Abstracts
Multi Vitamin/Mineral Supplement Promotes Weight Loss in Women
Multi Vitamins are considered by many to be little more than colourful contributors to urine flow that reflect a gullible individuals need to add capital to the water course. I have addressed the major complications with this facile comment in a previous commentary.
A paper out in the March 2010 International Journal of Obesity[1] throws added weight to the triage theory of Prof Bruce Ames,[2] when additional nutrients were added to the dietary intake of obese Chinese females. It is already understood that obesity contributes to reduced bioavailability of minerals and vitamins and certainly contributes to reduced blood concentrations.
The team of researchers based at Harbin Medical University in China recruited 96 Chinese women with an average body mass index of 28kg/m2 and aged between 18-55 for the 6 month study.
Three groups were randomly set up, with one getting a multivimin, the next calcium only (162mg) and the last placebo. The results were compelling; the multivimin group had reduced body weight, body mass index, fat mass, total cholesterol and LDL cholesterol. On the positive side, they had an increased level of resting energy expenditure and HDL levels also increased. They also found reduced waist size and better breathing.
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Vit D Deficiency = Fat Legs For Young Women!
It’s hard to ignore, it really appears there is a genuine epidemic (occurrence of a disease or disorder in a population at a frequency higher than that expected in a given time period) in progress, and its not H1N1 Flu.
An excellently developed study published in the March 2010 Journal of Clinical Endocrinology and Metabolism found a depressingly high 59% of study subjects had too little Vitamin D in their blood (</=29 ng/ml).[1] Nearly a quarter of the group had serious deficiencies (less than 20 ng/ml) of this important vitamin. Even the sufficient (>/=30 ng/ml) was only 41% and if we were to apply the generally regarded 50ng/ml as the base line for sufficiency, the numbers would decline even further. Since Vitamin D insufficiency is linked to increased body fat, decreased muscle strength and a range of disorders, this is a serious health issue.
The 90 young women in this group aged between 16-22yrs of age had an increased level of fatty tissue when their Vit D levels were low. Abnormal levels of Vitamin D are associated with a whole spectrum of diseases, including cancer, osteoporosis and diabetes, as well as cardiovascular and autoimmune disorders.
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Gluten May be Causing Your Brain Problems!
An interesting paper published in the Sept 2008 Annals of Neurology described a ‘new to science’ brain aggravating enzyme, triggered by reactivity to gluten, but acting independently of other coeliac symptoms.[1]
Most clinicians understand that overt gluten reactivity is classified under coeliac disease and the the classic constellation of symptoms and signs characterising malabsorptive syndrome is a readily recognised manifestation of coeliac disease. Frank malabsorptive symptoms include steatorrhea, weight loss or failure to thrive, bloating, and flatulence, with multiple deficiency states. More common but more difficult to recognise, however, are the other diverse ways in which coeliac disease presents.
Coeliac disease may also mimic many common clinical entities. These atypical modes of presentation include deficiencies of single micronutrients; nonspecific gastrointestinal complaints such as bloating, abdominal pain, diarrhoea, constipation, flatulence, secondary lactose intolerance, and dyspepsia; and non-gastrointestinal complaints such as fatigue, depression, arthralgia, milk intolerance, osteomalacia or osteoporosis, and iron deficiency anaemia.
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IBS Relief and Probiotics – They do Work
Probiotics are widely consumed and the widespread advertising is often not really justified by the evidence. Many products were never studied as such and some companies use studies performed with other (and different) products for advertising.
In the March edition of GUT a systematic review on the randomised control trials (RCT) undertaken so far suggests that many are of good quality.[1], they determine that meta-analysis is impossible due to the various strains, phenotypes and genome vary greatly.[2] As a consequence and as stressed by the FAO/WHO joint report the benefits of one probiotic ‘cannot be extrapolated to other probiotic strains without experimentation.[3] However there tend to be properties consistent with different groups, from which strain specific organisms may be extracted.
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Gut Immune Defect Links Bacteria and Metabolic Syndrome
The connection between gut bacteria and obesity has gained some weight, with new findings demonstrating links in mice among immune-system malfunction, bacterial imbalance and increased appetite.[1]
Mice with altered immune systems developed metabolic disorders and were prone to overeating. When microbes from their stomachs were transplanted into other mice, they also become obese. These latest findings add weight to the growing appreciation about the role of the bacteria in and on our bodies. We are all outnumbered in terms of human versus bacterial cells and the concept of human and bacteria symbiosis as a super-organism is gaining traction.
Already there have been strong associations between asthma, some cancers, autoimmune conditions and unwanted weight gain.
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Are Claims in Advertisements in Medical Journals Supported by RCTs?
There is at present a considerable amount of legislation being implemented concerning the role of claims linked to food and supplements.
Considerable complications in the food industry are being faced as the European Food Safety Agency apply very tight filters to allow different levels of claims to be applied to products. One complaint is that the pharmaceutical approach to validation is unsuitable and therefore unworkable as foods are not the same as medicines in terms of mechanisms and actions.
Though it is of course accepted that food is vital to managing health and lmiting disease risk there is a central dogma that protecting the consumer is paramount, even if the blind conviction in this aim results in the exclusion of safe and health contributing food and supplements.
It might be considered that the pharmaceutical approach must therefore be water tight or at least a very robust approach and accordingly that advertisments for medicine would be reliable and based on high quality research relevant to the medicine being advertised. In particular they use an extensive amount of data extracted from randomised clinical trials (RCT’s) regarded by many as the only applicable standard of evidence gathering. An earlier post looked at a JAMA that through significant doubt on the validity of many medical research trials that actually make it to publication.
Now, a recent study, supporting previous investigations of a similar nature, confirms that ‘claims’ made in advertisements in high quality medical journals such as the Journal of the American Medical Association, the Lancet, the New England Journal of Medicine, etc might not always be supported by high-quality evidence, and referenced studies may have been sponsored by the pharmaceutical industry itself. [1]
By and large they found, only 17% of referenced RCTs investigated between 2003 – 2005 attached to all adverts in high quality medical journals are of good quality, supportive, and not sponsored by the company itself.
This investigation supports the Lancet study from 7 years ago in which a similar analysis found a considerable discrepancy between medical claims made and the supportive studies.
The 1993 Lancet article concluded:
Doctors should be cautious in assessment of advertisements that claim a drug has greater efficacy, safety, or convenience, even though these claims are accompanied by bibliographical references to randomised clinical trials published in reputable medical journals and seem to be evidence-based.
The free access journal PLOS in 2009 undertook a systematic review of 24 journal articles looking at the quality of medical advertising they discovered overall that only 67% of the claims in adverts were supported by a systematic review, a meta-analysis or a randomised control trial and concluded:
Evidence from this review indicates that low quality of journal advertising is a global issue. As information provided in journal advertising has the potential to change doctors’ prescribing behaviour, ongoing efforts to increase education about drug promotion are crucial. The results from our review suggest the need for a global pro-active and effective regulatory system to ensure that information provided in medical journal advertising is supporting the quality use of medicines. [2]
Comment
What does this mean to us as nutritional therapists, well medicine and nutrition are disciplines in which the purported benefits linked to supplement of medicine consumption need to be explained to the consumer as well as the practitioner both disciplines have a responsibility to be accurate and fair.
The budgets available to pharmaceutical products are vast compared to those available to bodies exploring the potential benefits for food/supplements. The very financial difference should allow the medical adverts to apply a more rigorous level of qualification, espescially as they are normally associated with a level of risk. Foods and supplements need to be carefully described and as legislation evolves this will be enforced by law as well as moral and financial decisions.
It is of use to us to remember that for all the criticism that is leveled at the alternative medicine community for lack of credible (RCT) research, it appears that the very organistaions that hve promoted the RCT strategy as qualifying research are unable to be relied upon to use them appropriately anyway.
References
[1] Heimans L, van Hylckama Vlieg A, Dekker FW.Are claims of advertisements in medical journals supported by RCTs? Neth J Med. 2010 Jan;68(1):46-9. View Abstract View Full Paper
[2] Othman N, Vitry A, Roughead EE (2009) Quality of Pharmaceutical Advertisements in Medical Journals: A Systematic Review. PLoS ONE 4(7): e6350. doi:10.1371/journal.pone.0006350 View Full Paper
[3] Villanueva P, Peiró S, Librero J, Pereiró I. Accuracy of pharmaceutical advertisements in medical journals. Lancet. 2003 Jan 4;361(9351):27-32. View Abstract
Antioxidants Improve End Stage Cancer Survival
There remains controversy in the medical fields about the value of antioxidants, or risk of antioxidants in patients with cancer. In the Journal of International Medical research a pilot trial followed 41 patients over a 9 year period who had been diagnosed with end stage cancer. During this time they were given a mix of antioxidants including; Coenzyme Q10, vitamin C, selenium, folic acid and betacarotene.
The treatments were well tolerated and produced a > 40% increase in survival time with 76% of the patients surviving far longer than predicted. Whilst the study accounted for all participants and the disease course was well illustrated in all of the patients, there is a lack of retrospective design, matched controls and no blinding.
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IBD and Environmental Triggers- Vegetable Gardens Vs Genes
Crohn’s and Ulcerative colitis are understood to have a number of genetic related risks, but increasingly scientists are having to accept that our double helix does not predict our health risks except in a few single gene diseases such as cystic fibrosis, the haemoglobinopathies. In fact the enormous endeavours and resources spent pursuing this elucidation have produced surprisingly modest practical benefits.
Even when dozens of genes have been linked to a trait, both the individual and cumulative effects are surprisingly small and nowhere near enough to explain earlier estimates of heritability.[1]
The recent discovery by a New Zealand group that there are a number of childhood factors associated with the development of Inflammatory Bowel Disease, further supports the concept that environment – in this case during childhood plays an important role in modulating the risk for developing these conditions. The rising incidence of these diseases over the last 50 years also supports the role of environment, as genes take many hundreds of years to change.[2]
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Obesity, Probiotics and Pregnancy
There are numerous reasons to lose weight but scientists continue to explore complex connections between weight and health risks. A new study in the journal FASEB using rats as a model found that those mothers overweight during pregnancy passed on cellular programming in utero that made their off spring predisposed to inflammation related diseases including Parkinson’s, Diabetes, Stroke, Heart Disease and others from the day they are born. Even more depressing was the discovery that it made no difference if the off spring maintained normal weight during their life.
To determine this link the scientists gave rats one of three diets; (low-fat, high-saturated fat, and high-trans fat) four weeks prior to mating and throughout pregnancy and lactation. The high-fat diets rendered the mice clinically obese. The science team analysed the brains of the newborn pups after challenge by inflammatory stimuli.
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Vitamin D Vs Crohn’s (IBD) & Cancer
Crohns disease is an inflammatory disease of the intestines that may affect any part of the gastrointestinal tract from anus to mouth, causing a wide variety of symptoms. It primarily causes abdominal pain, diarrhoea (which may be bloody), vomiting, or weight loss, but may also cause complications outside of the gastrointestinal tract such as skin rashes, arthritis and inflammation of the eye.[1]
A new study has found that Vitamin D, readily available in supplements or cod liver oil, can counter the effects of Crohn’s disease.[2]
The data collated in this study suggests, for the first time, that Vitamin D deficiency can contribute to Crohn’s disease. Epidemiologically it had already been noted that people from northern countries, which receive less sunlight, necessary for the fabrication of Vitamin D by the human body, are particularly vulnerable to Crohn’s disease.[3]
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