Immediately after I typed the title for this blog I realized that those who know me, and my twisted sense of humor, would assume that I was making a zombie joke. While I do entertain a fondness for The Walking Dead (both the graphic novels and the TV show) I actually happen to be referring to an article that was linked from a blog post giving otherwise good advice on helping your loved ones who have depression; the related tip involved making healthy food for people whose desire to get out of bed, let alone go to a grocery store and cook, is little to none. While the tips were actually very good (speaking from my experience), this article linked to this post which had me asking why I click on links in the first place. Is there any evidence to any of advice she is giving?
This article does not start off well, as she starts off talking about our depression caused by "toxins." As I have said before, "Toxin" is usually just a modern day word for "miasma," "imbalanced humors," or even "evil spirits." So it is a) unlikely that you can be cleansed from something that doesn't exist, and b) if you really were poisoned, it is highly unlikely that eating cilantro, eating certain herbs, eating diatomaceous earth, or juicing your vegetables will remove the poison (or clear up your depression for that matter). Remember to, there really isn't any good evidence that organic food is always safer or healthier for you. Now to qualify that last statement, I'm not talking about taste, environmental issues, or supporting your local farmers, or saving money by growing your own food here--that's another blog post. the point is that this paragraph on toxins is about fear and selling a book on a pointless "cleansing" procedure.
The section foods to include for a healthy brain is another interesting mixture or information that might have some truth to it mixed in with unfounded assertions. The assertions about obtaining adequate protein, adequate fat, adequate B vitamins, and antioxidants is good information for anybody, and basically part of a general healthy diet for anyone. And as I've said before, this really is an "anti-depression" diet, it's a "be healthy so you don't aggravate or develop underlying health conditions that might contribute to depression" diet. Now, the point about getting adequate fat is intriguing to me, as there have been some studies (1, 2) that indicate that a very low fat diet can also increase a risk for depression, but, as the Psychology Today article pointed out, finding the causes is complicated. It is possible that those who ate too low in fat didn't get enough essential fats (like the omega-3s), or that they weren't getting enough fat to keep them satiated at meals and the subsequent hunger influenced depression, or that they replaced the fat with refined carbohydrates which led to blood glucose regulation issues which influenced depression, or maybe some combination thereof. I also find the link between gut bacteria and depression to be intriguing, but there isn't really a clear link there either (Link).
When it comes to testing urine for neurotransmitters, I recommend reading this excellent post from SciencebasedMedicine.org: Bogus Diagnostic Tests. Neurotransmitters are found in other tissues in the body (peripheral), and so any neurotransmitters that appear in the urine do not reflect the levels in the brain. As far as the supplements are concerned, remember that you don't need to supplement unless you are deficient, and that "natural" does not mean better or free of side effects. Notice that one of the supplements recommended, 5-HTP, has been associated with dizziness, nausea, and diarrhea (Link).
Several of the lifestyle changes like getting adequate sleep, meditation, limiting alcohol, and exercise have evidence to back them up, the others, not so much. Also remember too that when I talk about eating in such a way as to not aggravate other health conditions, I am not talking about dubious diagnoses like "Dubious Yeast Allergies."
Take home message--Eating a healthy diet, particularly with the help of loved ones when you don't feel like cooking, can help alleviate symptoms of depression. Unfortunately there are no certain "magic" foods or supplements that will relieve it.
Wednesday, February 19, 2014
Tuesday, February 11, 2014
Rehydration Solutions?
The norovirus has been in the news lately thanks to outbreaks at local schools and on a few cruise ships. As people recover from this illness the focus is often on rehdyration (replacing fluid loss from diarrhea and/or vomiting) as well as electrolyte replacement (replacing sodium and potassium lost from diarrhea and/or vomiting). You also want to make sure that the beverages that you use don't aggravate any nausea or diarrhea that you might currently have and make sure that the solution can be absorbed by the digestive system efficiently. Of course many people who are feeling terrible (or feeling stressed from caring for an ill person) will reach for what is readily available, which is often a sports drink such as Gatorade or Powerade or even just a regular sugary drink like a soft drink or kool-aid. But are these really the best things to offer for oral rehydration therapy after severe illness?
2 level Tablespoons (TBSP) of sugar
½ level teaspoon (tsp) of table salt (sodium chloride)
½ level teaspoon (tsp) of salt substitute such as No Salt (potassium chloride)
½ level teaspoon (tsp) of baking soda, dissolved into
4¼ cups (1 liter) of clean water
Add your favorite sugar free beverage mix to improve the taste.
All that said, an oral rehydration solution is only useful if to the sick person if he/she is willing to drink it. (One of my co-workers told me a story about how his cranky toddler threw a Pedialyte popsicle at him after tasting it). So you might be better off mixing your own where you can control the taste.
Also:
The evidence points to the answer being no for a variety of different reasons. First of all, the sports drinks like Gatorade may have enough sodium/potassium to replace sweat losses but not to replace losses from protracted/frequent vomiting and diarrhea. Second of all, the amount of sugar in sports drinks, and some sodas/sugar beverages, causes them to have a
high-osmolarity and can actually cause diarrhea and therefore more fluid/electrolyte losses. Third, sugary drinks like sodas also don't have the sodium and potassium needed to replace electrolyte losses. Fourth, some of the carbonated beverages might cause more stomach distension and promote that nauseated feeling.
A better option would be to choose a solution formulated to have the right amount of sodium, potassium and glucose (sugar) such as Pedialyte. For those of you who want to have additional control over the taste and flavoring of the solution, you can also make your own oral rehydration solution using this recipe used by the World Health Organization:
All that said, an oral rehydration solution is only useful if to the sick person if he/she is willing to drink it. (One of my co-workers told me a story about how his cranky toddler threw a Pedialyte popsicle at him after tasting it). So you might be better off mixing your own where you can control the taste.
Also:
- You might be able to to get away with using Gatorade, etc if your diarrhea/vomiting was very mild.
- Infants, frail elderly, and those who are immunocompromised are at a higher risk for dehydration and may need medical care.
- If you show signs of severe dehydration you need to seek medical care.
Thursday, February 6, 2014
Coconut oil for Everything?
Those familiar with this blog will be familiar with my love of infographics, where I get to dissect them, that is. So I was happy to see this appear in my feed to provide some blog fodder:
Coconut oil is a boon for those of us who don't eat dairy (for allergy or avoidance of animal products)but still need a cooking fat that will take high heat (think roasting vegetables), give a good mouth feel comparable to butter (think pie crust), can provide a creamy texture to soups (like a butternut squash bisque) and curries. But does it actually provide the above benefits?
1) Thyroid stimulating. There are no reliable sources or studies that indicate that coconut oil can help get people off their thyroid medication, not to mention that this particular paragraph says anything about the thyroid at all. As far as increasing your metabolism, the consistent use of coconut might help you burn a whopping 25-50 more calories a day. Every little bit helps, but keep in mind that 1/4 to 1/2 a slice of bread will give you 25-50 calories. So you still don't have much wiggle room there (Link)
2) Lowers cholesterol. The lauric acid can raise both HDL and LDL, which might improve the overall lipid profile, particularly if you are a lab rat. The human data is a little more sketchy. (Link).
3) Helps keep diabetes in check. There isn't any evidence that coconut oil stimulates the pancreas to produce more insulin, nor would this necessarily be beneficial if it did (because in the early stages of Type 2 diabetes the individual may be over producing insulin but the body can't use it efficiently). There is a possibility that coconut oil might improve one's sensitivity to insulin, which could ultimately help an individual have better blood glucose control or prevent the progression from pre-diabetes to diabetes, but we don't have enough good human studies to recommend it as a treatment.
4) Gastrointestinal malabsorption. Once again, there is no evidence that coconut oil applied to the skin can help people with fat absorption issues prevent fatty acid deficiency. The only human studies I could find used sunflower oil, and even those were small and requiring more research. Since coconut oil contains medium chain triglycerides, they do not require bile salts for digestion and passively absorb through the GI tract into the liver. This is a boon for those with fat malabsorption problems, but you still have to take it orally.
5) Helps with weight loss. The ways this is worded it makes it sound like any other fat would go immediately to the fat stores in your body, which sounds an awful lot like that tired old Weight Watchers' saying "A moment on the lips, a lifetime on the hips!" Of course, the body's ways of digesting, metabolizing, and storing is more complicated than that. I think what they might be getting at here is the problem/question that many people trying lose weight have to face, "How do I cut back on "x" without facing hunger that so intense that I can't think straight?" (There are many variations on that same question). Fat is satiating so those who try to cut out ALL fat will probably wind up with excessive hunger and have trouble keeping with their plan (or having a good quality of life). People who consume fat with abandon (and don't cut out the extra calories somewhere else) will have trouble losing weight as well. So an easily absorbed satiating fat, taken in the context of you cutting out calories somewhere else could be a useful tool in your weight loss regimen.
6) Kills Candida. I think in this case they are actually referring to a condition that Quackwatch calls the "Dubious Yeast Allergy" category, you can read Dr. Stephen Barrett's article about this here. You can't actually kill off a disorder that doesn't exist.
7) Supports the Immune System. The lauric acid has actually been studied as an anti-microbial agent in the treatment of acne, but no good studies exist as far as eating coconut oil to stave off the flu, etc. And remember, you may not want to "boost your immunity."
8) Reduces Heart Disease. There is a correlative link, but not a causative one in this case. Although it does cast doubt on the theory that all saturated fats raise your risk for heart disease.
9) Nourishing for the Brain. There was one doctor who performed one case study that said her husband's symptoms of Alzheimer's Disease improved through the use of coconut oil, but there have been no peer reviewed studies to support this. (Link)
10) Good for the Skin. This one actually shows some promise, at least in animal studies. (Link). Applying non-medical grade oil to any open wound would not be recommended, however.
Take home message--Including coconut oil as part of a portion controlled plan for weight loss and a carbohydrate controlled plan for diabetes can be useful, but don't expect a magical drop in weight.
Coconut oil is a boon for those of us who don't eat dairy (for allergy or avoidance of animal products)but still need a cooking fat that will take high heat (think roasting vegetables), give a good mouth feel comparable to butter (think pie crust), can provide a creamy texture to soups (like a butternut squash bisque) and curries. But does it actually provide the above benefits?
1) Thyroid stimulating. There are no reliable sources or studies that indicate that coconut oil can help get people off their thyroid medication, not to mention that this particular paragraph says anything about the thyroid at all. As far as increasing your metabolism, the consistent use of coconut might help you burn a whopping 25-50 more calories a day. Every little bit helps, but keep in mind that 1/4 to 1/2 a slice of bread will give you 25-50 calories. So you still don't have much wiggle room there (Link)
2) Lowers cholesterol. The lauric acid can raise both HDL and LDL, which might improve the overall lipid profile, particularly if you are a lab rat. The human data is a little more sketchy. (Link).
3) Helps keep diabetes in check. There isn't any evidence that coconut oil stimulates the pancreas to produce more insulin, nor would this necessarily be beneficial if it did (because in the early stages of Type 2 diabetes the individual may be over producing insulin but the body can't use it efficiently). There is a possibility that coconut oil might improve one's sensitivity to insulin, which could ultimately help an individual have better blood glucose control or prevent the progression from pre-diabetes to diabetes, but we don't have enough good human studies to recommend it as a treatment.
4) Gastrointestinal malabsorption. Once again, there is no evidence that coconut oil applied to the skin can help people with fat absorption issues prevent fatty acid deficiency. The only human studies I could find used sunflower oil, and even those were small and requiring more research. Since coconut oil contains medium chain triglycerides, they do not require bile salts for digestion and passively absorb through the GI tract into the liver. This is a boon for those with fat malabsorption problems, but you still have to take it orally.
5) Helps with weight loss. The ways this is worded it makes it sound like any other fat would go immediately to the fat stores in your body, which sounds an awful lot like that tired old Weight Watchers' saying "A moment on the lips, a lifetime on the hips!" Of course, the body's ways of digesting, metabolizing, and storing is more complicated than that. I think what they might be getting at here is the problem/question that many people trying lose weight have to face, "How do I cut back on "x" without facing hunger that so intense that I can't think straight?" (There are many variations on that same question). Fat is satiating so those who try to cut out ALL fat will probably wind up with excessive hunger and have trouble keeping with their plan (or having a good quality of life). People who consume fat with abandon (and don't cut out the extra calories somewhere else) will have trouble losing weight as well. So an easily absorbed satiating fat, taken in the context of you cutting out calories somewhere else could be a useful tool in your weight loss regimen.
6) Kills Candida. I think in this case they are actually referring to a condition that Quackwatch calls the "Dubious Yeast Allergy" category, you can read Dr. Stephen Barrett's article about this here. You can't actually kill off a disorder that doesn't exist.
7) Supports the Immune System. The lauric acid has actually been studied as an anti-microbial agent in the treatment of acne, but no good studies exist as far as eating coconut oil to stave off the flu, etc. And remember, you may not want to "boost your immunity."
8) Reduces Heart Disease. There is a correlative link, but not a causative one in this case. Although it does cast doubt on the theory that all saturated fats raise your risk for heart disease.
9) Nourishing for the Brain. There was one doctor who performed one case study that said her husband's symptoms of Alzheimer's Disease improved through the use of coconut oil, but there have been no peer reviewed studies to support this. (Link)
10) Good for the Skin. This one actually shows some promise, at least in animal studies. (Link). Applying non-medical grade oil to any open wound would not be recommended, however.
Take home message--Including coconut oil as part of a portion controlled plan for weight loss and a carbohydrate controlled plan for diabetes can be useful, but don't expect a magical drop in weight.
Thursday, January 9, 2014
To Drink or Not to Drink?
This past Tuesday the Centers for Disease Control (CDC) released new guidelines on the risks of consuming too much alcohol, and it appears that more of us might fall into the "excess drinking" category than we thought (Link). I think this article over at NPR sums up my initial reaction well in this statement : "But that doesn't seem to jibe with other studies that found that drinking alcohol makes for better heart health....." Fortunately, they also go on to say that the studies that indicated moderate consumption of alcohol is beneficial were based on population studies, not double blind studies, and they also reminded us that "correlation does not equal causation." In other words, people who drink moderately could also be engaging in other healthy behaviors and/or have a different set of genetics than people who are not drinking moderately. Which is also why the American Heart Association still does not recommend that people start drinking if they don't already do so.
So what kind of questions/considerations should a Skeptic ask/consider in light of the evidence that we do have as to whether or not to consume alcohol and how much? (Most of these questions are going to be based on individual health conditions; there are also plenty of social implications with excessive drinking that are also best discussed with your provider as well as your family, friends, or even a trained counselor).
1) Do you currently have any health conditions that would be made worse by consumption of alcohol? Some conditions, like liver disease, seem rather obvious. But some other conditions, like diabetic neuropathy, might be made worse by alcohol consumption as well. As with any type of health condition, you need to be in dialogue with your health care provider/specialist about the risks/benefits of consuming alcohol. You should take acute health conditions into consideration as well. For example, that hot toddy might help you feel better if you've got a head cold, but if you are recovering from an extended bout of the flu your body might not need one more thing to deal with.
2) Am I taking any medications that do not mix with alcohol? Some medications, when mixed with alcohol, could result in serious internal organ damage. Once again, you need to be upfront with your provider and/or your pharmacist about alcohol consumption so that you know if what you are taking is compatible with alcohol at all.
3) What is my daily caloric intake that I try to stay around to keep my weight under control? Alcohol has calories and needs to be applied toward your daily intake and quite often those calories can add up very quickly. There are plenty of resources on the Internet, and even on smart phones, that can help you get a good approximation for how many calories you are consuming per drink
4) For people with Type 2 diabetes/prediabetes and related conditions--How much carbohydrate is in what I am consuming? For people who are really working at controlling their blood glucose levels with diet and minimal medication/insulin, you may not have a lot of wiggle room in your meal time carbohydrate intake. Some of the beverages available might contain more carbohydrate than I would eat at one meal. As above, you can find resources online that can help you approximate how much carb you are taking in. For those with type 1 diabetes, always consume alcohol with food as you are more at risk for low blood glucose levels because alcohol inhibits gluconeogenesis in the liver.
5) How much is really in that glass that you are drinking? No seriously, how many ounces does your glass or bottle hold? That wine glass, etc might hold more than you think. So measure out your favorite wine, beer, etc at least one time so that you can get an idea of what your glassware holds. If at a restaurant or bar, ask how many ounces (they have to keep track of that for cost containment anyway) is in one of "their" glasses.
6) Does my alcohol consumption impact my appetite in some way? This can be either extreme, some people drink so much that they fail to take in enough nutrition, so you would definitely fall into the "excess consumption" category there. Some people find that that extra drink makes their appetite increase and they find it a lot harder to keep the calories under control.
7) Can I moderate my drinking? Some people find that in certain social situations that they find it very difficult to keep track of how much they are drinking. This could have some negative effects after that evening, but it could eventually thwart your other health goals as well. Put in place what you need to keep your social drinking under control.
Take home message--While we need more research on the long term effects of alcohol on cardiovascular health, etc, there are some known consequences for our weight control and everyday health that vary by individual.
So what kind of questions/considerations should a Skeptic ask/consider in light of the evidence that we do have as to whether or not to consume alcohol and how much? (Most of these questions are going to be based on individual health conditions; there are also plenty of social implications with excessive drinking that are also best discussed with your provider as well as your family, friends, or even a trained counselor).
1) Do you currently have any health conditions that would be made worse by consumption of alcohol? Some conditions, like liver disease, seem rather obvious. But some other conditions, like diabetic neuropathy, might be made worse by alcohol consumption as well. As with any type of health condition, you need to be in dialogue with your health care provider/specialist about the risks/benefits of consuming alcohol. You should take acute health conditions into consideration as well. For example, that hot toddy might help you feel better if you've got a head cold, but if you are recovering from an extended bout of the flu your body might not need one more thing to deal with.
2) Am I taking any medications that do not mix with alcohol? Some medications, when mixed with alcohol, could result in serious internal organ damage. Once again, you need to be upfront with your provider and/or your pharmacist about alcohol consumption so that you know if what you are taking is compatible with alcohol at all.
3) What is my daily caloric intake that I try to stay around to keep my weight under control? Alcohol has calories and needs to be applied toward your daily intake and quite often those calories can add up very quickly. There are plenty of resources on the Internet, and even on smart phones, that can help you get a good approximation for how many calories you are consuming per drink
4) For people with Type 2 diabetes/prediabetes and related conditions--How much carbohydrate is in what I am consuming? For people who are really working at controlling their blood glucose levels with diet and minimal medication/insulin, you may not have a lot of wiggle room in your meal time carbohydrate intake. Some of the beverages available might contain more carbohydrate than I would eat at one meal. As above, you can find resources online that can help you approximate how much carb you are taking in. For those with type 1 diabetes, always consume alcohol with food as you are more at risk for low blood glucose levels because alcohol inhibits gluconeogenesis in the liver.
5) How much is really in that glass that you are drinking? No seriously, how many ounces does your glass or bottle hold? That wine glass, etc might hold more than you think. So measure out your favorite wine, beer, etc at least one time so that you can get an idea of what your glassware holds. If at a restaurant or bar, ask how many ounces (they have to keep track of that for cost containment anyway) is in one of "their" glasses.
6) Does my alcohol consumption impact my appetite in some way? This can be either extreme, some people drink so much that they fail to take in enough nutrition, so you would definitely fall into the "excess consumption" category there. Some people find that that extra drink makes their appetite increase and they find it a lot harder to keep the calories under control.
7) Can I moderate my drinking? Some people find that in certain social situations that they find it very difficult to keep track of how much they are drinking. This could have some negative effects after that evening, but it could eventually thwart your other health goals as well. Put in place what you need to keep your social drinking under control.
Take home message--While we need more research on the long term effects of alcohol on cardiovascular health, etc, there are some known consequences for our weight control and everyday health that vary by individual.
Tuesday, December 24, 2013
Does Alcohol Keep Me Warm?
Yesterday I was listening to this rather entertaining story on NPR's "All Things Considered" involving variations on eggnog/holiday drinks: Don't Knock the Nog Until You've Tried this One. I am definitely in the "eggnog is icky" camp (and I'm dairy allergic) but I like hearing tales of recipe improvement, so I was listening happily until the person being interviewed made the off the cuff remark about "some booze to keep you warm." Some of you might be wondering if this is true, particularly if you remember the Bugs Bunny cartoons where St. Bernard dogs were used in avalanche "rescues" like this one:
Some of you might also get a warm, flushed feeling when you drink alcohol, as do I. Unfortunately, whether it's brandy, rum, or even the gin in the martini (assuming cartoon St. Bernard dogs prefer gin), the booze will not serve to keep you warm while you're skiing, working outside, or chasing rabbits. When you drink alcohol, even a swallow or two, the blood vessels under your skin artificially dilate and your warm blood moves closer to the skin, so you feel a temporary wave of warmth. The problem, however, is that the warm blood moves away from your internal organs and causes your core temperature to drop. If you were going to be outside in cold temperatures for a long period of time, you will be at an even higher risk of hypothermia. Also, if you drink enough to impair your judgement, you might not come inside out of the cold when you need to, putting you at more risk. So if you are planning on being outside for a long period of time, avoid the alcohol until you have the opportunity to be in a heated room.
While we are talking about myths, apparently the belief that St. Bernard's carried mini kegs of brandy around their necks while working as rescue dogs isn't true either. The belief started after a 17 year old painter named Edwin Lanseer painted Alpine Mastiffs Reanimating a Distressed Traveler in 1820 after being impressed by the site of these personable dogs trained by monks for alpine rescue. There is no other evidence that they actually carried brandy casks or that the monks actually thought it would be a good idea.
Take home message--Avoid alcohol if you are going to be working or playing out in the cold.
While we are talking about myths, apparently the belief that St. Bernard's carried mini kegs of brandy around their necks while working as rescue dogs isn't true either. The belief started after a 17 year old painter named Edwin Lanseer painted Alpine Mastiffs Reanimating a Distressed Traveler in 1820 after being impressed by the site of these personable dogs trained by monks for alpine rescue. There is no other evidence that they actually carried brandy casks or that the monks actually thought it would be a good idea.
Take home message--Avoid alcohol if you are going to be working or playing out in the cold.
Tuesday, December 17, 2013
Supplement Specifics
This week is not starting of well for those who hope to make money from selling vitamin supplements, particularly multivitamins. As summarized in this article three major studies published indicated that the use of a multivitamin did help ward off problems that strike fear into the hearts of many Americans: cancer, cognitive decline, and cardiovascular events.
One of the highlights of this article was this quote: "I think this is a great example of how our intuition leads us astray," Salzberg told Shots. "It seems reasonable that if a little bit of something is good for you, them more should be better for you. It's not true. Supplementation with extra vitamins or micronutrients doesn't really benefit you if you don't have a deficiency." (emphasis mine).
When I pasted this article on my Facebook feed I people point out that they take [insert vitamin here] for [insert medical problem here]. Yes, of course you do. You are taking a SPECIFIC vitamin at a SPECIFIC dose for a SPECIFIC problem. That is different than throwing a random bunch of things and a problem that may or may not exist and not have any evidence that it's helping you. "But I don't eat right" is another admission that I've heard from my patients over the years. Well, you probably don't, but if you take a multivitamin to make up for your, lack of vegetables, you might still be getting too much of one thing and too little of another to really help. And of course, as stated in the news article, some people take a multi w/o regard for how certain vitamins might actually increase the risk for certain conditions at high doses, might exacerbate a condition you already have, or might interact with a medication that you are taking.
I have actually covered a similar topic over a year ago in this post, which includes info on why taking a multi probably doesn't help your less than stellar diet, and also talked about who may or may not benefit from a vitamin D supplement. Some of you are probably still wondering if you might need to have a supplement for a specific condition, so here are some questions to ask yourself. And of course, get a blood test to verify that you are deficient and discuss your supplementation with a trusted physician and/or pharmacist so that you do not do yourself any harm.
1) Do I have a health condition that might keep my body from absorbing certain vitamins or minerals? For example, if you have had gastric bypass surgery, you might need to supplement with B-12 as you may not produce enough of a substance call intrinsic factor to effectively absorb this from food.
2) Do I follow a diet that eliminates certain food groups/is considered restrictive by the culture I live in? For example, if you are vegan, you won't get B-12 from plant sources because plants do not typically store B-12. The "usual" plant sources, like seaweed, can actually contain substances that can keep you from absorbing B-12 (link), so you might be better off taking a supplement.
3) Do I take medications that can cause me to be deficient in certain vitamins/minerals? I have a lot of patients that are on diuretics ("water pills") for congestive heart failure, etc. This medicine also can cause them to lose a lot of potassium in the urine, and so they need to take potassium supplements to compensate. The supplements are usually pretty large doses, however, so they need regular lab work to make sure the potassium doesn't go to high (which could be fatal).
4) If I have a known deficiency, can I realistically eat the amount of food required to measure up to the amount in a supplement? For example, if you go to donate blood and find that your blood test was a tenth of a point off, you could probably just be extra conscious about your iron intake until your next attempt at giving blood. If your iron levels are low enough that your physician is recommending a supplement, however, you might have to eat the equivalent of 2-2.5 pounds of liver per day to get the supplement equivalent. I like liver, but not that much, nor would I want to pay for it. I would take a supplement.
5) Do I have a condition that can be helped by large doses of a certain vitamin/mineral (that is backed by evidence)? See my previous post about supplementation with omega-3 in the presence of high triglycerides in HIV/AIDS patients treated with anti-retrovirals. And remember, you will have to be monitored frequently to make sure that the potential side effects of those large doses are not outweighing the benefits.
Take home message--Find out if you really are deficient in something before taking a supplement that you don't need or could actually harm you. If you do need to supplement, work closely with your physician to make sure you are getting the amount that you need of that specific vitamin/mineral.
One of the highlights of this article was this quote: "I think this is a great example of how our intuition leads us astray," Salzberg told Shots. "It seems reasonable that if a little bit of something is good for you, them more should be better for you. It's not true. Supplementation with extra vitamins or micronutrients doesn't really benefit you if you don't have a deficiency." (emphasis mine).
When I pasted this article on my Facebook feed I people point out that they take [insert vitamin here] for [insert medical problem here]. Yes, of course you do. You are taking a SPECIFIC vitamin at a SPECIFIC dose for a SPECIFIC problem. That is different than throwing a random bunch of things and a problem that may or may not exist and not have any evidence that it's helping you. "But I don't eat right" is another admission that I've heard from my patients over the years. Well, you probably don't, but if you take a multivitamin to make up for your, lack of vegetables, you might still be getting too much of one thing and too little of another to really help. And of course, as stated in the news article, some people take a multi w/o regard for how certain vitamins might actually increase the risk for certain conditions at high doses, might exacerbate a condition you already have, or might interact with a medication that you are taking.
I have actually covered a similar topic over a year ago in this post, which includes info on why taking a multi probably doesn't help your less than stellar diet, and also talked about who may or may not benefit from a vitamin D supplement. Some of you are probably still wondering if you might need to have a supplement for a specific condition, so here are some questions to ask yourself. And of course, get a blood test to verify that you are deficient and discuss your supplementation with a trusted physician and/or pharmacist so that you do not do yourself any harm.
1) Do I have a health condition that might keep my body from absorbing certain vitamins or minerals? For example, if you have had gastric bypass surgery, you might need to supplement with B-12 as you may not produce enough of a substance call intrinsic factor to effectively absorb this from food.
2) Do I follow a diet that eliminates certain food groups/is considered restrictive by the culture I live in? For example, if you are vegan, you won't get B-12 from plant sources because plants do not typically store B-12. The "usual" plant sources, like seaweed, can actually contain substances that can keep you from absorbing B-12 (link), so you might be better off taking a supplement.
3) Do I take medications that can cause me to be deficient in certain vitamins/minerals? I have a lot of patients that are on diuretics ("water pills") for congestive heart failure, etc. This medicine also can cause them to lose a lot of potassium in the urine, and so they need to take potassium supplements to compensate. The supplements are usually pretty large doses, however, so they need regular lab work to make sure the potassium doesn't go to high (which could be fatal).
4) If I have a known deficiency, can I realistically eat the amount of food required to measure up to the amount in a supplement? For example, if you go to donate blood and find that your blood test was a tenth of a point off, you could probably just be extra conscious about your iron intake until your next attempt at giving blood. If your iron levels are low enough that your physician is recommending a supplement, however, you might have to eat the equivalent of 2-2.5 pounds of liver per day to get the supplement equivalent. I like liver, but not that much, nor would I want to pay for it. I would take a supplement.
5) Do I have a condition that can be helped by large doses of a certain vitamin/mineral (that is backed by evidence)? See my previous post about supplementation with omega-3 in the presence of high triglycerides in HIV/AIDS patients treated with anti-retrovirals. And remember, you will have to be monitored frequently to make sure that the potential side effects of those large doses are not outweighing the benefits.
Take home message--Find out if you really are deficient in something before taking a supplement that you don't need or could actually harm you. If you do need to supplement, work closely with your physician to make sure you are getting the amount that you need of that specific vitamin/mineral.
Monday, December 9, 2013
Too (En)Riched for My Blood?
I just got a reminder e-mail for my regularly scheduled blood donation at one of our local blood donation centers. I always appreciate the reminders mostly so I can make sure my smartphone/calendar reminders are set up, but also because the donation also changes my eating/drinking/exercise habits around that time. I usually do not have a problem with the before donation tests that assesses my hemoglobin (the protein in my red blood cells that carries iron), but I know plenty of people that have shown up for their donation and were told that they did have a low hemoglobin. So this was on my mind when this particular infographic showed up in my Facebook news feed:
And so the "is this true?" part begins.
First of all, I have a problem with the use of the word "anemia." Anemia by itself means that there is a reduced number of red blood cells and/or hemoglobin in the blood; however, there are hundreds of different types of anemia and a variety of causes depending on what type you have (Which you can read more about here). If you are "anemic" because of blood loss from falling and cutting yourself on a sharp object, for example, then you are going to need a transfusion and eating certain foods isn't going to help you. Hopefully that type of example would be obvious, but I try not underestimate what people what people will and won't do, particularly if medical care is not readily available to them for whatever reason. But for the sake of seeking out the original intent of this infographic, however, we will assume that this infographic speaks to anemia as a result of limited intake of iron.
Second of all, we also need to recognize the type of iron that your body absorbs the best from from food (aka the most bioavailable) is a type of iron called "heme iron" that is only found in animal protein sources (Link with links to other sources). So if someone is looking to get what is truly best absorbed, vegetable sources or non-heme iron simply does not fit the bill. The other related problems are that sometimes you are not going to eat enough of a certain food, like garlic, to be considered a good source of iron, and most plant tissue contains something called phytic acid which can prevent iron from being absorbed by the body (Phytic acid by itself is not bad, it's how plants store the mineral phosphorus and might actually play a role in keeping us from absorbing too much of certain minerals. Like anything else, it's the amount that matters). So as a primary way of preventing anemia, I wouldn't put any of these on my top eight list.
"That's nice SkepticRD, but I refuse to eat animal products for [insert reason here] or I have trouble buying sources of heme iron for [insert reason here] and what I really want to do is see if there is something I can do to help me absorb non-heme iron better."
Fair enough. First of all, go back to this link to find other, and sometimes better, sources of non-heme iron that are not listed here. Second of all, when it comes to beans, nuts, and grains you can try soaking (48 hours or more), sprouting, and cooking to activate the enzymes in the plants that break down phytic acid. Third, you can include more vegetables that have been fermented in your diet. Fourth, you can make sure that you eat the non-heme iron foods with vitamin C rich fruit and vegetables. Fifth, be aware of foods that you are eating that are rich in calcium as they can also prohibit absorption of iron rich foods. Sixth, you can realize that there is a lot of work involved in doing all of the above steps, and you might want to have some compassion on those who choose to get their iron from heme sources.
Take home message---If you have anemia, discuss this with your physician to try to determine what type of anemia and potential causes. If you need to improve your diet, go for the heme sources or be prepared to do a little more work for the non-heme ones.
First of all, I have a problem with the use of the word "anemia." Anemia by itself means that there is a reduced number of red blood cells and/or hemoglobin in the blood; however, there are hundreds of different types of anemia and a variety of causes depending on what type you have (Which you can read more about here). If you are "anemic" because of blood loss from falling and cutting yourself on a sharp object, for example, then you are going to need a transfusion and eating certain foods isn't going to help you. Hopefully that type of example would be obvious, but I try not underestimate what people what people will and won't do, particularly if medical care is not readily available to them for whatever reason. But for the sake of seeking out the original intent of this infographic, however, we will assume that this infographic speaks to anemia as a result of limited intake of iron.
Second of all, we also need to recognize the type of iron that your body absorbs the best from from food (aka the most bioavailable) is a type of iron called "heme iron" that is only found in animal protein sources (Link with links to other sources). So if someone is looking to get what is truly best absorbed, vegetable sources or non-heme iron simply does not fit the bill. The other related problems are that sometimes you are not going to eat enough of a certain food, like garlic, to be considered a good source of iron, and most plant tissue contains something called phytic acid which can prevent iron from being absorbed by the body (Phytic acid by itself is not bad, it's how plants store the mineral phosphorus and might actually play a role in keeping us from absorbing too much of certain minerals. Like anything else, it's the amount that matters). So as a primary way of preventing anemia, I wouldn't put any of these on my top eight list.
"That's nice SkepticRD, but I refuse to eat animal products for [insert reason here] or I have trouble buying sources of heme iron for [insert reason here] and what I really want to do is see if there is something I can do to help me absorb non-heme iron better."
Fair enough. First of all, go back to this link to find other, and sometimes better, sources of non-heme iron that are not listed here. Second of all, when it comes to beans, nuts, and grains you can try soaking (48 hours or more), sprouting, and cooking to activate the enzymes in the plants that break down phytic acid. Third, you can include more vegetables that have been fermented in your diet. Fourth, you can make sure that you eat the non-heme iron foods with vitamin C rich fruit and vegetables. Fifth, be aware of foods that you are eating that are rich in calcium as they can also prohibit absorption of iron rich foods. Sixth, you can realize that there is a lot of work involved in doing all of the above steps, and you might want to have some compassion on those who choose to get their iron from heme sources.
Take home message---If you have anemia, discuss this with your physician to try to determine what type of anemia and potential causes. If you need to improve your diet, go for the heme sources or be prepared to do a little more work for the non-heme ones.
Subscribe to:
Posts (Atom)