MD and I just got back from yet another cross-country trip, which gave me the opportunity to catch up on my reading.  While reading a golf magazine, of all things, I came across an article that demonstrates why all such articles should be taken with a grain of salt.  I can’t tell you how many letters MD and I get from people who become concerned because they read a piece in a magazine or newspaper that, for whatever reason, got under their skin.  So, I thought dissecting this article like I did a while back with a scientific study would be instructive.

Before taking these kinds of pieces seriously, you’ve got to realize how they are structured.  And believe me, they are as structured as a sonnet.

Freelance writers are always trying to get their pieces sold, and they write them to a formula that most magazines demand, which is why most of them are pretty much the same.  Just switch the experts and the subjects and you’ve got an article on most anything.  Magazine editors give writers assignments often telling them what they want the article to say and how many words they want it said in.  The writer’s job is to follow the format, cram the info into the required number of words and sound authoritative.

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Changes in diabetic nephropathy

I received a short paper from a colleague in Portugal a couple of days ago that demonstrates in just a few pages how science should really work.

The paper from the journal Diabetologia reports on a study done in Pakistan showing that high-dose thiamin (vitamin B1) may be a valuable therapeutic agent in the treatment of diabetic nephropathy.   This small study certainly isn’t the final word, but it does show how medical science should work.

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Almost ten years ago when we were in practice in Boulder, Colorado we started looking for a good weightloss supplement to help our patients on low-carb diets lose a little more quickly.  We evaluated a lot of supplements on the market that were supposedly weight loss accelerators – chromium, hydroxycitric acid (HCA), ephedra, phenylpropanolamine, pyruvate and a few others – with out a lot of success.  The ephedra and, to a lesser extent, phenylpropanolamine unquestionably helped people lose weight, but were fraught with side effects.  Pyruvate showed promise, but was pretty expensive.  Our partner found a couple of medical papers using a combination of supplements, some of which individually didn’t work all that well but in combination seemed to show promise.  We cobbled together from healthfood-store supplements a sort of beta-prototype of this combination and used it on a number of our willing patients.  The vast majority, all of whom were on low-carb diets, tolerated the supplement and felt it made them lose weight better.

Happy with these results MD, our partner and I decided to take the next step and get an actual product made.  We did, and let patients try it.  Again, the patients liked the supplement and though they lost weight better on it.  Although we, too, thought the patients did better, we couldn’t really say because we hadn’t compared the supplement with a placebo in a controlled fashion.  We decided to take that next step.

We contacted a clinical lab that does testing for a fee (a substantial fee, I might add) and talked to the director of the facility, who was pretty discouraging.  He told us that he would be happy to take our money and test our supplement, but that we shouldn’t get our hopes up.  He related that his company had tested scores of nutritional supplements and had never found one that really did much.  And that he figured ours wouldn’t do well against placebo either.

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The standard Western diet is sadly lacking in omega-3 fats. Most of the recommendations we hear are to increase our intake of omega-3s by eating fish a few times per week. Most people who do eat fish eat tuna, the most readily available fish around that contains a halfway decent level of omega-3 fats.

But news reports over the past several years have put a lot of us off of tune, at least the canned variety, with reports of how much mercury such tuna contains. MD and I have opted to get our tuna as sushi grade tuna that we get either at Japanese restaurants or by purchasing it at a natural foods grocer and making our own sashimi. Now comes a report that gives us pause.

The International Herald Tribune published an article story showing that even sushi-grade tuna is crawling with mercury, which makes fish eating now a Faustian bargain. We can get the omega-3s, but at the expense of a ton of mercury. Read more »

The last post I wrote was on statin drugs and the couple before that were on the many benefits of vitamin D, one of which is the prevention of heart disease. According to a number of papers, statin drugs seem to increase levels of vitamin D in those who take them, which makes me wonder if any benefits that statins provide don’t come from this increase in vitamin D levels. If so, it would be a whole lot cheaper and a whole lot safer to simply take vitamin D3 supplements.

This issue reminds me of a talk on the mechanism of action of statins that I sat through at a medical meeting in Napa, California about 10 years ago. At that time researchers knew that along with their cholesterol-lowering capabilities statins also acted as anti-inflammatory agents. Statins increase the production of nitric oxide, an extremely short acting substance that has relaxing and anti-inflammatory effects on the lining of the arteries. The researcher giving the talk was from Harvard, and he had done a study in which he compared the nitric oxide releasing ability of l-arginine (an amino acid) and a statin drug. He found that the way that statins increased the production of nitric oxide mimicked the way l-arginine did the same thing. He proudly announced that his research showed for the first time how statins really worked to exert their anti-inflammatory effects. I wondered at the time why he didn’t just recommend that patients be given l-arginine – a natural substance with virtually no side effects – instead of statins? I would have asked the question, but this was a mainstream medical meeting, and I figured if I asked that question I might be stoned.

Thanks to this and subsequent research, we know that the anti-inflammatory benefits provided by statins can be had cheaper and more safely by taking l-arginine, available at health stores everywhere. ( Incidentally, know what the best natural source of l-arginine is? Wild game. Just another piece of evidence in favor of a Paleolithic diet.) And now we know that statins increase production of vitamin D, another heart-healthy substance.

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