Supplements – magic bullet or poison pill?

It seems everywhere you turn, someone is touting a new herbal supplement or extract as the solution to what ails you – prevent cancer, lose weight, reduce cholesterol, boost immunity. You name it, someone is probably selling an herbal concoction to fix it. And often, these claims seem to be backed by scientific research. So what’s the problem?

Unfortunately, there are many:
  1. Quality. As detailed in today’s Wall Street Journal, when supplements are submitted to quality testing, about 25% have problems like contamination or mislabeled dosage. In some cases, that contamination can be quite dangerous such as with lead.
  2. Safety. Herbal supplements aren’t subject to the same kind of testing that pharmaceutical drugs have to go through. This often means unsubstantiated claims and little information about risks associated with long term or high dosage use.
  3. Research quality. Many of the claims made about supplements are backed by research. Unfortunately, the fine print often reveals the research was funded by the supplement maker. The potency of plants can often vary as well – so the variety tested in the research study may not be the one included in the supplement you buy.  In many instances, the studies are also very small or not well designed, which makes for less reliable results, something often missing from the scientific pedigree supplement makers list in their ads or on their websites.  That many people who write about the benefits of these supplements don't have a great understanding of the research process, and what may seem in an article to be rock solid health benefits of a supplement, may be little more than anecdotal evidence.
  4. Reductionism.  Reductionism is when a single component of a whole food found to have health benefits is put into a supplement and assumed to have the same (or greater) health benefits of the whole foods.  The food is "reduced" to a single component, usually with mixed results.  The classic example is beta-carotene.  Studies had found that individuals who consumed higher amounts of fruits and vegetables had lower rates of lung cancer. Researchers hypothesized that this was due to the antioxidants (like beta-carotene) found in fruits and vegetables and began randomized controlled trials to see if these individual components had any health benefits in smokers.  The results were surprising.  Lung cancer rates were HIGHER in the groups taking beta-carotene. These results don’t mean you should go off and eat Twinkies instead of carrots, but they do suggest that extracting one component from a food doesn’t always lead to the desired result.
  5. Extrapolation. Extrapolation is taking a narrow set of results and applying it to broader populations.  It's a common practice, particularly in health news stories, and while it makes for great headlines, it often results in over-reaching.  Supplement makers do the same.  A small study in mice or cells in a petri dish can have seemingly astounding results - but the problems is that these studies are in....mice and cells.  Animal and cell studies are just a starting point in the research process, and more often than not the results don't pan out in good studies in humans.  It is also important to note that the doses of supplements and extracts applied to animals and cells in the laboratory often exceed those that humans would (or could) consume. The big concern here is that these extracts and compounds, tested in labs, will result in the same unanticipated consequences that beta-carotene did on lung cancer when tested in humans. Of course, there is also the possibility that they will have benefit, but until they are evaluated, we just don’t know.
It might seem that we're anti-supplement here at CNiC.  But that's certainly not true.  For a very long time, we've recommended a daily multivitamin as a great nutrition insurance policy for most people. A daily multivitamin with folate can provide added protection against certain cancers and other chronic diseases. Folate is a B vitamin that has been shown to lower the risk of colon cancer, as well as breast cancer in women who regularly drink alcohol. The calcium and vitamin D in most multivitamins may also help provide added protection against colon cancer.

What we worry about are the health claims many supplement makers and other proponents make that over-reach (often by a great deal) what the science has to say about both the effectiveness and the safety of their products.

In this day of ever-growing health care costs and tight budgets, it's only natural that we want to take control over our health, and turning to supplements can seem like an easy route to take.  But, it's important to know about some of the potential pitfalls with supplements so you can make good, informed decisions about your health.  Most of the time, the best choice is to keep those supplements on the store shelves and go for a good walk instead. Focus on fruits, vegetables, and whole grains, trying to get a wide variety of each. A single 100% RDA daily multivitamin is also a good nutrition insurance policy for most people.

Become an Ex - stop smoking

Second hand smoke exposure in the US was thoroughly documented last week in the CDC report noted in many media stories.

The report evaluated national data from 1999 through 2008, and estimates that 88 million non smokers greater than age 3 were exposed to second hand smoke. The authors note that the decline in exposure within the US has slowed pointing to the tapering off in our national public health efforts to control cigarette smoking.

Despite the increasing attention paid to obesity and the economic burden on society due to obesity, tobacco remains a leading cause of premature mortality, cancer onset. lost productivity, and health care expenditures. Continued efforts at smoking cessation and state-wide comprehensive laws to limit exposure in work places and public places can help avoid serious health effects.

The health effects of second hand smoke are are well documented.
  
Risks of secondhand smoke
Smokers not only risk their own health, they can also impact the health of those around them. Secondhand smoke (also known as environmental tobacco smoke) has been shown to increase the risk of disease in nonsmokers.  For example, secondhand smoke increases the risk of:
  • Lung cancer 
  • Heart disease
and in children, secondhand smoke exposure increases the risk of:
  • Sudden infant death syndrome
  • Reduced lung function
  • Asthma
  • Respiratory infections
  • Ear infections in children
 The good news is that many of tobacco’s harmful effects can be reduced by smoking cessation, and benefits of quitting can be seen almost immediately.  Quitting smoking is the single best thing that smokers can do to improve their health, and over 46 million Americans have successfully quit.

There are many rewards that come from quitting

Within the first day of quitting:
·      Blood pressure decreases
·      Carbon monoxide levels drop
·      Risk of heart attack decreases

Within the first year after cessation:
·      Energy increases
·      Circulation improves
·      Pulmonary function increases
·      Coughing and wheezing diminish
·      Respiratory infections decrease

Within the first 2 years:
·      The risk of dying from cardiovascular disease becomes half that of a current smoker.  
·      The risk of stroke falls.

With sustained abstinence of 5-15 years:
·      The risk of premature death drops significantly.
·      Risk of oral cancer is cut in half, with continued decline over time.
·      Esophageal cancer risk drops.
·      Laryngeal cancer risk decreases.
·      Bladder cancer risk drops by 50%.
·      The risk of cervical cancer in women falls significantly.
·      The risk of pancreatic cancer is reduced.
·      Lung cancer risk falls to 1/3-1/2 the risk of continued smokers, and continues to decrease with time.
·      Chronic obstructive pulmonary disease mortality is reduced.
·      The risk of cardiovascular disease is similar to that of someone who has never smoked.
·      The risk of stroke is reduced to the level of a never smoker.
·      The risk of peripheral vascular disease falls.

Not smoking also:
·      Saves money
·      Sets a good example for children and other adults
·      Helps prevent the exposure of others to second-hand smoke

It is important for health care providers and patients to recognize that there are significant health benefits for smoking cessation for men and women at any age, even in older individuals and those who have been diagnosed with smoking-related illness.  For example, cessation in people with known coronary heart disease results in a decreased risk of recurrent heart attack and cardiovascular death.  For patients with peripheral vascular disease, quitting smoking leads to a drop in risk of amputation following surgery, and increased exercise tolerance.  Health care providers should counsel all smokers and tobacco users to quit as soon as possible.

 Smoking during pregnancy

Because of the many health risks to the mother and baby, it is especially important that women not smoke during pregnancy.  While rates have been decreasing, over 10% of women continue to smoke during pregnancy.  Of those who do quit, about two thirds restart within the first year after delivery. 

Quitting smoking before pregnancy provides the greatest health benefits.  However, cessation at any point can benefit the mother and child.  Women who quit before or during pregnancy decrease the risk of preterm delivery, premature rupture of membranes, and low birth weight, compared to continued smokers.  In addition, women who quit smoking before delivery also reduce the risk of exposing their children to second-hand smoke and the many health problems associated with it.

Stopping smoking

for help stopping smoking many resources are available. Among the most helpful web-based resources is the site become an ex , where you can relearn life without cigarettes.



Second hand smoke in bar workers

More news from Alvin J. Siteman Cancer Center showing significant nicotine exposure from cigarette smoke in restaurant and bar workers. It is time for regulations to protect workers. We can cut the health impact of smoking now.  See story