Friday, November 5, 2010

Another Vitamin E Meta-Analysis on Vitamin E and Stroke Risk

The British Medical Journal just published another Vitamin E study suggesting that supplemental Vitamin E increases the risk for hemorrhagic (aneurism, or bleeding in the brain) stroke. Vitamin E did not increase the risk of ischemic (thrombosis, or blood clot) stroke.  This will, no doubt, alarm the public and those docs who only read headlines and don't bother to read the entire study before recommending that their patients stop taking supplemental vitamin E.

Here are a few reasons to stay positive about vitamin E supplementation.
  1. The majority of this meta analysis data was derived from studies involving diseases on high risk patients, so the results probably are not all that relevant to the general population. 
  2. This analysis only looked at studies involving supplemental vitamin E alone. We know that antioxidants (and all nutrients) don't function in isolation but as part of complex networks, so the idea that a single nutrient will have potent effects is probably misplaced to begin with.
  3. The study did not identify the percentage of participants who were supplementing with synthetic (dl) alpha tocopherol vitamin E vs. natural d-alpha tocopherol vitamin E.  
  4. Neither did the study identify the lucky subjects who were supplementing with a biochemically balanced mixture of alpha, beta, gamma and delta tocopherols and tocotrienols, which make up a  natural vitamin E molecule.
FYI:  The meta-analysis study authors estimated that for every 1000 high risk patients exposed to supplemental vitamin E they would predict 0.8% more hemorrhagic strokes and 2.1% fewer ischemic strokes.  So the benefits may actually outweigh the risks, when it come to stroke.

Friday, October 29, 2010

ABC's Good Morning America Suggests Supplements No Substitute for Healthy Diet?

Given that Healthy People 2010 data suggests that fewer than 11% of the U.S. population consumes even five servings of fruits and vegetables a day, the October 29 ABC news special suggesting that supplements are not necessary seems beyond irresponsible (the new fruit and vegetable serving intake recommendation is now 9-13 servings a day to reach RDAs of most nutrients.  Nutrient-emply high-calorie junk food has become the norm for a large percentage of the population and nutritional deficiencies that lead to degenerative disease have become common. 

October 29, 2010 Response From the Council for Responsible Nutrition:
Consumers should strive to get their nutrients from eating a healthy diet; however, realistically a large percentage of the population is not getting what they need from food alone. While dietary supplements should not replace a healthy diet, consumers need practical options for getting nutrients, and dietary supplements are a convenient, affordable choice for those consumers who want to ensure their nutritional bases are covered. We need to stop thinking of food and supplements as an either/or situation—they work hand in hand. We encourage consumers to take supplements in combination with other healthy habits, including a well-balanced diet, regular exercise and routine visits with a healthcare professional. More than 150 million Americans take dietary supplements each year—including multivitamins, fish oil, vitamin D, and others—as an insurance policy for good health.

Ellen Troyer, MT MA
Biosyntrx CEO / Chief Research Officer
Voting Member, Council for Responsible Nutrition

Thursday, October 14, 2010

The Lost Art of the Apology

This interesting article was written by Judy Blatman for the Council for Responsible Nutrition blog.  It speaks to the large amount of misinformation in today's press.

"There was a time when the press waited for facts to come to light before filing stories or broadcasting accusatory pieces. Those were the days when newsrooms were fat with budgets, and reporters would meet you for a burger and a scotch to get to know you and your industry. There were even fact checkers.

I’m not saying those things don’t exist today—but let’s face it, the network big budgets are gone—and broadcast bureaus and accompanying correspondents have been sliced from their jobs like the meat off the turkey carcass on Thanksgiving. Often there’s very little, if any, time to think about a story before it airs—as producers and editors are held hostage to getting the story out before their competitors. That was tough enough when the competition was two other networks.  Now, everyone is the competition—and getting it out first means living on an endless news cycle.

But still there are people responsible for getting things right. That’s what made it even more frustrating to have watched a couple of weeks ago as the story of the hospitalized high school athletes in Oregon unfolded.

Since all the info I have about the story comes from the press, I’m not completely sure how these athletes ended up with compartment syndrome, or who used the word “creatine” first, but I know what wasn’t known. Which is that at the time the story was reported, there was no proof that creatine was involved. But that didn’t stop a well-respected local doctor or the press from making noise that the supplement industry was unregulated or that creatine was likely involved.

Worst of all, it didn’t stop ABC News from airing a story that was at best, choppy and sloppily slapped together to fit that evening’s “scary story” slot  (or at least that’s how it appeared to me) with just enough innuendo to indict creatine without actually showing any relationship between the incident and the supplement. A story that was craftily produced to be difficult to criticize (or sue) on a factual basis, but edited in such a way that one could easily conclude that creatine was evil.  It was supposition at its best—or worst.  And not at the level of journalism that I would expect from the network news.

To compound matters, as the story unfolded, it became even more evident that creatine was not involved (although I’m not sure that even now, all the facts have been collected). But here’s the thing about creatine and this story—first,  the athletes weren’t taking any, and second, there doesn’t appear to be a scientific connection to creatine and compartment syndrome—the ailment that caused the hospitalization. So you think that at the very least ABC News would remove their story from the website? Or even respond to our email asking for the story to be taken down. Maybe the local doctor would write us back answering the email sent scientist to scientist—suggesting some of his “facts” were not? Or that we might have heard back from at least one of any of the number of print reporters we reached out to—asking them to make corrections to their characterization of supplement industry regulation or urging them to talk to an academic researcher about creatine and compartment syndrome. Nope. Apparently, in the era of a 24/7 news cycle, admitting you may have rushed to judgment or issuing a mea culpa is apparently a lost art.

So, if I’m being honest, I should probably concede that it is possible that the people we reached out to didn’t get our emails—perhaps the notes are stuck in junk mail folders, or we had outdated email addresses. But you know what…why should I bother to check the facts—if they don’t tie in to my story."

The good news is that the Council for Responsible Nutrition does check facts, and they require that member companies check their facts, as well. 

Ellen Troyer, MT MA
Biosyntrx CEO / Chief Research Officer
Voting Member - Council for Responsible Nutrition

Thursday, May 6, 2010

Interesting views on a Sensitive Subject

 Wall Street, the Downfall of the Economy, and Dietary Supplements?

By Steve Mister and Mike Greene

As the U.S. Senate takes up the issue of financial regulatory reform this week, rumors are
spreading that it includes a little-known provision that would spell the end of the dietary
supplement industry as we know it. Several grassroots consumer organizations have
even launched a campaign urging consumers to write to their members of Congress and
oppose the bill on that basis, claiming that a possible amendment to the bill that would
provide the Federal Trade Commission (FTC) with more authority is really a secret plot
by Chairman Waxman to undermine DSHEA. The problem is: this claim is not truthful,
it’s misleading and it’s not substantiated by the evidence. If it were a dietary supplement
advertisement, this propaganda would be illegal.

However, just like many impermissible advertising claims, there is a nugget of truth
buried in all the hyperbole. And that truth could have negative consequences for dietary
supplement advertising and a host of other consumer products that are regulated by the
FTC. The tricky part is separating the truth from the fiction. So here is what we know to
be true:

• This week, the Senate is holding floor debate on S 3217, the Restoring American
Financial Stability Act—which is intended to provide reform of the nation’s
regulation of financial institutions. The bill creates a new federal Consumer Financial
Protection Agency (CFPA) with this mission, which incidentally, will remove FTC’s
oversight of financial products and services and give it to the new CFPA.

• The House version of the legislation, HR 4173, was passed by the House of
Representatives back in December. It includes a provision that would offset the
FTC’s reduced authority over financial products with expanded rulemaking authority.
Currently, the FTC may not issue formal rulemaking without getting prior approval
from Congress to conduct such rulemaking. Other agencies with narrower
substantive mandates (like FDA and EPA) have this authority to issue substantive
rulemaking. The FTC used to have it, but after expansive misuse of that power in the
1970s, it was removed from the FTC.

• The House version of the bill was managed by Financial Services Committee
Chairman Barney Frank. Certain provisions were managed on the House floor during
debate by the Energy and Commerce Committee Chairman (and long-time industry
critic) Henry Waxman. That does not mean that Congressman Waxman is the source
of this provision.

• The provision is detrimental to dietary supplements along with a whole host of other
industries that make or market consumer products that are under the jurisdiction of
the FTC. It would give the FTC unfettered ability to make substantive rules
governing the marketing of these products without strict Congressional oversight.

History demonstrates that an FTC with broad jurisdiction and substantive rulemaking
authority can run amok.

• One need only look at recent FTC activity under its existing powers to see examples
of an agency that would like to increase the level of support required for consumer
advertising (new standards for testimonials, a requirement for product-specific
clinical trials, disclosure of financial support for research, etc.)

• There is speculation that Senator Rockefeller may offer the same amendment to the
Senate version of the bill. CRN, along with over 40 other trade associations
representing a broad swath of consumer industries have opposed the provision and are
urging Senator Rockefeller not to offer the language to the Senate bill.

Those are the facts. Granting the FTC new authority across broad sectors of the American
economy is not a necessary or relevant response to the causes of the recent recession. The
financial troubles of the past year have not been laid at the FTC’s doorstep, and
provisions to expand the Commission’s authority are out of place in legislation to reform
the financial system. CRN and other like-minded business groups believe that these
FTC-related issues deserve their own due consideration and debate in the more
appropriate context of an FTC reauthorization, as has been done in the past. In that
context, we could lay out the reasons for our opposition and be sure the concerns are
properly considered.

Unfortunately, the effort to prevent this amendment has led to much misinformation.
Blogs and websites are perpetuating rumors that ultimately discredit the industry’s
legitimate concerns and undermine the credibility and goodwill that industry has built as
a reliable source of information. For example:

o The amendment specifically targets the dietary supplement industry – This is not
true. Nowhere in the amendment are dietary supplements singled out for
disparate treatment. Although the FTC’s history of interest in supplements likely
means that expanded authority would lead to expanded interest in supplements,
the provision addresses all of the FTC’s jurisdiction.

o The amendment is a sneak attack by Congressman Waxman – Again, not true.

There is nothing that suggests Senator Rockefeller is being influenced by
Congressman Waxman. Moreover, there is nothing in the House debate that
indicates that he—as opposed to Congressman Frank—was the original source of
the language. This is a case of identifying an industry critic with the cause to
misrepresent this as a plot against supplements.

o A prosecution by the FTC means “secret FTC courts,” a presumption of guilt and
criminal penalties. Merely telling the truth can still get an advertiser thrown in
jail – Do we really need to respond to this one? Administrative law judges
adjudicate FTC proceedings, all of which are appealable to the District court, and
provide due process protections to the litigants. In fact, a recent decision
completely dismissed the FTC’s case, holding that the advertiser’s support for its
supplement ad was sufficient, even where there was conflicting data about the
efficacy of the product.

o This amendment is the end of the dietary supplement marketplace; it will take
your vitamins away from you – C’mon, how many times will we try this
exaggerated claim before consumers realize we are just “crying wolf”? Yes, the
expanded FTC authority could make it more difficult to craft advertising to our
consumers, but it is hardly the end of the industry. Overplaying our hand makes it
hard to be taken serious when a real threat (like the McCain bill) does arise.

It is up to industry and consumers to correct this misinformation as quickly as possible
before any further damage is done to the credibility of mainstream, responsible dietary
supplement industry and the propaganda being circulated makes us all look paranoid and

Steve Mister and Mike Green, both employees of the Council for Responsible Nutrition, clearly stated that this article represents their opinions and does not necessarily reflect the views of CRN or an official position of the association.

Friday, April 16, 2010

The Empowered Patient

More and more people who live with chronic conditions are becoming actively involved in high-stake health care decisions.  Professor James Burroughs of the University of Virginia designed a brilliant survey to identify traits and habits of people who feel empowered to take a lead role in managing his or her health care.

The questions included:
  • Relationships with doctors
  • Treatment history
  • Social habits
  • Need for cognition
  • Self-confidence
  • Media preferences
The survey suggests that people who take a direct role in managing their treatment plan have several traits that other more traditional patients lack.  The survey also discovered what factors don't influence the chances of a person being an empowered patient.  30 percent of the survey was identified as Empowered Patients.

This group likes situations that require a lot of thinking and they like the challenge of solving a problem. These patients were more likely to have a strong sense of self-efficacy, meaning that they were confident in their ability to accomplish almost anything if they decide to do it.

Interestingly, education, income, source of health insurance had almost no effect!

Empowered patients are leading the way online

When asked about personal experiences or seeking out other patients' stories, empowered patients were much more likely to be doing both of these things.  They take a more active role online that traditional patients do. Their tendency to be on the early edge of the social networking curve was much stronger than traditional patients.  Empowered patients preferred a combination of printed patient education materials and web sites over television and magazine ads.  They did not appreciate being talked down to.

Empowered patients still rely on traditional medical authorities to help improve their health, but they're not willing to cede all control.

The obvious question: can the other 70 percent be motivated or influenced to become empowered patients?

Dr. Burroughs and his team of researchers found that 50 percent of the the survey group had many of the same tendencies and personality traits as the empowered patients who fell into the 30 percent group. They could be influenced by appealing to their need to be addressed in a direct, straightforward manner, as opposed to a patronizing approach.  This group is likely to be swayed by social appeals from empowered patients. 

Empowered patients have the potential to be influencers and affect the opinions of traditional patients.

The 20% group did not share any qualities with the other two groups and the researchers suggested it unlikely that they could become motivated to become empowered patients.

Given the lack of available health care dollars now and in the future, it should be the goal of government and industry to empower as many patients as possible.  Empowered people take more personal responsibility for their healthcare and understand that lifestyle decisions matter.

Addendum: While writing this blog piece I kept thinking about Dan Roberts community of empowered AMD patients.  Kudos again to Dan for all he has done to help worldwide AMD patients become more empowered. And Major Kudos to the mdsupport community members who have or will become Empowered Patients.

Sunday, March 14, 2010

Advance Info From Healthy People 2010

Health & Human Services establish health and disease prevention goals every decade in a program called the Healthy People Project.  Although the next report isn't due until 2011; early reports suggest that the Healthy People Project goals are down 41 percent from the last decade.

In the area of nutrition, the percentage of people consuming the recommended servings of vegetables and grains per day has ranged from 4 to 11 percent during the past 9 years, well short of the 2010 50 percent target. In 2000, 25 percent of the population was obese. The HHS goal was to lower that number to 15 percent by 2010. The report suggests that the number of obese US citizens has actually increased to 34 percent.

Given that excess weight and improper nutrition increases the risk of heart disease, stroke, cancers, diabetes and eye disease, just to name a few, our government disease prevention messages don't seem to be getting to the public, or a large portion of the medical community.

It doesn't help when doctors refuse to discuss weight issues with their patients because it's uncomfortable for the doctor.  Nor, does it help when doctors tell their patients that they can get all the nutrients they need from their diets, since over 90 percent of the patients they see in their practices are nutrient deficient, 34 percent are obese and 65 percent are overweight -  if the HHS numbers are right.

Adequate nutrition has, sadly, become a major societal and economic issue.  High-profit, nutrient-empty high-calorie junk food, which is more often than not subsidized by our government, is relatively inexpensive and the most, or only food affordable to a large percentage of our population who have families to feed on low incomes.

The enormous healthcare costs associated with low-cost, nutrient-deficient fast and center-of-the-supermarket food should concern the tax paying public, and certainly the mainstream medical profession.