vitamin D makes muscles stronger in athletes (and you too)

A study published in the Oct 2012 issue of the Journal of Sports Sciences by the Research Institute for Sport and Exercise Sciences , Liverpool John Moores University , Liverpool , UK. (read abstract here) showed that 62% of a group of 61 professional UK athletes in winter months who were not taking vitamin D supplements were vitamin D deficient (average blood level of 25-hydroxy vitamin D was 12 ng/ml), which is quite low indeed. The control group was a group of 30 age matched healthy non athletes, who were also not taking vitamin D supplements, and 73% of them were deficient. The athletes were supplemented with 5,000 units of vitamin D per day (despite regulatory councils in both the US and the EU stating that 4,000 IU is the “upper safe limit”), which brought their average blood levels up to 41 ng/ml. (the units were expressed in nmol/L, which must be divided by 2.5 to get the units in ng/ml). The control group received a look alike placebo, and their blood levels of 25-hydroxy vitamin D levels did not change. The researchers then tested muscular performance with the following results: “There was a significant increase in 10 m sprint times (P = 0.008) and vertical-jump (P = 0.008) in the vitamin D group whereas the placebo showed no change (P = 0.587 and P = 0.204 respectively). The current data supports previous findings that athletes living at Northerly latitudes (UK = 53° N) exhibit inadequate vitamin D concentrations (<50 nmol · l(-1)). Additionally the data suggests that inadequate vitamin D concentration is detrimental to musculoskeletal performance in athletes. Future studies using larger athletic groups are now warranted.”

P values of .008 in a group this small (91 people) means that this effect is HUGE. Many clinical trials require thousands of participants to obtain statistically significant results, with p values of only .05   — .008 is HIGHLY significant.  Of course, skeletal muscle in professional athletes and elderly people, who are prone to falls and hip fractures, is made of the same stuff. Studies from years ago have shown that vitamin D supplementation reduces falls in the elderly. Muscle is muscle. Muscle, indeed EVERY tissue in the human body functions better with blood levels of 25 hydroxy vitamin D above 40 ng/ml (I prefer 50 ng/ml, for optimum health, and in my cancer patients, I aim for 70-80 ng/ml). Any athlete, trainer, or owner of professional sports team who is not measuring blood vitamin D levels and supplementing vitamin D to be sure their blood levels are >40 ng/ml is missing a very significant competitive edge. And if you have elderly parents who are looking frail, ask their doctor to measure their blood levels as well, and see that they are corrected if low. This will not only reduce the risk of falls, but of many many negative health consequences. Vitamin D is not only a ‘vitamin’— it is the most potent steroid hormone in the human body. Before the industrial revolution when people started working inside, humans got it from the sun in the summer, and stored enough in body fat to make it through the winter. These days, most people require 4000 to 5000 IU per day for optimum function, during the winter months in temperate regions, and all the time for people who don’t get regular sun exposure without sunscreen in the summer months. An hour of sun exposure in mid summer produces 10 to 20 thousand IUs of vitamin D, which was discovered for the first time by Dr.  Michael Holick and his team in the late 1980s. Up till then everyone assumed that 400 IU of vitamin D (the amount in a teaspoon of cod liver oil, which has been known for 100 years to prevent rickets in a baby), was all that healthy adults needed. We were only off by a power of 10…….

 

standardized OPC extract of French Maritime Pinebark clinically useful in asthma management

A clinical trial done at the Chieti-Pescara University in Pescara Italy, published in the Sept 2011 issue of Panminerva Medica, showed that a surprisingly small amount of a standardized oliogmeric proanthocyanidin (OPC) extract of French Maritime Pinebark (Pycnogenol®, produced by Horphag Research), made a very significant difference to a group of chronic asthma sufferers, who were already being treated with inhaled corticosteroids. You can read the abstract here. One group received only 50 mg of the OPC concentrate twice daily, while continuing their inhaled corticosteroids, whereas the control group continued to receive only inhaled corticosteroids. It has previously been shown that OPCs decrease expression of an enzyme that produces highly inflammatory fatty acids called leukotrienes, which are known to mediate bronchial muscle inflammation in asthma. Over the 6 month period of the study, nearly 20% of the control group required an increase in the dose of inhaled steroids to keep their asthma under control, whereas none of the Pycnogenol group did. In fact, in the group taking the OPC supplement, 55% of them improved enough that they were able to lower their dose of inhaled steroids, vs only 6% of the control group that was able to lower their inhaled steroid dose.

To quote detailed results from the study: “The levels of asthma control in the 6 interventional months as compared to the same period in the previous year were compared. In the Pycnogenol® group, night-awakenings were less frequent, the number of days with PEF<80% were decreased, days with asthma score >1 were lower, requirement for salbutamol and additional asthma medication less frequent, and consultation of general practitioner and specialist required less commonly. All these parameters were statistical significantly improved in Pycnogenol® + ICS (inhaled corticosteroid) group versus the ICS control group where no considerable changes were observed. Various common signs and symptoms were evaluated by visual analog scale, (dry) cough, severity of chest symptoms, wheezing, dyspnea and daytime symptoms. In the ICS-only group values did not improve while they did improve significantly in the ICS + Pycnogenol® group (P<0.05 vs. ICS only group). A decrease by 15.2% of the specific IgE titer was found in the Pycnogenol® + ICS group, whereas the titer increased by 13.4% in the ICS-only group.”

All that means that the group that received 50 mg of OPC from pine bark supplement twice daily for 6 months experienced very significant clinical improvement in their asthma symptoms, and were able to decrease dependence on medication. That fact that the results were statistically significant with only 76 patients in the whole study indicate that this was a very large effect. Many clinical trials require thousands of patients to demonstrate a statistically significant improvement.

Having grown up with pretty severe asthma myself (I recall one of my professors in medical school telling me that I could expect to develop chronic obstructive pulmonary disease (COPD, also known as emphysema), by the time I would be 60, which I am now well past)– I’ve learned that many nutritional factors can help to heal asthma. In addition to OPCs,  Fish oil (and keeping dietary intake of omega-6 fatty acids low), Evening Primrose oil (or other source of gamma-linolenic acid, an omega-6 fatty acid that is actually anti-inflammatory) vitamin D (5000 IU per day), lipid extract of New Zealand Green lipped mussel,  recognition of food sensitivities (and avoiding those foods) all have helped to the point, that, except for several weeks after the occasional viral upper respiratory infection, I can exercise, even in cold air, without wheezing, be around cats without the asthma attacks that only 25 years ago were predictable after exposure to cats, and generally live an active and for the most part asthma free life. So the only surprise to me about this study, was how little Pine Bark OPC it took to make a very significant clinical difference in this group of people with moderately severe asthma. Personally I have experienced and also seen similar effects in other people with asthma, from supplementation with grape seed derived OPC, and with combinations of grape seed and pine bark OPC concentrates. The important thing is that they be high quality, high purity concentrates, as is the case with Pycnogenol®.

I’m also glad that my medical school professor (who was a specialist in pulmonology, ie study of lung diseases) turned out to be quite wrong about me!

 

fish oil improves working memory in healthy young adults

Omega-3′s, especially DHA research, just keeps confirming what our grandmother’s said about fish being ‘brain food’. Research headed by Rajesh Narendran at the University of Pittsburgh was published in the on line journal PLOS one in early October 2012, (you can read the rather technically written abstract here). This clinical trial tested working memory in 11 young men and women between the ages of 18 and 25, before and after 6 months of supplementation with 930 mg of EPA and 750 mg DHA per day.

Working memory is the memory that we use to hold a number of different tasks in mind–such as when we ask our kids to ‘go upstairs, put on your pajamas, wash your face, brush your teeth, then get get a book, get in bed, and then I’ll come up and read to you”. Until this becomes a routine, it requires working memory to keep all those steps in mind. We need it a lot working with computers, to follow a set of complex sequential tasks–the better our working memory, the less often we have to refer back to the directions.

There were a number of very surprising things about this study. First, they found that baseline working memory correlated rather well with the level of DHA found in each participant’s red blood cell membranes (a convenient place to test, since DHA and EPA are taken up in cell membranes). Further, at the end of the study, all 11 subjects had an improvement in working memory, which again correlated with the increase in DHA content of their red blood cell membranes.Researchers were a bit disappointed that the sophisticated brain imaging that they also did could not discern the mechanism by which this improvement in working memory occurred.

Researcher Bita Moghaddam commented “Before seeing this data, I would have said it was impossible to move young healthy individuals above their cognitive best. We found that members of this population can enhance their working memory performance even further, despite their already being at the top of their cognitive game.” Coauthor Matthew Muldoon noted “So many of the previous studies have been done with the elderly or people with medical conditions, leaving this unique population of young adults unaddressed. But what about our highest-functioning periods? Can we help the brain achieve its full potential by adapting our healthy behaviors in our young adult life? We found that we absolutely can.”

These levels of EPA and DHA can be achieved with 2 capsules of any high quality fish oil that is concentrated to at least 2/3 EPA+DHA (standard fish oil is 1/3 EPA+DHA). Be sure that it is from small ocean fish, such as sardines, which have lower levels of environmental contaminants to begin with, is protected from oxidation during processing, which should include molecular distillation to remove residual contaminants such as PCBs, and dioxins, and is preserved with potent antioxidants. So if you or your kids want to do well in school, 2 capsules a day of high quality fish oil appears to definitely provide a benefit.

 

omega-3 supplementation associated with longer telomeres

A few posts ago I noted that I think telomere science is one of the most exciting areas in health and medicine–it has largely replaced the free radical/oxidative stress theory of aging, rather it has encompassed it, as oxidative stress seems to age us BY shortening our telomeres. As does inflammation, psychosocial stress, poor diet (back to inflammation), and sedentary lifestyle. So I thought it of interest that a recent study published in the journal Brain, Behaviour, and Immunity a few weeks ago (you can read the abstract here) found that supplementing a group of healthy sedentary overweight middle aged and older adults with 2 different doses of fish oil fatty acids (1/3 were given a look alike fatty acid supplement which mirrors the fatty acid composition of the American diet, which is to say it was mostly omega-6 fats), not only reduced indicators of inflammation and reduced the ratio of omega-6 to omega 3 fats measured in the blood, but they also found that as the omega-6 to omega-3 ratio went down, the length of the participants telomeres went UP (that’s a GOOD thing). It seems that the most potent natural products for actually increasing telomere length are some specific compounds present in small quantities in astragalus root, but its nice to know that good old fish oil (and likely lots of the things that are otherwise good for us) slow the rate of telomere shortening–which is another way of saying ‘slow the rate of aging’. Its also looking like if we actually can make the telomeres in our stem cells longer, that we get biologically YOUNGER…..

 

fish, mercury, omega 3s, and heart disease

An intriguing new study published in the American Journal of Clinical Nutrition, took a look at fish consumption, mercury levels, and blood levels of long chain omega 3 fatty acids from fish, in relationship to heart disease in Scandanavian men. You can read the abstract (and the full paper) here . Basically what they found was that eating more fish raised both blood levels of EPA and DHA, but also increased measured mercury levels. Those with the highest levels of omega-3s and the lowest levels of mercury, compared with those with the highest mercury levels and lowest levels of omega-3s had a greater than 3 fold difference in diagnosis of heart and vascular disease. The authors noted: “Our model indicated that even a small change in fish consumption (ie, by increasing S-PUFA by 1%–blood levels of EPA+DHA–) would prevent 7% of MIs (heart attacks), despite a small increase in mercury exposure. However, at a high hair-mercury content, the modeled beneficial effect of PUFA on MI risk was counteracted by methylmercury.”

Although not stated in the paper, it still seems to me like the safest way to get your EPA and DHA is from high quality fish oils–those that have been molecularly distilled to remove environmental contaminants, such as PCBs and dioxins–mercury is never an issue, even in low quality fish oils, as it stays in the fish protein, and does not come out in the oil. But many low quality fish oils are also oxidized (rancid), which can increase oxidative stress in the body significantly. As noted in a recent post about the meta-analysis (desk research) which stated that fish oils supplements were of ‘no value’–see that post for all the reasons that this was a very poor ‘study of studies’–not the least of which reasons is that many of those studies used over the counter fish oils and didn’t analyze them for content, rancidity, or toxins. Not all fish oils are created equal. When you do eat fish, choose small fish, like sardines, herring (pickled is fine if you like them), anchovies, mackerel. And NEVER farmed fish–unless the are certified organic, with a natural food chain established, rather then feeding them pellets of grain (which are often GMO corn and soy). Virtually all tilapia (a marketing term for perch) are farm raised, and their fatty acid profile is closer to that of bacon than to that of fish. Caveat Emptor!

 

fish oil has no impact on heart disease?

An article published in the Journal of the American Medical Association (JAMA), has been widely publicized in the media, for its conclusion that ‘fish oil doesn’t help heart disease”. You can read the full abstract here:  Now, let’s take a look at these ‘findings”.  First of all this is a type of research called ‘meta-analysis’, in which no actual clinical research at all is done. It simply takes a look at lots of articles published on a particular subject, and tries to draw conclusions. I call this “armchair research”.  Particularly when many studies with different research designs are studied together, results can be very misleading. But there are also some assumptions that bear looking at. In case you didn’t click on the link to read the abstract, these were the conclusions of the meta-analysis: “Omega-3 fatty acid supplementation was not associated with a lower risk of all-cause mortality, cardiac death, sudden death, myocardial infarction, or stroke.

I have collected an enormous amount of data that strongly suggest multiple benefits from the consumption of omega-3 fatty acids for cardiovascular disease, cancer, neurological disease, auto-immune diseases, and even in bone, skin and lung health. There is no question that the dietary ratio of omega-3 to omega-6 fats is a major factor in how susceptible people are to chronic inflammation, which underlies most chronic modern maladies. Good quality (molecularly distilled, preserved by potent fat soluble antioxidants) fish oil is, in my opinion, much safer than actually eating fish, as it contains many fewer environmental contaminants, such as mercury, PCBs, dioxins, etc.  It also takes a long time for it to be incorporated into cell membranes and other body structures, so it is not something that produces dramatic effects in less than a year, and many of the studies analyzed in this meta-analysis, were shorter than one year–and these were not separated out from the analysis of longer studies.

Another key point is that there was some heterogeneity in study design, including in dosage of omega-3 fatty acid used and patient populations. There is much uncertainty regarding the potency and purity of the over-the-counter supplements.  The majority of people taking omega-3 supplements are taking cheap, poor-quality, low-potency, and often even rancid products.  The public doesn’t know any different, and unfortunately very few of these studies actually analyzed the products that were used. Moreover, the control groups were exposed to varying amounts of fish oils, and this could account for a lack of effect seen between experimental and control groups. Another issue is that when placebo controls were used, due to the fish odor of omega-3 fatty acid supplements, complete blinding of fish oil studies may not be feasible. This imperfect blinding was not considered in the quality assessment of the studies.

Most of the restenosis studies only presented data among those who completed their follow-up angiogram. Consequently, restenosis data were generally analyzed using a modified intention-to-treat, which may result in biased results (in other words, if someone felt great and didn’t come back for their folowup angiogram, they were counted as a non-responder).

Finally, due to the lack of individual-level data, they did not estimate the change in risk of mortality or cardiovascular outcomes over time. In other words did the folks taking a therapeutic dosage get better results?  How much EPA and DHA were people consuming?  Of course this is essential information.  Availability of individual-level data would also have allowed us to examine which subgroups may derive the greatest benefit from the use of these agents. This study adds nothing to our understanding of the role of omega-3 fatty acids in reducing risk of heart disease, and creates a lot of confusion in the minds of consumers (and doctors), who don’t understand research design. Remember the old adage about computers, which applies equally to meta-analysis studies: “GIGO”.  Garbage in, Garbage out. Oh, and you can’t compare completely different types of studies and draw any valid conclusions. Better to go do an actual study. But that requires a lot more money, a lot more thought, and a lot more work. There seems to have been a spate of “supplements don’t work” publications in scientific journals lately, which this one adds to. But the people who experience benefits of high quality supplements in their own bodies over time are not likely to believe them.

 

my interview tomorrow nite of “five to thrive” internet radio

Hey folks–doing what should be an interesting interview looking back over my career which began in natural medicine and developed into integrative oncology, nutrition and botanical medicine. I’m being interviewed by Karolyn Gazella, coauthor with naturopathic oncologist Lise Alschuler of a wonderful book called ‘Five to Thrive’-inspired by both authors’ encounters with cancer  both in themselves and in their families–and the things they learned that helped them not only to survive, but to thrive.  I met Lise when we both spoke at an International Medicine Conference about cancer in Australia last June, and she asked me if I’d consider being interviewed on their show. So, tomorrow night (August 22nd  at 8PM EST.) , you can go to www.w4cs.com and tune in.  See you there!

 

Curcumin prevents progression from pre-diabetes to diabetes

Generally speaking, my strategies for approaching complex chronic health problems such as diabetes is multi-pronged–whole foods low glycemic diet, increase physical activity (especially resistance training, which has an insulin like effect), stress management (to reduce autonomic nervous system imbalance, reduce sympathetic tone, increase parasympathetic tone), and botanical-nutritional supplementation. However, such complex interventions are challenging to study with conventional clinical trial type approaches, and single interventions, such as 1 nutritional supplement, tend not to work as well as global complex diet and lifestyle interventions. So I was very impressed to run across a study in a diabetes journal (read the abstract here) in which 9 months of supplementing a fairly modest dose (< 1 gram per day) of curcumin (concentrated from the spice turmeric, the basis of virtually all curry dishes), prevented progression from pre-diabetes to diabetes.  In the placebo group, after 9 months, 16% of the trial participants had progressed from pre-diabetes to full blown type 2 diabetes. In the curcumin supplemented group, none progressed to type 2 diabetes. This is a pretty impressive result for a single supplement intervention. Although it is possible to fully reverse pre-diabetes and often even type 2 diabetes with a comprehensive nutritional-lifestyle program (and sometimes the medication Metformin as well–after all, integrative medicine is here to stay), its clear that curcumin supplementation is a useful component of any blood sugar normalizing strategy. Even insulin resistance (the earliest form of pre-diabetes) increases risk for many of the major modern life shortening diseases such as heart disease, Alzheimer’s dementia, and cancer, so it is well worth working to reverse.  And as I like to say, “a curry a day keeps the oncologist away”!

 

Back to the Blogosphere

Hi folks–haven’t posted since late 2009, its been a busy couple of years. I’ve been involved in a lot of projects, speaking, writing, and consulting for other physicians about their patients.  I’ve been involved in some new areas of study, one of which is telomere science (subject of the Nobel Prize for Medicine in 2009), and which I think is potentially  one of the most significant biological discoveries, with very immediate applications for human health, and especially for healthy aging–something of great personal interest to me as I find myself in my mid 60s.

The length of our telomeres–the little caps that protect the end of our chromosomes, is what allows our stem cells to continue to populate the 50-100 trillion cells that make up each of our bodies. How we live, in terms of our nutrition, our environment, our physical activity levels, how much stress we’re under, and how we manage it, and to a minor extent, our genetic heritage, all influence how rapidly our telomere’s shorten. Ground breaking research by Maria Blasco in Spain, and many others, have indicated that the % of our cells with critically short telomeres is an excellent indicator of our risk for cancer and other degenerative diseases, as well as our likely health span and lifespan. I’ll have a lot more to say about this emerging field over the next few months and years.  Its good to be back!