OT: Bad Medicine or Bad Reportage? VERY Interesting & EXCELLENT READ

[Guest guest]

This was a bad year for Alternative Therapies unless we carefully read

through this nonsense. According to the attacks we have all seen in the media

this

year we should just throw in the towel and go back to prescribing drugs.

 

This year's attacks in NEJM, JAMA etc. have found that Arginine and Saw

Palmetto and Vit D and Calcium and Glucosamine with Chondroitin and B vitamin

therapy for lowering Homocysteine and even low fat (20%) diet all did not stand

up to the scrutiny in these studies, in spite of previous favorable research.

Why is it we all hang in there?

 

First, we all know that research can prove or disprove whatever you set out

to do. Second, we all know that careful analysis of these studies shows that

in fact there were significant benefits that were ignored and shortcoming to

the studies that contributed to them being able to be used to discredit these

therapies. There were so many of these studies in such a short time that it

would seem that someone was helping set these up. However, with that said,

those of us in integrative medicine know we can always do better. We are fussy

about our supplier and fussy about the diagnosis and what the patient may do

to nullify benefits, i.e. if they are allergic to a food and continue

consuming it then results can be disappointing.

 

However, this leads to another aspect, we tend to always use our therapies

in the most favorable way. We all typically use these things as part of our

MULTI-MODALITY approach. We seldom use just one of these therapies.

 

We also all recognize that " one man's food is the next man's poison " so that

to have nearly 100% results it helps to realize that there is a need to

personalize our use of natural products based on Gene Testing (NUTRIGENOMICS).

 

Those who practice Western allopathic medicine know that their drugs kill

way over 120,000 each year (some believe the number is over 500,000), but they

do not throw in the towel. They accept the fact of these deaths and

rationalize them by pretending that their drug based therapies do more good

than harm,

but I think their days are numbered. FDA wants personalized medicine and has

a large department set up to bring this about. This will lead to

PHARMACOGENOMICS,

 

and again the consumers will benefit.

 

Moreover, there is now proof that these drugs have found their way into our

water supplies and they are now being shown to be helping to poison our

planet. This was supported again by the recent publication of research that has

found that virtually all the small mouth bass in the Potomac have eggs found

with their sperm (male and female). Experts state that the levels of birth

control pills, chemicals, Prozac, etc found in the water along with the

insecticides and

 

pesticides are among the most likely contributors to this sad state of

affairs, which will lead to even lower fish counts. We already have Krill

failing

to exist in the San Francisco Bay due to warming.

 

Once we are aware of the many challenges our bodies face and the published

research that genetics contribute around 33% to our current health issues, we

might consider that one way to have all of these somewhat " discredited "

therapies (if you believe their sloppy reporting) become part of mainstream

integrative therapy. If consumers are willing to spend their money for these

 

safe alternative therapies then limit their use to protocols where they are

totally appropriate for the patient's diagnosis and their genetics.

 

This way clearly useful therapies, as all of the above are, can be shown to

be useful by doing realistic studies where these products are used only as a

part of a total therapeutic program along with other therapies appropriate

for the patient's genes and their clinical condition. This would mean that a

patient with significant MTHFR problems would also concurrently receive the

appropriate form of Folic Acid (5'MTHF-Metafolin patented by Merck of Germany)

to optimize the potential for a full favorable response. I am confident that

this way there would be no reported 30% increase in heart attacks in patients

being treated for homocysteine issues with B vitamins. Now patients would be

receiving the optimal form of Folic Acid based on their genetic needs.

 

This way any one on the above therapies from Arginine to Saw Palmetto and/or

Glucosamine etc would concurrently be on the correct protein and other

nutrients needed based on their gene tests. Glucosamine in the above study

actually was quite effective for pain control in a subset of the study, and

significantly better than the toxic and dangerous drug for that subset of

patients,

but, of course, the media did not report that fact. Now with my personalized

medicine approach I believe that glucosamine with chondroitin would show

significant benefits across the board when tested for what it is intended to

be, a

nutrient. An amino sugar should reduce cartilage breakdown and stimulate

repair.

 

Garry F. Gordon MD,DO,MD(H)

President, Gordon Research Institute

www.gordonresearch.com

 

Bad Medicine or Bad Reportage?

 

So far, the year 2006 has been full of bad news for adherents of alternative

medicine. The first 2006 issue of JAMA (The Journal of the American Medical

Association) contained a study on L-arginine supplementation in people who

had recently had a myocardial infarction - the conclusion: L-arginine doesn't

help and may increase the risk of death. In the February 8th, 2006, issue of

JAMA we were told that low-fat diets don't help prevent breast or colon cancer

or heart disease. That same week, the New England Journal of Medicine

(February 9th issue) published a study that found one of the most commonly used

herbs, saw palmetto, was no better than placebo for the treatment of benign

prostatic hyperplasia or enlarged prostate. The article in the New England

Journal kicked off a sixpronged attack on alternative medicine. In the Feb. 16th

issue were two studies calling into question the efficacy of vitamin D and

calcium for decreasing the risks of bone fractures and colon cancer - both

conditions that have been found in previous studies to benefit from calcium and

vitamin D supplementation. The following week came a study proclaiming

glucosamine and chondroitin doesn't help arthritis. On March 13, the New England

Journal published two articles proclaiming that lowering homocysteine levels

with

B-vitamins does not reduce the risk of cardiovascular disease.

 

What these nine studies have in common is that the diet or supplements in

question have been previously studied, with consistently positive findings. A

collection of all the studies illustrating the benefits of L-arginine, low-fat

diets, calcium, vitamin D, saw palmetto, glucosamine, chondroitin sulfate,

and B-vitamins would easily reach the ceiling.

 

However, when it comes to medical reporting, " what's new is what's news. "

Medical reporters tend to act as though they have a very short memory, so when

a new study comes along that contradicts the findings of numerous previous

studies it becomes news because it's controversial. This is especially seen in

reporting on diets and supplements.

 

The media seems to thrive on telling the public " everything you know is

wrong. "

These latest studies must have been particularly attractive to the media

because they appeared to refute previously held beliefs, particularly in regard

to the low-fat diet/cancer/heart disease connection and the calcium/vitamin

D/osteoporosis/cancer connection. If a study had indicated that low-fat diets

prevented heart disease or calcium provided bone protection, they would never

have made a ripple in the 24-hour news cycle because people would have

thought, " What else is new? "

 

Contrary to the media reports, the results of these recent studies were not

as black and white as they were portrayed to be. This is partly the fault of

the sound-byte driven media, partly due to the somewhat misleading way the

researchers reported the bottom line in several of the studies, and partly a

result of the way JAMA and the New England Journal spun their press releases of

these studies.

 

L-Arginine Supplementation in Individuals Who Have Had a Recent Heart Attack

 

A study published in the January 4, 2006, issue of JAMA started this year's

attacks on supplements. Researchers at Johns Hopkins enrolled 153 patients

who had just had an acute myocardial infarction (heart attack, MI) and put half

of them on L-arginine (nonand increased the dose to 9 grams daily. Their

goal was to measure blood vessel and heart function, while also watching the

patients for other outcomes (another MI, etc.) for six months. They were still

recruiting more participants for the study when they decided to discontinue th

e study, six months after its initiation, because six patients in the

L-arginine group died, while none in the placebo group died. This of course was

trumpeted by the media as proof that L-arginine is dangerous, especially in

people who have recently had a heart attack. But let's take a closer look at

the

research and the outcomes.

 

Of the six patients taking L-arginine who died; one died after having

another MI (not uncommon after an acute MI); two died from " presumed sepsis, "

meaning they had to have been VERY sick and hospitalized; two were " found dead

at

home " - no cause of death noted; and one died four months after his acute MI

and three weeks after stopping L-arginine supplementation - the cause of death

was not listed.

 

These deaths, although terribly unfortunate, cannot be attributed to taking

L-arginine. They are most likely due to statistical chance - the researchers

even admit this. But this didn't stop them from recommending against the use

of L-arginine after having a heart attack. One problem with making any

conclusive statements about L-arginine safety in this study is that the

researchers

could not even prove the patients in the study actually ABSORBED the

L-arginine. Plasma L-arginine levels were THE SAME in both the Larginine and

the

placebo groups!

 

Numerous studies have shown L-arginine improves the health of blood vessels,

lowers blood pressure, and increases blood flow to the heart and throughout

the body. But it was very ambitious, and probably wrong, for these

researchers to believe a nutrient like Larginine might, in just six months,

reverse a

severe long-term disease process and the resultant damage after a heart attack.

 

But deaths make headlines, like these:

CNN.com said, " Bottom line: just say no to L-arginine for heart failure. "

The study had nothing to do with heart failure! MSNBC.com said, " Dietary

supplement may harm heart patients. Six volunteers taking L-arginine died,

researchers say. Heart attack patients should avoid the dietary supplement

L-arginine... "

The researchers were responsible in saying their recommendations related

only to patients who recently had a heart attack; however, the haphazard media

coverage of this study has, unfortunately, caused many individuals who

genuinely need L-arginine to stop taking it, out of the erroneous fear it will

kill

them.

 

Effect of a Low-fat Diet on Heart Disease and Cancer

The Women's Health Initiative Dietary Modification Trial sought to determine

the effect of a low-fat diet on risk for heart disease, stroke, breast

cancer, and colon cancer in 48,835 postmenopausal women, ages 50-79. The goal

was

to decrease total dietary fat to 20% and increase intake of fruits and

vegetables to five servings daily and whole grains to six servings daily. The

dietary intervention group was compared to a group of women who were not asked

to

make dietary changes but who were given diet-related educational materials.

 

This type of study is problematic for many reasons. Dietary changes are

usually made over a long period of time and, in this case, by the sixth year of

the study the participants in the low-fat group had only decreased their fat

intake by 8.2% and the saturated fat intake (that most associated with heart

disease) by only 2.9%. In addition, there was only an average daily increase

of 1.1 servings of fruits and vegetables and 0.5 servings of whole grains in

the dietary intervention group. Even with somewhat subtle dietary changes,

there was a trend toward decreased heart disease and breast cancer in those who

consumed the lowest levels of saturated- and trans-fats and in those who

consumed at least 6.5 servings of fruits and vegetables daily. These trends are

important since the health implications of a low-fat diet can take years to be

fully realized.

 

Another significant problem is that the participants in the dietary-change

arm of the study were asked to reduce total dietary fat to 20%. This does not

take into account the fact that there are " good fats " and " bad fats. " Thus,

this group may have decreased the intake of heart-healthy omega-3 fatty acids,

such as those found in salmon and other cold-water fish. These same fatty

acids have been found to help prevent cancer.

 

Saw Palmetto and Enlarged Prostate

 

The New England Journal of Medicine kicked off its attack of alternative

medicine on February 9th, 2006, with the publication of a study on the herb saw

palmetto for the treatment of enlarged prostate (benign prostatic

hyperplasia; BPH). The study design was very good, the dosage of saw palmetto

seemed

appropriate, and the herbal product used appeared to be of high quality. The

study may have been doomed from the beginning, however, by the choice of study

participants - men with moderate-to-severe prostate enlargement. Previous

positive studies have more often looked at men with mild-to-moderate BPH.

 

This brings to mind a previous study on St. John's wort for

moderate-to-severe depression in which the dosage used in the study was that

which had been

found in previous studies to benefit people with mild-to-moderate depression.

Rather than confirm these findings in a group with milder depression or

increase the dose to that which had been noted to benefit people with more

severe

depression, the researchers concluded that St. John's wort was useless for

the treatment of depression. A similar conclusion (with failure to qualify the

study group) was drawn by the saw palmetto researchers: " In this study, saw

palmetto did not improve symptoms or objective measures of benign prostatic

doubt that men who have found saw palmetto keeps them from getting up five

times a night to urinate will quit taking the herb, but these reports may deter

some who might have found benefit from this safe alternative.

 

Calcium and Vitamin D for Decreasing Fracture Risk and Prevention of Colon

Cancer

 

The fact that calcium and vitamin D are important for bone health is widely

accepted. Less widely known, but supported by significant positive research,

is the fact that both calcium and vitamin D seem to have a protective effect

against certain types of cancer, including colon cancer. So, when news

reports on the study from the February 16th issue of the New England Journal of

Medicine concluded that calcium and vitamin D don't prevent colon cancer or

bone

fractures, everyone was taken by surprise.

 

One of the most erroneous reports in print media was from the New York

Times, which began the article entitled, " Study Finds Calcium Supplements Don't

Prevent Broken Bones, " with the following statement: " Calcium and vitamin D

supplements increased the risk of kidney stones but did not prevent broken

bones

or colorectal cancer in middle-aged and elderly women, according to an

extensive study whose results are to be published Thursday. " It's not hard to

understand why the media would get it so wrong since the final concluding

statement in the official abstract from the published study, " Calcium plus

Vitamin D

Supplementation and the Risk of Fractures, " stated: " Among healthy,

postmenopausal women, calcium with vitamin D supplementation resulted in a

small but

significant improvement in hip bone density, did not significantly reduce hip

fracture, and increased the risk of kidney stones. "

 

But let's take a closer look at this study. It was part of the Women's

Health Initiative (described above in the low-fat diet studies). The study

included 36,282 postmenopausal women, ages 50-79 years. They were randomly

assigned

to receive either 1,000 mg of calcium in the form of calcium carbonate and

400 IUof vitamin D or placebo pills. Attempting to wade through the very

confusing protocol was somewhat daunting and raised more questions than it

answered. As a journal editor, I would have sent the article back to the authors

with

numerous questions before even sending it out for peer review.

 

Many of the women (16,089) were also enrolled in the hormone replacement arm

of the study, confounding the results because hormone replacement can have a

significant effect on bone density. Women in both the calcium/vitamin D

group and the placebo group were also allowed to take personal calcium (up to

1,000 mg daily) and vitamin D supplements (up to 600 IU daily; 1,000 IU daily

after 1999) as well as other medications for bone health.

 

Despite all these variables, the study resulted in an overall 12% lower rate

of hip fracture in the calcium and vitamin D group, compared to the placebo

group; this was not statistically significant. However, when the group was

analyzed for compliance it was determined that in the group who took at least

80% of the assigned supplements there was a 29% decrease in hip fractures. One

would question why people who didn't even take the supplements as directed

were even included in the final analysis. In addition, when the women were

stratified according to age, those age 60 and older - the group most likely to

suffer from hip fractures - experienced a 21% decrease in hip fractures, even

when they didn't weed out the non-compliers.

 

The calcium/vitamin D group had a 17% greater likelihood of kidney stones.

While the increase in kidney stone rate was reported widely, none of the

positive results reached the attention of the mainstream media, even though the

increased likelihood of kidney stones was less than the improvement in hip

fracture rate. It should also be noted that the form of calcium used in the

study

was calcium carbonate, one of the more poorly absorbed forms of calcium. If

they were concerned about kidney stones, which typically are not a problem

with calcium (in fact there have been studies indicating a protective effect

from calcium), the researchers should have at least considered using calcium

citrate. Not only is it more readily absorbed than calcium carbonate, but

citric acid (citrate) helps prevent kidney stones.

 

Since this same group of people was analyzed for the effect of calcium and

vitamin D on colorectal cancer, some of the same problems with the study

design apply - for instance, the fact that the placebo group was also allowed

to

take significant amounts of personal vitamin D and calcium. In addition, the

study lasted seven years and, due to the length of time it takes for cancers

to develop, this may have been too short a time to really see a beneficial

effect - a fact that was acknowledged by the researchers.

 

Glucosamine and Chondroitin in the Treatment of Osteoarthritis

In a study published in the February 23rd issue of the New England Journal

of Medicine, glucosamine and chondroitin, commonly used nutritional

supplements for osteoarthritis, were compared to the anti-inflammatory

medication

celecoxib or placebo. The study randomly assigned 1,583 people with

osteoarthritis

of the knee to receive 1,500 mg glucosamine HCl, 1,200 mg chondroitin

sulfate, a combination of glucosamine and chondroitin, 200 mg celecoxib, or

placebo

for 24 weeks. People in all groups were allowed to take up to 4,000 mg

acetaminophen (Tylenol?) daily if necessary. The groups were further divided

according to pain severity with 1,229 in a group with mild pain and 354 in a

group

with moderate-to-severe pain.

 

The study design was reasonable, although one might ask why glucosamine HCl

was used, rather than glucosamine sulfate, since the majority of positive

studies of the use of glucosamine for arthritis used the sulfate form. The

results reported by the researchers seemed accurate and relatively unbiased,

with

the following conclusions: " Glucosamine and chondroitin sulfate alone or in

combination did not reduce pain effectively in the overall group of patients

with osteoarthritis of the knee. Exploratory analyses suggest that the

combination of glucosamine and chondroitin sulfate may be effective in the

subgroup

of patients with moderate-to-severe knee pain. "

 

In fact, the combination supplement was significantly effective in the group

who need edit most - those with the most pain. On the scales used to analyze

benefit, those taking the combination of glucosamine and chondroitin

experienced significant benefit - 24.9 percentage points higher than placebo.

This

was compared to the anti-inflammatory drug celecoxib (Celebrex®), which

resulted in only 15.1 percentage points better than placebo.

 

Yet, the mainstream media reportage on this study was simply that

glucosamine and chondroitin don't work for arthritis. There was no mention that

it

indeed does work in those who need it most or that it worked better in these

individuals than celecoxib.

 

Lowering Homocysteine Levels With B-Vitamin Supplementation and the Risk of

Major Cardiovascular Events

 

The most recent articles bashing the use of nutritional supplements came

again from the least-trusted source on these issues, The New England Journal of

Medicine, on March 12, 2006. Two articles were published on the NEJM website

(www.nejm.org) before their publication in the print journal. Both studies

gave a group of people specific B-vitamins (folic acid, B12, and B6) and

measured outcomes. Sounds simple, but it isn't. The groups of people studied

were as

follows: in the NORVIT trial, 3749 men and women WHO JUST HAD A MYOCARDIAL

INFARCTION were given the B-vitamin combination and were followed for up to 40

months; in the HOPE-2 trial, 5522 people 55 years-of-age or older who HAD

VASCULAR DISEASE OR DIABETES were given B-vitamins and followed for five years.

The primary outcome was death from cardiovascular causes, myocardial

infarction, and stroke. In both studies there was a significant drop in

homocysteine

levels; however, there was no statistically significant difference in deaths

between the vitamin-supplemented groups and the placebo groups. In the

HOPE-2 study there was a significant 25-percent drop in non-fatal strokes in

the

supplemented group.

 

This is immediately reminiscent of the L-arginine study reported above -

researchers are trying to reverse significant damage with moderate doses of an

essential nutrient in people who have traveled down a 20-to-50-year disease

path. Yes, homocysteine levels were lowered in these patients, but they weren't

that high to begin with (approx. 12-13 u-mol/liter). It would be of much

greater interest to see if lowering homocysteine in asymptomatic individuals

with truly high homocysteine levels would reduce the risk of DEVELOPING

cardiovascular disease.

 

Of course, the media didn't get this right, either:

The Los Angeles Times: " B Vitamins Fail to Help Heart "

The New York Times: " Studies Find B Vitamins Don't Prevent Heart Attacks "

San Jose Mercury News: " Supplements Fail to Lower Stroke, Heart Attack Risk "

Washington Post: " Two Studies Deflate Benefits of B Vitamins "

These nine studies and the subsequent media reporting point to one

inescapable conclusion: there is a concerted effort on the part of the

aforementioned

medical journals (whose major advertising revenues come from pharmaceutical

companies) to publish as many negative studies as possible, thus confusing the

public regarding natural solutions to health problems. The media reports of

these flawed studies can only be described as clueless. Medical reporting is

not necessarily biased - they don't know enough to do this on purpose. They

are just guilty of taking the press releases from JAMA and the NEJM at their

word (as well as being guilty of not wanting to see their pharmaceutical

advertising revenues dry up). The media has neither the time nor the expertise

to

dissect a medical journal article, so they rely on these " experts " to

interpret studies for them. Until there are true medical journalists in the

media

who are willing to actually study a study, then issue a report based on their

knowledge, the public will continue to be misled by those who would prefer

that we all just " shut up and take our medicine. "

 

 

 

[Guest guest]

What is the full name of MTHFR? My family is genetically predisposed

to this, and we can't seem to get the name right. Amongst ourselves,

we've started calling it by another name which the initials seem to

spell out (add in a few letters). Thank you.

Deb

@, Angls4Hope wrote:

> This would mean that a

> patient with significant MTHFR problems would also concurrently

receive the

> appropriate form of Folic Acid (5'MTHF-Metafolin patented by Merck

of Germany)

> to optimize the potential for a full favorable response. I am

confident that

> this way there would be no reported 30% increase in heart attacks

in patients

> being treated for homocysteine issues with B vitamins. Now

patients would be

> receiving the optimal form of Folic Acid based on their genetic

needs.

>

> This way any one on the above therapies from Arginine to Saw

Palmetto and/or

> Glucosamine etc would concurrently be on the correct protein and

other

> nutrients needed based on their gene tests. Glucosamine in the

above study

>

> Garry F. Gordon MD,DO,MD(H)

> President, Gordon Research Institute

> www.gordonresearch.com

>

>