MD, PhD, FMedSci, FSB, FRCP, FRCPEd

supplements

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This study tested chondroitin sulfate 800 mg/day (CS) pharmaceutical-grade in the management of symptomatic knee osteoarthritis. It was designed as a prospective, randomised, 6-month, 3-arm, double-blind, double-dummy, placebo and celecoxib (200 mg/day)-controlled trial.  The primary endpoints were changes in pain on a Visual Analogue Scale (VAS) and in the Lequesne Index (LI). Minimal-Clinically Important Improvement (MCII), Patient-Acceptable Symptoms State (PASS) were used as secondary endpoints.

A total of 604 patients, diagnosed according to American College of Rheumalogy (ACR) criteria, were recruited in five European countries and followed for 182 days. CS and celecoxib showed a greater significant reduction in pain and LI than placebo. In the intention-to-treat (ITT) population, pain reduction in VAS at day 182 in the CS group (−42.6 mm) and in celecoxib group (−39.5 mm) was significantly greater than the placebo group (−33.3 mm) (p=0.001 for CS and p=0.009 for celecoxib). No difference observed between CS and celecoxib. Similar trend for the LI, as reduction in this metric in the CS group (−4.7) and celecoxib group (−4.6) was significantly greater than the placebo group (−3.7) (p=0.023 for CS and p=0.015 for celecoxib). Again, no difference was observed between CS and celecoxib. Both secondary endpoints (MCII and PASS) at day 182 improved significantly in the CS and celecoxib groups. All treatments demonstrated excellent safety profiles.
The authors concluded that a 800 mg/day pharmaceutical-grade CS is superior to placebo and similar to celecoxib in reducing pain and improving function over 6 months in symptomatic knee osteoarthritis (OA) patients. This formulation of CS should be considered a first-line treatment in the medical management of knee OA.

In my view, this is a good study with clear and useful results: CS seems to be efficacious and safe. Another recent study confirmed the superiority of CS over celecoxib at reducing cartilage volume loss in knee OA patients.

The current Cochrane review does not yet account for the new data; it concluded cautiously positive: A review of randomized trials of mostly low quality reveals that chondroitin (alone or in combination with glucosamine) was better than placebo in improving pain in participants with osteoarthritis in short-term studies. The benefit was small to moderate with an 8 point greater improvement in pain (range 0 to 100) and a 2 point greater improvement in Lequesne’s index (range 0 to 24), both seeming clinically meaningful. These differences persisted in some sensitivity analyses and not others. Chondroitin had a lower risk of serious adverse events compared with control. More high-quality studies are needed to explore the role of chondroitin in the treatment of osteoarthritis. The combination of some efficacy and low risk associated with chondroitin may explain its popularity among patients as an over-the-counter supplement.

The call for more high quality trials was justified but has now been answered. In my view, CS can be considered an evidence-based option in the management of OA.

In my view, the website of ‘FOODS 4 BETTER HEALTH’ should be more aptly called FOOD FOR QUICKER DEATH. At least this is the conclusion that came to my mind after reading their post on ‘Apricot Seeds: Nutrition, Health Benefits, and Their Role in Cancer Treatment’.

Under the heading ‘Apricot Seeds for Cancer Treatment’, we find the following explanations:

“Laetrile is a drug made from amygdalin. Apple seeds, Lima beans, plums, and peaches also contain amygdalin. Although laetrile isn’t a vitamin, it is labeled as amigdalina B17 or vitamin B17.

Dr. Kanematsu Sugiura received highest honors from the Japan Medical Association for his outstanding contributions in cancer research. He found that laetrile prevented the spread of malignant lung tumors in 10 to 20% of laboratory mice. Meanwhile, the mice given plain saline showed that lung tumor spread in 80 to 90% of the subjects. The study shows that laetrile reduces the spread of cancer and isn’t a cure for cancer.

According to a study published in the Public Library of Science, amygdalin blocks the growth of bladder cancer cells. The researchers studied the growth, proliferation, clonal growth, and cell cycle progression.

According to another study published in the International Journal of Immunopharmacology, the viability of human cervical cancer HeLa cell line was significantly inhibited by amygdalin. The researchers found apoptosis in amygdalin-treated HeLa cells.

However, a study published in The New England Journal of Medicine showed no substantial benefit of amygdalin on cancer patients. In fact, the blood cyanide levels of patients who received the substance intravenously increased alarmingly. But, the levels were relatively low in patients who received an oral dose.

A study conducted in 2002 at the Kyung Hee University in Korea found amygdalin to be helpful in killing prostate cancer cells. A similar study conducted on rats also linked the compound with pain relief, thus decreasing pain in cancer patients.

Amygdalin is considered as an alternative treatment for cancer. Since research so far has shown mixed and inconclusive results, apricot seeds may be helpful in the treatment of cancer, but shouldn’t be the only means to treat cancer. It is best to use it as a supplement with other cancer medications.”

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Cancer patients who read this sort of thing – and sadly the Internet offers plenty more of such irresponsible texts – might well decide to try Laetrile or start regularly consuming apricot seeds instead of chemotherapy or other effective cancer treatments. This decision would almost certainly hasten their deaths for two reasons:

  • Amygdalin is NOT an effective treatment for cancer.
  • It is highly toxic and would almost certainly kill some patients after chronic use.

To state, as the author of the above article does, that “research so far has shown mixed and inconclusive results” is irresponsible. The only thing that matters and the only message relevant for vulnerable patients is this: RESEARCH HAS NOT SHOWN THAT THIS STUFF WORKS FOR CANCER.

I know, many of you think that proponents of alternative therapies are a bit daft, intellectually challenges or naïve. This may be true for some of them, but others are very much on the ball and manage things that seemed almost impossible. Who, for instance, would have thought it possible to combine all of the following features, concepts and principles in one single alternative approach:

  • healing,
  • creativity,
  • simplicity,
  • balance,
  • alkalizing,
  • maintenance,
  • going green,
  • tradition,
  • holism,
  • synergism,
  • beauty,
  • the deepest level,
  • new way of living,
  • goodness,
  • medicinal food,
  • adaptogen,
  • vitality,
  • immunity,
  • live food,
  • etheric potion,
  • cosmic beam,
  • wellness,
  • longevity,
  • alchemizing,
  • elixir,
  • superior states of clarity.

You may think it impossible, but Amanda Chantal Bacon has skilfully combined all of them. A true feast, I hope you agree. Amanda believes that “food is as much about pleasure as healing; creativity as sustenance; and simplicity as the exquisite.” Amanda has several cards up her sleeve; one trump card is to alkalize. Alkaline foods, she claims, “balance your pH, making your body an inhospitable environment for disease. Disease can only exist in acidic states, so keeping an alkaline climate in your body is the ultimate form of protection. Existing in an alkaline state is a key to maintaining a calm and joyful life. Alkalinity will promote not only peace within but also an overall glow with radiant skin and sparkling eyes. A simple tip to remember: just go green when in doubt. Our favorite daily alkalizers are green juice, almonds, lemon and apple cider vinegar.”

Amanda is as creative as she is productive. She invented several formulas for the good of her customers: “When I compose a recipe, I draw inspiration from both my far flung travels and my local farmers markets; the traditional pairings of my culinary training and the chefs I have worked with; holistic remedies and artisanal producers. When I create a juice or a milk or a cookie I want it not only to taste extraordinary, but also to work synergistically to heal and enhance your beauty, brain, body and spirit at the deepest level.”

In her pursuit of good health, well being, holism and deeper levels, Amanda created a firm called ‘Moon Juice’ which is “for people interested in a new way of living. Not a way where you have to erase your past, but a way fueled by excitement to help yourself live better. Our only intention is to add goodness and beauty to your life.”

“In 2006” Amanda explains, “I began studying the power of raw, medicinal foods to heal the hypothyroid condition I had had since I was a teen, in addition to my severe allergies to wheat, sugar, and cow dairy. Although I was still working as a chef in fine dining, at this juncture my whole diet changed. I ate primarily vegetables and legumes from the farmers market, and foods that would serve as hormonal adaptogens. Within a few months, I noticed a radical shift. My next round of blood work revealed that my thyroid hormone levels were back to normal. Working in fine dining was amazing, but my own transformative experience – backed up by extensive blood tests, the scrutiny of several physicians, renewed feelings of vitality, and a shift in my personality, immunity, appearance, and thought – inspired me to create Moon Juice. These live, medicinal foods changed me from the inside out. That is what Moon Juice is – not just our products – but rather a healing force, an etheric potion, a cosmic beacon for those seeking out beauty, wellness, and longevity. There is nothing I want more than to share this experience and education with as many people as I can.”

Well?

Perhaps there is something that Amanda might want even more: your money?

Amanda is not selfish; no, she wants everyone to benefit from her inventions. Therefore, she sells her products; the one I liked best was Brain Dust™ . This is “an enlightening edible formula alchemized to align you with the mighty cosmic flow needed for great achievement. An adaptogenic elixir to maintain healthy systems for superior states of clarity, memory, creativity, alertness and a capacity to handle stress.” The ingredients of Brain Dust are Organic Astragalus, Shilajit, Maca, Lion’s Mane, Rhodiola, Ginkgo and Organic Stevia. Of course, such an exquisite product has to come at a price: you can purchase one jar (14 servings) of Brain Dust for US$ 30.

As I said, not all of them are daft!

How Jackfruit Kills Cancer… This title hardly left any doubt that jackfruit (Artocarpus heterophyllus Lam) is effective in curing cancer. The website continued in this vein:

“Jackfruit contains phytonutrients like lignans, saponins, and isoflavones, which have anticancer, antihypertensive, anti-ulcer, antioxidant, and anti-aging properties (2).

Lignans are tissue-selective phytoestrogens that have anti-estrogenic effects in reproductive tissues that can be beneficial in preventing the hormone-associated cancers of the breast, uterus, ovary, and prostate. It may also help maintain bone density (3).

Isoflavones are also beneficial phytoestrogens that have been proven to reduce the risk of breast, endometrial, and prostate cancers (4,5).

Saponins, on the other hand, kill cancer cells by directly binding to cells as well as boosting white blood cell activity and preventing cell differentiation and proliferation (6,7).

Hình ảnh có liên quan

Lastly, the cancer-preventing abilities of the fruit are due in part to dietary TF-binding lectins (8). The pulp has the ability to reduce the mutagenicity of carcinogens and combat the proliferation of cancer cells (9).

In addition, the fruit contains carotenoids, flavonoids, and polyphenols that lower blood pressure, fight stomach ulcers, boost metabolism, support nerve function, and play a role in hormone synthesis. They also contain polysaccharides that boost immunity by interacting with white blood cells, including T cells, monocytes, macrophages, and polymorphonuclear lymphocytes (10).

Each part of the fruit and tree can be used: the flowers help stop bleeding in open wounds, prevent ringworm infestations, and heal cracks in dry feet while the root is used to treat skin diseases, asthma, and diarrhea. Additionally, the wood has a sedative and abortifacient effect…”

END OF QUOTE

To many desperate cancer patients, this would sound convincing, not least because the references provided by the author look sophisticated and seem to back up most of the claims made.

But where are the references to clinical trials showing that jackfruit does cure this or that type of cancer? Where is the evidence that it does “lower blood pressure, fight stomach ulcers, boost metabolism, support nerve function, and play a role in hormone synthesis”? Where are the data to prove that it does “boost immunity”?

I did conduct a ‘rough and ready’ Medline search and found precisely nothing; not a single clinical trial that would confirm the multiple claims made above.

You are not surprised?

Neither am I!

But what about the desperate cancer patients?

How many fell for the scam? How many gave up their conventional cancer treatments and used jackfruit instead? How many consumers know that it is not unusual for plants to contain lignans, saponins, isoflavones and many other ingredients that have amazing effects in vitro? How many know that this rarely translates into meaningful health effects in human patients?

We will never know.

One thing we do know, however, is that articles like this one can cost lives, and that alternative cancer cures are and always will be a myth.

Traditional and folk remedies have been repeatedly been reported to contain toxic amounts of lead. I discussed this problem before; see here, here, and here. Recently, two further papers were published which are relevant in this context.

In the first article, Indian researchers presented a large series of patients with lead poisoning due to intake of Ayurvedic medicines, all of whom presented with unexplained abdominal pain.

In a retrospective, observational case series from a tertiary care center in India, the charts of patients who underwent blood lead level (BLL) testing as a part of workup for unexplained abdominal pain between 2005 and 2013 were reviewed. The patients with lead intoxication (BLLs >25 μg/dl) were identified and demographics, history, possible risk factors, clinical presentation and investigations were reviewed. Treatment details, duration, time to symptomatic recovery, laboratory follow-up and adverse events during therapy were recorded.

BLLs were tested in 786 patients with unexplained abdominal pain, and high levels were identified in 75 (9.5%) patients of which a majority (73 patients, 9.3%) had history of Ayurvedic medication intake and only two had occupational exposure. Five randomly chosen Ayurvedic medications were analyzed and lead levels were impermissibly high (14-34,950 ppm) in all of them. Besides pain in abdomen, other presenting complaints were constipation, hypertension, neurological symptoms and acute kidney injury. Anemia and abnormal liver biochemical tests were observed in all the 73 patients. Discontinuing the Ayurvedic medicines and chelation with d-penicillamine led to improvement in symptoms and reduction in BLLs in all patients within 3-4 months.

The authors of this paper concluded that the patients presenting with severe recurrent abdominal pain, anemia and history of use of Ayurvedic medicines should be evaluated for lead toxicity. Early diagnosis in such cases can prevent unnecessary investigations and interventions, and permits early commencement of the treatment.

The second article German researchers analysed 20 such ‘natural health products’ (NHPs) from patients with intoxication symptoms. Their findings revealed alarming high concentrations of mercury and/or lead (the first one in “therapeutic” doses). 82 % of the studied NHPs contained lead concentrations above the EU limit for dietary supplements. 62 % of the samples exceeded the limit values for mercury. Elevated blood lead and mercury levels in patients along with clinical intoxication symptoms corroborate the causal assumption of intoxication (s).

The authors concluded that, for NHPs there is evidence on a distinct toxicological risk with alarming low awareness for a possible intoxication which prevents potentially life-saving diagnostic steps in affected cases. In many cases patients do not communicate the events to their physicians or the local health authority so that case reports (e.g. the BfR-DocCentre) are missing. Thus, there is an urgent need to raise awareness and to initiate more suitable monitory systems (e.g. National Monitoring of Poisonings) and control practice protecting the public.

The authors of the 2nd paper also reported a detailed case report:

Patient, male, 31 with BMI slightly below normal, non-smoker, was referred to the neurological department of the university clinic with severe peripheral poly neuropathy and sensory motor symptoms with neuropathic pain. The patient was in good general state of health until approximately 3 weeks before hospital admission; he spent his holiday in Himalaya region and came back with headaches and fatigue. He was taking pain medication without any relieve; his routine blood values were normal. He claimed to take no further medications. Since poly neuropathy and fatigue could be caused by pesticides or other poisoning, i.e. heavy metals, we have been consulted for taking a detailed exposure history. While in the clinic, 3 different NHPs were found in form of globules, (a, b, c for morning, lunch time and evening respectively), which he imported from his trip to Asia and ingested 3 times a day against stress. We have analyzed these 3 NHPs and found: 45 μg/g, 53,000 μg/g and 28 μg/g lead (for morning, midday and evening globules, respectively) and additionally 15.72 μg/g mercury in the “evening globules”. Since, his blood metal levels were: 340 μg/L Pb and 15 μg/L Hg a diagnosis of heavy metal intoxication was made. Slowly occurring clinical recovery after starting chelation therapy corroborated with the causal assumption proposed. He was released for further consultancy to his family physician. The administrated treatment and the improvement of his status corroborate lead and mercury intoxication.

The researchers finish their paper with this stark warning: In many countries, even in Germany, no comprehensive nutria vigilance- or poisoning monitoring system exists, from which the application of natural health products and the consequent intoxication can be estimated. There is also an urgent need for comprehensive scientifically evaluated studies based on efficient national monitoring to protect the consumer from heavy metal intoxications. There are no comparable surveillance systems like the US ABLES program for lead- and no surveillance systems for mercury exposures allowing any comparisons. Exposure to lead and mercury from environmental sources remains an overlooked and serious public health risk.

In the realm of alternative medicine, the Internet is a double-edged sword. It can be most useful to many, particularly to those who are able to think critically. To those who do not have this ability, it can be outright dangerous. We have researched this area in several way and always arrived at this very conclusion. For instance, we evaluated websites providing advice for cancer patients and concluded that “the most popular websites on complementary and alternative medicine for cancer offer information of extremely variable quality. Many endorse unproven therapies and some are outright dangerous.”

This makes it abundantly clear that, for some, the Internet can become a danger to their health and life. Recently I was reminded of this fact when I saw this website entitled ‘Foods that will naturally cleanse your arteries’. Its message is instantly clear, particularly as it provides this impressive drawing.

.

The implication here is that we can all clear our arteries of atherosclerotic plaques by eating the right foods. The site also lists the exact foods. Here they are:

START OF QUOTE

Salmon

Salmon is one of the best heart foods as it is packed with healthy fats which reduce cholesterol, triglycerides, and inflammation. However you must make sure that the fish is organic.

 

Orange juice

Orange juice is rich in antioxidants which strengthens the blood vessels and lowers blood pressure. Simply drink 2 glasses of fresh orange juice a day and you’re good to go.

 

Coffee

According to numerous studies 2-4 cups of coffee a day can significantly reduce the risk of stroke and heart attack by 20%. However don’t drink excessively as it may cause problems with your digestion.

 

Nuts

Nuts are packed with omega-3 fatty acids, healthy properties and unsaturated fats which regulate your memory, cholesterol and prevent joint pain.

 

Persimmon fruit

The persimmon fruit is packed with fiber and sterols which help lower cholesterol. It makes a great addition to salads and cereals

 

Turmeric

Curcumin, the active ingredient in turmeric provides a large variety of health benefits. It helps reduce tissue inflammation and prevents overactive fat accumulation. Feel free to add it to your meals or to your tasty cup of tea.

 

Green tea

Aside from having a soothing effect, green tea helps energize the whole body, boost the metabolism and lower the absorption of cholesterol. Just drink 1-2 cups of green tea a day and you have nothing to worry about.

 

Cheese

Cheese can also help lower blood pressure and cholesterol.

 

Watermelon

Watermelon is the most delicious summer fruit. But aside from its amazing taste, it also improves the production of nitric oxide which enhances the function of the blood vessels.

 

Whole grain

Whole grains are rich in fiber content which helps lower cholesterol and cholesterol accumulation in the arteries. Consume more whole grain bread, brown rice and oats.

 

Cranberries

Cranberries have been long known to be the richest source of potassium. Due to this, they can easily lower bad cholesterol and increase the good one. 2 glasses of cranberry juice a day can lower the risk of heart attack by 40%.

 

Seaweed

Seaweeds are packed with vitamins, proteins, minerals and carotenoids which easily regulate your blood pressure.

 

Cinnamon

Cinnamon prevents buildups in the arteries and lower cholesterol.

 

Pomegranate

It is an exotic fruit that provides a healthy portion of phytochemicals. These improve the production of nitric oxide, and boost circulation. Add pomegranate seeds to your salads.

 

Spinach

It is high in folic acid and potassium. You need this to lower your blood pressure, strengthen muscles, and prevent heart attack.

 

Broccoli

Broccoli is rich in vitamin K, which help lower blood pressure and cholesterol when eaten steam-cooked or raw.

 

Olive oil

Olive oil helps maintain your health at its peak. Be sure to use cold-pressed oil as it is rich in healthy fats which lower cholesterol and reduce the risk of heart attack by 40%.

 

Asparagus

Asparagus prevents inflammation, clogging and lowers cholesterols. Implement it to dishes, noodles, soups or potatoes.

 

Blueberries

Blueberries are high in potassium and as we mentioned above, potassium is the key to reducing bad cholesterol and increasing the good one. Drink 2 glasses of blueberry juice a day.

 

Avocado

Avocadoes are without a doubt – one of the healthiest fruits known to man. They’re rich in healthy fat and improve the balance of bad and good cholesterol.

 

END OF QUOTE

As far as I know, there is no good evidence for the claim that any of these 20 foods will clear arteriosclerotic arteries. There is some evidence for fish oil and some for green tea to reduce the risk of cardiovascular disease. But surely, this is quite a different matter than reversing atherosclerotic plaques.

What’s the harm? I believe the potential for harm is obvious: people at high risk of suffering a major cardiovascular event who read such nonsense and believe it might think they can abandon the treatments, drugs and life-styles they have been advised to follow and take. Instead they might eat a bit more of the 20 ingredients listed above. If they did that, many would die.

I think many of us who know better have become far too tolerant of dangerous nonsense of such nature. We tend to think that either nobody is as stupid as to follow such silly advice, or we assume that taking a bit of daft advice will not do much harm. I fear we are wrong on both accounts.

 

 

A recent article in the Guardian revealed that about one third of Australian pharmacists are recommending alternative medicines with little-to-no evidence for their efficacy, including useless homeopathic products and potentially harmful herbal products.

For this survey of 240 Australian pharmacies, mystery shoppers were sent in to speak to a pharmacist at the prescription dispensing counter and ask for advice about feeling stressed. The results show that three per cent of the pharmacists recommended homeopathic products, despite a comprehensive review of all existing studies on homeopathy finding that there is no evidence they work in treating any condition and that ‘people who choose homeopathy may put their health at risk if they reject or delay treatments’. Twenty-six percent of all pharmacists recommended Bach flower remedies to relieve stress. A comprehensive review of all existing studies on Bach flower remedies found no difference between the remedies and placebos. Fifty-nine per cent of people were just told the complementary and alternative product recommended to them worked, and 24% were told the product was scientifically proven, without any evidence being provided to them.

Asked about these findings, Dr Ken Harvey, a prominent Australian expert, said they demonstrated that some pharmacists were failing in their professional duty to consumers. “Pharmacists are giving crazy advice, and it is dangerous in some cases,” he said. “My view is that pharmacists, if they are going to sell these products, need to have a big shining sign over the shelves of the complementary and alternative medicine section that says ‘these products have not been assessed by the government regulators to see if they work, please talk to pharmacist’.Pharamacists are giving poor advice and they clearly have a conflict of interest,” Harvey said.

If you had hoped that in other countries pharmacists behave more responsibly, I must disappoint you. The information available shows that, when it comes to alternative medicine, pharmacists across the globe act much more like shop-keepers than like health care professionals. They are in the habit of putting profit before their duty to abide by the rules of evidence-based practice. And, in doing do, they violate their own ethical codes so regularly that I ask myself why they bothered to even implement one.

On this blog I have written so often about this issue that one could come to the conclusion that I have a bee under my bonnet:

The truth, however, is not that I am the victim of a bee.

The truth is that this is a very important public health issue.

The truth is that pharmacists show little signs of even trying to get to grips with it.

The truth is that pharmacists who sell bogus medicines put profit before professional ethics.

The truth is that such behaviour is not that of health care professionals but that of shop-keepers.

The truth is that I intend to carry on reminding these pharmacists that they are behaving like charlatans.

A new joint position statement of the Italian Society of Diabetology (SID) and of the Italian Society for the Study of Arteriosclerosis (SISA) has recently been published. In the context of this blog, it seems relevant enough for its summary to be reproduced here:

Evidence showed that LDL-cholesterol lowering is associated with a significant cardiovascular risk reduction. The initial therapeutic approach to hypercholesterolaemia includes dietary modifications but the compliance to recommendations is often inadequate. Some dietary components with potential cholesterol-lowering activity are present in small amounts in food. Therefore, in recent years the use of “nutraceuticals” (i.e., nutrients and/or bioactive compounds with potential beneficial effects on human health) has become widespread. Such substances may be added to foods and beverages, or taken as dietary supplements (liquid preparations, tablets, capsules). In the present manuscript, the cholesterol-lowering activity of some nutraceuticals (i.e. fiber, phytosterols, soy, policosanol, red yeast rice and berberine) will be discussed along with: 1) the level of evidence on the cholesterol-lowering efficacy emerging from clinical trial; 2) the possible side effects associated with their use; 3) the categories of patients who could benefit from their use.

DATA SYNTHESIS:

Based on the current literature, the cholesterol-lowering effect of fiber, phytosterols and red yeast rice is consistent and supported by a good level of evidence. Over berberine, there is sufficient evidence showing significant cholesterol-lowering effects, although the results come from studies carried out almost exclusively in Asian populations. Data on the effects of soy are conflicting and, therefore, the strength of recommendation is quite low. The evidence on policosanol is inconclusive.

CONCLUSION:

Although health benefits may arise from the use of nutraceuticals with cholesterol-lowering activity, their use might be also associated with possible risks and pitfalls, some of which are common to all nutraceuticals whereas others are related to specific nutraceuticals.

END OF QUOTE

Many advocates of alternative medicine are highly sceptical of the value of statins. Yet, it seems clear that statins exert considerably larger effects on our lipid profile than nutraceuticals. So, why not use the treatment that is best documented and most efficacious? One answer could lie in the well-known adverse effects of statins. However, can we be sure that nutraceuticals are devoid of serious side-effects? I am not sure that we can: statins have been fully investigated, and we therefore are well-informed about their risks. Nutraceuticals, by contrast, have not been monitored in such detail, and their safety profile is therefore not as well-understood.

Other advocates of alternative medicine argue that cholesterol (I use the term simplistically without differentiating between the ‘good and bad’ cholesterol) has been hyped by the pharmaceutical industry and is, in truth, not nearly as important a risk factor as we have been led to believe. This line of thought would consequently deny the need to lower elevated cholesterol levels and therefore negate the need for cholesterol-lowering treatments. This stance may be popular, particularly in the realm of alternative medicine, but, to the best of my knowledge, it is erroneous.

Obviously, the first line treatment for people with pathological lipid profiles is the adoption of different life-styles, particularly in terms of nutrition. This may well incorporate some of the nutraceuticals mentioned above. If that strategy is unsuccessful in normalizing our blood lipids – and it often is – we should consider the more effective conventional medications; and that unquestionably includes statins.

I do not expect that everyone reading these lines will agree with me, yet, after studying the evidence, this is my honest conclusion – and NO, I am not paid or otherwise rewarded by the pharmaceutical industry or anyone else!

 

The Committees of Advertising Practice (CAP) write and maintain the UK Advertising Codes, which are administered by the Advertising Standards Authority. On their website, the CAP recently published an updated advertising code for naturopathy. As we have regularly discussed the fact that the public is being frequently misled in this area, I consider the code important in the context of this blog. I therefore take the liberty of repeating it here – not least in the hope that this helps preventing misinformation in the future [the numbers in square brackets refer to me footnotes below].

START OF QUOTE

What is Naturopathy?

Naturopathy is a holistic [1] approach to healthcare that uses a combination of one or more different disciplines (for example herbal medicine or hydrotherapy) and a healthy lifestyle [2] in order to gain and maintain a healthy body [3].

What claims are likely to be acceptable?

The promotion of a healthy [4] lifestyle is likely to acceptable as are claims that go no further than those commonly accepted for healthy [4] eating, sleeping well, taking exercise and the like.

What claims are likely to be problematic?

The ASA and CAP have not yet been provided with evidence which demonstrates that Naturopathy can be used to treat medical conditions (Rule 12.1).  Therefore, any claims that go beyond accepted claims for a healthy [4] lifestyle are likely to be problematic [5] unless they are supported by a robust body of evidence.  In 2013, the ASA ruled against claims on a marketer’s website which said that Naturopathy could be used to treat acute and chronic illness and disease because the marketer had not provided any evidence in support of their claims (CNM The College of Naturopathic Medicine Ltd, 13 March 2013).

What about serious medical conditions?

Claims to offer treatment on conditions for which medical supervision should be sought [6] are likely to be considered to discourage essential treatment unless that treatment is carried out under the supervision of a suitably qualified health professional (Rule 12.2).

END OF QUOTE

Naturopathy has been the subject of my posts before – see for instance here, here, here, here and here. Naturopathy can be dangerous to the point where it can kill the patient – see for instance here and here. Therefore it is important that advertising gets regulated. To make it very clear: the above statement by the CAP is, in my view, a step in the right direction, and I encourage alternative practitioners to look up the equivalent CAP documents for their specific therapy.

Having said that, I still feel the need to make a few comments:

  1. It is misleading to call naturopathy ‘holistic’. This is often factually incorrect and also gives the impression that conventional medicine is not holistic – see also here.
  2. Are we sure that all lifestyles promoted by naturopaths are, in fact, healthy?
  3. Maintaining a healthy body is naturopathy speak for DISEASE PREVENTION. Who decides what is effective prevention? On what evidence? How come many naturopaths are against the most effective means of prevention of all times – vaccination?
  4. Who decides what is ‘healthy’? On what evidence?
  5. Why ‘problematic’? Are they not wrong or bogus or false or fraudulent or criminal?
  6. Are there conditions for which medical supervision should not be sought? Which are they?

Perhaps I have a weak spot for fish oil; more likely, however, I just like positive news – and, in alternative medicine, there is not much of it. That’s why I have written about the potential benefits of fish-oil again and again and again and again.

Reduced intake of fish oil, i.e. n−3 long-chain polyunsaturated fatty acids (LCPUFAs), may be a contributing factor to the increasing prevalence of asthma and other wheezing disorders. Yet the evidence is neither clear nor strong. This study was aimed at shedding more light on the issue; specifically, it tested the effect of supplementation with n−3 LCPUFAs in pregnant women on the risk of persistent wheeze and asthma in their offspring.

The investigators randomly assigned 736 pregnant women at 24 weeks of gestation to receive 2.4 g of n−3 LCPUFA (fish oil) or placebo (olive oil) per day. Their children were followed prospectively with extensive clinical phenotyping. Neither the investigators nor the participants were aware of group assignments during follow-up for the first 3 years of the children’s lives, after which there was a 2-year follow-up period during which only the investigators were unaware of group assignments. The primary end point was persistent wheeze or asthma, and the secondary end points included lower respiratory tract infections, asthma exacerbations, eczema, and allergic sensitization.

A total of 695 children were included in the trial, and 95.5% completed the 3-year, double-blind follow-up period. The risk of persistent wheeze or asthma in the treatment group was 16.9%, versus 23.7% in the control group (hazard ratio, 0.69; 95% confidence interval [CI], 0.49 to 0.97; P=0.035), corresponding to a relative reduction of 30.7%. Prespecified subgroup analyses suggested that the effect was strongest in the children of women whose blood levels of eicosapentaenoic acid and docosahexaenoic acid were in the lowest third of the trial population at randomization: 17.5% versus 34.1% (hazard ratio, 0.46; 95% CI, 0.25 to 0.83; P=0.011). Analyses of secondary end points showed that supplementation with n−3 LCPUFA was associated with a reduced risk of infections of the lower respiratory tract (31.7% vs. 39.1%; hazard ratio, 0.75; 95% CI, 0.58 to 0.98; P=0.033), but there were no statistically significant associations between supplementation and asthma exacerbations, eczema, or allergic sensitization.

The authors concluded that supplementation with n−3 LCPUFA in the third trimester of pregnancy reduced the absolute risk of persistent wheeze or asthma and infections of the lower respiratory tract in offspring by approximately 7 percentage points, or one third.

The authors must be congratulated. This trial is stunning in many ways: it was carefully designed and executed; its results are clear and important; its write-up is excellent. The research was supported by private and public research funds, all of which are listed at www.copsac.com. The Lundbeck Foundation, the Danish Ministry of Health, the Danish Council for Strategic Research, the Danish Council for Independent Research, and the Capital Region Research Foundation provided core support.

It is debatable whether the intake of fish oil falls under the umbrella of alternative medicine. In a way, it reminds me of the famous saying: what do we call alternative medicine that works? We call it medicine. It also holds an important reminder for all who make claims about the benefit of alternative therapies: extraordinary claims require extraordinary evidence.

Can these findings be translated into practical advice to consumers? The NEJM discussed this question in an accompanying article in which the case of a fictional pregnant woman (Ms. Franklin) was considered. Here is what they concluded: …there is benefit and little risk associated with n−3 LCPUFA supplementation. Even though we do not know Ms. Franklin’s EPA and DHA levels, there is likely to be a benefit for her child, at little risk, cost, or inconvenience. She should start taking n−3 LCPUFA supplements.

Despite my soft spot for fish oil, I might add that, while we give advice of this nature, we nevertheless need to insist on independent replications to have certainty.

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