Dietary supplements questioned

pillsThe best the experts can say is that the most commonly consumed vitamin and mineral supplements don’t cause any harm. That is as they barely provide any consistent health benefits at all. Still in the latest Australian diet survey almost a third of the participants reported that they had taken at least one dietary supplement on the survey day. Are we so gullible?

Or rather, some of you must be gullible. I haven’t taken any dietary supplements since my mum forced me to swallow a daily spoon of cod liver oil many, many years ago.

Our crusade

Thus we’ve been on a crusade now for some time to have people understand that it is money wasted to be buying most dietary supplements. And we have repeatedly directed an evil eye towards food supplements on this blog site, being it herbal supplements or micronutrients.

Sure, in cases where specific vitamin or mineral deficiencies have been identified by healthcare providers, they might be treated by taking an appropriate dietary supplement. Or, probably even better, diet adjustments to get the right nutritional balance from the food and drink consumed.

But you don’t have to take my word for it, just listen to the experts.

Further confirmation

publicationsThe negative view of dietary supplements was further confirmed by a recent systematic review of 179 existing scientific studies covering single randomized control trials published in English from January 2012 to October 2017. The supplements examined included vitamins A, B1 (thiamin), B2 (riboflavin), B3 (niacin), B6 (pyridoxine), B9 (folic acid), C, D, E, beta-carotene, and the minerals calcium, iron, zinc, magnesium and selenium. Multivitamins were defined as including most of these vitamins and minerals.

In studies testing the four common supplements of multivitamins, vitamin D, calcium and vitamin C, there was no reduction in incidence of heart disease, stroke or premature death. This means there was no benefit from taking them, but also no harm.

They also evaluated less common supplements that did have some positive impacts on early death, heart disease and stroke. Here they found folic acid supplements showed a reduction in heart disease and stroke.

While a small benefit for taking folic acid was found, researchers also found some adverse effects from supplementation. Among those taking statin medication to lower blood cholesterol, slow or extended release vitamin B3 (niacin) increased the risk of early death by 10 per cent.

For studies testing “antioxidant” supplements, there was a marginally significant increased risk of early death.

Surprised scientists

The authors actually expressed surprise to find so few positive effects of the most common supplements consumed. Therefore they concluded that in the absence of significant positive data — apart from folic acid’s potential reduction in the risk of stroke and heart disease — it’s most beneficial to rely on a healthy diet to get your fill of vitamins and minerals.

diet2_(Masahiro_Ihara)So far, no research on supplements has shown us anything better than healthy servings of less processed plant foods including vegetables, fruits and nuts.

Most people in Western countries don’t have an optimal diet. This review shows taking supplements as an “insurance policy” against poor dietary habits does not work. If it did, there would have been a reduction in early deaths.

Eat whole foods

Taking supplements is very different from eating whole foods. Complications or health problems due to nutrient intakes are virtually always due to taking supplements, not eating foods. When you concentrate on one vitamin, mineral or nutrient in a supplement, you miss out on the other phytonutrients found in plant foods that contribute to overall health.

Convinced now? Thought so.

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Better stop now!

pillsComplementary medicines, to use a nomenclature that make them sound really important, or simply homeopathic medicines or in some instances dietary supplements, have been questioned before. And we and many others have repeatedly issued warnings of lack of evidence for claimed effects, illicit adulteration and the use of cheap fillers instead of the claimed substance. But it seems to no avail.

Agreed, some complementary medicines have actually been proven to work.  But what use is that when many of the products as sold do not match the dosages that have been clinically proven. And if they do it’s virtually impossible for consumers to distinguish the real from the fraudulent products.

When 500 complementary medicines out of 11,000 on the market in Australia were checked by the regulator, the Therapeutic Goods Administration, 400 of the products had compliance breaches.

Not particularly good.

The nail in the coffin

Traditional Chinese medicine is widely used all over the world as a form of complementary medicine for various indications and for improving general health. There is also an ever-growing market worldwide for a variety of health products, which contain herbal or other natural ingredients with claimed nutritional, physiological or health-promoting effects.

Such products are widely believed to be ‘natural’ and safe by many consumers, but some can pose severe danger to health in that undeclared compounds are lurking in the supposedly beneficial remedies. Adulterations commonly include prescription drugs, drug analogues and banned drugs.

Scientists in Hong Kong recently examined the files of 404 patients seeking medical attention due to moderate to severe reactions (including deaths) to the use of complementary medicines or other health products. Testing the implicated products  found more than 1200 illicit compounds. The 487 complementary medicines or health products consumed by the patients contained on average three adulterants with a maximum of an astonishing 17 undeclared adulterants.

The details of the findings

The six most common categories of adulterants detected were NSAIDs (17.7%), anorectics (15.3%), corticosteroids (13.8%), diuretics and laxatives (11.4%), oral anti-diabetic agents (10.0%) and erectile dysfunction drugs (6.0%). None of them declared on the packet.

Sibutramine, a slimming agent (anorectic) that has been withdrawn from the market due to its association with increased cardiovascular events and strokes, was the single most common adulterant identified.

Other banned drugs, such as phenolphthalein, fenfluramine, phenformin, phenylbutazone and phenacetin, were also not uncommonly detected in these adulterated complementary medicines. These drugs were usually withdrawn from the market owing to their higher toxicities and potential carcinogenicity.

Drug analogues, for which the chemical structures are substantially similar to those of the original compounds, were also occasionally identified. These drug analogues were probably added to the illicit products in an attempt to evade detection by regulatory authorities. The presumption that these analogues have similar pharmaceutical effects as the original drugs is unproven and, worse still, they may lead to adverse effects that are different or even more severe than those associated with the original compounds.

Psychosis, iatrogenic cushing syndrome, and hypoglycaemia were the three most frequently encountered adverse effects. Other effects included heart palpitations, renal impairment, abnormal thyroid function, damaged liver function and adrenal insufficiency.

Serious warning warranted

pharmacy_(Chis_de_Rham)Disguised as natural and safe products, some complementary medicines are clearly hazardous to the public with the overall area needing new and effective regulatory control.

The Hong Kong scientists stressed that the findings should serve as a serious warning to consumers and health professionals. If still tempted to use complementary medicines, as a short term solution at least make sure that they come from a reputable manufacturer.

In the longer term there is an urgent case for introducing mandatory testing of all complementary medicines both for purity and confirmation of claimed health effects.

In the meantime it might be best to save your money rather than risk your health in filling the pockets of shonky operators.

Watch out for milk thistle!

milkthistleMilk thistle is a flowering herb related to the daisy and ragweed family. It is native to Mediterranean countries. It’s ironic that milk thistle is used as a dietary supplement often taken to help protect the liver, while it can be contaminated by high levels of mycotoxins that are potentially harmful to the liver.

This has again been confirmed by a recent report by the European Food Safety Authority looking at the presence of the two mycotoxins T2 and HT2 in the diet. They found that milk thistle contained about five times higher levels of the two mycotoxins than any other product tested, with 220 µg/kg (T2) and 370 µg/kg (HT2) on average for milk thistle compared to oats with 40 µg/kg (T2) and 90 µg/kg, the second highest contaminated product.

And it is not the first time that a dietary supplement of some sort is at the top of the contamination table for a range of harmful compounds. And still people take them to improve their health. What’s wrong?

A little bit of background

Milk thistle is a plant also known as Chardon de Marie, Holy Thistle, Lady’s Thistle, Lait de Notre-Dame, Marian Thistle, Mariendistel, Mary Thistle, Shui Fei Ji, Silibinin, and many other names (in case you are looking for it).

Silymarin is the main active ingredient in milk thistle. Silymarin is both an anti-inflammatory and antioxidant. But it is unclear what benefits, if any, silymarin may have in the body.

Irrespective of clear proof of any beneficial effects, milk thistle has been used in alternative medicine as a possibly effective aid in treating heartburn, or seasonal allergy symptoms. Other uses not proven with research have included treatment for malaria, mushroom poisoning, spleen or gallbladder problems, menstrual problems, liver problems, and other conditions.

Milkthistle-supplementThere is not enough scientific evidence to say whether or not milk thistle can help liver problems. Some early research suggests milk thistle may aid people with alcohol-related liver disease. Other studies show no improvement in liver function in this group of people.

Some studies also show milk thistle may offer a possible benefit for people whose liver is damaged by industrial toxins, such as toluene and xylene.

However, more information is needed before it is possible to say that milk thistle actually benefits the liver.

Thus, let’s be clear that medicinal use of milk thistle compounds has not yet been supported by any regulatory authority. Still they are in common use all over the world.

Possible effect of mycotoxin contamination

Contamination of milk thistle with T2 and HT2 toxins have been reported from several parts of the world. T2 toxin and its deacetylated form HT2 toxin are members of the large family of trichothecenes. Fusarium species are the predominant moulds that invade cereal crops and produce T2 and HT2 under cool and moist conditions. Similar to most trichothecenes, T2 and HT2 not only inhibit protein synthesis and cell proliferation in plants, but also cause acute or chronic intoxication of humans and animals.

Toxic effects include growth retardation, myelotoxicity, hematotoxicity, and necrotic lesions on contact sites.

And this can be serious business.

Alimentary toxic aleukia (in simple terms a decrease in important white blood cells), a disease which is caused by trichothecenes, killed many thousands of USSR citizens in the Orenburg District in the 1940s. It was reported that the mortality rate was 10% of the entire population in that area.

During the 1970s it was proposed that the consumption of contaminated food was the cause of this mass poisoning. Because of World War II, harvesting of grains was delayed and food was scarce in Russia. This resulted in the consumption of grain that was contaminated with Fusarium moulds, which produced the two mycotoxins.

So what to do?

As for many dietary supplements it is probably best to stay away at least until any beneficial effect has been finally proven. There is also very little official oversight of the composition of any dietary supplement product. It has been proven again and again that they might contain several other compounds than what is declared on the label. Some that are themselves directly toxic.

So don’t gamble with your health!

Omega-3 fatty acids and improved sleep

The benefits of omega-3 fatty acids

The benefits of increasing omega-3 fatty acid intake

We have been a bit hard on dietary supplements in previous posts, and fair enough. A decent diet and there is no need for pill popping. But there might be an exception, particularly if you go easy on fish. We are talking about omega-3 fatty acid supplements that we have written about before. And the list of beneficial effects are growing.

To recapitulate there are three omega−3 fatty acids that are important in human physiology: α-linolenic acid (18:3, n−3; ALA), eicosapentaenoic acid (20:5, n−3; EPA), and docosahexaenoic acid (22:6, n−3; DHA). They have either 3, 5, or 6 double bonds in a carbon chain of 18, 20, or 22 carbon atoms, respectively. Although the body can convert the short-chain omega−3 fatty acid ALA to long-chain forms (EPA, DHA), the efficiency is a low 5% in men, but greater in women.

New claim that omega-3 fatty acids can improve sleep

There are many health benefits of omega-3 fatty acids. Research shows strong evidence that the omega-3s EPA and DHA can help lower triglycerides and blood pressure. And there are studies showing that omega-3 fatty acids may help with other conditions, including rheumatoid arthritis, depression, and many more. Now they have been shown to also be associated with improved sleep patterns. At least in children.

And we are talking about a randomised placebo-controlled study and not some suspect epidemiological study. The researchers explored whether 16 weeks of daily 600 mg supplements of algal sources would improve the sleep of 362 healthy 7-9 year old UK school children. The children were supposed to have normal sleep patterns, but were all struggling readers at a mainstream primary school. As it happened parents revealed that four in ten of the selected children in the study also suffered from regular sleep disturbances. They showed resistance at bedtime, anxiety about sleep and constant waking in the course of the night.

Previous studies have shown that blood levels of omega-3 DHA in this general population sample of 7-9 year olds were alarmingly low overall, and could be directly related to the children’s behaviour and learning difficulties.

Improvements to sleep with higher DHA levels (Photo: rlcalamusa1)

Improvements to sleep with higher DHA levels (Photo: rlcalamusa1)

The new results showed that higher blood levels of the long-chain omega-3 DHA (the main omega-3 fatty acid found in the brain) were significantly associated with better sleep, including less bedtime resistance, parasomnias and total sleep disturbance. Higher ratios of DHA in relation to the long-chain omega-6 fatty acid arachidonic acid were also associated with fewer sleep problems.

Various substances made within the body from omega-3 and omega-6 fatty acids have long been known to play key roles in the regulation of sleep, with lower ratios of DHA linked with lower levels of melatonin. Maybe the behaviour and learning difficulties seen previously could be related to poor sleep.

To take or not to take the supplement

So should we recommend taking omega-3 fatty acid supplements? They seem to do a lot of good.

Not so fast! There is another brand new study showing no reduction in heart attack, stroke or heart failure among almost 1,100 people taking omega-3 supplements, compared to similar numbers of people taking other supplements or just an inactive placebo.

It has been conventional wisdom that saturated fats increase “bad” LDL cholesterol, which can cause plaques to form in  arteries and raise the risk of a heart attack or stroke, while omega-3 fatty acids were said to improve heart health because it increases your level of “good” HDL cholesterol. Good cholesterol is believed to help the body rid itself of bad cholesterol. While this is still true, neither effect seemed to make much difference for overall cardiac risk.

So in summary, it is clear that we need omega-3 fatty acids for numerous normal body functions, such as controlling blood clotting and building cell membranes in the brain.  And dieticians say that there’s no question that eating fish provides tremendous value in reducing risk for cardiovascular disease, but the use of a supplement – whether it’s a fish oil or any other nutrient – really needs to be handled carefully.

So we seem to be back to the old advice. Get your omega-3 fatty acids from food rather than dietary supplements if possible. If not, maybe the supplement can be justified.

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