Newsletter 2009 - Supplement Research Update Newsletter 2009 by Ray Sahelian, M.D.

See Newsletter 2008 back issues.

Emails from newsletter readers
I recently subscribed to your e-mail newsletter, and I am very happy to have your calm, common sense information.

I really like your newsletter. I've been paying attention to my diet since I was 20, when I got pregnant with my first child. Your advice is the most sensible I've run across in years. Thank you.

Thank You for your newsletter. I find the information interesting. With new information coming out every day about nutrition and supplements it makes it difficult at times to keep up. I consider you one of the primary newsletters for factual information. I don't always agree but you do give sound advice. Thanks for your devotion.

I am a regular reader of your newsletter. Dr. Sahelian's website and his balanced views on supplements is one of the few i have seen in Alternative healthcare industry . The best thing is he mentions the Scientific Double blind studies for the Herbs / supplements on the site which makes the customer make an educated trial on their usage.

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SUPPLEMENT RESEARCH UPDATE - by Ray Sahelian, M.D.
Vol. 6, Issue 13 -- December, 2009
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In the last issue of the newsletter I mentioned my thoughts on vitamin D supplementation and that I believed many people would benefit from supplementation but some people may potentially be taking too high a dosage when the scientific evidence is still too early to recommend daily amounts greater than 2000 units for long term use, such as years and decades. Most of the emails we received were appreciative that I was taking a cautious approach. But there were a few people who felt my suggestions were too cautious. For instance, one person said that he was taking 5000 units a day based on the recommendation of his doctor and the fact that his doctor wanted to give him enough of the vitamin to maintain a very high blood level. I wonder about the logic of this kind of thinking. What evidence do we have that maintaining an excessively high blood level of vitamin D by taking thousands of units a day will lead to a longer life? As of November 2009 I cannot tell anyone for certain what the ideal daily intake of the vitamin should be nor what the ideal blood level should be. Perhaps taking several thousands units a day is a good thing. But then again we may find out years later of unexpected consequences that we are currently unaware of. It's up to you on how much you want to take. For the time being I prefer to stay on the 400 to 1000 unit dosage range as explained in detail in the previous newsletter. More on this issue later.
    There were some interesting recommendations recently regarding new guidelines for mammogram testing that I review below.

At what age should you get a mammogram?
New guidelines were issued by the United States Preventive Services Task Force USPSTF whose position influences coverage of screening tests by Medicare and many insurance companies. The government panel of independent doctors and scientists concluded that getting screened for breast cancer early and often is harmful, causing too many false alarms and unneeded biopsies without substantially improving women's chances of surviving the disease. The guidelines are for the general population, not those at high risk of breast cancer because of family history or other reasons. The new guidelines say:

Most women in their 40s should not routinely get mammograms. Starting mammograms at age 40 would prevent one additional death but also lead to 470 false alarms for every 1,000 women screened. For each case of cancer death prevented among younger women, 1,900 women must be screened. These new guidelines spare women the worry of false alarms and the cost and trouble of extra tests. The USPSTF 's last recommendations in 2002 called for routine mammograms every one to two years for all women older than 40.

Women 50 to 74 should get a mammogram every other year until they turn 75, after which the risks and benefits are not well known. For each case of cancer death prevented among women 50 to 59 years old, 1,300 must be screened. The ratio drops to 1 for 377 for women 60 to 69 years old. The panel said there is not enough evidence to say women over 74 benefit from mammograms because at that age screening may be detecting cancers but the cause of death is more likely to be from heart disease or other causes of old age.

The USPSTF also said the value of breast exams by doctors is unknown. And breast self-exams are of no value. That means women can stop routinely checking their breasts for lumps.

These new guidelines were quickly challenged by the American Cancer Society. "This is one screening test I recommend unequivocally, and would recommend to any woman 40 and over," the society's chief medical officer, Dr. Otis Brawley, said in a statement. Dr Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, said the group will not change recommendations for routine mammograms for women starting at age 40.
   Dr W. Phil Evans, president of the Society of Breast Imaging, said "The USPSTF recommendations are a step backward and represent a significant harm to women's health.". The website of the Society of Breast Imaging says: "Today, published in the Annals of Internal Medicine, the U.S. Preventive Services Task Force recommended radical changes in the clinical guidelines for screening mammography. These include: Screening mammography should not be done routinely for all women age 40-49 years. Women aged 50-74 years should have mammography every two years. There is not enough evidence to recommend for or against screening mammography after age 74 years. The Society of Breast Imaging and the American College of Radiology, the American Cancer Society, and many other respected professional organizations, will voice strong opposition to these proposed changes. It is the opinion of your SBI leadership that adopting these guidelines would result in a major step backward in women's healthcare and increased deaths from breast cancer. "

Comments: I think too many tests are done in this country sometimes without adequate proof that these mammograms, blood tests, x-rays, invasive procedures, etc., prolong life. I tend to agree with the recommendations by the USPSTF. It is interesting that the groups and organizations who oppose these new guidelines are most likely to be, directly or indirectly, financially hurt by fewer mammograms being performed. Therefore, when you listen to advice on television, newspapers or on the internet, keep in mind whether the person giving such advice has any financial ties to such testing. I trust the advice of the USPSTF more than I trust the advice of the American Cancer Society or the Society of Breast Imaging. By the way, international guidelines also call for screening to start at age 50; the World Health Organization recommends the test every two years, Britain says every three years. Annals of Internal Medicine, November 17, 2009. See http://www.raysahelian.com/breastcancer.html

Vitamin D deficiency leads to increased cardiovascular disease risk
Low intake of vitamin D, increases a person's risk of stroke, heart disease and even mortality. Examining 27,686 Utah patients aged 50 or older with no history of cardiovascular disease, a study by the Heart Institute at the Intermountain Medical Center in Salt Lake City found those with very low vitamin D levels were much more likely to die early than those with normal levels, more likely to develop coronary artery disease and more likely to have a stroke. Studies have shown that vitamin D also helps regulated key body functions such as blood pressure, inflammation and glucose control and that deficiency of the vitamin is associated with musculoskeletal disorders. Brent Muhlestein, director of cardiovascular research at Intermountain, noted that because the study was only observational, definitive links between vitamin D deficiency and heart disease could not be established. The researchers chose Utah in part because the population consumes low levels of tobacco and alcohol, thus allowing them to focus the study on vitamin D's effects on the cardiovascular system. The patients were divided into three groups based on their vitamin D levels -- normal (over 30 nanograms per milliliter), low (15-30 ng/ml) or very low (less than 15 ng/ml) -- and were followed for a year to determine whether they developed some form of heart disease.
    Comments: This study does not address the issue whether taking vitamin D supplements that put a person at a greater than 30 nanograms per milliter range offers any additional benefits, or causes potential harm. As I mentioned in the previous newsletter, I don't think most people need to get their vitamin D level tested. Taking 400 to 800 units a day should be fine for most people without incurring the expense and inconvenience of getting vitamin D levels checked on a regular basis. See http://www.raysahelian.com/vitamind.html

Emails
The vitamin D dosage controversy
Q. I am sure you realize those on the opposite side of the fence claim that the tiny amounts of vitamin D currently recommended in the RDAs are adequate only to prevent rickets. While, they say, there is other serious evidence which demonstrates that appreciably larger intakes are necessary to prevent quite a few other very serious health issues. They also point out that people taking even much larger amounts than 4000 IUs daily have serum levels that are nowhere remotely close to those that have been found to represent toxicity. I am truly open-minded about this, and am very happy to listen to evidence on both sides.
    A. Those who advocate large dosage use of vitamin D, such as more thank 2000 units a day, are the ones who are responsible in providing evidence of safety over years and decades of use and they need to provide evidence that longevity is increased by such supplementation. Thus far there are no studies to show whether the general population in the United States would be better off ingesting several thousand units of this vitamin. There are no long term studies that indicate that having a very high blood level of vitamin D, beyond the high normal range, will make you live longer. There are studies that indicate low vitamin D levels are associated with a higher incidence of stroke, heart disease, and increased mortality. A reasonable and cautious medical doctor or scientist does not make haphazard and careless recommendations of high dose supplement use without adequate evidence of long term safety. There are countless dietary supplements that have shown to have a positive role to play in improving health, at least in the short term. If you read all these enthusiastic reports on certain websites you will end up being convinced that you need to take dozens or hundreds of vitamins, nutrients, and various herbs, fruit and vegetable extracts, amino acids, hormones, etc in high dosages. Not only is this expensive, but we have no idea of all the interactions that could occur, positive or negative.

Fish oil and vitamin E
Q. I had one question on fish oil. How much vitamin E is needed with omega-3 at doses of 1500-2000mg EPA / DHA, such as 5 or 6 softgels daily. There are many different recommendations by health experts ranging from as low as 30IU to 800 IU of vitamin E. What would be the dose which is effective but not problematic to health in long term since more is not necessarily good.
    The dosage of vitamin E as an antioxidant to protect fish oil fatty acids such as EPA and DHA is not fully known but does not appear to be high. Even 5 to 10 units should be sufficient and 30 units is plenty. http://www.raysahelian.com/vitamine.html

Older people and lesser dosage
Q. On a website it says if over the age of 50, limit Diet Rx pills to one or two a day instead of 3 or 4. Why? What does age have to do with dosage?
   A. As a general rule, older individuals usually have a poorer liver metabolism, poorer kidney function, weaker heart, are more likely to be on prescribed medications and can be more sensitive to herbal products and pharmaceutical drugs. Therefore, to be cautious, it is best that older individuals take medicines and supplements in lower dosages.

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SUPPLEMENT RESEARCH UPDATE - by Ray Sahelian, M.D.
Vol. 6, Issue 12 -- November, 2009
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The topic of vitamin D has come up a lot lately in the news media and I've had many people ask my opinion regarding supplementation. We've had many emails from readers informing us that their doctors are recommending daily dosages of 1000 units or higher. From the research evidence I have read thus far, it does appear that many people in this country are not getting enough of this vitamin. But what is the right dosage for supplementation? Is it 400, 1000, or 2000 units? A close friend of mine, who is a broker for a supplement company, informed me that the company she represents is heavily promoting a 5000 unit pill which is selling quite briskly. Later I discuss the benefits and risks of supplementation and the necessity or lack thereof of testing for blood levels.

Let the sun shine
Vitamin D plays an important role in calcium balance and for optimal skeletal growth and bone strength. The major function of vitamin D is to improve the efficiency of calcium absorption from the small intestine. Epidemiological data show low levels of vitamin D lead to a higher incidence of breast cancer, colon cancer, prostate cancer, ovarian cancer, as well as multiple myeloma. Patients with Crohn's disease are known to have low levels. Vitamin D supplementation may even decrease symptoms of depression during the winter months.
   Few people now question the importance of this vitamin, and with the benefits being touted in the media many consumers, and doctors, now think that the more they take the healthier they will be. I want to caution you of the danger regarding excessive intake. Vitamin D taken in high amounts can cause excessive calcification of bone, calcification of soft tissue, kidney stones, headaches, weakness, nausea, and vomiting. Are there currently unknown long term effects of high dose daily use?
   Bottom line: Some people may not need to supplement since their diet includes plenty of the vitamin and they get a lot of sun exposure. Most people may benefit from taking 400 units a day either as a pill or as part of their multivitamin product (in addition to their diet and some sun exposure which could be several hundred units a day). A few people -- those who do not consume much of this vitamin in their diet, live in Northern latitudes, or some elderly who get little sun -- may benefit from taking 600 to 800 units daily. More is needed in the winter season and less in the summer season. Those who have hardly any sun exposure, or have certain chronic medical conditions, may temporary need 1000 to 3000 units a day for a few weeks or months and then back to 600 to 1000 units daily. I do not think that the average person with a good diet and some regular sun exposure needs to take more than 400 to 600 units a day as a supplement. I have received emails from some doctors who claim I am being too cautious. I would rather err on the side of taking less until long term studies are published regarding the safety of supplementing with 1000 units or more taken daily for a decade or longer. If such studies do get published in the next few years and show the safety of such high dose supplementation, I will change my recommendations. At this time I certainly do not think the 2000 and 5000 unit pills being promoted are appropriate for the vast majority of the population. Could people taking these high dosages end up dying sooner due to excessive calcification of their blood vessels and soft tissues? There is some early indication that high dosages of vitamin D could cause calcification of vessels in the brain leading to cognitive decline. Could taking high doses of calcium along with these excessive doses of vitamin D make matters even worse?
   As with many natural vitamins and supplements too low a dosage can be detrimental to health and too high an intake can have adverse effects.

Do you recommend people being tested for vitamin D levels before taking a supplement?
   Unless a person has an unusual diet or a chronic health condition that could lead to severe vitamin D deficiency, I don't think testing is necessary. There are hundreds of blood tests available to check levels of different vitamins, minerals, amino acids, hormones, cholesterol, various lipids, inflammation markers, liver studies, kidney studies, etc., etc.. At some point one has to balance the costs and inconvenience of testing versus the potential benefits they provide. Unless a person has an unusual medical condition or diet where blood vitamin D levels are suspected to be too low or too high, blood testing does not give us much of a clue on exactly how much to supplement. I am cost conscious and practical in my approach. I think in this country we are going overboard in terms of testing, and for the amount of money we spend on diagnostic testing and health care we are not even close to being one of the healthiest nations on the planet. We do so many diagnostic tests in this country without knowing whether people are actually healthier or live longer as a result of the testing. The people who end up being better off are doctors and the those who own the labs. I think the vast majority of people who don't have an unusual diet or serious and chronic medical condition just take 400 to 800 units a day they should be fine and they don't have to worry about checking for vitamin D levels.

Animal study: Mucuna herb works as an aphrodisiac
Investigators at the University of Madras in Chennai, India tested the effects of Mucuna pruriens seed extract on general mating behavior, libido and potency of normal male rats. The extract administered orally significantly increased the mounting frequency, intromission frequency and ejaculation latency, and decreased the mounting latency, and inter-intromission interval. They say, "Resulting aphrodisiac activity of the extract lends support to the claim that it has traditionally been used for the treatment of sexual disorders."
    Comments: I have personally found this herb to be useful as an aphrodisiac. The herbal extract is available as a supplement by itself, or combined with other aphrodisiac herbs in Passion Rx. See http://www.raysahelian.com/mucunapruriens.html

Emails
Q. Would you post on your website some info please about what people who have been close physical proximity with some friends who later on had a family member diagnosed with swine flu, can and should do? Would you recommend some other supplement? Are there herbs that treat the swine flu infection?
   A. The best option at this time in terms of prevention or reducing severity of the swine flu is to maintain an overall healthy immune system through a good diet, moderate exercise, low stress, and deep sleep. Washing hands and being aware of anyone who is sick and keeping a distance is, of course, quite helpful. I am not aware of any specific herbs or supplements that have been tested to prevent or cure the swine flu even though many of these are advertised and promoted on the internet. The immune page can offer some general suggestions. See http://www.raysahelian.com/immune.html and http://www.raysahelian.com/swineflu.html

Q. In regards to your previous issue of the oldest living person in the world at 113. He claims he eats breakfast and lunch and not much for dinner and does not overeat. Sounds like Walter has been practicing, in large part, calorie restriction (DR). I understand in the book The CR Way, the authors suggest modifying the standard CR protocol used in many animal studies by including of daily fasts -- large breakfast, small lunch, no dinner. I might also mention my wife's grandmother, who lived to be 107, at very small portions.
   A. Yes, you make a good point.

Q. I am looking at your Mind Power Rx supplement and have a question. I notice in response to questions regarding the taking of multiple herbs together, Dr. Sahelian often recommends starting with a low dose of one to see how it affects the person taking it. The mind power supplement appears to have a combination of many different herbs. I was wondering what the philosophy is on putting so many herbs into one formulation when much of the advice on the website is to start small with one or two herbs. Does combining so many herbs into one formula increase the chance for side effects or does the fact that each herb is in a lower dose then normally taken individually mitigate this risk? Is the combination done to increase the efficacy in a wide group of people since each individual reacts differently to each of the herbs in the formula and chances are at least one of the herbs would have the intended effect on someone taking it?
   A. When I suggest people try one herb or supplement at a time, it assumes that the product is taken in its full dosage. Mind Power Rx has a fraction of the content of a particular nutrient or herb. For instance, the normal dosage of acetyl l carnitine in a capsule is between 250 and 500 mg. The mind formula has only 25 mg. Sometimes the combination of several herbs and nutrients in small dosages works better than a high amount of just one, but each person is different in their response and not all combination formulas work well. Some people may respond better to one single nutrient as opposed to a combination formula. It's difficult to predict and the only way to know is through trial and error.

Q. After taking Eyesight RX for only 8 weeks I went to my Eye Dr. and he said my eyesight was improved and I wouldn't need as strong of a prescription. He thought it was the new contact lenses I had been wearing (which let more air into the eyes), but I knew it was the Eyesight Rx because I started being able to read smaller print shortly after taking it, plus I hadn't been wearing my contacts every day anyway. I am very satisfied with your product. I was taking half a tablet a day 5 days a week.
   A. Thanks for sharing this, it is quite interesting. Many people do notice improvement in vision within a few days of taking this eye formula. The dosage may need to be reduced over time. Taking 2 or 3 fish oil capsules a day could also help with vision.

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SUPPLEMENT RESEARCH UPDATE - by Ray Sahelian, M.D.
Vol. 6, Issue 11 -- October, 2009
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I always enjoy reading about people who live past 100 years of age to find out if there are any secrets they attribute to their longevity. I recently read articles about Walter Breuning from Great Falls, Montana, who turned  113 in September 2009. What is his secret to longevity? He claims he eats just two meals a day (he skips dinner), drinks water, takes one baby aspirin and eats plenty of fruit. He wakes up around 6 in the morning. eats breakfast at 7:30 a.m. usually eggs, toast or pancakes. He is quoted as saying, "I think you should push back from the table when you're still hungry. You get in the habit of not eating at night, and you realize how good you feel. If you could just tell people not to eat so darn much." Walter has weighed 125 pounds for the past 35 years. He also attributes his longevity to working hard.
   Genetics has a lot to do with living a long life. It's difficult to say whether his dietary approach would work for others. I find it interesting that so many get concerned about eating eggs for fear of high cholesterol levels, yet Walter has been eating eggs practically daily for decades.
   One of the largest groups of people who live past 100 years are found in Okinawa, Japan. The Okinawan diet is rich in grains, vegetables and fish, a lot of fish! In particular, cold-water varieties such as tuna, mackerel and salmon are the most common. Most studies reveal that areas in the world that have a high rate of centenarians have a diet that has good amounts of fish, vegetables, mushrooms, seaweed, corn, and whole grains - and little meat. Scientists have confirmed the longevity benefits of a diet high in fish and vegetables and low in animal products. See http://www.raysahelian.com/longevity.html

Organic foods, is paying the extra price worth it?
A couple of months ago the news media made big news of a report from the London School of Hygiene and Tropical Medicine regarding organic foods. Their conclusion was that, after reviewing 162 studies published in the scientific literature over the last 50 years, they found no significant difference in health benefit from consuming organic foods. Alan Dangour, one of the report's authors, said "A small number of differences in nutrient content were found to exist between organically and conventionally produced foodstuffs, but these are unlikely to be of any public health relevance, our review indicates that there is currently no evidence to support the selection of organically over conventionally produced foods on the basis of nutritional superiority."
   I was puzzled and skeptical regarding the conclusions achieved by the investigators. I thought at the time that perhaps the researchers did not adequately consider the difference in content of pesticides and toxins and my impression was that they did not compare the antioxidant flavonoids and carotenoid content as well as they should. I was glad to see another opinion on the topic by Denis Lairon of the University of Aix Marseille in France. His review of data compiled for the French food agency AFSSA shows organic plant products contain more dry matter and minerals, including iron and magnesium, and more antioxidant polyphenols and salicylic acid. He also reports that almost all organic food does not contain pesticide residues, while organic vegetables contain much lower nitrate levels than conventionally produced foods. Lairon, D. "Nutritional quality an safety of organic food, a review." Agronomy for Sustainable Development (2009) DOI: 10.1051/agro/2009019.
   Organic fruits and vegetables are much more expensive than conventionally grown foods. If your budget allows, purchase organically grown produce and meat, but if you are on a tight budget, don't worry too much. As long as you make overall healthy dietary selections, you should do just fine. After all, Walter Breuning has lived to 113 without fussing about organic versus non-organic foods. See http://www.raysahelian.com/organic.html

Strontium mineral for bones
Just when you thought you had figured out which supplements to take as a prevention or treatment for osteoporosis, such as vitamin D, calcium and perhaps magnesium, another study comes along that makes us wonder whether an additional mineral should be considered.
   Researchers in Mexico propose that strontium therapy in postmenopausal women has a double effect both on resorption and bone formation. To evaluate the effect of strontium on bone mineral density (BMD) a prospective study was carried out in 23 postmenopausal women who had decreased BMD who received daily strontium orally during 12 months. BMD at the spine and hip increased significantly after 12 months of treatment.
   Comments: Are strontium supplements better than calcium and vitamin D as a treatment for osteoporosis? It appears that strontium supplements are effective for increasing bone strength but it is not clear whether they offer any advantages over calcium and vitamin D and whether all three supplements can be combined, and if so, what the appropriate dosages would be. For the time being I recommend calcium and vitamin D, perhaps magnesium, and, if you have a strong family history of osteoporosis or if you already have osteoporosis, consider discussing with your doctor regarding the addition of strontium supplements. The multi-year benefits and risks of strontium mineral therapy, and how it interacts with calcium and vitamin D, is not fully understood at this time. My thoughts would be to take a strontium pill of 300 to 400 mg two or three days a week until we learn more about the appropriate dosage and long term side effects. See http://www.raysahelian.com/strontium.html and http://www.raysahelian.com/osteoporosis.html

Emails
How long of a break is good from taking vitamins or multivitamins?
    There is no simple answer that applies to everyone. As a general rule, for multivitamins that are taken for overall health maintenance purposes, it is a good idea to take a minimum of one day off a week and a 3 or 4 days off each month. This is just my personal opinion, some doctors do not believe multivitamins are necessary while others believe high doses are beneficial taken every day.  The field of supplementation is not an exact science, taking a little more or less is not likely to make a big difference, the general idea is to not rely taking these supplements all the time except for the treatment of a specific condition that requires daily use.

My doctor told me (after taking blood test of DHEA and testosterone) that my adrenal glands are not releasing enough DHEA, he said that my blood level was low and advised me to take 25 mg of DHEA twice per day for 25 days then take a break for 5 days and continue. I worry about the side effects of DHEA. What do you advise?
    I can't make specific suggestions or give personal advice, but I think it would be helpful for your doctor to read about the potential side effects of hormone use, and I list DHEA side effects on my web page. Many doctors are not aware of these potential adverse reactions, either to hormones or medications they prescribe. Many are also not aware of the potential negative interactions between the various medications they prescribe.  See http://www.raysahelian.com/dhea.html

Thank you very much for your research with pregnenolone. At first I didn't listen fully to your precautions but after only several days of taking the hormone pills, I experienced heart excitability. I will now follow your suggestions. I took 10mg sublingual for 2 days followed by 5mg for two days. I can almost say it puts me into sort of a pre-psychedelic feeling high space. My goal was to increase memory and energy levels not to get high. Thank you again for your invaluable information.
    Yes, many people notice heart rhythm disturbances from a dosage above 5 or 10 mg, and I am not comfortable with products that are sold in 25, 50 and 100 mg. See www.raysahelian.com/pregnenolone.html

I rely on your website for honest opinions regarding supplements, even though you also formulate products. I was thrilled to find you after a confusing and stressful experience with a vitamin company heavily promoting and encouraging the taking of lots of pills, and Suzanne Somers's book. I appreciate the fact that you do NOT support taking a supplement every single day, but a few times a week. This tells me that you are not only not pushing your product, but that you have a conservative rather than fanatical take on natural health and supplementation. I am a 57 year old woman who like many baby-boomers are growing more concerned and interested in fighting the aging process and keeping disease at bay. And you are also very accurate about all of the conflicting information out now. Most of it by apparent reputable physicians, that one feels should be trusted in their knowledge and honesty. But it seems that no matter the source or study, their recommendations are also opinion driven based on their interpretation and feelings on the subject. You mention that we should not take more than 5 to10 supplements except for medical reasons. I take more than that at the moment, and have cut back a great deal. But just when I read something that cause me alarm, and cut it, I read something else that promotes it's safety and effectiveness for possible disease prevention. Would you consider calcium, vitamin D (osteoporosis prevention), bromelain, probiotics (digestion / irritable bowel syndrome), glucosomine / chondrointin (osteoarthritis) part of this list of medical reasons? This still leaves around ten that I take because they're supposed to be good and safe (including fish oil, flax seed oil, garlic, ginger, turmeric, CQ10, R-Lipoic Acid, Acetyl L Carnitine, quercetin). Some I take a few times a week, most I take daily. These are the ones I have thru research deemed effective and safe, hopefully. I know you can't comment on personal situations, I was just wondering if I could be doing more harm than good. I have concerns about what these are possibly doing to my liver (so then I hear about ginkgo, which protects the liver, and I'm off and running). Frankly, even reading your extensive list of information on almost every supplement, one would think they needed ALL of them. I have a wonderful primary care physician, but I'm not sure how much she really believes in alternative preventative medicine. And frankly, I'm somewhat embarrassed to admit just how much my fear allows me to believe, even though I try and err on the side of safety and conservativeness. Anyway, I'd appreciate any feedback you may have.
    This is an excellent question that most people who take supplements grapple with. There are literally hundreds and thousands different nutrients, vitamins, minerals, supplements, fruit and vegetable extracts, and herbs available over the counter, and most of these have had preliminary research that supports their health benefits as antioxidants, lowering blood sugar, lowering blood cholesterol, improving mental function, increasing wellbeing and vitality, and other benefits. However, it is not possible or practical to take them all. Which ones should one choose? There is no simple answer. Many nutrients and herbs are quite safe and don't conflict with others. For instance, low or reasonable dosages of calcium, vitamin D, probiotics, glucosamine, chondroitin, fish oils, flax seed oil, garlic, ginger, turmeric, are quite safe. CoQ10, alpha lipoic acid and acetyl l carnitine are also safe when used in low dosages. One way you can tell if you are taking too many supplements or too high a dosage of certain ones is if you notice being restless, have excessive energy, feel anxious, notice your heart rate beating much faster, feel an elevated body temperature, and have difficulty sleeping. These could be symptoms and signs that you are taking too many pills. Much also depends on your activity level. If a person is very active and does physical labor, such as construction, or runs several miles a day, then they can tolerate higher dosages since they are using up the excess energy provided from the supplements. But those who have a sedentary job may not use up all the energy and this could lead to shallow and restless sleep.  As a general rule, it is a good idea to take each supplement separately for a week or so to determine how that particular pill is having an effect on you. I suggest everyone who plans to take supplements for prolonged periods to read this page in full. http://www.physicianformulas.com/store/Scripts/prodview.asp?idproduct=224&name=NEWSLETTER

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SUPPLEMENT RESEARCH UPDATE - by Ray Sahelian, M.D.
Vol. 6, Issue 10 -- September, 2009
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According to an article published in the August 15, 2009 issue of the American Journal of Epidemiology, people who take multivitamin supplements that include vitamin E and C daily for several years have a slightly lower risk of heart disease and lower rate of death. Vitamin C supplement use was associated with a lower rate of cancer. Over the past few decades there have been dozens of major studies evaluating the role of vitamin supplements and the risk of heart disease and cancer. The results have not always been in agreement. Having reviewed most of these studies, my personal opinion at this time is that there is some benefit from the use of these vitamins but diet plays a much more important role. If a person takes the appropriate amounts of vitamins through pills but has a terrible diet that includes lots of sweets, sugared drinks, white bread, and fried foods, the vitamins will not help prevent the subsequent heart disease and cancer resulting from these bad food choices. The bottom line is to eat as healthy as you can and, if you wish, take a multivitamin supplement a few days a week. The researchers in this study focused mostly on vitamins C and E. Most multivitamin products, such as MultiVit Rx, contain one to three dozen vitamins, minerals, nutrients and sometimes herbal extracts such as green tea. There are thousands of different multivitamin products on the market each with its own mix and dosage of ingredients. Therefore it is not easy to predict the overall influence on health of taking a multivitamin that has many more ingredients than just vitamins C and E. If you plan to take MultiVit Rx, one or two capsules 3 or 4 times a week should be fine for most users. If you already take many other supplements and antioxidants daily, consider taking the multivitamin less frequently.
    A few months ago an offer was made for a free bottle of stevia liquid, the no calorie sweetener that you can use in your tea or coffee or to sweeten lemonade. This was the most successful free offer thus far and a very large number of people took advantage of it. This stevia liquid bottle is being offered for free again to all newsletter subscribers. Click on the image of the bottle and add it to your cart.

1. Should you stop your daily aspirin use?
Many doctors recommend their healthy patients take a daily dose of aspirin in order to prevent heart attacks. Do the blood thinning benefits trump the potential risks? The results of the Aspirin for Asymptomatic Atherosclerosis study found that the risks of bleeding from taking aspirin were such that its routine use in healthy people is not advised, although the researchers did agree its benefits in patients with a history of vascular problems such as heart attack or stroke. Professor Peter Weissberg, medical director of the British Heart Foundation which helped fund the research, says, "The findings of this study agree with our current advice that people who do not have symptomatic or diagnosed artery or heart disease should not take aspirin, because the risks of bleeding may outweigh the benefits." The study involved 3,350 men and women aged 50 to 75 years whose leg arteries were partially hardened -- but who had no history of heart attack. They were given either a daily 100 mg dose of aspirin or a placebo and evaluated over eight years. While there was no difference in the number of heart attacks or strokes, major bleeding occurred in two percent of the aspirin group compared to just 1.2 percent of the placebo group.
    Comments: If you have no heart or vascular problems, it is not necessary to take aspirin. If you wish to take it, limit your dosage to a baby aspirin two or three times a week rather than daily. A baby aspirin has 81 mg. Also consider fish oil pills or other herbal supplements since they can help thin the blood but have a very low rate of bleeding problems. See http://www.raysahelian.com/bloodclot.html

2. PSA tests for prostate cancer, are they necessary?
Screening for prostate cancer is a controversial topic. The tests can find cancers in a few men but cause needless worry and expense for the vast majority who may end up getting treated for tumors that enlarge too slowly to do any harm. Dr. H. Gilbert Welch of the VA Outcomes Group in White River Junction, Vermont, reports routine screening for prostate cancer has resulted in more than one million men being diagnosed with tumors who might otherwise have suffered no harmful effects. The increased diagnosis rate more than tripled in men aged 50 to 59 and increased more than a sevenfold in men under age 50. And while prostate cancer deaths in the US have declined since the introduction of PSA testing in 1986, about 20 men have to be diagnosed and treated for every one who benefits. All current forms of treatment -- surgery, radiation or hormone therapy -- can cause a high rate of side effects, such as erectile dysfunction and incontinence, Just being told you have cancer is psychologically damaging, causing anxiety and feelings of vulnerability and fear of death. A U.S. expert panel last year urged doctors to stop screening men over 75, but doctors still disagree about the right approach to PSA screening.
    Comments: Different doctors have different recommendations regarding the necessity and timing of PSA tests. Since there is a wide range of opinions on this topic, much depends on you, the patient, and your personal feelings about testing. Men will need to weigh the potential benefits and risks of PSA testing and what works for them and their lifestyle and overall approach to health maintenance. I tend to lean on the side of testing less often and focusing more on making dietary and lifestyles changes that reduce the risk of this condition. See http://www.raysahelian.com/prostatecancer.html

3. Danger of diet pills
The US Food and Drug Administration is reviewing 32 reports of serious liver injury, including 6 cases of liver failure, in patients taking the weight loss drug orlistat, marketed as the prescription drug Xenical or the over-the-counter medication alli.
    Comments: If the same serious side effects had occurred with a nutritional supplement, it is likely that government agencies would have already banned its use. For natural ways to lose weight including tips on diet and food choices, see http://www.raysahelian.com/weightloss.html

Emails
Q. I read an article on AOL health news that said, "Take the dynamic duo of supplements. They're what Bruce N. Ames, Ph.D., a professor of biochemistry and molecular biology at the University of California, Berkeley, swears by: His daily 800 mg of alpha-lipoic acid and 2,000 mg of acetyl-L-carnitine. In these amounts, he says, the chemicals boost the energy output of mitochondria, which power our cells. "I think mitochondrial decay is a major factor in aging," Ames says -- it's been linked to diseases such as Alzheimer's and diabetes. In his studies, elderly rats plied with the supplements had more energy and ran mazes better. "If you're an old rat, you can be enthusiastic," Ames says. "As people, we can't be sure until clinical trials are done." (They're under way.) But the compounds look very safe -- the worst side effect documented in humans is a rash, Ames says -- and "the data in animals looks really convincing," says S. Mitchell Harman, M.D., Ph.D., president of the Kronos Longevity Research Institute in Phoenix." I have followed your writings for many years and often find that you are a lot more practical and cautious than some other doctors who recommend supplements. What is your opinion on the above?
    A. There is some good evidence that acetyl l carnitine (ALC) and alpha lipoic acid (ALA) are excellent supplements, but I am much more cautious about the dosages. My personal opinion is to limit the use of ALC to 300 mg or less two or three times a week and ALA to 50 mg or less two or three times a week. We have to keep in mind that, unlike rodents who were given ALC and ALA exclusively, most people take additional supplement pills, such as multivitamins, herbs and antioxidants, or drink coffee and alcohol, that could interfere or enhance the effects of alc and ala. I have had reports of people getting heart rhythm disturbances on high dosages of ALA, and both ALC and ALA can cause shallow sleep or insomnia if used in high dosages. Not sleeping deeply leads to pro-aging effects. See http://www.raysahelian.com/antioxidant.html

Q. I'd like to say my opinion about acai berry, as I am from Brazil, maybe the main producer, and I've been to the Amazon a few times. It's a very strong tasty berry, that people do not eat raw. We drink the frozen pulp with water or mixed with sugar and banana like a very soft icy paste, resembling a sorbet, although in the north of Brazil some people eat it as food dishes, with salty assortments (either way people squash the fruits and freeze the juice still in the Amazon state, then sell it to producers of the final ice cream we eat). Because it has a strong and a bit earthy taste, its usually a love-it-or-leave-it. I love it from childhood, we know its a strong fruit, known for good fatty acids, vitamins, and for being highly energetic (can make you fat if you eat too much). I've never heard in 20 years eating it everywhere, that it helps you lose weight. For me, this is one more proof of how marketing and not-so ethical people are making everyday more false promises, specially in the US. As you wrote about it in the last issue of the newsletter, it's a healthy addition to someone's diet, not a miraculous berry that will make you lose many pounds of fat.

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SUPPLEMENT RESEARCH UPDATE - by Ray Sahelian, M.D.
Vol. 6, Issue 9 -- August, 2009
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Oprah and the medical doctor who often comes on her show, Dr. Oz, are suing 50 different companies for using their names and images without their approval to sell products, many of them dietary supplements. In the last issue of the newsletter I warned you about the acai scam, how some marketers are offering free bottles and collecting credit card numbers and then charging the customers monthly for shipping additional bottles. Some of these acai companies are also using the image and unapproved endorsement of Oprah to sell their products. As I have previously mentioned, I think acai is a healthy berry and supplement, but is not likely to be much more beneficial than a number of other berries such as blueberry, boysenberry, cranberry and goji berry.
   There's another supplement that is recently getting a lot of hype. Many subscribers have asked my thoughts on resveratrol. One recent email asked me to comment regarding claims made on another website. The article the person quoted said, "Resveratrol is a potent antioxidant found in certain fruits, vegetables and cocoa that is emerging as a modern-day fountain of youth. The science surrounding this compound is so compelling that it has become an all-time favorite antioxidant. Resveratrol is typically associated with grapes and red wine, and was originally believed to be the reason for the so-called “French Paradox” -- the tendency for French people to have great cardiovascular health despite a “poor” diet and love for wine."
   I will offer you my thoughts on resveratrol below.

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The Resveratrol hype, is this an anti-aging supplement?
Resveratrol is a chemical found in various plants, including grapes, berries, and cacao. What made resveratrol popular was a November 2006 study that reported mice lived longer when given this substance. Research studies continue to find more interesting benefits from this red wine compound, including potential anti-cancer and anti-aging activity. Animal research from all over the globe indicates that resveratrol has a wide range of beneficial properties. However, thus far, the research has focused in animals, worms and fruit flies, and we have no idea what would happen if humans ingested this supplement for prolonged periods, and how it interacts with other supplements or medications. Most of the resveratrol supplements on the market are an extract, usually 5 to 40 percent, of an herb called Polygonum cuspidatum which has a very high content of the substance. Therefore, when you take a resveratrol pill, you are also ingesting many other substances found within this herb. It is likely these substances are also beneficial, but we don't know for sure. The resveratrol product sold on the Physician Formulas website has 10 mg of this antioxidant derived from 40 mg of Polygonum Cuspidatum root. Hence it is a 25 % extract.
   Furthermore, even if this substance has anti-aging benefits in humans, we have no idea what the proper amount would be. Is it 5 mg a day, 10 mg, 50 mg, or more? There are a number of unanswered questions. For practical purposes, if you do wish to take this pill, I think a safe approach is to take one capsule of the 10 mg product 2 or 3 times a week. There are countless beneficial antioxidant substances in the form of supplements available to the consumer and I think taking small amounts of different ones is a reasonable approach until we have a clearer idea of the proper dosages. If you are a wine lover, Pinot Noir seems to have the highest concentration of resveratrol. See http://www.raysahelian.com/resveratrol.html

Fewer close encounters, but a healthier heart
I love garlic and usually consume it an evening when I know I will not go out or be around people the next morning. Too bad this wonderful herb, with so many health benefits, has such a distinct odor. Is the encapsulated form or cooked garlic just as healthy? In one recent study, garlic was found beneficial to the heart and blood vessels, but fresh garlic had more heart-healthy benefits. Researchers at the University of Connecticut School of Medicine in Farmington report that raw, crushed garlic generates hydrogen sulfide which acts as a chemical messenger in the body, relaxing blood vessels and allowing more blood to pass through. However, processed and cooked garlic lose most of their ability to generate hydrogen sulfide. The researchers gave freshly crushed garlic and processed garlic to two groups of lab rats, and then studied how well the animals' hearts recovered from simulated heart attacks. Both crushed and processed garlic reduced damage from lack of oxygen, but the fresh garlic group had a significantly greater effect on restoring good blood flow in the aorta and other blood vessels,
    Comments: You are better off consuming fresh garlic, but, if you cannot do so for taste or social reasons, then garlic pills are a good alternative. See http://www.raysahelian.com/garlic.html

Emails
Q. I have been reading your newsletters now for years and you have helped me many times regarding which supplements you recommend and which ones there are not enough information on as well as the email you answered in last month's newsletter from the 27 year old male and whether or not he should start taking supplements and in what quantity. I have been taking pretty much the same supplement for years, maybe changing brands, adding some supplements along the way and dropping others. What you said to this man has helped me once again. You told him to take time off, whether it's skipping a day here and there or for a couple of weeks is also a good idea. I never allow myself off the hook and even on vacation I take along all of my supplements. I am leaving for about 10 days this week to go out of town and guess what, I'm going to leave most of my supplements home. I will take my probiotics and my vitamin D because I know that it's important to have the right level of D; other than that, the rest will stay home and I will take a nice break.
    A. If you are going to get a lot of sun on your vacation the vitamin D may not be necessary, either. There are some supplements I take along on vacation just in case. Zinc lozenges are a good idea, along with vitamin C, to have in your possession in order to start them at the first onset of a cold. Sometimes I take a natural sleep aid such as melatonin on Good Night Rx if I think I may have occasional nights of trouble sleeping. I like to take along a couple of tablets of SAM-e and take one pill once or twice while I am on vacation since I find it makes the day I use it slightly more interesting and magical, along with providing an upbeat mood. Fiber pills or powder is a good idea to take on a trip to prevent constipation unless the food you will eat has a high fiber content.

Q. I see many commercials on TV regarding herbal male enhancement products. They claim that their herbal formula increases the size of the male organ and some penis enlargement ads on the internet even claim that one can gain an inch or two, or even three inches. I respect your opinion and wanted to know if this was possible.
   A. Male enhancement is not a clearly defined term. Some people use this term to claim that their natural product increases the size of the penis, whereas others use the term male enhancement to refer to overall sexual improvement through the use of herbs, which is easily done.
   I am not aware of any herbal or pharmaceutical pill that leads to an anatomically bigger penis. However, if s person is normally not very aroused sexually, and the penis is normally flaccid, certain herbs can improve engorgement. It is possible that one will achieve maximal penis engorgement which could lead to a little larger penis than one used to. But this does not mean that it got larger, it just means that it became the maximum size it would normally have been under ideal arousal and healthy conditions.
   It is also possible that if a penis is normally very flaccid, the sexual herbs can improve blood flow and one may notice the non-erect penis to be larger or fuller due to improved circulation or blood pooling. However, and again, this does not mean that these natural herbal sexual pills actually led to penis enlargement. They are just improving circulation and helping with maximal dilation and engorgement that one may otherwise achieve under ideal aroused situations.
   Many websites promise potential customers that if they use their herbal product for a few weeks or months that they will gain one to three inches. They even show pictures (we all know how easy it is to manipulate graphics) of men before and after. If you purchase such products with the thought that your penis will become larger by 1 to 3 inches, you are likely to be disappointed.
   However, this does not mean that such products are worthless. Many natural herbal pills sold over the counter are effective in enhancing sexual pleasure, stamina, sex drive and can help men achieve longer lasting erections and more powerful orgasms. Many natural substances really work. It is surprising to me that so many doctors and scientists dismiss the benefits of these natural aphrodisiacs. If they do, it is most likely due to their lack of personal experience or lack of a review of studies which are gradually showing, in double blind studies, that such herbal aphrodisiacs do exist and are worthwhile. A few of these herbs include catuaba, horny goat weed, maca, mucuna pruriens, muira puama, tongkat ali, tribulus terrestris, yohimbe, or a combination found in Passion Rx. They often take a few days to start working and are best used at least a half hour or an hour before breakfast. See http://www.raysahelian.com/natural_sex_boosters.html

Q. In the last issue you mentioned how some online supplement sellers will keep charging your credit card regularly even though the consumer may ask to stop regular shipments. My credit card company now has a feature that will generate a temporary number with a limited amount of dollars available under this temporary number. in your newsletter you say people fall victim and can't stop charges, all they would have to do is use this temp cc# with a limited dollar amount available. Thx for the gr8 newsletters.
   A. Thanks for the info.

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SUPPLEMENT RESEARCH UPDATE - by Ray Sahelian, M.D.
Vol. 6, Issue 8 -- August, 2009
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Every day there are a few emails in my spam folder about the benefits of acai berry products as potent antioxidants, energy boosters, and for weight loss. I have several friends and patients who have recently asked me whether they should take acai supplements since it is being touted so heavily as a one of a kind superfood pill.  Some websites make such claims as "30 pounds of weight loss in 30 days!" A few websites offer free trials. Consumers are asked to provide a credit card to pay shipping and handling charges, but begin almost immediately receiving $50 to $80 monthly charges. Countless consumers have had difficulty stopping those charges once they canceled the free trial offer.
   As of now I have not come across any human trials regarding the use of acai supplements as a treatment of a specific medical condition or as a way to improve health or longevity. Acai, just like any berry, has a number of beneficial substances, but I can't say that it offers any more benefits than others such as common one available in grocery stores, for instance blueberries or cranberries. All berries have helpful substances and I would rather alternate their consumption rather taking a high amount of just one supplement or consuming only one type. I think it is probably beneficial to take an acai extract capsule a few times a week, and on other days other fruit and vegetable extracts can be used. I have seen no evidence that the use of acai berry supplements leads to weight loss.

Flaxseeds lower blood cholesterol
A study funded by the Chinese Academy of Sciences reviewed the benefits of flaxseed and its derivatives on blood lipid profiles. A thorough literature search was performed of randomized controlled trials of flaxseeds on lipid profiles and cholesterol levels in adults. Twenty-eight such studies were included. Flaxseed interventions reduced total and LDL cholesterol. Significant reductions were observed with whole flaxseed and lignan supplements but not with flaxseed oil. The cholesterol-lowering effects were more apparent in females (particularly postmenopausal women) and individuals with high initial cholesterol concentrations. No significant changes were found in the concentrations of HDL cholesterol and triglycerides. Flaxseed significantly reduced circulating total and LDL-cholesterol concentrations.
    Comments: Flaxseeds are an excellent addition to one's diet. They help reduce symptoms of constipation and can help reduce levels of bad cholesterol. Add whole flaxseeds to soups or when you make a fruit smoothie. I like the crunchy feeling biting into a flaxseed that has absorbed fluids and become expanded, moist and full. Perhaps those who are treated with statin drugs could reduce their drug dosage if they consume half a teaspoon or a teaspoon of whole flaxseeds a day. Flaxseed oil may provide other health benefits but does not appear to lower cholesterol levels. See http://www.raysahelian.com/flaxseed.html

Probiotics reduce the incidence of the common cold and reduce symptoms of vaginosis
Kids who drink a mixture of probiotic bacteria mixed in milk during the winter and spring have fewer colds and need fewer antibiotics. A study in China involved 326 children, ages 3 to 5 years, who were assigned to three different groups: Group one took bacteria called Lactobacillus acidophilus mixed in milk, another received the same organisms along with a strain of other bacteria, Bifidobacterium animalis, and a third received just milk with placebo. The test formulas were given twice daily by school officials during the week and by parents on weekends. Compared to the placebo group, the Lactobacillus group had 53 percent fewer fevers, 41 percent fewer cough episodes, and 28 percent fewer runny noses. The Lactobacillus / Bifidobacterium group had even larger reductions in symptom rates. When children in the test groups did get fevers, coughs or runny noses, they recovered faster. Compared to placebo, the length of illness was decreased by 32 percent with Lactobacillus and by 48 percent with the combination Lactobacillus / Bifidobacterium. See www.raysahelian.com/probiotic.html and http://www.raysahelian.com/bifidobacterium.html

Q. I am in my fifties and trying to maintain good muscle tone since I understand it will help me later in life and I also want to look good. I have no intention in being a big muscle man. I look through many muscle magazines when I visit Barnes and Noble, and there are countless substances and supplements, including hormones, being promoted for muscle gain. I trust your judgment and opinion and would like to know which of the various such products on the market you think are most helpful.
   A. Without a doubt, creatine supplements are the most effective in maintaining and increasing muscle mass and most people notice the benefits after a few days of taking 3 or 5 grams daily. Creatine comes as a powder and you can mix a teaspoon or so in a couple of ounces of fruit or vegetable juice once daily for a week or so and then every other day. You can also find creatine capsules. Protein powders are also effective, such as whey protein or soy protein. For the average person who has no interest in being a big bodybuilder or athlete, these two simple options are the most practical and effective. See http://www.raysahelian.com/bodybuilding.html and http://www.raysahelian.com/creatine.html

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SUPPLEMENT RESEARCH UPDATE - by Ray Sahelian, M.D.
Vol. 6, Issue 7 -- July, 2009
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"Omega-3 little help in slowing Alzheimer's, but supplements may ease memory problems in healthy seniors."  This headline was found on many health news sites on the internet. The article, written by Reuters news service, continues,  "Omega-3 fatty acid supplements did nothing to slow memory declines in people with mild to moderate Alzheimer's disease, but a study in healthy people with slight memory complaints did show promise. The findings from an 18-month, government-backed study suggest taking supplements of docosahexenoic acid, or DHA — an omega-3 fatty acid — does not arrest Alzheimer's in people who have already developed the mind-robbing disease."
   The fatty acid they are talking about is DHA, a type of omega-3 fatty acid found in fish oils. Omega-3 fatty acids include a number of different fatty acids, each with its own function and influence on health and disease. For instance, alpha linolenic acid, ALA, is a smaller omega-3 fatty acid found in walnuts hemp seed, and many seed oils. The omega-3 fatty acids found in fish and fish oils include EPA and DHA. The role of ALA in the body is different than that of EPA and different than that of DHA. The title of the article heading is imprecise since the term omega-3 can include a number of different fatty acids. More on this study later.

PRODUCT DISCOUNTS at Physician Formulas -- For the next few days we are offering a free bottle of turmeric curcumin supplement. If you would like this bottle, click on the image and make sure you add it to your shopping cart. As a newsletter subscriber you are eligible to get this free bottle. We are also offering Joint Power Rx at an excellent discount. Joint Power Rx is quite popular in those who wish to improve their joint health, particularly as they get older.

DHA omega-3 Alzheimer's and memory study
The reason this study only used DHA, but not the combination EPA and DHA normally found in fish oils, is because it was funded by Martek Biosciences, a company which has its own DHA product. In the Alzheimer's study, researchers compared Martek's DHA supplements to a placebo in 402 people with mild to moderate Alzheimer's disease. Although blood levels of DHA increased, there was no significant improvement in those with Alzheimer's disease. In a related study lasting six months, researchers looked at the effects of a 900 mg daily dose of DHA on 485 healthy people with an average age of 70 who had a mild memory complaint. The DHA supplements helped restore some of the mental acuity they had lost.
   My comments: DHA supplements are probably helpful for mild memory loss in older individuals, but they are very expensive and I don't see the need to take DHA by itself when fish oils are available that provide both EPA and DHA at a much lower cost. DHA supplements are derived from algae and are appropriate to vegetarians and vegans who do not wish to take fish oils. I have reviewed other studies in the past regarding the role of fish oils in Alzheimer's disease, and it appears that once this condition has reached a moderate level of severity, fish oils are not helpful. See http://www.raysahelian.com/dha.html

Hair pulling treatment
Dr. Jon E. Grant from the University of Minnesota, Minneapolis, reports that N-acetylcysteine is helpful in the treatment of repetitive or compulsive disorders. His team evaluated the effects of N-acetylcysteine treatment in 50 adults with trichotillomania, or obsessive hair pulling. Twenty-five subjects were randomly assigned to receive 1,200 milligrams to 2,400 milligrams of N-acetylcysteine per day; the other 25 received placebo or dummy pills. After 12 weeks, patients taking the supplement had significantly greater reductions in hair-pulling symptoms than those taking placebo.  Acetylcysteine may influence the glutamate system, the largest neurotransmitter system in the human brain. See http://www.raysahelian.com/acetylcysteine.html

The role of diet in prostate cancer
A review of studies done by Australian scientists finds the risk of developing prostate cancer, or slowing its progression, may be possible by reducing intake of bad fats, processed or grilled meats, or dairy products. Men who regularly eat vegetables, including tomatoes and cruciferous vegetables like broccoli, cauliflower, cabbage and Brussels sprouts have a lower risk of developing the cancer. The same appears true of men who consume greater amounts of vitamin E, soy, fish and omega-3 fatty acids -- "good" fats found in oily fish and certain other foods, such as flaxseeds. Improving dietary habits after prostate cancer diagnosis may also improve survival from the disease. Men who drink heavily raise their risk of developing prostate cancer. See http://www.raysahelian.com/prostatecancer.html

Creatine helps with muscle recovery after exercise
Dr. Matthew B. Cooke of Baylor University in Waco, Texas, assigned 14 young, non-exercising men to take creatine and carbohydrate or carbohydrate only for five days before and 14 days after a heavy exercise session. Creatine is a natural substance found in muscle tissue and available over the counter as a supplement. Study participants were instructed to take the supplement mixed with water throughout the day before the heavy workout. The men taking creatine had  faster recovery in muscle strength.
   Comments: Creatine is a supplement that really works in terms of increasing muscle strength and muscle mass, particularly in those who do some weight training. Those who wish to increase their muscle mass can take this supplement any time of day at a dosage of 3 gram once or twice daily a few times a week. After a few days you will notice bigger muscles. See http://www.raysahelian.com/creatine.html

Why you cant trust medical articles in journals
Lilly ‘Ghostwrote’ Articles to Market Drug, Files Say
See http://www.bloomberg.com/apps/news?pid=20601109&sid=a5OeWzHgCtFo
It was reported by Bloomberg News that, "Eli Lilly & Co. pharmaceutical company officials wrote medical journal studies about the antipsychotic Zyprexa and then asked doctors to put their names on the articles, a practice called “ghostwriting,” according to unsealed company files. Lilly employees also compiled a guide to hiring scientists to write favorable articles, complained to journal editors when publication was delayed and submitted rejected articles to other outlets, according to documents filed in drug-overpricing suits against the Indianapolis-based company, the largest manufacturer of psychiatric medicines.
    Comments: Doctors get a number of medical journals for free and some of these articles are, in my opinion, biased towards medications promoted by drug companies that take out ads in these magazines or pay doctors to write favorable articles. Unfortunately, many doctors read these articles with little or no skepticism and are thus partially or fully "brainwashed."

Emails
I just read some very interesting information on SAM-e on Dr. Sahelian's site. I have been looking for a reliable source about natural supplements and I just found one!! My husband and I had started taking SAM-e a month or so ago. We are both in our mid 50s, overweight, and on daily doses of Lexapro (10 mg for me, 20 for my husband) and have been for more than 3 years. Neither one of us likes taking it, but when we try wean ourselves off we are reminded very quickly about why we started it in the first place. We started on 200 mg of SAM-e once in the morning at least half hour before breakfast. I had read an article in one of the health journals I get and it said that the dosage should be up to 800 mg daily. We really liked the way we felt at 200 mg but increased it to 400 mg. Whew! Wrong thing to do!! I had a severe anxiety attack one or two nights after increasing the dose and my husband had one the night after I did. So we weaned ourselves off the SAM-e. After stopping SAM-e we both noticed that we had actually felt better on it and my knees didn't pain me as much!
    Comments: Many studies using SAM-e for depression give the patients 800 mg or more, but in real life I find much lower dosages are effective and safer.

I take 5-htp nightly for sleep and mood improvement. I used to be able to take it at night, but for the last few months, I wake up in the middle of the night with a peculiar energy. Would taking it in the day help with sleep at night?
   It's possible. Some people prefer to take a lower dosage in early evening which seems to help with sleep better than a higher one before bed. For instance, taking 20 to 50 mg a half hour before dinner may work better than taking 100 mg an hour or so before bed. Also, it is a good idea not to take it daily and skip at least 1 or 2 days a week. 5-HTP supplements are absorbed better on an empty stomach. Good Night Rx is an excellent alternative for sleep.
 

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SUPPLEMENT RESEARCH UPDATE - by Ray Sahelian, M.D.
Vol. 6, Issue 6 -- June, 2009
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We have had an unusual number of emails regarding herbs for anxiety and sleep. Due to the difficult economic situation a great number of people have had more stress and tension than usual. Many are visiting their doctors to get anti-anxiety medications such as Xanax, sleeping pills, while others are searching for natural alternatives. However, there are certain natural supplements that could be helpful. There was a recent report that Australian researchers gave 60 adults with chronic anxiety symptoms either kava pills or placebo pills for one week. During the second treatment week, placebo patients were switched to kava and kava patients to placebo. Patients' anxiety symptoms declined on the kava extract, as did depression symptoms in some. Below I discuss other options for natural anxiety treatment.

Natural anxiety treatment
Exercise, deep sleep and yoga are consistent and proven ways in helping to reduce stress and anxiety. Meditation and prayer works for others. If you temporarily need additional help to help you relax, there are several options to choose from. Kava is one of the most potent anti-anxiety herbs available over the counter. The effects often begin within an hour or two after taking a capsule. However, there have been rare reports of liver harm when kava has been used daily. For this reason I suggest not taking kava pills more than 3 days a week. Another herb that I like is passionflower. The effects begin in an hour or two and include relaxation and sleepiness. Passionflower is quite safe and can be used on the days when kava is not taken. Ashwagandha is an Ayurvedic herb that many people find to be helpful in easing tension. Certain amino acids and related compounds are popular for stress relief including 5-HTP, GABA and theanine. I personally have not found GABA to be very effective although some users really like this supplement. Theanine is a good option when taken in the evening since it helps with sleep. 5-HTP helps to balance mood, reduces tension, and helps with sleep. The timing of these supplements depends on the severity of your anxiety. They can be taken during the day if you happen to be very anxious and alert. But if your symptoms are milder and you just need a natural pill to help you relax after work, these pills can be taken in the early evening.
   An excellent sleep product that I have formulated is Good Night Rx. A capsule is taken 2 to 4 hours before bed on an empty stomach and the vast majority of users find they get a deeper and more restful sleep with hardly any side effects. Wait al least a half hour after taking Good Night Rx before consuming dinner or a late evening snack. For more info, see http://www.raysahelian.com/anxiety.html and http://www.raysahelian.com/kava.html

Your diet can influence your vision
Diets with good amounts of omega-3-fatty acids slow the progression of early age-related macular degeneration. The findings are based on a review of data from 2924 subjects who were enrolled in the Age-Related Eye Disease Study (AREDS). As part of this study, subjects completed food frequency questionnaires at the beginning of the study and underwent periodic general and ophthalmologic physical examinations, Dr. C-J. Chiu, from Tufts University, Boston, found that higher quantities of omega fatty acid intake lowered the risk of progression to advanced macular degeneration. In addition, a lower dietary glycemic index was associated with a reduced risk of progression. Omega-3s can be obtained from fish oils and flaxseed oil. A low glycemic intake can be achieved by eating less sugar and simple carbohydrates. See http://www.raysahelian.com/maculardegeneration.html and http://www.raysahelian.com/glycemicindex.html. Flaxseed oil has a high concentration of a type of omega-3 fatty acid called ALA which can convert into fatty acids found in fish oil called EPA and DHA. See http://www.raysahelian.com/flaxseed.html

L-Carnitine helpful for diabetics
Patients with type 2 diabetes are under high oxidative stress. The objective of this Italian study was to evaluate the benefit of L-carnitine on the reduction of oxidized LDL cholesterol in patients with type 2 diabetes. Eighty-one patients with diabetes were randomly assigned to 1 of 2 treatment groups for 3 months. The 2 groups received either 2 g L-carnitine once daily or placebo. At the end of the study period, the L-carnitine-treated patients showed significant improvements compared with the placebo group. The following decreased: oxidized LDL levels; LDL cholesterol; triglycerides; and apolipoprotein A1 concentrations.
    Carnitine appears to be an additional supplement to be potentially beneficial in those who have diabetes. A dosage of 250 mg a day or 500 mg three times a week is a good option. See http://www.raysahelian.com/carnitine.html

Emails
Q. Can you explain to me the term "herbal extract." How does one know the potency of an extract and whether it is good or not from the label, besides trying it. Also one more question about ratio 4:1 or what ever, what does that mean. Is it a health issue or a danger to take it say ratio 10:1 or higher.
    A. Herbs can be used as a pure crushed powder or in more potent forms such as extracts. There are many, many different companies that make potent concentrations of various herbs and each one has their own method of extraction, concentration, and processing. Therefore, the same herb can have dozens of different extracts depending on how it is manufactured. One example is tongkat ali herb. It comes as regular powder and also in various extract potencies such as 10 to 1, 20 to 1, 50 to 1, and higher. In order to know which herbal extract concentration is more effective, each extract has to be tested in humans and compared to another extract potency. Since few such studies have been done, this makes the whole issue very complicated. Therefore, the only good way to know which herb is useful to a person and in what extract potency is for the individual to try it in different dosages and extract potencies. It is not possible to tell from the supplement fact panel on the label whether one particular extract is better for you than another one. A 10 to 1 extract is more concentrated than a 4 to 1 extract but this does not mean the stronger one is necessarily better suited for the condition you are treating. Furthermore, one company may claim that their extract is a concentrated 10 to 1 whereas another company may have a 10 to 1 extract that happens to be much more potent since their extraction method and process yields different concentrations of the active ingredients. The whole topic is very complicated and there are no simple answers, and few universally accepted guidelines. The best way to find out is for you to try different herbal extracts from different companies to see which one provides you with the best improvement for your condition. Also keep in mind that some companies may not be honest in their representation. They may claim their product is a high potency extract whereas it may be a weaker version.

Q. Has there been any research on fish oil’s blood thinning strength. I am 67 years old and taking one 81 mg aspirin every other day. I plan to go from one 1,000 mg fish oil capsule per day to three per day to hopefully enhance brain efficiency. Will a 81 mg aspirin plus three 1,000 mg fish oil capsules possibly cause a bleeding problem? What’s your opinion of fish oil’s effect on the brain?
   A. It is difficult to predict the blood thinning potential or effect of aspirin and fish oils in any one individual without doing testing since each person has a different reaction based on their body chemistry, other supplements used, other medications taken, and diet. It is very rare for fish oil supplements to cause a bleeding problem when used alone. Aspirin alone can cause bleeding problems by itself and it is possible that the combination with fish oils can thin the blood even more. Whether this will result in a clinically obvious case of internal bleeding is difficult to predict. Those who take Coumadin or Plavix should notify their health care provider if they intend to take fish oil capsules. Fish oils have important health benefits, including improving brain function. See http://www.raysahelian.com/bloodclot.html

Q. A few months ago you wrote about vitamin D and you cautioned people not to take more than 1000 units a day until more long term data are available. This note is just to let you know that I have noticed a side-effect of high vitamin D supplementation: whole-body anxiety and restlessness. I acquired hypothyroidism due to destruction of my thyroid by Hashimoto's autoimmune thyroiditis. The Hashimoto was perhaps caused by gluten. I also acquired multiple nutritional deficiencies as a result of gluten enteropathy. After getting off gluten in 2003, the process of finding and fixing the many nutritional deficiencies the enteropathy caused, has been lengthy. Early in 2008 I discovered that taking vitamin D3 caused me to go into hyperthyroidism. I had to lower my T4 dose from its high of 118mcg. After taking up to 3000 IU D3 daily for 5 months and finally achieving D sufficiency at 50ng/ml, I dropped back to about 600 IU vitamin D3 daily. Reducing the level of vitamin D supplementation, improved the way I feel. Apparently high blood levels of vitamin D are excitatory for me, because the 3000 IU vitamin D supplementation had created a whole-body anxiety situation. It had also interfered with my thyroid treatment. Taking T4 while I also had a high blood level of D3 would cause intense anxiety, so I had throttled back my T4 dose to a low level (usually 12mcg per day) that wasn't sufficient to keep my TSH reasonably low and my FT3 and FT4 both within the normal ranges. I have a friend whose son was put on high vitamin D supplementation after he was found to have gluten sensitivity and multiple deficiencies. The doc put him on a dose of 8000 IU D3 as drops, once per week. When I talked to his mom about my experience with high-dose vitamin D supplementation, she found it interesting. She told me that when she gives her son his 8000 IU D3 on Sunday, he acts "crazy" on Monday. So evidently I'm not the only person who finds that high blood levels of vitamin D3 are excitatory.
 A. This is interesting. I wonder if others have found very high dosages of vitamin D to cause anxiety or have excitatory effects.

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SUPPLEMENT RESEARCH UPDATE - by Ray Sahelian, M.D.
Vol. 6, Issue 5 -- May, 2009
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PRODUCT DISCOUNTS at Physician Formulas -- For the next few days we are offering a free bottle of acai berry supplement. If you would like this bottle, click on the image and make sure you add it to your shopping cart. As a newsletter subscriber you are eligible to get this free bottle. We are also offering Eyesight Rx at a discount. This tablet is melted under the tongue and used every other day. Most users find Eyesight Rx improves day and night vision, enhances color perception, and also improves near and distant vision. It takes a few days for the benefits to be noticed. In addition, this product supplies a number of beneficial nutrients and antioxidants for long term eye health.

Red yeast rice and fish oils as good as statin drugs for cholesterol
Pharmaceutical companies have a great deal of money to promote their cholesterol lowering drugs such as Lipitor and Zocor. Yet there are quite a number of natural alternatives that may be just, or more, effective, cheaper, and safer. Unfortunately these natural options are rarely mentioned by the media which seems to repeat whatever news release is put out by the drug companies regarding the results of the studies they have funded. The results of many such studies may not reliable or accurate. Here is a quote from an article. "Many medical studies simply are not accurate. Further, the media is known to distort key aspects of medical studies, twisting findings by virtue of ignorance, blowing obscure, unpublished "breakthroughs" out of proportion, and frequently failing to disclose industry funding even when the researchers do mention it."
   In a study conducted at Chestnut Hill Hospital, University of Pennsylvania Health System, in Philadelphia, PA, investigators wanted to compared the lipid-lowering effects of a lifestyle changes, red yeast rice, and fish oil with a standard dose of a cholesterol lowering statin drug called Zocor. There was a significant and equal reduction in LDL-Cholesterol  levels in both groups. The patients taking the natural supplements had a higher reductions in triglycerides levels than those on taking the drug (-29% vs -9%).
   Comments: We get emails from doctors who practice conventional medicine criticizing me for not promoting statin drugs. Many doctors think they are doing their patients a favor by staring them on these medications even if their cholesterol levels are mildly high. I wish these doctors spent more time reviewing the research regarding the benefits of natural products to help with cholesterol management. They would realize that many options are available that are cheaper and safer. See http://www.raysahelian.com/cholesterol.html and http://www.raysahelian.com/redyeastrice.html

Soy controversy revisited
Q. I have been reading your newsletter for a couple of years and truly appreciate the honesty and avoidance of hype. I read on a website that soy ingestion is harmful to health but the writer of the article did not seem to present any good research. Has your opinion changed from a year or two ago regarding the safety of soy consumption?
   A. I still hold to my position that the occasional consumption of soy foods, in reasonable amounts and preferably organically grown, should not be a concern and may even have some positive benefits. A recent analysis by investigators at Grand Forks Human Nutrition Research Center, Agricultural Research Service, US Department of Agriculture, Grand Forks, ND, and the Department of Mathematics, Washington University, St Louis, MO., found soy consumption reduced the risk for prostate cancer, see http://www.raysahelian.com/prostatecancer.html. Another study found soy consumption reduced the risk of colon cancer in women, see http://www.raysahelian.com/coloncancer.html. I know many older people who have been eating soy products regularly for most of their life and they are in good health. I don't see why some web sites claim that consumption of even small amounts of soy products to be toxic and a danger. It just does not make sense to me.

Fish oils improve mood in those with Parkinson's disease
Brazilian researchers gave fish oil pills for a period of three months to patients with Parkinson's disease who were diagnosed with depression. The patients taking fish oil supplements had improvements in their depressive symptoms.  Fish oils are also helpful in women after menopause in terms of mood elevations, see http://www.raysahelian.com/menopause.html.
   Comments: It is not clear how fish oils would interact, if any, with medications currently used for PD. I don't suspect taking 3 or 4 fish oil capsules would interfere with these medications. Mucuna pruriens is an herb that is recommended by some doctors for PD. I don't think there would be a problem combining the fish oils and mucuna pills. See http://www.raysahelian.com/parkinson.html for more information and discuss with your doctor before making changes to your medication regimen.

Emails
Q. I am having an argument with my wife. My point of view is that housework helps the heart, just like exercise, stay healthier and can help one live longer while she thinks it has no influence. Who is right?
   A. There was a recent study in the American Journal of Epidemiology that found the time people spend doing housework such as scrubbing floors or cleaning windows and gardening does not seem to make a strong influence on heart health, but it can reduce mortality. Any kind of movement is better than being sedentary and sitting on a couch watching TV. See http://www.raysahelian.com/exercise.html

Q. I am interested in routinely measuring / tracking my blood antioxidant level. What are your thoughts on the value of this?
   A. I do not see any clinical value in knowing one's antioxidant status through blood studies unless there is a specific medical condition or disease that needs to be evaluated and monitored with this method. Just do your best in eating as healthy as possible with a wide variety of fruits and vegetables, along with herbs and spices. You may also consider taking certain supplements that provide antioxidant protection, and a list is included on this page http://www.raysahelian.com/antioxidant.html.

 Q. There are a lot of myths out there on cod liver oil and where it comes from. How does one know he or she are getting a superior product when purchasing cod liver oil supplements and that there are no toxins or pollutants? Are all cod liver oil supplements basically the same? Is it necessary to take a vitamin D supplement if taking cod liver oil?
  A. There are a number of companies that sell cod liver oil supplements. It is not possible for the consumer to know which is the best product unless the consumer sends a sample pill to a lab for analysis. This is not practical. Furthermore, even if one buys the cod liver oil bottles from the same company, over time, each batch could be different depending on where the fish were caught and how the oil was extracted and processed. If a person is very concerned, one option is to buy a cod liver oil product from a different company each time a new bottle is needed thus not relying on one source in case that particular source happens to be inferior. You could alternate two, three or four sources. As to vitamin D, each person has a different requirement depending on diet and sun exposure. Check to see how much vitamin D is in the cod liver oil supplement you are taking, add it to any other sources of vitamin D you are getting from supplements, such as multivitamin pills or calcium / vitamin D pills, and dairy products, and limit your overall intake to less than 1000 units a day. See http://www.raysahelian.com/codliveroil.html

Q. I have read with interest your take on potential problems with higher supplemental doses of Vitamin D and calcium as discussed in a previous newsletter. I have been diagnosed with very low bone density and, at the time of diagnosis, my blood level of vitamin D (25-OH) was 10 nanograms per ml (optimal is 20 to 60). I have subsequently -- and under monitoring -- taken 4,000 I.U. of vitamin D3 and still only managed to raise my levels to 39. I am now taking 5,000 I.U. and due to be tested soon. If even "heroic" doses of vitamin D3 are merely maintaining what are considered desirable levels, can these doses still pose potential health problems?
    A. It's difficult to say. Blood levels of vitamin D, or many other vitamins, may not necessarily reflect what is actually going on in bone tissue, brain tissue, or other parts of the body. Many doctors overly rely on blood levels to determine the proper dosage of vitamins, drugs, and hormones, but blood tests do not always reflect accurately the levels or effects of these medications in various tissues of the body or what is actually going on within each cell. There could be a normal level of the vitamin or medication in the blood stream yet untoward effects could be going on in some part of the body. For instance, if a person takes DHEA hormone and their blood test shows the level to be within the normal range, it is possible that the levels in hair tissue could be high causing hair loss. Same with vitamin D. It is possible that blood levels could be low or normal, yet untoward reactions could be occurring in other tissues, such as brain tissue.

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SUPPLEMENT RESEARCH UPDATE - by Ray Sahelian, M.D.
Vol. 6, Issue 4 -- April, 2009
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I was recently interviewed for a Newswire article on stevia, the natural herbal sweetener. This plant has leaves which contain compounds that are more than 200 times sweeter than table sugar but have no calories. Stevia has been available in the USA since the mid to late 1990s, but the FDA did not allow it to be called a sweetener, it could only be called a dietary supplement. In other words the label on stevia products, whether in liquid form or powder, could not say that it could be used as a sweetener. Interestingly, a couple of years ago, when large companies such as Coke and Pepsi approached the FDA and asked to use a stevia extract in their drinks, suddenly attitudes changed at the administration and now stevia is allowed to be called a sweetener. This plant can be used by children and those who have diabetes. More about this later.
   To celebrate stevia's new status as a government-sanctified safe sweetener, an offer of a free bottle of stevia liquid is being made for the next few days to all subscribers of the newsletter. This bottle is normally sold for 14.95. This liquid is my favorite. I use 3 or 4 drops in my herbal teas each morning. I have been doing so safely for over a decade. You can also add it to coffee. Kids will love lemonade sweetened with stevia. This sweetener is also available in packets, powder, chewing gum and lime-flavored packets that you can add to a pint of water for a calorie-free delicious iced drink, especially appreciated during warm days.

I was introduced to stevia in the late 1990s by a friend. We were at a restaurant in Los Angeles and before we ordered from the menu she requested the waiter to bring a few cut lemon pieces and a glass of water. She then proceeded to squeeze the lemons in the water and asked me to taste. Of course it was sour. She then added a few drops of stevia liquid. I could not believe how such a small amount of an herbal extract could immediately turn the sourness into such a delicious lemonade. I was so impressed that it prompted me to co-author a book with her called The Stevia Cookbook. I researched the history of the plant and all the safety studies while she worked on the recipes. After reviewing multi-generational studies done in rodents in high dosages where this plant was fount to be non-toxic and safe, and realizing that some countries such as Japan had been using stevia in their foods since the 1970s without any ill effects, I was convinced that this sweetener was safe. However, I was puzzled that the FDA claimed that it had concerns about its safety and would not allow it to be called a sweetener. Over the years stevia gradually became more popular in alternative health circles but it was not until the FDA changed its mind in 2008, and Coke and Pepsi began adding it in their drinks, that catapulted stevia to its new famed status. You are soon likely to find a number of foods, drinks, nutrition bars and other products to include stevia. There are a number of companies that sell stevia extracts and not all of them are of good quality. Some stevia product may have a bitter aftertaste. After searching for several years, I came across a stevia clear liquid product that has become my favorite and is being offered as a free bottle for the next few days. For fascinating information about this whole topic, see http://www.raysahelian.com/stevia.html. See also an article that was sent over the Newswire where I was quoted, http://jscms.jrn.columbia.edu/cns/2009-03-17/solash-steviasweetener

Combining prebiotics and probiotics helps those with ulcerative colitis
There is growing optimism that a combination of probiotics, which are friendly gut bacteria, and prebiotics, certain complex carbohydrate substances that stimulate the growth of friendly bacteria in the gut, work together quite well in treating certain medical conditions. Japanese researchers at Nippon Medical School in Tokyo discovered that patients with ulcerative colitis on a combination prebiotic and probiotic therapy experienced greater quality-of-life changes than patients on either treatment alone. See http://www.raysahelian.com/ulcerativecolitis.html  and http://www.raysahelian.com/probiotics.html

Melatonin helps children with autism sleep better
Dr. Beth L. Goodlin-Jones, at the University of California Davis Health System in Sacramento, gave children, ranging in age from 2 to 15 years, melatonin 3 mg nightly for two weeks and compared them to a placebo group. These children had autistic spectrum disorder and/or fragile X syndrome. Reports from children who completed the study showed that use of this natural hormone led to improvements in total night sleep durations, sleep latency times and sleep-onset times.
   Comments: For long term use I suggest no more than half or 1 mg of melatonin for a maximum of three nights a week. I am concerned that if parents give 3 mg nightly for many weeks or months tolerance could develop or side effects could occur. It is possible that even a third of a mg used two to three hours before bed could also be effective. See http://www.raysahelian.com/autism.html and http://www.raysahelian.com/melatonin.html

Raw or cooked broccoli?
Eat your vegetables, raw. Although some vegetables are more appropriate eaten cooked, it appears that an active anti-cancer substance in broccoli, called sulforaphane, is destroyed when this vegetable is cooked. Researchers in The Netherlands asked eight men to eat 200 grams of crushed broccoli, raw or cooked, with a warm meal. Higher amounts of sulforaphane were found in the blood and urine when broccoli was eaten raw (bioavailability of 37%) versus cooked (3%). See http://www.raysahelian.com/sulforaphane.html

Emails
I am sensitive to doses and I have found, in the past, that the usual market doses are too strong for me. For example, I used to take CoQ10 30 mg everyday but found after a few days it was too stimulating. So I resorted to taking it every second day but I would prefer taking a smaller dose, say 10 mg, everyday. The same thing with R Alpha Lipoic acid. I would like trying a dose of about 5 mg to begin with but the smallest dose available is 50 mg. Can the capsule be emptied into a container with, say orange juice, and mixed and one can consume a prescribed fraction of that juice each day. Or will putting these supplements into a juice and leaving in the refrigerator for a few days destroy the supplement?
    It is certainly okay to open a capsule of a supplement and use a portion. I would say for most supplements it should not be a problem to keep them two to five days in juice in the refrigerator although I would prefer not much longer. Another option is to open a capsule, pour out some of it, and then close the capsule. Most  capsules can be opened by twisting and pulling on each end. I encourage people who are sensitive to use smaller amounts. One of the most important things to recognize about taking a medication or supplement is that there is a wide range of dosages that are appropriate. For instance, we have had feedback from Passion Rx users that a third of a capsule taken for a few days works, whereas others say they need a capsule and a half or two capsules for several days to notice an effect. There are some people who notice an effect from a supplement or prescription drug that is a tenth as small as someone else who has a high threshold.

 Q. I recently read an article that said drinking yerba mate tea Increases cancer risk. Can you comment on this article, here is an excerpt, "Yerba mate, the South American tea gaining popularity among the health-conscious and caffeine-shy, may be linked to significantly increased rates of some cancers, according to new studies. Some studies have linked the brew to possible reductions in heart disease and cancer. In lab tests, the herb helped protect heart and liver cells against stress. In rats, it lowered blood pressure and kept fat from accumulating in blood vessels. But scientists warned that tests in labs and on rats don't necessarily translate into the same human results. In fact, a 1994 study found mate drinkers had a 60 percent higher chance of contracting respiratory or digestive cancers than non-mate drinkers. Two years later, another study, of 1,000 Uruguayan men, found those who drank yerba mate regularly had a 60 percent higher chance of developing lung cancer than non-tea drinkers."
   A. It is possible that daily drinking of yerba mate may increase the risk for cancer and I am not about to question the results of these studies without additional information. However, as a practical and reasonable suggestion, people should not drink the same tea daily. I have at least a dozen tea boxes on my kitchen counter and I alternate their use. Some of the ones I use include ginger, peppermint, chamomile, rooibos, Earl Grey, licorice, green tea, black tea, and a few others, including yerba mate. By drinking different teas, you will get a variety of beneficial polyphenols and other substances, and avoid repetitive exposure to substances that are harmful to the body if ingested in excess. Based on my reviews of the medical literature, I feel very confident that yerba mate tea is safe when used a few times a month.

Q. I am confused about conflicting information I've read about probiotics. Some sources say you must take enteric-coated capsules so that the probiotics will bypass the stomach and stomach acid (which they say destroys the probiotics) and be released in the intestines. Other sources say that stomach acid does not destroy the probiotics and that enteric-coated capsules are an unnecessarily expensive method of getting your probiotics. What is the truth?
    A. I asked Dr. S.K. Dash, President of UAS Laboratories, Inc and producer of a product called DDS-Probiotics. He is an expert on this topic and the author of "The Consumer's Guide to Probiotics." He said, "Probiotics made by reliable companies are acid and bile resistant (97%). Not only do they pass through stomach acid, they implant in the intestine, producing digestive enzymes, vitamins, lactic acid and natural antibiotics. Selection of the right probiotic strain is the key to success of a probiotic supplement. DDS-Probiotics do not need enteric coating. All probiotics are not same. Some weaker strains may need enteric coating."

Q. I am medical doctor. This is my first visit to your website and I found the information to be good and reasonable and the advice given on supplements very sound. I particularly appreciate the way you advise a lower rather than higher dose as well as to stop and start or take supplements on a few days a week. This has been my experience also with my patients and I find many manufacturers as well as sellers of health products happily telling their clients to keep taking their products causing iatrogenic illnesses caused by an excess exposure to the supplements.
 
Q. I have no illness but I take many herbal products which are also blood thinners such as ginkgo biloba, green tea extract, grape seed extract, fish oil and a few others. I try take them at various times of the day. I wanted to know if taking a lot of blood thinners can thin the blood too much and be a risk. How can I tell the potency of any herbal blood thinner so to avoid a bleeding problem?
   A. Research regarding the potency of different herbs and supplements in terms of blood thinning potential has not been extensive and we don't know as much as we need to know. The blood thinning potential of supplements also depends on the dosage used. One good way to tell how all of these blood thinning supplements are working is to get a blood test to measure your overall blood clotting ability. The blood thinning effect of some supplements may only last a few hours while others may have an effect for several days. As a practical matter, though, it is very rare to have a serious bleeding problem with the use of natural supplements unless they are combined with aspirin, Plavix, Coumadin, or other prescription blood thinning medications. A potent natural anti clotting product is nattokinase and this enzyme should be used with medical supervision.

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SUPPLEMENT RESEARCH UPDATE - by Ray Sahelian, M.D.
Vol. 6, Issue 3 -- March, 2009
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Have you heard of maca herb? Maca is a plant native to the high Andes of Peru and Bolivia and used by locals as a root vegetable and as a medicinal herb.  I came across two new studies with this herb and its aphrodisiac properties. I really appreciate coming across studies with these herbs on humans rather than relying on the interpretation of results from animals or lab studies. For centuries and millennia indigenous tribes have known about locally grown roots, herbs, barks, and other natural substances that have sexual enhancing properties, yet modern science is still skeptical that these herbs work. I think over the next few years, as more data becomes available, doctors, the media, and scientists will begin to realize and accept that natural aphrodisiacs are effective. Most of these herbs take a few days or up to two weeks to work as opposed to Viagra and its cousins that take a few hours. But the herbs are safer and enhance the overall sexual experience, sensation, libido, orgasms, etc, rather than the purely mechanical aspects of blood vessel dilation. If the first herb or formula does not work for you, try one or two others. Eventually, through trial and error, you will find a single herb, or a combination, that will revive some of the passion you thought had long gone.
   In the last issue of the newsletter I discussed bio-identical hormones and hormone replacement therapy. Just about all the feedback on this topic was positive and most people appreciated my balanced viewpoint that pointed out the benefits and unknown risks.
   The home page of my website has an index of three or four hundred topics. However, there are about 2000 pages on this site. If you are looking for a particular topic not listed on the home page, you can google, yahoo, or msn my last name followed by a space and then the keyword. Example: sahelian ginkgo.

PRODUCT DISCOUNTS - We are providing a 10 percent discount to our customers for the next few days. All the items at PhysicianFormulas.com website are on sale for an additional 10 percent off on top of the existing discounts, including the bestselling formulas Passion Rx, Diet Rx, Mind Power Rx, Joint Power Rx, Prostate Power Rx, MultiVit Rx, and Eyesight Rx. As a newsletter subscriber you are eligible to get this discount. After you add the products to your cart, type the word spring in the discount code provided and then click update below it. If you have questions, call the customer care representatives at the number listed on the website.

Maca as a mild aphrodisiac
There were two interesting studies I came across recently. The first one shows maca has a small benefit in men with impotence, and the second one shows maca to be helpful in reversing some of the sexual dysfunction associated with the use antidepressant medications.

Italian scientists at the Department of Urology, Morgagni-Pierantoni Hospital, in Forlì, Italy, wanted to find out the effects of maca extract on well-being and sexual performances in patients with mild erectile dysfunction. They gave 50 men with mild erectile dysfunction (ED), maca dry extract, 2400 mg a day and compared them to a placebo group. After three months, those on maca experienced a significant improvement in physical and social performance-related sexual score compared to those who did not receive the herb. They say, "Our data support a small but significant effect of maca supplementation on subjective perception of general and sexual well-being in adult patients with mild ED.

In the second study, Dr. Dording and colleagues at the Department of Psychiatry, Massachusetts General Hospital, in Boston, wanted to find out whether maca is helpful in patients who have sexual dysfunction as a result of taking SSRI drugs for depression. SSRI drugs, such as Paxil, Zoloft, and Prozac, influence serotonin activity in the brain. Excess serotonin inhibits sexuality. One group received 1.5 g/day and another group took 3 grams a day. Those taking 3 grams a day had a reversal of their dysfunction. They conclude, "Maca root may alleviate SSRI-induced sexual dysfunction, and there may be a dose-related effect. Maca may also have a beneficial effect on libido."

   My comments: I like maca herb and I have personally noticed a mild sexual enhancement and energy from it. But, in my opinion, it is not as potent as some other herbs such as tribulus, mucuna, horny goat weed, catuaba, muira puama, yohimbe, and tongkat ali. Maca is a gentle herb and perhaps it may be safer to use in those with SSRI induced sexual problems. It is possible that low dosages of other herbs may also be effective and not cause unpleasant interactions with the medications. If you take any prescription medications or hormones, or are over the age of 50, have mild high blood pressure, be careful when using aphrodisiac herbs and always begin with low dosages for a few days. If the small amounts are not effective, then you can increase the dosage little by little. Have approval by your health care provider. If you have moderate to severe high blood pressure or a heart condition, it may be best not to use these herbs since they can increase heart rate and in very high amounts cause heart rhythm disturbances. See http://www.raysahelian.com/maca.html

Cranberry almost as good as an antibiotic for UTI prevention

Scottish researchers wanted to know how cranberry extract compared to low-dose trimethoprim (an antibiotic) in the prevention of recurrent urinary tract infections (UTIs) in older women. For a period of six months, 137 women with two or more antibiotic-treated UTIs in the previous 12 months were randomized to receive either 500 mg of cranberry extract or 100 mg of trimethoprim. The average time to recurrence of UTI was 84 days for the cranberry group and 91 days for the trimethoprim group. Trimethoprim had a small advantage over cranberry extract in the prevention of recurrent UTIs in older women but had more adverse effects. They say, "Our finding will allow older women with recurrent UTIs to discuss with their clinicians the inherent attractions of a cheap, natural product like cranberry extract whose use does not carry the risk of antimicrobial resistance or super-infection with Clostridium difficile or fungi. See http://www.raysahelian.com/cranberry.html

Emails
Q. My husband and I have a son who is a high-functioning autistic. He also developed type 1 diabetes as an adult. In a report my husband and I read on the Internet, you mentioned a nutrient, L-Carnosine to help type 1 diabetics and said it also helped brain function in autistics. We decided to try it and told our son we had something we thought might help his diabetes. Within a couple of weeks, he became much more talkative (he's a very quiet person and usually keeps his opinions to himself) and began voicing his political opinions. It was obvious he had put quite a bit of thought in them. Friends began noticing how much more he was talking with them and not immediately retreating to his room when they came to visit. And to prove it wasn't all in our heads, his endocrinologist has lowered his insulin twice since he began taking the L-Carnosine. So, thanks for pointing us in that direction. See http://www.raysahelian.com/autism.html

Q. I started taking St. John's wort recently to help with menopause depression. I took a German preparation which was a single 900 mg tablet in the morning for a week. I was waking frequently in the night, but knew that insomnia was a potential side effect. My doctor took my blood pressure. I am normally quite normal. My blood pressure was an astronomical 180 / 100. I could not think why, and then later did some research online that seemed to indicate this could be a side effect of St. John's wort. I had the same experience when taking licorice. I must be very sensitive. I stopped taking the St. John's wort and feel quite a bit better. I haven't had my blood pressure checked but will do so soon, however I am sure it is back to normal as I don't feel so anxious and fluttery. I realize there are lots of studies to show that St. John's wort does not affect blood pressure. Unfortunately the studies clearly do not cover cases like myself. I thought you and others should know.
   A. In my opinion, 900 mg of St. John's wort extract is quite a high dosage even though most studies have used this high amount. I prefer to prescribe 300 mg of St. John's wort extract and even reduce the frequency of use to every other day once the benefits begin. Insomnia is a side effect of St. John's wort on high dosages. See http://www.raysahelian.com/stjohn.html

Q. Dear Dr. Sahelian, I appreciate your objective approach to hormone replacement therapy. My wife has been using bio identical progesterone for a number of years and has seen a great reduction of PMS and peri-menstrual acne. I recognize that her results are subjective and anecdotal. Unfortunately I don't foresee a U.S. peer reviewed study of bio identical hormones in the future because American pharmaceutical companies dictate where the research will be directed and non-prescription approaches to medical treatment is simply not profitable enough for them.
 

Q. First, thank you for your informative web site and the one you consult for physician formulas. They exhibit an unusual amount of objectivity about the various supplements. Recently, I was reading a page and was struck by the fact that it said "Take this capsule several times a week." Naturally, supplement manufacturers or doctors who consult for them, have an underlying conflict of interest regarding dosage and frequency - the more often a customer takes the supplement, the more often they will buy a new bottle. So, it is no surprise that in decades of taking vitamins and supplements, I have never seen one that does not list the word "daily" in the recommendations. In fact, the original mass marketed vitamin was called "Once A Day". Most supplements state " 1-3 times daily " on the label. It would be of great benefit if you could write a separate article for your web site that would list which supplements are not necessary or helpful to take every day.
   A. I appreciate your email. My first concern, and that of the folks at Advance Physician Formulas, is to provide supplements that are helpful for people with the most benefits and fewest side effects. Having tested supplements on myself for over 30 years, I recognize that some of them can have cumulative effects, and whereas it was beneficial at first to take them daily, after a while side effects occurred with continued use. As such I believe that it is sometimes, or often, better to take these pills less frequently as I have suggested the folks at APF, whom I consult for, to be cautious in their dosage suggestions and err on the side of suggesting people take less, not more. See the next email as an example of why some of these supplements should not be taken daily.
   We feel that if customers are happy, they will come back to shop again. A company can make a profit in the vitamin industry while being honest and not greedy. See http://www.physicianformulas.com/store/Scripts/prodview.asp?idproduct=224&name=NEWSLETTER and scroll down half way down the page for suggestions on how often to take certain supplements.

Q. I started on a dosage of 400 mg SAM-e supplement daily and after a week felt like I was going insane. So I decided to step down the dosage to 50 mg. It seems though like the 400 mg week long course almost acted like a loading dose. Even stopping for 3 days and trying 50 mg immediately brought me back to the same symptoms I was feeling before - shortness of breath, anxiety, anger, etc. Every time I try and re-challenge with the 50 mg tablet the symptoms come back. This is weird since the 400 mg dose was fine for the most part of a week. It could just be I am just sensitive to the SAM-e effects. I also take daily mega doses of B vitamins which could also be extending its effects.
   A. Once the body is loaded up with certain herbs or supplements, smaller amounts can trigger the same effects as higher amounts. This occurs with SAM-e and B vitamins could enhance the effects. This is also true of aphrodisiac herbs. It may take a few days to notice the initial benefits, but the effects are noticed much quicker after taking a pill once there is enough of the herbs in the body. See http://www.raysahelian.com/sam-e.html

Q. This is in regards to dosage instructions on supplement bottles. I would like to know why a rhodiola supplement bottle I bought has instructions that states to use it twice a day, usually before breakfast and dinner on an empty stomach. Can you tell me what the reason is for 2 separated doses instead of taking the rhodiola herbal extract once a day?
   A. There are many rhodiola products on the market and they have different instructions written on the bottle in terms of how to use this herb. There are several reasons for this. Often not enough human research is available to determine the best way to take, the best timing, and the ideal dosage of these herbal supplements. Also, many or most of the instructions on bottles of supplements are not written by doctors or herbal specialists, but are written by company staff, marketers, promoters, or others with minimal nutritional knowledge, who may have no clue on how to take supplements and thus will write the instructions on dosage and usage based on little solid scientific evidence or practical knowledge. As a general rule, I prefer rhodiola being taken once in the morning but there are others with different opinions. Certain herbs and supplements can cause insomnia if taken late in the day.

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SUPPLEMENT RESEARCH UPDATE - by Ray Sahelian, M.D.
Vol. 6, Issue 2 -- February, 2009
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We had an unprecedented number of email responses to the last issue of the newsletter. Here is one example: "The January 2009 newsletter Supplement Research Update discusses the disastrous effects of conjugated equine estrogens and synthetic progestins uncovered by the Women’s Health Initiative study in terms of increasing breast cancer risk. My understanding is that the WHI did not study the use of bio-identical human estrogens and progesterone at all. Everything I’ve read indicates that they have a completely different effect on women’s bodies, and in fact progesterone (the real thing, not synthetic progestins) may be protective against breast cancer."
   Over the past few decades doctors have prescribed horse-derived estrogens and synthetic progestins to women in order to relieve menopausal symptoms and as a way to potentially reduce the risk for osteoporosis or heart disease. A few years ago doctors began suspecting that, in many or most women, the harm from this treatment in terms of increased breast cancer risk and heart disease risk outweighs the benefits. Many women stopped taking these medications, others turned to herbs and supplements, and still others turned to natural hormones such as bioidentical hormones. Many of you may not be familiar with this term. Bioidentical hormones differ from traditional hormone replacement therapy since they are chemically identical to hormones found within the body -- such as estradiol and progesterone -- rather than molecules that are similar, but not identical to human hormones (such as Premarin, derived from the urine of pregnant horses) or synthetic progestins (such as medroxyprogesterone). Many women believe that these bioidentical natural hormones are safe, or safer. These bioidentical hormones are promoted by compounding pharmacists, some alternative medicine practitioners and even a celebrity, Suzanne Somers. Estradiol is also available in many FDA-approved pills, patches, creams and gels from traditional pharmaceutical companies. Is there evidence to support the safety or superiority of bioidentical hormones over standard hormone replacement approaches? I will focus most of this newsletter on this important issue.

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Chondroitin, glucosamine and quercetin helpful for osteoarthritis
A new 2009 Japanese study finds a combination supplement of 1200 mg glucosamine hydrochloride, 100 mg of chondroitin (from 300 mg shark cartilage), and 45 mg of quercetin, taken daily, is helpful as a treatment for osteoarthritis. Forty-six osteoarthritis and twenty-two rheumatoid arthritis patients were given the glucosamine chondroitin quercetin supplement orally for 3 months. The osteoarthritis patients showed a significant improvement in pain symptoms, daily activities (walking and climbing up and down stairs), and changes in the synovial fluid properties. No such effects were observed in the rheumatoid arthritis patients.
   Comments: Over the past few years there have been numerous studies regarding the role of glucosamine and chondroitin as a treatment for osteoarthritis. Most, but not all, studies show these natural nutrients to have a benefit. Quercetin supplements are available by themselves and can be taken together with a joint formula that has chondroitin and glucosamine. See http://www.raysahelian.com/osteoarthritis.html

Hormone replacement controversies
Here are some of the emails we received and my responses.

Q. I think your information is great, but I strongly disagree regarding estrogen / progestin. First of all, both Premarin and progestins should be against the law, as we women are not horses and synthetic progestins are carcinogenic. However, bioidentical hormones are a different breed and I have been on them (low dose) for the last 5 years. I don't even think about cancer. I eat a very strict, clean, mostly organic diet and go to an MD who knows what he's doing. Yes, Western medicine is the problem---still giving women Premarin and progestins---it's a disgrace how mishandled most women are today at the hands of misinformed and arrogant doctors who don't want to learn what's new and better.
   A. All doctors, including me, are fallible and have the potential to make mistakes or give wrong advice. In the past few decades many doctors were just as assured and complacent of the safety of hormone replacement therapy with PremPro as many bioidentical hormone promoters are today. There are currently no long term studies with bioidentical hormones to prove their safety.

Q. Dear Dr. S, the horse urine estrogen and synthetic progestin that have been fed to women world wide has been the problem, not bioidentical estrogen and progesterone. I am 63, was never able to take the horse urine product without feeling ill, so I didn't, even after my hysterectomy at 33 with the inevitable negative results for my bones. Five years ago, my doctor started me on a bio-identical estrogen patch, along with additional magnesium and bio-identical topical progesterone cream. My annual DEXA scans have shown an amazing gain in bone strength, this includes both hip and spine. I no longer expect to end up with dissolving bones which is what other doctors have stated is the fate of most people who live to be very old. Since people in my family lines normally die between 85 and 95, I have been concerned about osteoporosis because the folks who did die earlier usually died from the results of a broken hip. It wasn't fast, usually a year, and it wasn't pleasant and isn't solved by hip replacement. The fact is bio-identical estrogen and progesterone protect your bones from osteoporosis. The incidence of some form of osteoporosis in the aged is very high. Which means MOST people will get osteoporosis. MOST WOMEN DON'T GET CANCER.... MOST WOMEN DO GET OSTEOPOROSIS. A relatively low percentage of women get cancer and die from it.
   A. This email summarizes one of the basic dilemmas regarding the benefits versus the risks of hormone replacement therapy. Does the benefit of decreased bone fractures outweigh potential harm from an increased cancer rate, heart attack, stroke, or other problems that are related to hormone replacement therapy? Would having an adequate intake of calcium and vitamin D, along with exercise and weight training reduce or eliminate the need for hormone replacement? Science does not have the full answers at this time.

Q. In your Jan. 2009 newsletter, you site an MSNBC news article that reports taking menopause hormones for five years doubles one's risk of breast cancer. The article clearly stated that the hormones studied were horse estrogen and synthetic progestin ingested by mouth. This is quite different than applying a cream of bio-identical hormones. It may be that these creams increase the risk, as well, but that is not part of the referenced study, and many contemporary studies indicate otherwise.
   A. Until long term studies are done testing bio-identical hormones in terms of their effect on breast cancer and how they compare to synthetic progestins and conjugated equine estrogens, it is premature to claim that one form has less risk than the other. What if bioidentical hormones end up being even more potent in stimulating certain cancers than synthetic progestins or equine estrogens? It took decades for the medical community to find out the full risks of hormone replacement and it may take a long time for women who are currently taking bioidentical hormones, under premature safety assurances by many natural hormone marketers and promoters, to find out that these medications have risks that we are currently not aware of. I did mention in the newsletter that if you were to use hormones as symptomatic relief for menopausal symptoms, my current impression is that it would be preferable to use natural hormones. If you are aware of long term studies regarding the safety of natural hormone use, please let us know.

Q. I received Dr. Sahelian’s January 2009 newsletter article with his comments on using estrogens and progestins to help with menopause symptoms. I feel it is very important to point out that the HRT used in the WHI study contained horse estrogen which is not the same as human estradiol now available in products such as Estrace and the Vivelle patch. While the horse estrogen does bind to human estrogen receptors, it does not have the same action as the human estradiol, ie. It fits in the lock but you can’t turn the key. Also, since the human body doesn’t have the enzymes necessary to break down the horse estrogen, it can stay in the body attached to the receptors for several months. Human estradiol is essentially out of the body in 2 days after you stop treatment. I have read several books and studies indicating that replacing a women’s estradiol with the so called bioidentical estradiol is very beneficial. I personally have found this to be the case.
   A. Scientists do get important clues by studying the effect of these hormones on receptors in a laboratory, but until actual human studies are done for several years with natural estrogens in varying dosages,  their safety will not be known to their full extent. When ingested orally these hormones are altered by the liver before they make it to the cells. Therefore, cell studies in a laboratory do not give us the full picture. Also, what if we find out someday that natural hormones stimulate cancers in certain tissues of the body more potently that the horse estrogens? At this time we don't have any long terms studies that compare bioidentical hormones to Premarin.

Other points to keep in mind:
How do we know the right dosages for these bioidentical hormones in terms of long term use? How many years should one take them? When should one stop using them?
How do we know which form of estrogen is best: estriol, estradiol, estrone, and in what proportions? How do we know whether slow steady release / absorption of these hormones is better or worse that a quick absorption with a high peak and low valley? How are we to know for sure whether compounding pharmacies are preparing the correct bioidentical hormones since there is little or no oversight?
How do we know which is better, oral or topical hormone use?
How do we know whether saliva testing is reliable? How is one to know the right hormone dosage to use based on saliva testing or blood testing? There is little evidence that a blood level or saliva level of a hormone can predict exactly the actual hormone amount a woman needs to take. The dosage of these hormones is most likely best managed through symptom relief of hot flashes, mood swings, sleep problems, and other symptoms rather than relying on blood or saliva levels.
Could natural progesterone have a protective effect on breast cancer but potentially cause other health issues such as an increased risk for heart rhythm disturbances?

My opinion as of February 2009
The bottom line is that every woman has to decide for herself whether the benefits of hormone use, in terms of menopause symptom relief and potential reduction of osteoporosis or treating other medical issues, outweighs the potential risks for cancer, heart attack, stroke, or other serious conditions from HRT use. Does the use of hormone replacement increase or decrease mortality? The answers are not yet in.
   Keep in mind that there is a physiological reason why hormone levels drop with age. The human body was not meant to be exposed to high levels of certain hormones with aging. Therefore, any form of hormone replacement through pills, creams, or shots, and whether synthetic or bioidentical, is not something the human body is genetically adapted to. Humans have lived on this planet for a long, long time but it has been only in the last few decades that doctors started prescribing hormone replacement therapy to such a large number of women. If, a decade or two from now, research shows bioidentical hormone use to be safe, I will wholeheartedly promote their use. Until then, women who are using these hormones, particularly in high dosages and for prolonged periods, are taking a gamble. If natural hormone replacement is the only solution to reducing your menopausal symptoms or taking care of other health issues you have, use the least dosage that works and for the shortest period of time. Exercise, weight training, calcium and vitamin D are a few good options in reducing the risk for osteoporosis. The risk for heart disease, stroke, and mental decline can be reduced through diet, exercise, low stress, yoga, deep sleep, and by taking certain natural herbs and supplements. See http://www.raysahelian.com/menopause.html and http://www.raysahelian.com/diet.html
   I want to emphasize that I am not in favor, nor am I against, the use of hormone replacement therapy. I just want women to be aware of all the benefits and risks and make an informed decision. The quality of life of many women has improved through HRT, whether synthetic or bioidentical, while other women have discovered the use of hormones has caused more problems than benefits. I support a woman's decision, no matter what, as long as she is informed and knows all the options, benefits and risks. I came across an interesting article that you may appreciate: http://online.wsj.com/article/SB123362356236541855.html

Q. Many herbalists I know suggest that supplements should be taken a half-hour before meals or 1-2 hours after meals on an empty stomach. In contrast, supplement bottles often state on the label to take with meals. When should supplements be taken, with or without meals?
   A. It depends. As a general rule, if you are taking a supplement in order to experience a quick mental, sexual, or physical effect from it, it is best to take it on an empty stomach so that it is absorbed quickly and without interference from food. For instance, Mind Power Rx can provide quicker and more noticeable mental enhancement when taken on an empty stomach, but it is also possible that the side effects would be more pronounced, such as restlessness, if the contents of the capsule are absorbed too quickly. When taken with a meal, the effects become more subtle and steadier. Another option is to take it a few minutes before a meal to get both a quick and slow absorption. Older people may wish to take them with a meal to cushion the effects. Passion Rx would fall in the same category as Mind Power Rx. As far as taking supplements for long term health, where an immediate reaction is not needed, for instance antioxidant pills or multivitamins, one can take them with a meal, usually breakfast. These are just guidelines and each person would need to try their supplements with a meal or on an empty stomach to determine which method works best for them.

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SUPPLEMENT RESEARCH UPDATE - by Ray Sahelian, M.D.
Vol. 6, Issue 1 -- January, 2009
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Doctors gave wrong advice for several decades by routinely recommending women after menopause take estrogen and progesterone pills. It now seems quite clear that taking estrogen and progesterone after menopause increases the risk for breast cancer. In fact, a new study finds the use of menopause hormones for five years doubles the risk for breast cancer. Even women who took estrogen and progestin pills for as little as two years had a greater chance of getting cancer. And when women stopped taking the hormones, their risk was reduced, returning to a normal risk level about two years after quitting the hormones. The study results are from the Women's Health Initiative which tested estrogen and progestin pills that doctors long believed would prevent heart disease, bone loss and many other problems in women after menopause. The actual estrogen and progestin combination in the study was Wyeth Pharmaceuticals' Prempro. The main part of the study was stopped in 2002 when researchers saw surprisingly higher risks of heart problems and breast cancer in hormone users. http://www.msnbc.msn.com/id/28222004/
   Although the benefit of natural herbs for menopausal symptom relief continues to be debated, at least there is no current evidence these herbs and supplements cause an increased risk of breast cancer. If you are a woman who has postmenopausal symptoms, and herbal therapies have not worked well, and hormone therapy is the only option, take the lowest dosage possible, use natural forms of these hormones, and take them for as little time as possible. Are bio-identical hormones safer? I will discuss this in the next issue. See http://www.raysahelian.com/menopause.html

PRODUCT DISCOUNTS at Physician Formulas -- For the next few days all subscribers are eligible to a FREE bottle of DMAE. DMAE is a methyl donor used for mind enhancement and mental clarity. The following products are on sale.  Diet Rx is a popular herbal appetite suppressant. Most users notice appetite suppression within 2 or 3 days of use and report being full while eating less food. Astaxanthin is a natural and potent carotenoid antioxidant. Fenugreek supplement helps support sugar metabolism and may help maintain a healthy blood sugar level. Indole 3 Carbinol is an extract from cabbage, cauliflower, and Brussels sprouts. Indole-3-carbinol is converted in the gut to diindolylmethane (DIM) which has anti-tumor activity. Nattokinase is a blood thinning and blood clot dissolving enzyme. Discuss with your doctor before using this supplement especially if you take aspirin or other pills that thin the blood.

1. Why not use natural brain boosters instead of prescription brain boosting drugs?
According to recent trends, some people are increasingly turning to brain-enhancing drugs like Ritalin to enhance their performance in school or at work. Surveys on college campuses have found that drugs like Novartis' Ritalin, or methylphenidate, and Cephalon's Provigil, or modafinil, for narcolepsy are being used by students, professors and others as a way to get a competitive edge.
   Most people are not aware that there are quite a number of natural pills that improve concentration, focus and alertness and these are much safer than the prescription drugs. Some of the well known natural mind boosters include acetyl l-carnitine, DMAE, ginkgo biloba, trimethylglycine, dimethylglycine, cdp-choline, and bacopa monnieri. A free DMAE bottle is being offered, use half a capsule at first with breakfast. High dosages of DMAE can cause tenseness. A good combination I have formulated is Mind Power Rx which includes most of these supplements, including bacopa (see below). My book, Mind Boosters, has a full review of these, and other, mind enhancing supplements. See http://www.raysahelian.com/memory.html

2. Bacopa monnieri herb for better memory
Researchers at the Brain Sciences Institute, Swinburne University, in Australia gave healthy participants a bacopa extract for 90 days and compared the results to a group of individuals who got placebo pills. The bacopa monnieri product significantly improved memory accuracy. See http://www.raysahelian.com/bacopa.html 
   There are many herbs and nutrients that are potentially beneficial for memory and mental enhancement including acetyl l-carnitine, DMAE, certain B vitamins, fish oils and others. It is difficult to predict in any one individual which nutrient, herb, or combination will provide benefits.

3. Another reason to be cautious using statin drugs for high cholesterol
Even at normal doses, statin drugs may cause rare instances of eye muscle disorders. Drs. F. W. Fraunfelder and Amanda B. Richards, from the Casey Eye Institute, Oregon Health & Science University, Portland, evaluated reports from several sources. A total of 256 case reports of diplopia, ptosis, or ophthalmoplegia associated with statins were identified in databases. The average time to occurrence of the adverse drug reaction was 8 months. Among the 256 case reports, 62 patients stopped the statin drug and the diplopia or ptosis was resolved. Sixteen case reports indicate that the statin was started again and the diplopia or ptosis reoccurred. The problem is probably due to a localized myositis in the extraocular muscles just as statins can cause myositis in other skeletal muscles in the body. Lab experiments indicate that statin drugs reduce the ability of progenitor muscle cells to multiply and then repair and regenerate damaged muscles.

Emails
Q. I came across an article from the Los Angeles Times by Karen Kaplan (Dec. 21, 2008 front page) "Vitamin pills aren't a cure at all and can hurt..." I just want to know what you think about this. I am sure many Americans must have read this article too and must be feeling insecure about taking vitamin supplements now.
   A. I have not read this article. There are many opinions on the benefits and risks of supplements. Just as it would be meaningless to say all prescription medications are bad or all medications are good, it is meaningless to say all vitamins are bad or all vitamins are good. If a person finds taking supplements, makes them feel better, gives them more energy, makes them more productive, or improves their health or treats a particular medical condition, then it's a good thing. I am not yet convinced that taking very high dosages of supplements improves longevity.

Q. I was reading some of your prior newsletters and you mention that you occasionally drink diet soda. Isn't diet soda pure poison?
   A. I drink a can of diet or regular soda a few times a year whenever I have an urge for one. I do not claim to be, nor wish to be, a perfectionist. My philosophy is to live life as an A, not an A plus. It is too stressful, counterproductive, and too rigid to try to be perfect at all things all the time. There is no harm in drinking a can of soda a few times a year.

Q. I enjoy your newsletter. I notice that you are conservative when it comes to alpha lipoic acid. Juvenon website recommends 400 mg alpha lipoic acid a day along with 1,000 mg of acetyl l-carnitine for stimulating the mitochondria and help with longevity. Dr. Andrew Weil also touts the Juvenon formula. Do you have any evidence to base your position that these high dosages will not necessarily lead to a longer life or improved health?
   A. When a doctor, scientist or a supplement marketer promotes or recommends high dosages of a supplement or a combination of supplements with the promises of improved health and longevity, it is their responsibility to provide such evidence of health improvement rather than the responsibility of another doctor or researcher to provide contrary evidence or to defend a more cautious position. As of January 2009, I have not come across any human studies that taking Juvenon or high dosages of a combination acetyl l carnitine or alpha lipoic acid prolongs lifespan. In fact, in my experience, high dosages of alpha lipoic acid and acetyl l carnitine can disrupt sleep and ALA may even cause heart rhythm disturbances. If evidence is provided to me that taking several hundred milligrams of a combination of ALA and aceytl l carnitine for months or years provides health benefits, then I will reconsider my current viewpoint. These supplements may be used temporarily in higher dosages as a treatment for certain conditions, see below. See http://www.raysahelian.com/lipoic.html

Q. I started taking Advance Physician Formulas Acetyl l-Carnitine 300 mg and R Alpha lipoic acid 50 mg (one capsule each daily, taken in the morning) several weeks ago for fibromyalgia. I found that the effectiveness of one capsule of each per day does not last throughout the day (I work in the evenings). I began taking another of each in the late afternoon, maintaining the effectiveness of the pain reduction throughout the day, into the evening. My question is, what are the long term effects to the body of taking that much of the supplements?
   A. The long term effects of taking acetyl l carnitine alone, alpha lipoic acid alone, or the combination has not been studied. Most trials regarding these supplements have lasted at the most a few months. Possible side effects with high doses of these supplements include insomnia, excessive energy and increased heart rate, possibly leading to heart rhythm disturbances. The benefits of supplements and medications have to be balanced with their potential side effects. Ideally medications and supplements are taken in the lowest dosage that work and for the shortest period of time. Also taking breaks, for instance one day a week and a few days a month, can significantly minimize potential long term side effects. Perhaps other supplements or medications can be substituted during the breaks if the fibromyalgia symptoms are severe. See http://www.raysahelian.com/fibromyalgia.html

Q.  In your November 2008 newsletter there was a question about magnesium stearate. Recently, by chance, I have been trying to gather information about this additive since it seems to be in almost all capsule form supplements. This is what I have gleaned. Most of the time magnesium stearate is made by subjecting cottonseed or palm oil to high heat and pressure in the presence of a metal (in this case magnesium) catalyst for several hours. This creates a hydrogenated saturated fat. I did the math and it follows that if each 1000mg capsule has approximately 2% magnesium stearate in it (this seems to be about average) that means 20 mg of the capsule is hydrogenated fat. If I take ten capsules a day I would be ingesting about 70,000mg of hydrogenated fat per year or about 2 ounces. Like most people who pay attention to their health and do take supplements, I take a lot more than ten capsules a day. As a person who reads labels at the grocery store and promptly rejects any foodstuff with hydrogenated oil in it, why would I take a supplement with hydrogenated oil in it? I believe you when you say that you haven't seen any studies that indicate that magnesium stearate has any negative side effects. Common sense seems to suggest that if hydrogenated oil is no good for you when it’s in the food you eat, then its probably not good for you when its in your supplements. I have read, in my limited research, it is not necessary to use magnesium stearate to make supplement capsules; it’s just easier and cheaper. Its only purpose is to keep the production machinery running smoothly. To me, the choice between smooth running machinery and my health is really a no brainer. Also, I've read that the presence of magnesium stearate significantly impedes absorption of the nutrient. I really don't know if this information is accurate its just what I've read as I surfed many sites on the internet. What do you think?
   A. The amount of stearate consumption is even less since the magnesium part of magnesium stearate is part of the weight. Therefore, even if there is 20 mg or so of magnesium stearate in a 1,000 mg supplement capsule, some of that weight is magnesium, a healthy mineral. Some people can get quite obsessed about minutia that, practically speaking, have little or no influence on their health. One could get worried about these tiny amounts of hydrogenated magnesium stearate that is not likely to have any health effects yet have no concerns about getting in the car to drive to the local movie theatre. The risk of a car accident with bodily harm or inhaling pollutants while on the road are much more likely to occur than the minute amounts of magnesium stearate causing harm to health. If a person is that worried about every possible harm that could occur to them, then they would stay home and not even go out of the house. Then again that has its own risks since once could become vitamin D deficient due to lack of sunlight and possibly get depressed due to lack of human interaction. I have not seen any evidence that magnesium stearate impedes absorption of vitamins and herbs.
   The amount of hydrogenated oils you mention as a result of ingesting 10 capsules a day about the same or less than eating one donut over a period of one year. If your diet is so perfect (with absolutely no sugar, bad fats, cookies, cakes, ice cream, etc) that eating the equivalent of one donut over a period of year would concern you, then you may look to find supplements that do not contain magnesium stearate. I think there are more important health issues to worry about than the insignificant amounts of magnesium stearate in capsules.
   One other point to keep in mind is that some websites or nutrition writers who make a big deal about magnesium stearate may be doing so as a marketing tool in order to differentiate their products from others and to use this as a selling point. See http://www.raysahelian.com/magnesiumstearate.html