing; this herb has no serious problems, but the placebo effect may help them (until they read this report!).
A 200-year-old system of medical philosophy known as homeopathy can be traced to a German phyician Samuel Hanemann. In 1825, homeopathy came to the U.S. Later homeopathic drugs were legitimized by the 1938 Food, Drug, and Cosmetic Act, which listed these treatments in the Homeopathic Pharmacopoeia of the United States. The latter lists homeopathic drugs, but these treatments have never been subjected to standards of safety and efficacy normally required for drugs by the FDA. “Homeopathic Drugs” are exempted from standards of purity and efficacy by the infamous 1994 law that also shields herbs and supplements. In fact it would be difficult to argue that homeopathic drugs are dangerous, because they more or less do not exist! Proponents of this anti-scientific nonsense believe that the most potent homeopathic drugs are the most dilute! A typical homeopathic drug (derived from minerals, plants, animal parts, or microorganisms is dissolved and repeatedly diluted with water or alcohol. Insoluble homeopathic drugs are pulverized and repeatedly mixed with an inert sugar, lactose. These sequential dilutions are typically carried out from 600 to 20000 times. In most cases, sequential dilutions of 240 or more times make it unlikely that even one molecule of the original substance remains in the final product. Even the most hopeless scientific illiterate could convince themselves of that fact by considering mixing a pea with 100 grains of corn, and then doing this again and again 100 more times, never adding another pea. The homeopathic philosophy is that the diluted solution contains “a memory” of the original solution and that “like cures like”. Since strychnine causes vomiting, so can be used to stop vomiting.
In August 27, 2005 the British medical journal, “The Lancet” reviewed clinical trials using homeopathic treatments, compared with conventional therapeutic interventions, and concluded that any benefits from homeopathic treatments are based on “placebo” effects. Recall that positive results, “placebo effects” are typically obtained in about 20 per cent of individuals treated with innocuous sugar pills. These are psychological benefits. These new statistical studies examined a series of randomized placebo-controlled trials involving homeopathic treatments and compared these with randomized placebo-controlled trials of several conventional medical interventions based on the disorder being treated. These authors concluded that homeopathic treatments do not appear to be superior to ordinary placebo effects, whereas conventional medical treatments do show clinically significant results. There is one advantage of homeopathic medicines. Since they have no real physiological effects, they should have no negative side effects.
What should we learn from this new report? That scientific nonsense is just that, but a fool is easily separated from his or her money. Homeopathy can be compared to a religion, based on beliefs, not science. It is too bad that the media, which are currently discussing “intelligent design” don’t call attention to this old, expensive form of medical nonsense.
In a recent Norwegian study 4749 heart attack survivors were given various combinations of vitamin B and folic acid supplements. This study found that vitamin B or folic acid did not lower the incidence of heart attacks or strokes, but the combination of vitamin B pills and folic acid increased the incidence of heart attacks and strokes by 20 per cent. The participants were divided into four groups: one group took a high dose of vitamin B pills daily for three years; the second group took a high dose of folic acid; the third group took both pills every day; and the fourth group took a placebo. This study surprised some who expected that taking B vitamins and folic acid would reduce concentrations of an amino acid, homocysteine, which is a known marker for heart disease (see page 73 in Naturally Dangerous). This recent Norwegian study weakened the argument concerning the relationship between homocysteine and heart disease. This study should also give caution to those taking vitamin supplements. There may be danger without a benefit. Other, larger studies of this issue are underway. One point of interest is to discover whether flour throughout the World should be fortified with folic acid as is required in the U.S. (refer to page 73 in Naturally Dangerous). (Newsday.com, September 6, 2005)
Some herbal remedies are efficacious, but few have been tested using a placebo in a double-blinded study. Butterbur roots have been used for centuries as an herbal remedy. Now a prescription drug, called Tesalin, prepared from an extract of the butterbur plant was compared in a clinical study with a placebo and with a synthetic antihistamine, Allegra, also called Telfast. The herbal extract, Tesalin, was shown to be as effective in treating hay fever as the synthetic pharmaceutical, Telfast. This study should give a boost to the use of the cheaper natural remedies, but these still need careful, double-blinded studies. (Chemical & Engineering News, August 19, 2005, page 27)
Michael Specter has written an informative overview of dietary supplements in the New Yorker (February 2, 2004). Some interesting aspects of this important issue are given below. This should reinforce information in Chapter 3 of Naturally Dangerous.
The huge dietary supplement business encompasses many segments: vitamins, minerals, herbs, diet pills, and many combinations. This enterprise is anchored on the 1994 Dietary Supplement Health and Education Act. This federal law permits companies to say almost anything about potential health benefits as long as there are no claims of a cure for a specific disease such as cancer, diabetes, or AIDS. Furthermore, no evidence need be cited that a product has the claimed benefit such as improving the immune system or protecting the heart. In addition, there are no standards regulating the manufacture of these pills. Because of this federal law, consumers have no idea of what is in these pills or the purity of the ingredients. Companies manufacturing and selling these “health products” are not required to prove that they are effective or safe. Why does the public buy this stuff? One argument is that supplements are “natural” and therefore must be safe; moreover they are cheaper than prescription drugs. Many consumers distrust the synthetic, unnatural chemicals that make up modern prescription drugs. This belief system borders on a religion and is fostered by scientific ignorance. The market for dietary supplements is huge and growing. In 2003 Americans spent nineteen billion dollars on dietary supplements. Sixty per cent of Americans take at least one supplement a day, but many of these are vitamins that are prescribed by their physicians. Some supplements that are still being taken are known to be dangerous. Examples include kava, which the FDA says may cause liver damage, comfrey tea, whose ingredients may contain phorbol, a co-carcinogen, and ephedra, which has recently been banned because it has been implicated in deaths, strokes, seizures, and other maladies. Some supplements are clearly beneficial. Examples include Vitamin C, which wards off scurvy, folic acid, which helps to prevent neural-tube defects in pregnant women, and Vitamin B12, required for good health in strict vegetarians.
The current situation resembles the patent medicine quackery of the eighteenth and nineteenth centuries. Protected by patent legislation in 1793, manufacturers were able to conceal their formulations resulting in a growing business promoted by newspaper advertising. Many manufacturers of patent medicines became rich on products laced with alcohol, cocaine, caffeine, and opium. This situation was brought under some control with passage of the pure food and drug act of 1906, which ensured that labels contained no false or misleading advertising. But the 1906 law insured neither efficacy, nor safety. A dramatic incident that took place in 1937 that finally brought pressure resulting in passage of the 1938 Food Drug and Cosmetic Act, which gave the F.D.A. the authority to regulate the safety and efficacy of drugs. How did this happen? A pharmaceutical company had dissolved one of the first antibiotics, sulfanilamide, in a solvent, diethylene glycol. This formulation was given to children, who have trouble swallowing pills. Diethylene glycol is a sweet liquid used in antifreeze, but synthetic chemical is also a deadly poison. Scores of children experienced severe abdominal pain, vomiting, and convulsions resulting in the death of 137 children. A national uproar over this incident created the political pressure to pass reform legislation. Looking back, this regulatory authority was long overdue. How many Americans were made sick or died from impure or toxic medicines during the decades before the 1938 law? Dietary supplements have always been covered by the First Amendment, which protects commercial speech and can be used to defend claims that contain even tiny grains of truth. From 1984, when the Kellog Company claimed that their All-Bran cereal might reduce the risk of cancer, other food companies have advertised their products with similar claims, linking them to health benefits. This situation extends to supplements. Read for yourself claims on labels of food and supplements and you will observe many examples of this dubious practice. A specific disease is usually not mentioned, because that would be illegal under the 1994 law controlling supplements. Not only is the language in these claims stretched, but the 1994 law does not require proof of these claims. In the few instances where health claims supporting supplements have been examined in a double-blinded statistical study, the supplement is usually found to be ineffective. An example is Echinacea, one of the most commonly used cold remedies. Over 400 children were studied over a four-month period and this study found that a placebo works just as well, moreover some children taking Echinacea developed a rash. In spite of this study, Echinacea is still widely sold as a cold remedy. Another example is Ginseng, an herb which is promoted as an energy booster. A study by the military found no evidence to support this claim. Yet this “fact” is still claimed today on Ginseng supplements. This false advertising is very weakly controlled by the Federal Trade Commission, the F.T.C., not by the F.D.A. The F.T.C. is overwhelmed and ineffective. For example in 2002 over half of the hundred or so weight-loss ads were found to be false or contained misleading statements, but new companies spring up wherever a previous one is restrained by the F.T.C. Since the supplement industry does not have to report adverse events, the F.D.A. does not have the information to prove a particular product is unsafe. A highly publicized example of this problem concerns a twenty-three-year-old major league pitcher, Steve Belcher, who died of heat stroke after taking an over-the-counter, unstudied product that contained ephedra, which is the most popular supplement in the U.S. (sales around one billion dollars a year). The active ingredient, Ephedrine is known to increase adrenaline, stress the heart, and speed up the rate of metabolism. Combined with caffeine, ephedra has been associated with an increased risk of heart attacks, and other disorders, resulting in death. After Belcher’s death three states banned supplements such as ma huang that contain Ephedrine, but it took the F.D.A. nearly a year to propose such a ban, even though that agency had recognized the danger in products that contain this natural drug.
A principal sponsor of the 1994 Dietary Supplement Act is Senator Orrin G. Hatch, from Utah. Hatch continues to defend this law and to fight tighter regulations on products like ephedra. Hatch’s son, Scott is a well-paid lobbyist for firms that dietary supplements and herbs. Germany has strict regulations over the formulation and purities of herbal medicines. Consider purchasing herbal remedies from Germany. An example is black cohosh, which has been used for many years to treat ailments such as menstrual and menopausal problems. The German version of black cohosh is reported to be more consistently effective than products formulated by U.S. companies.
In ancient times blood-sucking leeches and flesh-eating maggots were used by doctors that we would now consider quacks. Leeches were used for many centuries; for example it is thought that George Washington died after his physicians used leeches to drain quarts of blood from him during an illness. Maggots were employed to clean festering wounds. These “natural” agents have been discarded for many decades, but now they are back and are used in special circumstances. A federal advisory group is discussing for the first time general guidelines to regulate leeches and maggots, specifying how they could be grown, transported and sold. Leeches will be used to drain excess blood from appendages reattached by micro-surgeons. Leeches inject a cocktail of natural substances into a wound including an anticoagulant, an anesthetic, and antibiotic, and a substance that dilates blood vessels thus promoting fast bleeding and removal of extra blood. Maggots are used to clean festering, gangrenous wounds saving limbs and speeding healing. Perhaps squeamish premedical students should consider another vocation or at least avoid becoming a surgeon. (Gardiner Harris, New York Times, 2005)
Some cats are genetically predisposed to respond to catnip no matter what they are doing. But kittens are indifferent to catnip until they are three months of age. Sensitivity towards catnip is inherited, but many cats never develop an interest. If one parent is attracted to catnip, only half the kittens will exhibit sensitivity. There seems to be no correlation between catnip sensitivity and sex, color, or breed. The active compound is called nepetalactone, but only veterinarians know that obscure fact. Catnip is classified as a member of the mint family of plants, which include basil, oregano, and spearmint. Cats must rub against fragile bulbs in catnip to release the attractive oil; that is why cats rub against or chew catnip leaves. The active agent does not act on the mouth, but only on the nose.
Catnip has a place in folk medicine. A tea formed by infusion of catnip leaves is claimed to have a calming effect on humans. Catnip came from Europe and Asia to Colonial North Americain herbal gardens; the plant escaped and spread across the U.S. and Canada. Catnip oil has been shown to repel insects and on a same-weight basis is claimed to be ten times as potent an insect repellent as the most widely sold synthetic repellent, DEET, but due to its volatility and that it decomposes in air, catnip loses its effectiveness in a few hours. For these reasons, cat owners store their catnip in a freezer to preserve its potency. (Chemical & Engineering News, August 1, 2005, page 39)
The U.S. Food and Drug Administration (FDA) issued a statement in July 05 that there is no strong evidence to show that green tea prevents cancer, neither breast cancer in women nor prostate cancer in men. Earlier, weaker studies did suggest a benefit, but these are now discounted. This situation is reminiscent of earlier studies claiming dangers in drinking coffee, which were subsequently discounted by larger, better designed studies. Weill Medical College of Cornell University: Food & Fitness Advisor, September, 2005, page 2)
Recent studies of vitamin E supplements taken by women suggest a modest benefit for older women, but taking vitamin E supplements is generally not wise and may carry risks. Here are summaries from a Women’s Health Study (WHS) conducted among about 40,000 women over 45. These randomized studies used either 600 international units (IU) or a placebo taken every other day over a ten-year period. Among women over 65, vitamin E was found to reduce the risk of death from a heart attack or stroke by 49 percent and cut the incidence of heart attacks by 34 percent, but no benefit was found for women younger than 65. Another WSH report found neither aspirin nor vitamin E prevented cancer. Previous studies of vitamin E supplements reported that with doses over 400 IU compared to 200 IU increased the risk of death by over 10 percent. Because of this result the routine use of vitamin E supplements is not recommended. The tolerated upper limit is 1,500 IU, but some experts think that should be cut 50 percent. The recommended dietary allowance (RDA) for vitamin E is 22.5 IU (15 mg.). Most adults get half their RDA from foods such as nuts, seeds, vegetable oils, avocados, sweet potatoes, and green leafy vegetables. (Weill Medical College of Cornell University: Food & Fitness Advisor, September, 2005, page 3)
Many optimistic Americans believe they can erase years of abuse by changing their habits; stopping smoking, losing weight, changing their diets, and staying out of the sun. There are examples that some damage may not be reversed. Peter Jennings, the news-broadcaster, died of lung cancer decades after he stopped smoking. Jim Fixx, a running advocate, had lost weight, stopped smoking, and ran every day, but Fixx dropped dead of a heart attack. Apparently there are limits to what an individual may do to reverse the damage that accumulated during a lifetime of unhealthy living.
In fact, the good health that may arise from leading a proper lifestyle is probably overestimated. Eating multiple servings of vegetables and fruit every day does not prevent cancer. The deadly skin cancer, melanoma, does occur in people who have not been exposed to mid-day sun. Calcium pills have not been shown to prevent osteoporosis later in life. Adhering to a low-fat diet in adulthood has not been shown to prevent breast cancer.
Some changes in lifestyle do improve you odds against coming down with dangerous diseases, but the changes are small. Smokers can never again become “never-smokers”. Your risk of lung cancer will be reduced if you stop smoking, but not to the degree of a never-smoker. Optimism is good for your health. Exercise, better eating, drinking less, and relaxing is a good plan; you will feel better, even if statistically one cannot reverse health risks from earlier behavior. (Gina Kolata, New York Times, Section 4, April 17, 2005, page 1).
In spite of your age, most of your body is about 10 years old. This strange idea comes from the fact that most of the cells in your body’s tissues are being constantly replaced. Only a few of the body’s cells endure from birth to death. Using carbon-14 isotopic dating scientists have been able to measure the age of your cells in a manner similar to dating trees and checking those dates with tree rings. All the carbon-14 in any cell’s DNA is acquired on the cell’s birth date; thus the extent of carbon-14 enrichment can be used to calculate a cell’s age. Various tissues have been found to have diverse ages. The muscles around a 30- year old person’s ribs are about 15 years old, whereas an adult’s red-blood cells last only 120 days; after all these have traveled nearly 1,000 miles through the body’s circulation system. Old blood cells are dispatched in the spleen. Liver cells turn over in approximately 300 and 500 days. Other parts of your body must last as long as you do, For example, neurons in the cerebral cortex, the inner lens of the eye, and probably the muscle cells in one’s heart must last a lifetime. Bones also turnover; the human skeleton was found to be about 10 years old in adults. This regeneration should keep a person young forever, but one’s DNA becomes damaged through “mutations” thus losing instructions to make correct new cells. The DNA in the power cells, called mitochondria are thought to be the most fragile. These ideas are still being examined using this carbon-14 age test. Keep tuned! (The New York Times, August 2, 2005, page D1)
Lutein or xanthophylls, is a yellow pigment, chemically similar to carotine. This oil-soluble molecule cannot be made in your body, but is required for good health. Lutein is an antioxidant that is found in the macula, which lies in front of the cones in the retina, where it is believed to act as a yellow filter. According to a Nurses Health Study, higher intake of this essential micronutrient is correlated with a reduced likelihood of needing cataract surgery. Lutein is found in many common foods: leafy green vegetables, such as spinach, kale, collard greens, romaine lettuce, leeks and peas. Egg yolks and red peppers are other sources of lutein. Some older individuals appear to be deficient in lutein in spite of the fact that it is required in small quantities. These individuals may have impaired fat absorption and digestion. Note that lutein is another essential fat, something to remember in our fat-adverse society. Some individuals who have early symptoms of macroreticular degeneration are advised to take small supplements of lutein. (Refer to the National Eye Institute)
Cyanobacteria is sold in health food stores as blue-green algae. Blue-green algae has been used as a food supplement for centuries without any reports of ill effects. Its advocates claim a myriad of heath benefits: increased memory, improved digestion, heightened immune function, relief from fatigue, control of hypoglycemia and depression. There seem to be no controlled studies to verify these claims, but the belief is strong and the believers are numerous. On the other side there are growing concerns about dangerous toxins that have been found in some samples of blue-green algae. The leading source of blue-green algae comes from Upper Klamath Lake in Oregon, especially from a company called Cell Tech. The Canadian government has begun to examine blue-green algae supplements to determine whether these products are safe. A major concern is possible contamination with microcystin, a toxic substance that can be produced along with blue-green algae, depending on the environmental conditions of the body of water in which the algae is grown. Microcystin’s toxic effects include jaundice, shock, nausea, abnormal pulse rates, and death. In 1996 an unusual blooming of Microcystis, which produces the toxin, microcystin, was detected in Klamath Lake by Cell Tech. Earlier this toxin was reported to kill fish, and laboratory mice. Microcystins are known to be dangerous to patients on kidney dialysis and should be kept away from children. Canada, Great Britain, and Australia require that drinking water contain less than one ppm of microcystis; a similar standard has been set in Oregon, where Klamath Lake is located. A neurotoxin, B-N-methylamino-L-alanine, BMAA, which can affect the human nervous system, has been reported by Hawaiian scientists to be generated by blooms of blue-green algae. BMAA has been associated with several nervous system diseases: Alzheimer’s disease, Parkinson’s disease, and Lou Gherig’s disease (ALS). This study began with a neurological disease found among Guam natives and was traced to their unusual diet of fruit bats. The bats acquired cyanobacteria by eating seeds from cycad trees. BMAA was found in brain tissues of a small group of people in Canada who had died from Alzheimer’s disease. There are no fruit bats or cycad trees in Canada, but various still ponds do have blue-green algae. It seems past time to analyze blue-green algae supplements for diverse neurotoxins and to examine the claims of health benefits in this widely consumed, potentially dangerous supplement. (Natural Life Magazine, July/August, 1999) (Jan Ten Bruggencate, firstname.lastname@example.org)
There is emerging scientific evidence that pomegranate juice is another nutraceutical, natural substances, which are found in food and have medicinal properties. Pomegranates have been known for 4,000 years. This red fruit apparently originated in Iran and then spread to India and elsewhere. The fruit itself is filled with seeds and pith and is difficult to eat. A more convenient form is pomegranate juice, which is now widely sold as a potent antioxidant. The promotion of pomegranate juice is based on a small study of cultured human coronary artery endothelial cells and mice that had a form of atherosclerosis, known as hardening of the arteries. This medical condition results in a build up of plaque in the walls of arteries causing reduced blood flow that can lead to heart attacks. These small studies showed that pomegranate juice significantly slowed hardening of the arteries that resulted from high cholesterol. It is claimed that pomegranate juice has a higher antioxidant content (polyphenols) than other fruit juices, including blueberry, cranberry, and orange juice, or even red wine. Earlier studies had demonstrated that these antioxidant-rich beverages can protect arteries and improve blood flow. Further double blind studies of pomegranate juice should be carried out to verify these preliminary findings, but it appears that pomegranate juice may be one of the more effective nutraceuticals. (Proceedings of the National Academy of Sciences, online March 21, online, Filomena de Nigris et al.)
The origin of autism, a tragic neurological disease found in increasing numbers of children, remains elusive. A recent report from the University of Arkansas suggests that autism may be related to oxidative stress. Glutathione, a strong antioxidant that is produced in the body, was found to be reduced in 80 percent of children afflicted with autism. Blood samples from 90 autistic children were compared with samples taken from 45 children without the disorder. Further studies showed changes in three genes of children with autism; it was speculated that these genetic differences are connected with glutathione metabolism. Autism is thought to have a genetic basis but to be activated by an unknown environmental trigger. Earlier, heavy metals such as the mercury preservative, thimerosal, an antibacterial preservative that had been used in children’s vaccines, had been suspected as a trigger for genetically susceptible children, but later studies have discounted this hypothesis. In 2004, the Institute of Medicine issued a report ruling out vaccines as a trigger for autism. Glutathione may also help remove heavy metals from the body. Low levels of glutathione may signify oxidative stress. All these factors are hints, but do not help in understanding or treating this tragic disease. (Health Day News, April 3, 2005 , by Aerena Gordon)
There was good reason to believe that vitamin C supplements might improve the health of diabetics, because such patients have high, uncontrolled levels of blood sugar, which is thought to promote unhealthy oxidation reactions. Vitamin C is a reducing agent. Such logic does not always stand up to statistical studies of actual patients. A group at the University of Minnesota, School of Public Health evaluated cardiovascular disease in 1,923 postmenopausal women with diabetes, but examining their diets and vitamin C supplements. Those who consumed 300 mg a day of vitamin C (this amount cannot be obtained from foods and is therefore probably came from supplements) faced a2.3 times greater risk of death from stroke and twice the risk of dying from heart disease than the other diabetic women who did not consume this level of vitamin C. An assessment of other women who were not diabetics showed no risk from taking this amount of vitamin C. Thus vitamin C and diabetes is a bad mixture. Will this apply to younger women or to men at any age? This is uncertain and awaits future retrospective studies; new double-blinded studies would be unethical. Linus Pauling, the famous chemist who advocated vitamin C for many ailments, would be shocked at these results; perhaps he is “rolling in his grave”? (Science News, January 1, 2005 , Vol. 167, page 12)
Echinacea, an herbal medicine derived from a flowering plant in the southwestern U.S., was used by American Indians to treat various aliments. Eichinacea products, teas, pills and drops, are widely sold in “Health Food Stores” and grocery stores. U.S. sales are estimated to top $300 million a year! Eichinacea is touted as a treatment for the common cold. A first year medical student, Thomas Caruso, has analyzed the nine previous studies of Eichinacea’s effectiveness as a cold treatment and has found the six studies showing the herb to beneficial are badly flawed. Two out of three studies showing Eichinacea has no benefit were double blinded; moreover, the recipients did not know whether they were receiving Eichinacea or a placebo. After reviewing the evidence, Caroso concluded in an article in the March 15, 2005 issue of Clinical Infectious Diseases that there is no valid evidence that this popular herbal remedy is efficacious. He remarked that: “We are in a new golden age of medical fraud”. But Caroso doesn’t think his analysis will change anyone Eichincaea users’ practice, such advocates don’t want to know. Probably their relief is another example of the placebo effect.
The financial and political muscle behind supplements became evident with a special exemption given to DHEA, a naturally occurring precursor hormone, which the body converts into the steroid hormones androstenedione (Andro) and testosterone. DHEA is described on page 80 in Chapter 3 in Naturally Dangerous.
A new act of Congress: The Anabolic Steroid Control Act of 2004 gave the Drug Enforcement Administration authority to ban other steroids with a single exception: DHEA. But DHEA is already banned by the International Olympic Committee, the World Anti-Doping Agency, the National Collegiate Athletic Association, the National Football League, The National Basketball Association, and minor league baseball. Andro, formerly a dietary supplement, is now illegal in the U.S. Actually DHEA itself was banned as an over-the-counter drug by the F.D.A. in 1985, but this restriction was subsequently overturned by the Dietary Supplement Health and Education Act of 1994. This bill, which underpins the nearly $20 billion supplement industry sponsored by Senators Orin Hatch, a Republican from Utah and Tom Harkin, a democrat from Iowa. As described in Naturally Dangerous, this legislation protects the dietary supplement industry from control by the F.D.A. Hatch has been very active defending the unrestricted sales of supplements and herbs. It is rumored that behind the scenes economic pressure was involved in inserting this single steroid, DHEA into the recent legislation. Hatch is on the key Senate committee, which brokered the decision to exempt DHEA. He has a role in two Senate committees that oversee the F.D.A. and the Drug Enforcement Agency. Last year, about $47 million worth of DHEA is thought to have been sold in the U.S. Senator Hatch’s son, Scott is a lobbyist for the National Foods Association, a trade group behind the dietary supplement industry, much of which is centered in the state of Utah.
There have been no large, double-blind studies of DHEH itself, either in the sense of its positive effects or its side effects. But steroids such as Andro do enhance muscle growth, but can cause long term physical and psychological harm. Excess testosterone is also dangerous. Hatch and others argue that DHEA has positive anti-aging effects. This supplement is reported to have side effects in women such as acne and facial hair and to be more potent in women than in men. As a new pharmaceutical, there is no way that DHEA would be approved at the present time and it is not available, even by prescription in advanced Western countries. (New York Times, April 17, 2005 , page 1)
Although large studies have shown that fish oil supplements (sources of omega-3 fatty acids) are effective in reducing heart attacks for most people, anew, small study conducted by the Oregon Health & Science University, School of Medicine indicates that some patients should avoid fish oil supplements. Patients who have suffered from dangerous heart rhythms such as VT or VF, and have implanted defibrillators were found to be at risk from taking fish oil supplements. This small, double blinded study examined 200 patients in 6medical centers fitted with implanted cardioverter defibrillators. Half were given a placebo (olive oil) and the others fish oil supplements. The results showed that fish oil tended to increase the risk of VT and VF, not to decrease this risk, which was the expected result. It recommended that this special group of heart patients avoid taking supplemental fish oils. (June 15 issue of the American Medical Association).
Each year large numbers of individuals spend huge sums buying antioxidant vitamin supplements in efforts to ward off diseases. It has been widely assumed that antioxidant supplements would reduce the incidence or severity of cancers and cardiovascular (heart) diseases. Two recent articles in the British medical journal, Lancet, strongly challenge this concept. Recall that the effects on human health of any drug or supplement are best tested by conducting large, well designed statistical (epidemiological) studies – especially randomized, controlled trials. One article (Lancet Vol. 364, October 2, 2004, pages 1219-1228) analyzes several large randomized trials of carotene, and vitamins A, C, and E looking for possible reduction of gastrointestinal cancers such as colon cancer. These authors could find no evidence that these antioxidant supplements prevent gastrointestinal cancers!! Moreover, people taking these supplements experienced an unexpected mortality (higher death rates)! An earlier statistical study concerned the effect of the antioxidants vitamin E and beta-carotene on cardiovascular disease and this study also found no positive effects on diverse populations. Moreover, a slight increase in mortality was revealed from carotene (Lancet, Vol. 361, June14, 2003, pages 2017- 2023). Populations for these studies were chosen from developed countries, which tend not to have vitamin deficiencies. These conclusions should not be extended to the consumption of fruits and vegetables, which other studies have shown to be related to lower incidences of cancer. It is possible that other substances in foods such as micronutrients, dietary fiber, and phytochemicals may be beneficial. The study related to the effect of supplements on cancer did show a beneficial effect of selenium (see Chapter 6, page 145-6 in Naturally Dangerous). The authors recommended that additional studies be carried out on selenium supplements.
What will be the outcome of these surprising statistical analyses? It may seem strange that this news has been slow to appear in the popular print media, or on TV. However, a lot of money is involved as well as an ingrained concept that many users will be reluctant to abandon. Additional focused studies should be carried out to clarify this issue, but the potential danger of carotene is great enough that it is not ethical for this supplement to be used in further human studies.
Although exercise is believed to prolong life, excessive exercise can kill! The risk of exercise is not well publicized, but it should be. Each year tens of thousands of Americans die from vigorous exercise; about 17% of the sudden cardiac arrests are triggered by strenuous exercise. This little recognized danger was brought to the attention of the medical community when three physicians at Johns Hopkins Hospital died within one year from sudden cardiac arrest while exercising. The oldest was only 51; all were careful with their diets and had exercised regularly. Like other things that may be good for you, one can get too much exercise. Moreover, middle-aged and older patients who participate in a vigorous exercise program should undergo tests to determine whether they are at risk. Electrocardiograms, exercise stress tests, and possibly an ultrasound scan of the heart can identify some defects that should warn patients to limit their workouts. Like every thing else exercise should be taken with caution and moderation. Sedentary lifestyles are also dangerous and lead to obesity, raising the odds of experiencing heart attacks, cancer, and a range of other diseases. But too much can be too much. For example, running marathons or participating in triathlons can lead to unexpected, fatal heart attacks, or can be detrimental to one’s immune system. Some facts are sobering: approximately one half million Americans per year participate in at least one marathon; one in 50,000 people who finish a marathon die from it. This risk of running a marathon (26 miles) is greater than running shorter races. Moreover, marathon runners can sustain muscle injuries that can lead to hyponatremia, a swelling of the brain. This deadly disorder is the result of a hormonal response to injury coupled with drinking more water than necessary during the race. Marathon runners are advised: drink only when you are thirsty. There is also some statistical evidence of higher than normal cancer rates seen among marathoners and fitness fanatics. Talk while you run or jog and avoid races is probably prudent advice. High intensity exercise of more than 5 hours a week may do you more harm than good. Thirty minutes a day of moderate exercise (even walking) is sufficient for most people. There are special recommendations for those who insist on running marathons and the like: eat a diet that is rich in antioxidants such as green vegetables. But vigorous long-distance running is addictive, and many (even physicians) won’t quit. (Wall Street Journal, 10/11/04, page R7)
A particular class of unsaturated fatty acids is essential to human health because these chemicals cannot be made in our bodies and must be obtained from food. These so called omega-3 fatty acids are found in fish and certain plant oils. These important nutrients can be obtained, either by eating a food that is rich in omega-3 fatty acids, or by taking supplements. A second unsaturated fatty acid, omega-6, is also essential, but most normal western diets have sufficient quantities of this substance. It is important to understand that for good health, one should consume a particular ratio of these two unsaturated acids. The recommended ratio should consist of between one and four times as much omega-6 as omega-3. Unfortunately, American diets usually contain much more omega-6 than omega-3 resulting in typical ratios of between 10 and 30. This imbalance is thought to result in poor health arising from inflammatory diseases. It is interesting that the Mediterranean diet consists of a healthier balance between omega-6 and omega-3 fatty acids. This fact may partially explain the better health and the longevity associated with Mediterranean diets. People who eat American or European diets can improve their health by consuming foods or taking supplements that are rich in omega-3 fatty acids. Achieving an appropriate ratio of these essential fats is thought to alleviate a remarkable number of conditions such as: high cholesterol, high blood pressure, heart disease, strokes, diabetes, obesity, arthritis, osteoporosis, depression, eating disorders, burn healing, skin disorders, inflammatory bowel disease, asthma, macular degeneration, menstrual pain, colon cancer, breast cancer, and prostate cancer. There is good statistical evidence supporting most of these claims; some are based on double blinded studies, whereas other studies are incomplete and still in progress. The strongest evidence connecting omega-3 fatty acids to health is related to the reduction of heart disease.
For those who like more detail may wish to know that there are three major types of omega-3 fatty acids in foods: ALA, EPA, and DHA. In the body ALA is converted into EPE and DHA, the latter two are used in the body.
What foods and supplements provide the essential omega-3 fatty acids? Two or three servings of fatty fish per week are recommended to provide enough EPA and DHA. Fish rich in omega-3 fatty acids are oily cold-water fish such as Atlantic salmon, lake trout, tuna, or Atlantic mackerel. Another food that is rich in omega-3 fatty acids is New Zealand green lipped mussels. If fresh fish or mussels are not available or you dislike eating fish because of the taste or your concern about methyl mercury contamination, you can take between 3 and 4grams of standardized, tasteless fish oil capsules each day. A single, 1 gram (1,000 mg) fish oil capsule typically contains about 180 mg EPA and 120 mg DHA. Keep the fish oil capsules refrigerated, because they can support bacterial growth.
Remember there is no free lunch; too much of even a good thing can have negative side effects. People who bruise easily should consume omega-3 fatty acids with caution, because these substances can cause bleeding. Eating more than three grams of omega-3 fatty acids per day increases the risk of suffering a stroke! Because of the risk of increased bleeding, people taking omega-3 fatty acids should not take warfarin (coumadin) and they should consult a physician before taking aspirin.
Too much ALA increases the risk of macular degeneration. This problem is currently being studied. Similarly, although fish and fish oil may protect against prostate cancer, consumption of the precursor, ALA raises the risk of prostate cancer! Foods rich in ALA are: flaxseed oil, canola oil, soybeans, walnuts, and walnut oil. If you are measuring your intake of, ALA, one should take about 2,200 mg per day.
What about the other class of beneficial unsaturated fats: omega-6 fatty acids? The most healthful omega-6 fats contain linoleic acid, which is converted in the body into the active form: GLA. This chemical is then converted into hormones called prostaglandins, which regulate inflammation, blood pressure, gastrointestinal, heart, and kidney function. Dietary sources ofomega-6 fatty acids include many foods: cereals, eggs, poultry, most vegetable oils, and whole-grain breads. Some supplements are rich in omega-6 fatty acids: borage oil, primrose oil, and black current oil. Primrose oil has been studied for its safety and effectiveness for treating ailments; however, almost all normal diets have sufficient omega-6 fatty acids so that it is unnecessary to take supplements to obtain this essential fat. In fact, such supplements may throw off the balance with omega-3 fatty acids that is discussed above.
Vitamin D has many benefits: it preserves muscle and bone strength, perks up the immune system, fights inflammation, and provides some protection against multiple sclerosis (MS), diabetes, and certain types of cancer. Recent studies indicate that many older people and individuals of all ages living in dark climates are deficient in vitamin D. Because of these health benefits, some scientists have recommended additional vitamin D supplements for older people and others who are exposed to limited amounts of sunlight. However, there is not universal agreement in the medical community about the wisdom of taking vitamin D supplements. In fact, you cannot buy vitamin D in a grocery store or a “health food store” in California. Moreover, in some parts of the World including the United States, livestock have become ill when they feed on certain plants that make the active form of vitamin D. In order to purchase vitamin D supplements, you must obtain a doctor’s prescription. Let’s examine some of the science behind this issue.
Strictly speaking, vitamin D is not really a vitamin. The usual definition of a vitamin is that it is an essential food constituent that the body can’t make. By exposure to ultraviolet light, people are able to make vitamin D in their skin from a cholesterol-like precursor molecule. Check out the energetic ultraviolet form of light by referring to page 199 in Naturally Dangerous. Exposure of too much ultraviolet light from the sun can cause sunburn and initiate skin cancer, but a person needs some ultraviolet light for good health, because this high-energy light is needed to create vitamin D.
There are several different chemical forms of vitamin D. In the body cholesterol is transformed into a similar molecule, which is subsequently converted by ultraviolet light into pre-vitamin D3. This substance is then transformed into vitamin D3. A similar molecule, vitamin D2 can be obtained in the diet from a plant product. D2 and D3 are converted into the active form of vitamin D. This “1,25 dihydroxy vitamin D”, referred to as 1,25-D, is an important hormone. The transformation of D3 into the 1,25-D hormone occurs both in the liver and in the kidneys by an enzyme reaction requiring oxygen. This hormone 1,25-D, promotes the formation of vital proteins in many different target cells (in bone, the gut, and the kidneys). The active hormone form of vitamin D increases absorption of calcium and phosphorous in the gut, increases bone turnover promoting good bone health, and facilitating the uptake of calcium and phosphorus in the kidneys. A balance of these actions is required for good health. However the presence of too much of this active 1,25-D hormone is toxic and can result in an excessive absorption of calcium, and in dangerous deposits of calcium in soft tissues throughout the body. Thus damage to the heart, lungs, tendons, ligaments, and kidneys can result from exposure to an excess of the 1,25-D form. Because of these toxic effects that can arise from an overdose of vitamin D, this vitamin cannot be purchased over the counter as a supplement in California. Vitamin D supplements should be taken under a physician’s supervision. On the other hand, vitamin D is added by law as a supplement to all milk sold in the United States at levels too low to be toxic.
Which vitamin Ds are usually being referred to? Both the D2 and D3 are lumped together and discussed interchangeably. The amounts are rather small. One international unit of vitamin D is only 0.025 micrograms (a microgram is 1/1000 of a gram); for adults from 50 to 100 IUs are recommended, but consider that between 1000 and 2000 IUs can be toxic to children. Milk is usually fortified with 125 IU of vitamin D per glass.
It is interesting that four different weed-like plants produce the same 1,25-D vitamin as a carbohydrate derivative; there are many reports of livestock being poisoned by eating leaves from these toxic plants.
For many years sports physiologists have known that fatigued muscles associated with anaerobic exercise become sore because of a buildup of lactic acid. A typical anaerobic (lack of oxygen) exercise is sprinting during which more energy is used than can be supplied by normal respiration, because there is not enough oxygen available. Since an experiment performed with frogs in 1929, it has been assumed that lactic acid accumulation contributes to muscle fatigue. This old concept is now being challenged. The new theory is that the buildup of lactic acid does not result in the decline of muscle function. In fact lactic acid buildup may have a beneficial effect on tired muscles. The scientific background is complex and is still not well understood, but lactic acid buildup is not necessarily bad. (Science, Vol. 305, 20 August, 2004, page 1112)
On page 83 in Naturally Dangerous a small section discusses performance-enhancing drugs. There is an ongoing battle between chemists and biologists, who are working out methods for detecting these banned substances and athletes who are determined to use performance-enhancing substances, even chemicals that occur naturally in the body. During and after the Olympic Gamesin Athens, 24 competitors have been found guilty of using performance enhancing drugs. In fact, more athletes from the recent Olympic Games in Athens may still be detected as new tests are developed that can be used on blood samples taken from competitors in these recent Olympic games. Remember that the ancient Olympic competitors used herbs and mushrooms to try and improve their performance, but these probably didn’t help the athlete. Recent chemicals can give a boost to performance. Up to 180 urine samples were processed on the average day during the recent games, and each urine sample was subjected to as many as 12 different analyses. The first modern Olympics to be drug tested was the 1968 games in Mexico City and only one athlete was caught (a Swede using excessive alcohol). By 1976 methods were developed for detecting anabolic steroids and more athletes were disqualified. Next came tests for natural hormones that are produced in small quantities in the body, such as EPO (erythropoetin), testosterone, and very recently human growth hormone (hGH) – all of which are discussed in Naturally Dangerous. Developing tests for natural hormones is very challenging and time consuming; there is a constant struggle between the chemists and the athletes who use drugs. Ratios of carbon isotopes (nuclear siblings) were developed to distinguish synthetic testosterone from that made in the human body. Following the development of a recombinant form of EPO, a natural hormone made in the kidneys to boost the number of red blood cells, scientists had to find a method to distinguish between the body’s natural EPO and that injected from the recombinant form. This test took 10 years to develop, and was not used until after several world-class cyclists had died from apparent overuse of this synthetic hormone (refer to page 82 in Naturally Dangerous). This complicated new test was first used in the Sydney Olympic games, resulting in the withdrawal of several athletes. It is notable that one out of eight competitors in the 1998 Tour de France were found to be using EPO. Recently a completely artificial steroid, THG, was found to be used by professional athletes such as baseball players. The discovery and detection of THG was not developed until last year by the Olympic Analytical Laboratory in UCLA. These scientific sleuths worked out the formula for this previously unknown substance and made a sample of this steroidal hormone mimic. A standard test for THG is now routine. A valid test for human growth hormone, hGH, has just been certified. It is possible that blood samples taken from this year’s Olympic athletes will now be tested and will show that some athletes abused this natural hormone in this year’s Greek games. What about the future? It is now possible to use gene therapy to enhance performance. Developing methods for detecting such unethical activity will be very challenging. (Chemistry World, October, 2004, page 54)
Deeply colored pigments in several fruits are healthful. The dark blue pigment in blueberries, a powerful antioxidant, has been claimed to lower cholesterol, fight cancer, inhibit cell damage and preserve memories. Have you heard about a small cousin of blueberries called bilberry? Sometimes called European blueberries or huckleberries, bilberries are dark blue with their pigments distributed throughout the fruit, whereas the color in American blueberries is mostly confined to the berry skins. There is a lot of folklore related to the use of bilberries, which are claimed to improve eyesight, to treat diarrhea, and to be an anti-inflammatory, because of the flavonoids in this small dark blue berry. Some preliminary studies suggest that bilberries have antimicrobial and anticancer properties, but wait until thorough studies have been done. Of course you can buy bilberry extract tablets in the “health food store”. As a fan of blueberries, I hope there is some truth in these claims, but anyway one can enjoy pies or cakes that contain blueberries. By the way, wild blueberries taste much better than the less expensive larger commercial fruit. (Lee Bowman, Scripps Howard News Service, 8/24/04)
Many people take this herb thinking that it will fight symptoms of a cold. The belief is that Echinacea stimulates the immune system. This herb is known to have side effects by interfering with the natural deactivation of drugs via enzymes in our liver. One should not take Echinacea, if they are taking “real drugs” such as steroids and methotrexate (used to treat rheumatoid arthritis. But does Echinacea help with your cold? A recent analysis of over 100 studies on Echinacea, including nine double-blinded studies have not produced rigorous evidence that Echinacea reduced symptoms, nor shortens the duration of a cold. (Bottom Line Health, November 2004, page 9)
Performance enhancing drugs are discussed on page 85, Chapter 3 in Naturally Dangerous. In 2003 a major scandal broke out with respect to tetrahydrogestrinone, or THG, a new synthetic version of the male hormone, testosterone. On October 28, 2003, the Food and Drug Administration ruled that THG is illegal and cannot be sold in the United States. Because THG was previously unknown, drug testing failed to detect it. Notable major league baseball players, Barry Bonds, Jason Giambi, and Gary Sheffield were called to testify before a grand jury concerning possible use of performance-enhancing drugs obtained from a company purported to sell THG; all of these athletes denied using illegal steroids. It was determined that THG builds muscle mass, and could presumably enhance long-range hitting performance. It is not clear whether players will be tested for THG and related substances because the players union would have to agree. The major league baseball commissioner, Bud Selig, cannot set up drug testing rules without agreement from the player’s association. Currently players with major league contracts are tested only twice within a one-week period each year and penalties are much weaker than those involved in Olympic sports. THG seems to have been designed to act as a performance enhancing substance, but to be difficult to test for because it was a previously unknown compound.
For many years physicians and epidemiologists have believed that exercise promotes better health. Recently there have been more thorough studies of this issue; these studies confirm exercise’s positive effects with respect to many serious diseases. Exercise wards off heart disease, strokes, diabetes, obesity, and several types of cancer. Your lipid profile (high and low density cholesterol and triglycerides) is improved and you will develop increased blood flow as well as stronger muscles and bones. Symptoms of arthritis will be reduced and your mental acuity will sharpen. Exercise is the antidote for too much food and too little activity. Sedentary activities such as becoming a “couch potato” watching TV is a strong risk factor for coronary heart disease (CHD). If present lifestyles continue, more than 33% of children born in 2000 will develop type-2 (adult-onset) diabetes, a condition in which cells in the body become resistant to the hormone, insulin, causing blood-sugar levels to remain high. If this trend continues, for the first time adults will live longer than their children!
Mild exercise is effective. Even walking 40-50 minutes a day is calculated to lower the risk of developing type-2 diabetes. While watching TV, get up and walk around the room; that bit of activity will help. If you get type-2diabetes, you will have it for life; there is no cure, but you can help manage this disease. Three fourths of people with type-2 diabetes will die of a heart attack, but exercise lowers the risk of cardiovascular disease. Long-term exercise, regular long walks or runs, build up your supply of nitric oxide (NO) the smallest hormone, which among other things relaxes your blood delivery systems and increases blood flow. Check out this little hormone on pages137-138 in Naturally Dangerous. The same hormone is involved in male sexual activity; thus exercise helps to fight erectile disfunction without requiring Viagra!
What about strenuous exercise? How much is necessary for better health? The experts don’t agree about this; some say intensity is helpful, but others say you get benefits from continuous, milder exercise. Increasing the intensity of exercise among adult males burns more visceral fat. Anything that removes this type of fat is healthful; for example lowering visceral fat reduces inflammation, which can lead to cardiovascular illness. Strenuous exercise lowers the level of, C-reactive protein, the marker for inflammation, which is a better predictor for heart attacks than cholesterol levels. Insulin resistant, type-2 diabetics have more insulin in their blood; this excess insulin can have deleterious effects. Fat can build up, raising the risk of cancer; moreover, insulin is a growth factor and may accelerate the proliferation of cancer cells. Rates of colon cancer are known to be reduced in people who exercise; this is thought to be related to insulin sensitivity. Developing prostate cancer is not reduced by exercise, but survival rates are increased.
It is well known that people who exercise feel better. Levels of cortisol, a mood enhancing hormone, increase with exercise. Cortisol is also an anti-inflammatory hormone.
What are the effects of exercise on aging? There are many advantages: healthy joints, increased muscle mass, slower cognitive decline, less stress and depression are a few. Father Time cannot be completely defied. Your pulse rate drops about one second a year, even with strenuous exercise. That is why middle aged women now pass me while running on steep hills. Moreover, I know of no studies that demonstrate increased longevity specifically as a result of exercise. Maybe such studies will come forth, but it is clear that one will be healthier while not necessarily living longer as a result of continuous exercise. Time and patience are required. (Harvard Magazine, March-April, 2004, page 36)
Recent studies of the hormone, melatonin, may put informed readers off this dietary supplement. Melatonin has been recommended for insomnia, jet lag, arthritis, stress, alcoholism, migraine headaches, and symptoms of aging and menopause as well as protection from heart disease and cancer. That’s quite a list; what is the truth? For starters, a recent Harvard Medical School study found no difference in melatonin level between the young and old. Thorough clinical trials of melatonin as a treatment for insomnia have not been reported, but many scientists agree that melatonin induces sleep, but people taking it may not stay asleep. It can produce drowsiness and a hangover the next day. A group of Norwegian physicians flying between Oslo and New York took Melatonin, but reported no benefit against jet lag, but this question is still considered inconclusive. Melatonin is a powerful antioxidant, but it may not protect against aging and chronic diseases. The use of this powerful hormone as a supplement is further complicated by the fact that melatonin levels are affected by drugs such as aspirin and levels in individuals vary between individuals and the time of day. Because melatonin interferes with other hormones, children and pregnant women should avoid taking melatonin. Finally, chronic use of this supplement may suppress your body’s production of melatonin. I stopped taking this supplement several years ago. UC Berkeley Wellness Letter, May 2000, page 1.
This popular British bitter orange jam contains citrus aurantium referred to as Bitter Orange. Like grapefruit juice, a constituent in Bitter Orange inhibits a member of the enzyme family called P450; these enzymes are responsible for removing many drugs from our body by attaching oxygen atoms. As mentioned on page 50 in Naturally Dangerous, this enzyme metabolize soil-soluble drugs by converting them into water-soluble products, which pass through the kidneys into the urine. Inactivation of this natural drug-disposal system can result in some drugs being maintained at dangerous levels in the bloodstream. But there is an additional risk: Bitter Orange is also sold as a component in dietary supplements that are being sold as substitutes for earlier supplements that contained ephedra. Some over-the-counter-diet drugs containing ephedrine were banned a few years ago, because under certain circumstances, they can cause strokes. Bitter Orange is a component in so-called ephedra-free dietary supplements. However, there is another chemical in Bitter Orange called synephrine that has an action similar to ephedra; some scientists are worried that, in combination with caffeine, synephrine can induce heart attacks and strokes. Others argue that there is too little synephrine in these herbal supplements to be dangerous. This situation is still unclear, but it should remind everyone that herbal supplements are drugs and also that particular drug combinations can be dangerous; moreover, in the U.S. herbal supplements are not controlled for efficacy or purity. (Science, September 19, 2003, page 1669)
Scientists are discovering genetic secrets that may extend life!! It has been found that the natural life spans of yeasts, nemotode worms, fruit flies, and mice can be doubled by turning selected genes on or off. The anti-ageing gene of greatest interest is called sir2; when this gene is activated, aging is retarded; this mimics the effect of caloric restriction. It had long been known that a low calorie diet extends life for many creatures from flies to monkeys and presumably man. Naturally occurring chemicals have been found to activate the enzyme produced by the sir2 gene. The most potent chemical that activates this enzyme is resveratrol, which is found in red wine. Resveratrol has been shown to prolong the life spans of yeast and fruit flies. It exists in the skin of both red and white grapes, but its levels are 10 times in red wine compared to white wine. Pinot noir wines produced in cool climates such as Burgundy contain more resveratrol than cabernet wines produced in warm climates such as California and Australia. Oxygen in the air destroys resveratrol so simple grape juice should be less effective as an anti-aging agent. Other chemicals have a similar, but weaker effect; for example, the flavones found in olive oil also activate this anti-aging enzyme. Perhaps these factors account for part of the “French paradox” – the fact that the French, who consume fatty foods, nevertheless are long lived. (N.Y. Times, August 25, 2003, page A10; September 21, 2003, page 1)
The list of drugs that are affected by St. John’s Wort grows. This natural herb contains at least 10 compounds that can have a pharmacological activity, mostly by activating liver enzymes, which remove drugs from the body. This herb, which is taken by millions of Americans for depression, inactivates the HIV drug, indinivir, the heart drug digoxin, the blood thinner, warfarin (Coumadin), several oral contraceptives, and cyclosporin, which is used by people after they have received an organ transplant. Moreover, patients taking prescription antidepressants along with St. John’s wort have reported side effects such as dizziness, confusion, headaches, and anxiety. If you are heading for surgery, tell your anesthesiologist if you are taking this herb. UC Berkeley Wellness Letter, May 2000, page 7.
A fascinating article in Nature (vol. 423, 5 June, 2003 ) by Jared Diamond discusses historical, genetic, and statistical data concerning diabetes-2, and the puzzles that these studies reveal. You may remember Diamond as the author of “Germs Guns and Steel”, which is listed as Further Reading for Chapter 4. I strongly recommend this book to any person who is interested in the history of human development. In this Nature article Diamond discusses the increasing prevalence of type-2 diabetes in modern populations and relates this impending medical crisis to genetics and history, somewhat in the style of his famous book. This article on diabetes is written in simple terms and should be readily accessible to non-scientists.
Recall from Chapter 3 that both forms of diabetes involve the hormone, insulin. Type-1 patients cannot make enough insulin and type-2 patients do not make effective use of their insulin to transport glucose from the blood into cells where it is metabolized. It may interest you to know that type-1 patients tend to be thin, whereas type-2 patients tend to be obese.
In Diamond’s article, we learn that diabetes-2 is presently a huge problem in the U.S. where it is costing 100 billion dollars per year, a figure that is 15% of all medical costs! Over much of the rest of the world, this disease is also rapidly increasing and will soon become one of the major health problems. For example, it is estimated that by 2010 over half of the world’s diabetics will live in India and China, although it has been less common in the rural areas of those countries. The puzzling exception to the growth of type-2 diabetes is Europe, where the increase is modest. Although type-2 diabetes is often called adult-onset, this disease is also showing up in an alarming number of Children.
Next we learn that, like the less-common type-1, juvenile-onset diabetes, which is known to be inherited, type-2 diabetes also has a genetic component, but it has a behavioral link as well. From a genetic point of view, the fact that identical twins (“monozygotic twins”) have a nearly 100% coincidence of type-2 diabetes, but non-identical twins (“dizygotic twins”) have only a 20% concordance strongly confirms the genetic connection. In addition to genetics, type-2 diabetes is connected to lifestyle. The two majorrisk factors are weight gain and lack of exercise. There is some good news: type-2 diabetes can be reversed by dieting and exercise! Diamond’s article contains some interesting examples of increases in the incidence of diabetes-2 when populations migrate or adapt a new lifestyle with ample food and little exercise and other instances where this disease disappeared under starvation conditions. The lifestyle associated with type-2 diabetes has also been observed in overweight, under-exercised primates in zoos.
An evolutionary puzzle discussed in this report concerns the question of what genetic advantage might be conferred on populations that become predisposed to type-2 diabetes. The best current hypothesis is that such people have an unidentified “thrifty gene”, which is proposed to allow selected members of their population having that gene to survive periods of near starvation.
In July, 2002 approximately 5.6 million American women were taking hormone replacements as they passed through menopause and thereafter. This hormone replacement therapy, HRT, was thought to prevent several diseases and to treat symptoms of menopause. A series of large, double-blinded statistical studies published in 2002 and 2003 have demonstrated that serious health risks are associated with HRT, particularly for older women. Moreover, these new studies have found few advantages in alleviating symptoms. As a result, HTR sales have plummeted and are likely to fall further. If these drugs were being considered deno-vo (from a fresh start), these drugs might not win approval, except under strict guidelines. These new large and rigorous studies have found serious numerous problems with the most popular hormone combination of estrogen and progestin, Prempro, which is marketed by Wyeth. Prempro was found to pose increased risks of heart attacks, strokes, blood clots, breast cancer, and Alzheimer’s disease! Moreover, other randomized studies have found few benefits in the “quality of life” (general health, psychosocial functioning, pain, energy level, sleep quality, sexual satisfaction, and cognitive functioning). Patients did experience fewer hot flashes and a slight improvement in their sleep. Although the health risks are small, they are significant and the sum of these adverse effects is troubling. Another problem is that, those taking Prempro who came down with breast cancer developed tumors that were discovered at a later, more dangerous stage. Taking a single hormone is not a solution. For example estrogen taken alone can only be prescribed for patients who have had a hysterectomy because this hormone increases the risk of uterine cancer. The combination drug, Prempro does help combat osteoporosis, but there are other safer, non-hormone treatments such as Fosamax from Merck or Evista from EliLilly & Co that have been developed specifically to treat this bone-thinning disease. This is just another example that not all natural things are safe. (Harvard Women’s Health Watch, volume 10, number 10, June 2003)
A new small study (Science Now, 23 June) explains a possible connection between excess insulin and Alzheimer’s disease. Remember that insulin is a protein-like hormone that escorts glucose into our cells. Insufficient insulin levels or poor insulin utilization cause diabetes. It has been known that insulin can improve short-term memory, but high levels of insulin are dangerous and can result in a condition known as insulin shock. In a small but well designed “double-blind” study neuroscientists have found that higher levels of insulin tie up an enzyme called IDE that the body uses to break down insulin. Unfortunately the same enzyme has another job – to clear beta-amyloid from the body. When this protein builds up, it clumps into plaques in the brain, an action that seems to be involved in Alzheimer’s disease. Too much insulin diverts IDE from its task to keep beta-amyloid levels down and this could promote Alzheimer’s. This is yet another example of the need for a biological balance called homeostasis (see page 48 in Naturally Dangerous). The present study is too small to be definitive; further work may clarify this interesting situation.
The Following essay is taken from a term paper submitted by Rachel Nass, a Stanford undergraduate. Rachel has given her permission to put this on the website. Those readers who enjoy herbal teas may wish to read this.
Herbal remedies have been used as healing products for millennia. Egyptian medical papyri, dating back as far as the 2nd century B.C., contain descriptions of various ailments and herbal remedial agents, including myrrh, cumin, peppermint, caraway, fennel, olive oil, and licorice. The Chinese also recognized the value of herbs. According to Chinese legend, we can attribute the “discovery” of herbal tea to the Emperor Shen Nong, who, in the 3rd millennium B.C., was sitting beneath a tree while his servant boiled drinking water. A tree leaf dropped into the water and Shen Nong decided to try the brew, which he described as “refreshing”. Shen Nong went on to write the earliest Chinese book on medicinal herbs, in which he especially noted ginseng’s incredible potency to preserve youth and strength. Indian and Japanese legends attribute the discovery of tea to Bodhidharma, the devout Buddhist priest who founded Zen Buddhism. According to Indian legend, Bodhidharma began to feel drowsy in the fifth year of a seven-year sleepless contemplation of Buddha. After plucking leaves from a nearby bush, his tiredness was dispelled (bombayteacompany.com 1). Many other cultures, however, were also familiar with the use of various herbs, including the Persians, Romans, Greeks, Babylonians, Hebrews, Arabs, Africans, South Americans, and Indians. In the U.S., American Indians relied on forest products to alleviate ills, and the early colonists brought additional plant remedies to the New World (Lucas13-14). All these and other sources illustrate that herbal remedies, including teas, have been renowned for their medicinal properties by numerous cultures.
In the U.S., consumption of herbal teas has become increasingly fashionable. The company Celestial Seasonings created a mass market for herbal teas in the United States in the 1970s. Since the 70s, the popularity of herbal teas has skyrocketed. While Celestial Seasonings reported $1 million in sales in 1974, this number rose to $80 million in 1997 (Postlewaite 22). Although Celestial Seasonings had a near monopoly in the 70s, it is now forced to compete with many emerging companies that widely advertise the effectiveness of their herbal teas. The industry as a whole continues to grow at a rate of 10 to 15 percent a year (Danitz 42). In fact, today you can find herbal teas everywhere in local supermarkets, health food stores, and on the internet.
Most Americans drink these teas often and believe that because they are “natural” they must be safe. However, while herbal teas can have beneficial effects, it is important to realize that herbal remedies may also have dangerous effects. Half of all prescription drugs are made from plants and many of the herbs used in herbal tea drinks come from these same plants. Thus, the same precautions are advised when drinking (at least certain) herbal teas as when taking any other kind of drug (Danitz 1).
Unfortunately, the average American is uninformed about many of these dangers. Health risks have resulted from the lax regulation of herbal teas and other products by the FDA. In 1994, under the Dietary Supplement Health and Education Act (DSHEA), Congress defined the term dietary supplement as “a product taken by mouth that contains a dietary ingredient intended to supplement the diet” (FDA 1). These dietary ingredients include vitamins, minerals, herbs, botanicals, amino acids, enzymes, organ tissues, glands, and metabolites. Although these supplements were subject to the same regulatory requirements as were other foods prior to 1994, DSHEA created a new regulatory framework, in which firms, rather than the government, are now responsible for determining that the dietary supplements they manufacture are safe and that the claims made about them can be substantiated by evidence. The FDA, however, does require that these herbal products be labeled with a descriptive name of the product, a statement that it is a “supplement”, the name and place of business of the manufacturer, a complete list of the ingredients, the net contents of the product, and a supplement facts panel.
While some companies strictly regulate their products, other companies sell products that have not been proven either safe or effective. Although drug products that are regulated by the FDA are subject to strict rules, manufacturers of herbal products are not even required to disclose evidence to the FDA or consumers about either their product’s safety or any claims that they make. It is thus extremely difficult to know whether information about these products is reliable. Due to this lax regulation, many of these herbal teas contain potentially harmful ingredients of which consumers are unaware. Some companies have received approval from the FDA for their teas. However, most companies manufacturing herbal teas are unable or unwilling to test and patent teas in the way that drug companies can with medicines. Thus, it is essential that consumers take the initiative to seek information about the herbal teas that they purchase.
There are three main categories of tea – black, green, and oolong. All of these teas are derived from the tea plant Camellia sinesis. Black and oolong tea are made by first allowing the leaves to wither at normal temperatures. The leaves are then rolled, which breaks the cell walls of the leaf and allows for fermentation. Green tea, however, is made from unfermented leaves. Many claim that green tea provides the greatest health benefit due to its content of catechins, compounds that are destroyed in the fermentation process used to make black tea (oolong tea is prepared in a slightly different way from black tea and thus has higher catechin content). It has been demonstrated that catechins lower cholesterol, generally improve lipid metabolism, and have significant anticancer and antibacterial effects. In general, all teas contain the ophylline, a substance similar to caffeine, which can be both stimulating and addictive when consumed in high doses (Adams 54-55).
Herbal teas differ from black, green, and oolong tea in that they are not derived from the tea plant Camellia sinesis. Instead, they are made from the leaves, bark, roots, seeds, and flowers of many other plants. Companies claim that these teas afford many health benefits, including aid for colds, flu and allergies, women’s health, digestion and cleansing, energy, and relaxation. Other more questionable claims include that these teas aid in weight loss, help people to stop smoking, “tone” the body, and improve sexual potency. No data has been submitted to the FDA to substantiate any of these claims (Snider 34).
Herbal teas tend to pose health threats when they are consumed in very high doses. Problems arise when teas are consumed in excess, when they are used for medicinal purposes, when an uniformed consumer mistakenly uses unsafe herbs, or when a long-revered herb may be found to have toxic properties that were previously unknown (Snider 32). Problems associated with herbal teas include liver damage, gastrointestinal problems, changes in heart function, anticholinergic effects, interference with the central nervous system, and complications when taken with other medicines. There are numerous examples of teas that may result in these complications when used improperly.
Liver complications have resulted in consumers who drink comfrey, gordolobo, groundsel, mate, chaparral, and tansy ragwort teas. Comfrey is perhaps the most dangerous of these teas. Comfrey, a fast-growing leafy plant, has become extremely popular because of its supposed healing properties. Marketers of this tea advertise that it can help relieve anything from broken and damaged bones, to scars, arthritis, various skin problems, and bronchitis. However, according to the FDA, between 1985 and 1993 at least seven cases of hepatic veno-occlusive disease (which causes obstruction of blood flow from the liver with potential scarring) resulted from the use of commercially available comfrey products. These complications are caused by pyrrolizidine alkaloids, toxic substances found in comfrey. According to the FDA, veno-occlusive disease is usually acute and may result in fatal liver failure or chronic liver disease. One case involved a 47-year-old woman who, in an attempt to cure stomach pains, fatigue, and allergies, developed a liver ailment after consuming up to 10 cups of comfrey a day and handfuls of comfrey pills for more than a year (Snider 30). Tests on animals have shown that the pyrrolizidine alkaloids in comfrey may also cause pulmonary, kidney, and gastro-intestinal pathologies, as well as cancer. Due to these side-affects, the United Kingdom, Australia, Canada, and Germany have restricted the use of comfrey products (including herbal teas made with comfrey) to use only under a physician’s prescription. Comfrey, however, is still widely sold in the U.S although it is considered extremely unsafe.
Herbal teas can also cause gastrointestinal side effects. Teas that are known to cause these problems include buckthorn, pokeroot (pokeweed), cascara, and senna. Senna can be found in various diet teas but much of the weight loss is attributable to the fact that it is a potent laxative. In fact, senna is used to make many laxative and digestive products, including Senokot, Ex-Lax, and Naturalax. Senna contains compounds called anthraquinones that stimulate bowel contractions, but can also cause severe cramping when misused. When used for more then seven days, senna can cause fluid and electrolyte losses, especially when taken in conjunction with cardiac medications, corticosteroids, or diuretics. Extended use can also destroy bowel tone and make the consumer dependent upon the tea for normal bowel function (Environ. Nut. 7). These diet teas can be potentially fatal. Cases have been reported in both California and Florida of women who died from cardiac arrhythmia (caused by electrolyte derangements) after drinking diet tea for months (Danitz 42).
There are also various teas that interfere with normal heart functions, including fox glove, lily of the valley, ephedra, and yellow and common oleander. Herbal products coming from the evergreen plant Ephedra, such as Herbal Ecstasy, are used in herbal teas that are designed to promote weight loss and boost energy levels. The Chinese have used the herb, which they call ma huang, to treat upper-respiratory problems for over 2,000 years. These products are sold today in novelty shops and health-food stores and in magazine advertisements. They promise a “natural” high and are marketed as alternatives to illegal street drugs. However, the ephedras contain various chemical stimulants, including the alkaloids ephedrine, pseudoephedrine and norpseudoephedrine and various tannins. Although the concentrations of alkaloids depends upon the species of ephedra used, according to the FDA these chemicals cause hypertension (elevated blood pressure), palpitation (rapid heart rate), neuropathy (nerve damage), myopathy (muscle injury), psychosis, stroke, and memory loss. Arthur Whitmore, a spokesman from the FDA, says that there have been almost 400 cases of reported health problems associated with the use of ephedrine containing products, including 15 deaths since the late1980s (Danitz 42).
Mandrake, lobelia, burdock, and thorn apple (jimson weed) can be found in herbal teas and are known to cause anticholinergic effects, including blurred vision, dry mouth, dilated pupils, disorientation, and delirium. Lobelia, or Indian tobacco, was used to treat bronchitis and asthma throughout the 19th century. In the 1960s, lobelia became popular and people reported that it produced feelings of mental clarity, happiness, and well being when brewed in tea. However, Varro E. Tyler, a pharmacognosist and former dean of the School of Pharmacy at Purdue University, argues that drinking lobelia is “sheer folly” (Snider 30) because it is toxic when the dose is not tightly controlled. Because lobelia contains pyridine-derived alkaloids, it produces affects similar to those produced by nicotine. The FDA reports that it can either cause autonomic nervous system stimulation or depression. While at low doses it causes bronchial dilation and increased respiratory rate, at higher doses it can result in respiratory depression, sweating, rapid heart rate, hypertension, or even death. Reactions can be caused by as little as 50 milligrams of dried herb. Although lobelia is similar to nicotine and potentially dangerous, it is found in many supplements marketed for use by children, infants, pregnant women, and smokers.
Because herbal teas can contain powerful chemicals, it is extremely important that patients who are taking other medications are aware of complications that may result. Squill, meliot, tonka bean, and woodruff are examples of teas that contain naturally occurring anticoagulants (blood thinners). Patients who are already taking anticoagulants or have other bleeding disorders should avoid these herbs. According to the Journal of the American Medical Association, a 25-year-old woman developed abnormal menstrual bleeding after drinking tea in an attempt to lose weight. The tea contained tonka beans, meliot, and woodruff, all which contain coumadin (an anticoagulant). The woman was simultaneously taking other medicines and vitamins that magnified the affects of the anticoagulants found in the tea (Snider 30).
Another negative effect attributable to herbal tea is the possibility that it may erode tooth enamel. In a study at the University Dental Hospital of Manchester in the United Kingdom, three groups of 21 extracted teeth were dropped into regular black tea, herbal tea, or water and were not removed for 14 days (this time period is equivalent to drinking three cups a day for 18 years). Herbal tea caused an erosive effect five times more severe than the black tea. The study attributes its finding to the high acid content in herbal teas (Napoli).
On another note, while advocates of herbal teas often argue that they help reduce the risks of various cancers, this is not always the case. The root and root bark of sassafras, a small tree in eastern North America, was used by the Native Americans as a blood tonic. It quickly became popular among European settlers and in Europe, where it was often sold as a tea. It was used as a diuretic, to treat urinary tract disorders, kidney problems, syphilis, rheumatism, and arthritis, to ease painful menstruation, help women recover from childbirth, and treat high blood pressure, colds, flu, bronchitis, and relieve toothache. However, in the 1960s scientists determined that sassafras contained safrole, a known carcinogen. Safrole concentrations of 80-90% are known to cause tumors in the livers of laboratory animals. In 1960 the FDA banned the use of sassafras volatile oil and its use as a flavoring additive (it was often used to flavor root beer), and in 1976 the FDA prohibited the shipment of sassafras bark for making tea. Reports indicate that one teaspoon of sassafras can kill an adult and that potentially hazardous amounts can be found in less than the dose typically used to make sassafras tea. Sassafras poisoning may result in vomiting, nausea, confusion, and paralysis. Although the affects of sassafras are well known, sassafras was reportedly being sold in some health food stores in 1994. A 1993 article appearing in “Midwifery Today and Childbirth Education” even advocated its use to cure breast inflammation after childbirth (Davidson 1-3).
It is clear that it is essential that consumers make sure they are aware of the herbal teas, and herbal products, that they purchase. Herbal teas can be beneficial when used properly and problems usually only arise when consumers drink excessive amounts or are unaware of the possible complications. It is advisable to buy herbal teas from major manufactures that can guarantee quality and purity of their products. Problems result when people make their own teas from herbs they collect themselves, or buy herbs from poorly regulated companies. In one case, a 30-year-old woman died after drinking a tea that she made from leaves that she believed to be eucalyptus but were actually oldeander, which is poisonous (Snider 32). This example demonstrates that when drinking herbal teas, it is essential to be aware of what is being consumed and the possible side-affects – just because something is “natural” does not mean that it is safe.
It is well recognized that breast feeding contributes to an infant’s good health. Recent studies have shown that exclusive breast feed children should receive vitamin D supplements to prevent rickets, the bone-weakening disease that is being recognized among infants. Conventional wisdom was that babies would get enough vitamin D from mother’s milk, if they were exposed to sufficient sunlight required to stimulate production of vitamin D in their bodies. Refer to the discussion of this “sunshine vitamin” on page 74 of Naturally Dangerous. Moreover, concerns about skin cancer from excessive exposure to the sun have led mothers to apply sunscreen to their children, reducing the production of adequate vitamin D. In some cases this has resulted in rickets from vitamin D deficiency. Although there are insufficient statistical records, recently dozens of cases of rickets have been reported by pediatricians in the U.S. Many cases of rickets affect black children, who’s skin does not absorb sufficient sunlight. All of these factors have led to a new recommendation that certain children should be given over-the-counter multivitamin supplements containing 200 international units of vitamin D. (CNN.com/Health, April 7, 2003)
The tragic death on February 17, of Steve Bechler, a 23-year old pitcher for the Baltimore Orioles has been blamed in part on the dietary supplement ephedra that he was taking to lose weight. The 6-foot-2 Bechler reported for spring training weighing 249 pounds, about 10 pounds over his playing weight the prior season. He was taking Xenadrine, a dietary supplement said to be a “rapid fat loss catalyst”. The active ingredient, ephedrine was found in Bechler’s body. This natural chemical acts as a thermogenic agent that increases a person’s body temperature, resulting in metabolism of fat, but it also constricts blood vessels, which slows a person’s ability to cool off. Bechler’s temperature was 106 degrees when he entered the hospital and rose to 108 before he died. Such stimulants can be even more dangerous than steroids, because stimulants can cause immediate effects such as a stroke or a heart attack, whereas steroids act over longer periods. The Food and Drug Administration has received over 1,400 reports of adverse side effects from ephedra products. It has been estimated that 64 percent of all reported adverse reactions to herbal supplements involve ephedra. More than $3 billion worth of products containing ephedrine are sold in the United States each year! These products can be purchased without restriction in “health food stores”, drugstores and on the Internet. Ephedra supplements have many labels such as Xtreme Lean and MetaboLoss; the active ingredient ephedrine is also present in the Asian drug ma huang. Such substances are forbidden by the NFL and in the Olympics but are still permitted in professional baseball, which may tempt young people to use these readily available, over-the-counter supplements. There is growing pressure on the players union and baseball owners to ban these supplements.
The Food and Drug Administration (FDA), has finally moved to impose rules forcing manufacturers to make clean and accurately labeled supplements. The changes are long overdue, but they are imperfect. For nine years the FDA had the authority to insist on good manufacturing standards and levels of the active ingredients in dietary supplements; however, because of the 1994 law discussed on page 61, the government cannot force sellers to prove that the supplements are safe or efficacious. It is still: buyer beware. After the announced proposed changes in early March, there will still be a 90-day comment period before enforcement in 2004. Moreover, there is apparently no plan for factory inspections or random testing. This means that the new rules may not really be enforced. It’s a start, but a weak one.
Herbal remedies, especially those from China, continue to suffer from problems with purity. According to the Wall Street Journal, a Chinese herbal substance called PC-Spies which is recommended by some oncologists for treatment of prostate cancer in cases where traditional treatments fail, has been removed from the market after it was found to be contaminated with warfarin, a blood thinner. It is claimed that PC-Spies holds down levels of PSA, prostate-specific antigen. PSA levels correlates to the progression of prostate cancer. (Wall Street Journal, May 21, 2002 , p. S4)
Recent medical reports document unexpected and potentially dangerous side effects from taking herbal remedies. St. John’s Wort, a popular herbal treatment for depression, can stimulate our body’s “garbage disposal”, which protects us from potentially harmful, unnatural chemicals such as pharmaceutical drugs. Drugs and other toxins are removed from our body by liver enzymes. Patients taking St. John’s Wort were found to have dramatically reduced levels of prescription drugs that they were taking. The list includes antiseizure, birth control, asthma, blood clotting, and immuno-suppressant drugs. Tell your doctor what herbs you may be taking, but be warned: the dose, purity, and side effects of herbal remedies are often unknown. Herbs are natural and cheap, but they can be dangerous! (Science, vol. 291, January 5, 2001, p. 35)
Many claims are made for various vitamins having medical efficacy. One that seems well documented is that vitamin E has a beneficial effect in suppressing prostate cancer. This claim is now supported by studies demonstrating that a vitamin E derivative suppresses an androgen receptor in prostate cells. This androgen receptor is required for the development of both the normal prostate gland and prostate cancer. Inhibitors of androgen receptors have previously been shown to suppress early stages of prostate cancer. Perhaps this research will lead to more effective prostate cancer treatment.
Thousands of elderly people have been taking human growth hormone (HGH) in search of a fountain of youth. In 2001, over 21,000 prescriptions for HGH were written in the United States. Are the recipients improving their health or ruining it? That question is very difficult to decide. Many reports are anecdotal and therefore subjective and unreliable. A few small double blind studies have recently been reported and these have given mixed results. A controlled double-blind study from the National Center for Complementary and Alternative Medicine reported on 57 women and 74 men ranging from 65 to 74 years old. This study, published in The Journal of the American Medical Association in 2002, showed that HGH combined with testosterone (for the men) or estrogen and progesterone (for the women) results in a gain of lean body mass and loss of fat. Of the male patients, only those taking both sex hormone and HGH increased their cardiovascular endurance. Those taking HGH alone did not show increased endurance. Moreover during the brief period of this test participants did not experience increased strength; that might take longer. The same side effects noted in earlier trials: swollen feet and ankles, joint pain, carpal tunnel syndrome, and increased blood sugar levels were observed in the new study. These effects disappeared when the drug treatment was stopped. These results should warn individuals not to take HGH unless a knowledgeable physician supervises them. Moreover, recent problems with female hormone replacement should discourage women from taking these hormones in combination with HGH. An earlier, 1996 double-blind study of 52 older healthy men, by Dr. Maxine Papadakis if the University of California in San Francisco reported similar results: decreased body fat and swelling, but she also noted no improvement in mental clarity. A lot more research with larger numbers of patients over longer periods will be needed to evaluate HGH therapy for older people. For isolated patients HGH therapy is a dangerous, expensive gamble. (New York Times, November 4, 2002, p. A26; December 22, 2002, p. 29)