Archive for the 'Nutrition' Category

May 31 2012

POM: Not So Wonderful

“POM Wonderful” is a brand of pomegranate juice. It is manufactured by a company owned by Linda and Stewart Resnick, California billionaires who pretty much single-handedly created a multi-million dollar market for pomegranate juice where none existed before. Or, as LA Times columnist Michael Hilzik wrote,

It has long been clear that the most wonderful thing about Pom Wonderful pomegranate juice is the spectacular marketing skill that persuades consumers to fork over their hard-earned cash for a liquid that sells for five to six times the price of, oh, cranberry juice.

He’s right about the expense: a daily 8 oz. dose of POM Wonderful juice costs about $780 annually according to a recent Federal Trade Commission case, which we’ll get to soon.

The Resnicks parlayed their success selling pomegranate juice into two additional products, both dietary supplements, in the form of POMx pills and POMx liquid. The Resnicks and their companies have shelled out $35 million in sponsored research to determine what health benefits might arise from ingesting pomegranate juice or its components, research they have not been shy about using in touting their products. The couple apparently has a flair for taking the mundane and making it appear, well, wonderful to the consumer – they also own Fiji Water and the Franklin Mint, among other business interests.

In 2010, the Federal Trade Commission (FTC) filed a complaint against Resnicks, one of their business partners, and two of their companies (which I’ll refer to collectively as “POM”), alleging unfair and deceptive trade practices. POM, according to the FTC complaint, made false and misleading claims that its POM products treat, prevent, and reduce the risk of heart disease, prostate cancer and erectile dysfunction.

An Administrative Law Judge (ALJ) agreed with the FTC and on May 17, 2012, issued a 335-page decision and cease and desist order, ruling POM lacked competent and reliable scientific evidence that drinking 8 ounces of POM Wonderful Juice daily, or taking one POMx pill, or one teaspoon of POMx liquid, treats, prevents or reduces the risk of heart disease, prostate cancer, or erectile dysfunction. In the Matter of POM Wonderful, LLC, et al., F.T.C. No. 9344 (May 17, 2012).

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Apr 20 2012

Spring Update on Prior Posts

Although I write the definitive entries on topics in this blog, new information trickles in after publication.  The new studies are often not worth an entire entry, recapitulating prior essays, but the new information is still worth a mention.  What follows are updates on topics covered in  prior SBM posts.

Raw Milk

In Oregon we are having a small outbreak of infections from consumption of raw milk.  Not a surprise, since milk is a wonderful culture media and the udder is just down the gravity well from the cows anus.  Raw milk violates the classic dictum “Don’t shit where you eat” although I understand the saying concerned dating in its original conception.

Although the sale of raw milk is illegal in muchof the US,  the law can be bypassed by owning the cow rather than buying the milk,  a reverse of dating advice.  Such is the case in Oregon, where 48 people are time sharing the cows responsible for the current outbreak.  There has been the spread of pathogenic E. coli to at least 5 people, mostly  children, and has lead to the hospitalization of at least 3 children.

Of course, it is hard to get infected. Humans have lived in Filth and Squalor (like Minneapolis and St. Paul or Buda and Pest) for centuries, drinking and eating contaminated food and enough survived perpetuate the species.  Most infections in the past would have been from consuming contaminated food and drink.  I have wondered if the reason fevers are often associated with diarrhea and/or vomiting is that it an evolved response for removing infected material as soon as possible.
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Mar 27 2012

CAM as a Dumping Ground

I know a woman who is a survivor of colorectal cancer. At one point, doctors had given up hope and put her in hospice, but she failed to die as predicted and was eventually discharged. She continues to suffer intractable symptoms of pain with alternating diarrhea and constipation. I don’t have access to her medical records, but she tells me her doctors have talked about irritable bowel syndrome (IBS) and have also suggested that the heavy doses of radiation used to treat her cancer may have caused permanent damage to her colon. Whatever the cause, her symptoms have seriously interfered with her mobility and her quality of life. Her health care providers have recently recommended questionable treatments in what I think can be construed as using CAM  as a dumping ground for difficult patients.

The Surgeon

Colonoscopy hadn’t shown any obstruction, but one of her doctors had hypothesized that her symptoms might be due to impaired bowel motility in the irradiated area. She was desperate enough to consider surgery if there was a chance that bowel resection or colostomy might improve her symptoms. She belongs to a large, well-known HMO with a good reputation. She asked her primary HMO physician who thought the idea was plausible and referred her to a surgeon. The first surgeon said surgery was not indicated and referred her to another surgeon on staff. In addition to being board certified in general surgery, the second surgeon was allegedly board certified in something related to CAM (my friend can’t remember his exact words and has been unable to verify any such credentials online).

The surgeon recommended acupuncture, not once but twice. My friend’s husband (who teaches statistics at a nearby community college) told the surgeon that he was fascinated by the challenges of double-blinded studies of acupuncture and that he was aware of no benefits beyond the placebo level. The surgeon then retreated a little and suggested that the primary benefit of acupuncture in treating IBS was the “relaxation” effect.

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Mar 01 2012

Is gluten the new Candida?

Much of the therapeutics I was taught as part of my pharmacy degree is now of historical interest only. New evidence emerges, and clinical practice change. New treatments replace old ones – sometimes because they’re demonstrably better, and sometimes because marketing trumps evidence. The same changes occurs in the over-the-counter section of the pharmacy, but it’s here marketing seems to completely dominate. There continues to be no lack of interest in vitamin supplements, despite a growing body of evidence that suggests either no benefit, or possible harm, with many products. Yet it’s the perception that these products are beneficial seem to be seem to continue to drive sales. Nowhere is this more apparent than in areas where it’s felt medical needs are not being met. I covered one aspect a few weeks ago in a post on IgG food intolerance blood tests which are clinically useless but sold widely. The diagnosis of celiac disease came up in the comments, which merits a more thorough discussion: particularly, the growing fears over gluten consumption. It reminds me of another dietary fad that seems to have peaked and faded: the fear of Candida.

It wasn’t until I left pharmacy school and started speaking with real patients that I learned we are all filled with Candida – yeast. Most chronic diseases could be traced back to candida, I was told. And it wasn’t just the customers who believed it. One particular pharmacy sold several different kits that purported to eliminate yeast in the body. But these didn’t contain antifungal drugs – most were combinations of laxative and purgatives, combined with psyllium and bentonite clay, all promising to sponge up toxins and candida and restore you to an Enhanced State of Wellness™. There was a strict diet to be followed, too: No sugar, no bread – anything it was thought the yeast would consume. While you can still find these kits for sale, the enthusiasm for them seems to have waned. Whether consumers have caught on that these kits are useless, or have abandoned them because they don’t actually treat any underlying medical issues, isn’t clear.

The trend (which admittedly is hard to quantify) seems to have shifted, now that there’s a new dietary orthodoxy to question. Yeast is out. The real enemy is gluten: consume it at your own risk. There’s a growing demand for gluten labeling, and food producers are bringing out an expanding array of gluten-free (GF) foods. This is fantastic news for those with celiac disease, an immune reaction to gluten, where total gluten avoidance is essential. Only in the past decade or so has the true prevalence of celiac disease has become clear: about 1 in 100 have the disease. With the more frequent diagnosis of celiac disease, the awareness of gluten, and the harm it can cause to some, has soared. But going gluten free isn’t just for those with celiac disease. Tennis star Novak Djokovic doesn’t have celiac disease, but went on a GF diet. Headlines like “Djokovic switched to gluten-free diet, now he’s unstoppable on court” followed. Among children, there’s the pervasive but unfounded linkage of gluten consumption with autism, popularized by Jenny McCarthy and others. Even in the absence of any undesirable symptoms, gluten is being perceived as something to be avoided. Continue Reading »

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Feb 14 2012

Killer Tomatoes and Poisonous Potatoes?

Remember the movie “Attack of the Killer Tomatoes”?  That was fiction, but some alarmists would have us believe that the tomatoes and potatoes on our plates are really out to get us.

I recently got an e-mail inquiry from an MD who said he had read that solanine in tomatoes, potatoes, and eggplants could be responsible for essential hypertension and a number of GI complaints, as well as symptoms of rheumatoid arthritis, apparently through their inhibition of acetylcholinesterase. He had looked for supporting scientific studies and hadn’t found any. He wondered if I had seen any such studies. I looked too. I couldn’t find any either.

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Feb 07 2012

Applied Kinesiology by Any Other Name…

Applied kinesiology (AK) was briefly mentioned in Scott Gavura’s article on Food Intolerance Tests last week.  Since AK is arguably the second silliest thing in CAM after homeopathy, I thought it wouldn’t hurt to say a little more about it.

A press release on the Wall Street Journal website recently announced that a chiropractor in Illinois was offering “Nutrition Response Testing”

…to help patients optimize overall health…[the test] determines the specific balance of nutrients necessary to optimize metabolic function at the cellular level… the chiropractor then uses this information to make nutritional recommendations for patients…[the test] provides precise feedback that can also help identify the underlying cause for chronic pain and illness.

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Dec 27 2011

Inflammation: Both Friend and Foe

A number of buzz-words appear repeatedly in health claims, such as natural, antioxidants, organic, and inflammation. Inflammation has been implicated in a number of chronic diseases, including diabetes, Parkinson’s, rheumatoid arthritis, allergies, atherosclerosis, and even cancer. Inflammation has been demonized, and is usually thought of as a bad thing. But it is not all bad.

In a study in Nature Medicine in September 2011, a research group led by Dr. Umut Ozcan at Children’s Hospital Boston (a teaching hospital affiliated with Harvard Medical School) reported that two proteins activated by inflammation are crucial to maintaining normal blood sugar levels in obese and diabetic mice. This could be the beginning of a new paradigm. Ozcan says:

This finding is completely contrary to the general dogma in the diabetes field that low-grade inflammation in obesity causes insulin resistance and type 2 diabetes. For 20 years, this inflammation has been seen as detrimental, whereas it is actually beneficial.

Increasing levels of these inflammatory signals might actually be therapeutic in diabetes and obesity. On the other hand, they might worsen inflammatory diseases like asthma and rheumatoid arthritis. Ozcan’s findings are intriguing and might eventually lead to new treatments, but there are no clinical applications as yet.

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Dec 22 2011

Hypothyroidism: The facts, the controversies, and the pseudoscience

As glands go, we don’t give the butterfly-shaped thyroid that straddles our trachea too much  thought — until it stops working properly. The thyroid is a bit like your home’s thermostat: turn it high, and you’re hyperthyroid: heat intolerant, a high heart rate, and maybe some diarrhea. Turn it down, and you’re hypothyroid: cold, tired, constipated, and possibly even depressed. Both conditions are associated with a long list of more serious health consequences. Between the two however, hypothyroidism is far more prevalent. The mainstay drug that treats it, levothyroxine (Synthroid), is one of the most prescribed in the world.

One of my more memorable pharmacy experiences involved levothyroxine. The store had recently changed its prescription labelling standards: It switched from listing the brand name, to only including the generic name (with the manufacturer in parentheses). Few patients noticed. But one elderly patient, taking Synthroid, was furious, and accused me of making a dispensing error. I assured her that levothyroxine was the active ingredient in Synthroid, and she was getting the exact same product as her last visit — but she would have none of it. Her symptoms had worsened, she said, because the medication wasn’t the same. “I want Synthroid — this levothyroxine stuff does not work,” she screamed at me across the counter. No amount of reassurance would satisfy her — I think we eventually resorted to custom, typewritten labels.

I mention this anecdote not to dismiss the symptoms of hypothyroidism as sensitive to placebo effects — hypothyroidism is a real condition with objective monitoring criteria. But this episode was one of my earliest lessons in understanding how perceptions  can shape expectations of effectiveness — something that I’ll come back to, when we look at the controversies of this common condition. Any the treatment of hypothyroidism is not without its controversies – most of which occur outside the realm of medicine, and can more accurately be labelled pseudoscience. Continue Reading »

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Dec 08 2011

Vitamin B12 – The Energy Panacea?

Having spent many hours working in close proximity to a wall of vitamins, I’ve answered a lot of vitamin questions, and given a lot of recommendations. Before I can make a recommendation, I need to ask some questions of my own. My first is almost always, “Why do you want to take a vitamin?” The most common response I’m given is “insurance” – which usually means supplementation in the absence of any symptom or medical need. Running a close second is “I need more energy.” With some digging, the situation usually boils down to a perceived lack of energy compared to some prior period: last week, last year, or a decade ago. While I may identify possible medical issues as a result of these interviews (these are referred to a physician), I’m often faced with a patient with mild and non-specific descriptions of fatigue. And more often than not, they’ve already decided that they’re going to buy a multivitamin supplement. When it comes to boosting the energy levels, they’re often interested in a specific one: Vitamin B12 (cobalamin). So why does vitamin B12, among all the vitamins, have a halo of benefit for fatigue and energy levels? The answer is part science and a whole lot of marketing. Continue Reading »

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Dec 06 2011

Eat Fat, Get Thin?

Published by under Nutrition

I recently received an e-mail from a high school science department head who is teaching a unit on nutritional science. He asked for my opinion of a YouTube video of a lecture advocating a high saturated fat diet. The speaker is Donald W. Miller, Jr., M.D., a cardiothoracic surgeon at my alma mater, the University of Washington. My correspondent commented, “I have a feeling that there is room for some skepticism.”   I agree: there’s a whole lot of room for skepticism.

An article based on that video lecture is available on Dr. Miller’s website.   It’s entitled “Enjoy Saturated Fats, They’re Good for You!”  If you want to judge for yourselves, I recommend the article over the video, as he is a poor public speaker.

Dr. Miller’s website contains a lot of disturbing material.  He appears to be a contrarian who disagrees with the consensus of scientific experts on a wide variety of topics, for instance:

  • Health Benefits of a Low-Carbohydrate, High-Saturated Fat Diet
  • Fighting Fluoride [fluoride is poison!]
  • Cardiac Surgeon Dr. Donald Miller Tells Dr. Dean Ornish to Take a Hike
  • Avoid Flu Shot, Take Vitamin D [flu is a Vitamin D deficiency disease?]
  • Questioning HIV/AIDS, Human-Caused Global Warming, and other Orthodoxies in the Biomedical Sciences
  • A User-Friendly Vaccination Schedule [no vaccinations before age 2, no live vaccines, etc.]

He refers to questionable sources of information like the Weston Price Foundation and the notorious AIDS denialist Peter Duesberg. Continue Reading »

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