SaluGenecists Science Blog

I just finished The China Study by T. Colin Campbell, and wanted to give a quick review. This book has been on my mind for a while because my nutrition students this year had a ton of questions about its unique conclusions.

Globally speaking, I was very happy with this book. Unlike most of the recent diet best-sellers that make it to the mega-stores, this book does not make any conclusions that I find bizarre, dangerous, or far out of step with current nutrition practice. It is written in a manner that is well-referenced enough to please the most pedantic of professors (my preferred nickname for myself), but easy enough to understand that I would be willing to share it with patients. I’ll give it two thumbs up.

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My friend got a package in the mail a couple days ago with a fake invoice enclosed. The package contained an Acai berry product, named in a way that implied it would aid weight loss. It looked quite official, sort of impressive.

But looking at the product ingredients, it was basically the same old same old weight loss product. It’s full of caffeiene and caffeine-like stimulants. There is no scientific reason to believe that adding Acai to caffeine improves the efficacy over caffeine alone.

Acai is a good source of antioxidants, and like other plant flavonoids, these antioxidants may provide some mild anti-inflammatory benefit. But this would also be true of a lot of fruits that we don’t have to fly in from the Amazon. As long as 70% of Americans don’t eat two servings of fruit per day, the conversation about which fruit is most nutrient-dense is a bit ridiculous.

The companies behind these multi-level marketed scams are already getting themselves into hot water. I’m sure excited to see what companies pop up to take their place.

Medicine is hard, even compared to other sciences. Take chemistry. If I put a tray of water in my freezer, leave it there for eight hours, and come back and check, it is always ice. And physics. If I throw a book across the room (probably in response to another Vista crash), it always ends up on the floor, and I could even do a mathmatical model to predict an area where it will land.

But with medicine, youneverknow. You can put a patient on the community standard of care protocol, and they can get worse. You can give them placebo, and they get better. Sometimes, they get better in one way and worse in another. You get the picture. What is interesting to me is how different professions have dealt with the uncertainty.

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There are two new studies out this week showing contradictory results of PSA screening effect on prostate cancer mortality. The debate is an interesting one on several levels, most importantly for clinical practice is the basic question of whether we should continue to screen or not. Although screening is widespread here, the U.S. Preventive Services Task Force concluded last year that the evidence was insufficient to support this practice fully.

Understanding or recommendation a course of action in this confusing environment is well beyond my knowledge base and pay grade. But one part of the debate that caught my eye was the realization that turning a healthy middle-aged man into a person who identifies himself as a cancer patient has real consequences. I’m glad to see emotional costs becoming part of this conversation.

Too bad we can’t have a real discussion of the financial costs, as well.

Sometimes, I feel kind of disappointed when an ancient naturopathic treatment fails to show significant treatment effect in a particular condition. But when the treatment is the stuff of nightmares, I’m sort of secretly glad.

Surely all my friends in the CAM community know of the semi-synthetic botanical derivative that has been linked with a 10-15% drop in overall mortality in multiple clinical trial settings. In addition to being efficacious, it is cheap, readily available, and relatively benign at the recommended doses. 

Based on these findings, the United States Preventive Medicine Task Force has issued what is, as far as I’m aware, the first recommendation for a botanically-derived agent as a primary prevention strategy. Any guesses what that agent is?

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Here’s an article from yesterday’s New York Times that answers a question that came up in my class last week - does autism exhibit a tendency to cluster in particular areas and/or groups? Like the article says, it is really hard to have a definitive answer to a question like this, given normal levels of statistical variation across a population. But they sure make a good case for a high prevalence group among Somali children born in Minnesota.

This is both devastating news for parents and an exciting development for people invested in finding a cause of autism. As the article details, there is no shortage of people who think they have a good theory, but they all have significant reasons to believe they don’t fit. 

Clearly, the cause of autism is multifactorial. The genetic database assembled by Cure Autism Now, along with sibling and twin studies, have shown a pretty clear role for genetics, but also that genetics aren’t destiny in this condition the same way they would be in cystic fibrosis. Hopefully, study of the highest risk groups will help us understand whether environment, in utero exposures, infectious agents, or any other unsuspected factor is playing a role in this complicated pathophysiology.

Here’s the other question this article suggests: is the grey lady getting story ideas through spying on my class? Either way, I’m grateful to them for helping answer a question that was over my head.

Human Chorionic Gonadotropin (hCG) injections have been used as an alternative medicine treatment for weight loss for over half a century. In many applications, although not all, it is prescribed along with a 500 calorie per day diet. Procedures vary, but in its original application, the recommended dose of hCG appears to have been 125 IU injection 6 days per week for 6 weeks.

Since conventionally trained doctors have never embraced this therapy, it exists largely in the domain of CAM practitioners. Let’s put it to the standard CAM therapy evaluation, shall we?

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Well, it depends who you ask.

According to this 2003 policy report from the American Board of Pediatrics, 200 IU per day was plenty to prevent vitamin D deficiency. If the goal is simply to prevent rickets, the skeletal condition related to overt vitamin D deficiency, this amount is probably sufficient.

A 2008 update to this policy statement updated the recommendation to 400 IU per day. This was based on a redefinition of what “normal” levels of vitamin D are; the standard was increased from greater than 27.5 nmol/L to 50 nmol/L. Currently, this is the standard of care in the pediatrics community.

A recent study from Lebanon, however, suggests that these standard recommendations are far too low. In this report, a daily dose of 2000 IU (actually, a weekly dose of 14000 IU) was far more likely than a 200 IU dose (OK, 1400 IU per week, that is) to normalize blood vitamin D levels. Better yet, there was no evidence for vitamin D toxicity in the study group.

Note that this 2000 IU per day dose is exactly the tolerable upper limit for vitamin D established by the National Academy of Sciences (upper limit is 1000 IU for infants under 1 yr). I think that safety concerns will keep the standard recommendations much lower than the 2000 IU level, even though the evidence for toxicity at this dose is lacking.

There continues to be a large disconnect between the conservative standard recommendations for vitamin D intake and the evidence emerging from clinical trials at a meteoric rate (150 clinical trials in the past year alone). In my clinical practice, I do see many people who have chosen to go up to the higher dose levels suggested by emerging research.

I continue to worry that there is a significant and as yet unidentified downside to keeping vitamin D levels up at a level upwards of 80 nmol/L. Our experiences with hormonal treatments like cortisol and estrogen should serve as reminders that the lack of acute toxic effect is not sufficient evidence of long term safety.

On the balance, I do think that the 2000 IU dose looks like a solid and safe recommendation for children and adults alike. I think that going beyond this may introduce unanticipated risks without having supportive evidence for preventive benefit.

Nonnutritive sweeteners are a controversial topic in the nutrition world, and an area where emotion and clinical data are often at cross-purposes. There are questions both about their safety and about their efficacy as part of a weight loss program. Today, let’s take on the latter question.

There are currently 5 nonnutritive sweeteners approved by the FDA for use in food products: saccharin, sucralose, aspartame, acesufame-K, and neotame. Other botanically derived nonnutritive sweeteners, stevia and lo han are available through a legal loophole that allows for their use as dietary supplements.

The important question on the table related to efficacy is whether adding these agents into a normal diet reduces total calorie intake. As you might guess, a large body of research has been published in an attempt to answer this question.

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