Marc Joseph Nutrition - Blog

There are so many easily accessible sources for sound, scientific nutrition knowledge, including:

• Leading journals like the:
  • American Journal of Clinical Nutrition
  • Journal of Nutrition
• The OHSU Linus Pauling Micronutrient Center
• And the Institute for Functional Medicine

That’s why it’s so disappointing to see yet another mainstream media article questioning the usefulness of nutritional supplementation. This one was in the LA Times (”Daily vitamin: Is it really necessary?“).

The gist of the article is summarized in this excerpt:

“…there’s little science to support America’s love affair with vitamins…”

Yet, the resources mentioned above contain many studies indicating that nutrient deficiencies may contribute to the development of numerous chronic diseases and that nutritional supplementation may play a role in preventing or treating these conditions.

Unfortunately, the article brings up many of the same tired arguments often cited by supplement naysayers, e.g.:

Argument #1: “[M]any in public health worry that a recommendation for a pill might signal to people that actual food isn’t important.”

Response: Of course actual food is important. No responsible, knowledgeable nutritionist would say otherwise or suggest people substitute supplements for healthy food choices. It’s a silly strawman argument.

Argument #2: “People with a deficiency in vitamin B12 — and that includes a lot of elderly people — are at risk of crippling neurological damage if they take too much folic acid, because the substance masks their B12 deficiency, leaving it to languish untreated.”

Response: Of course. Any well-trained nutritionist knows that (along with many other nutrient relationships). But rather than damning individual folic acid supplementation, which can be helpful in many conditions and was a commonplace deficiency prior to food fortification, why not call for a simple disclosure on the supplement bottles that tells consumers the importance of not exceeding the recommended dose and also ensuring adequate vitamin B12 intake through diet and potentially supplementation?

Argument #3: “[T]he use of beta carotene among smokers actually increased the risk of lung cancer.”

Response: You knew it was coming. You can’t have a vitamin naysaying article without mentioning the infamous study showing the risk of beta-carotene supplementation risk to smokers. If I were a smoker, though, beta-carotene supplementation would probably be the least of my health worries.

Argument #4: “Yet many nutrition experts believe that the real issue is different — that Americans need to simply eat better. “We need to focus on the quality of our diets,” says McGinnis. “We don’t know how all of these micronutrients work.”

Response: Of course Americans need to simply eat better. But, you know what? They don’t! (in general) Given the choice between a less than optimal diet with no nutrient supplementation or one with supplementation, I’d opt for the latter every time.

Argument #5: “We can take a guess that one element in a food is the responsible agent, good or bad — but it’s a guess.” (McGinnis)

Response: Goodness, McGinnis talks about nutrition as if it’s witchcraft. It’s science! There’s plenty of credible nutrition research making a strong case for the role of different nutrients in helping to prevent and treat disease. It doesn’t have the big pharmaco dollars behind it to fund as many multi-year, double-blind, placebo-controlled, randomized studies, but there is still plenty of solid research (see the links at the beginning of this post).

To their credit, the authors do cite individuals with a more balanced viewpoint, e.g., Jeffrey Blumberg, professor of nutrition and director of the Antioxidants Research Laboratory at Tufts University:

“I think all Americans — adults, teenagers and children — should be taking a multivitamin. Period.”

The authors also mention:

Even those most dismissive of daily vitamins are quick to concede that specific groups of people, including those with underlying problems such as diabetes, have nutritional needs not typically met through diet. Almost everybody older than 65 needs a B12 supplement, for example. People dieting to lose weight and eating fewer than 1,500 calories should also take a multivitamin, as should pregnant women and women of childbearing age.

“It all depends on where you are in life,” says Ann Yelmokas McDermott, project director of the Boston Obesity, Genetics and Lifestyle Study at Tufts.

But in some ways, hand-wringing over the role of multivitamins boils down to concern over the American diet. There are no food shortages in this country, and people routinely eat far more calories than they need — but still, Blumberg says, most Americans don’t get even half of their recommended dose of vitamin C, and fall way short of vitamins A and E, and such minerals as magnesium and potassium.

Exactly!!! Given the poor diets of most Americans, multiple nutrient deficiencies are commonplace among the general population. Add up all the people who are seniors, diabetics, teens & college-aged kids, pregnant women, women of childbearing age, dieters, fast-food-aholics, etc. — and you’re talking about the majority of the people in this country! (and in most industrialized countries)

The authors note that sorting through all of the information can be confusing:

“You can’t blame people for being confused. Every week, it seems, some study appears in the literature raising a new vitamin hope or dashing an old one…

…It’s tricky stuff, deciding how much of which nutrient to take in supplemental form for optimal health — especially if one rejects the one-size-fits-all multivitamin for a personalized regimen. “If you were sufficiently expert in nutrition and could conduct a full dietary and nutritional status assessment, then you could certainly design an individualized supplement regimen,” Blumberg says. “But few people are suitably qualified.”

That’s definitely a legitimate and important point. Nutrition is complex. It’s the basis of cell function, and along with other environmental factors like toxin exposure and stress, is a primary driver of health. Many people do supplement with the wrong things at the wrong doses.

But, is that a reason to question nutritional supplementation’s usefulness? Or, should it be a call for better education of both the public and health care professionals, so that nutritional supplementation as a basic tool for preventive health can be better implemented in practice? (Don’t ask the pharmacos that last question.)

The bottom-line: I agree with Blumberg — a well-qualified nutritionist can help people to sort through it all and create an individualized supplement regimen that meets a particular individual’s needs. Nutritional supplementation is not a panacea, but it can be an important part of a well-rounded approach to maintaining good health.

A recent study in the Journal of Gerontology took a look at the potential protective effect of beta-carotene in people with Alzheimer’s disease (AD). The researchers found that those individuals with a specific genotype known to be associated with greater risk of developing AD had a significantly reduced risk of cognitive decline if serum beta-carotene levels were kept high.

Earlier studies have identified that people who have blood lipoproteins of the apoE4 genetic type are at greater risk of developing early-onset AD. Lipoproteins are molecules that help transport fats and cholesterol through the blood. There are three types of these particular lipoproteins: apoE2, apoE3, and apoE4.

Each person has two copies of the gene that codes for this lipoprotein, one from the mother and one from the father. If both copies of the gene code for apoE4, then one is considered homozygous for that trait. If only one of the parents’ genes code for it, then one is considered heterozygous for that trait. Those at highest risk are individuals who are homozygous for apoE4.

More on the different gene types here:

• ApoE4 is associated with a higher risk of Alzheimer’s. About a quarter of the population inherits one copy of the ApoE4 gene, which increases their risk of developing Alzheimer’s disease by up to four times.
• Two per cent of the population get a ‘double dose’ of the ApoE4 gene, one from each parent. Their risk of developing Alzheimer’s disease is increased by about ten times.
• Sixty per cent of the population have a ‘double dose’ of the ApoE3 gene and are at ‘average risk’. About half of this group develop Alzheimer’s disease by their late 80s.
• ApoE2 is least associated with Alzheimer’s disease. One in six people carry it. People with one ApoE2 gene and one ApoE3 gene (11 per cent of the population) have a 50 per cent chance of getting Alzheimer’s disease when they reach their late 90s.
• One in 200 people inherit two copies of the ApoE2 gene and are at a lower risk of developing Alzheimer’s disease.

The researchers in the beta-carotene study found that in those individuals who were either hetero- or homozygous for apoE4, high serum levels of beta-carotene reduced the risk of cognitive decline by 89%. Little effect (11% risk reduction) was observed in people with no apoE4.

The researchers hypothesize that the beta-carotene may help to reduce the oxidative stress and resulting tissue damage that is observed with the build-up of beta-amyloid plaque deposits in AD brains. Also, there is research that suggests that people with the apoE4 form of the gene are less able to prevent the buildup of the plaque deposits observed in AD.

Another hypothesis as to why people with apoE4 are at higher risk is that a primary difference between the three lipoprotein types is the number of cysteine amino acids in the lipoprotein’s amino acid chain. apoE2 has two cysteine amino acids, apoE3 has one, and apoE4 has none. Cysteine is a sulfur-containing amino acid. Mercury has a high affinity for sulfur. The absence of cysteine in the apoE4 form of the lipoprotein may make individuals with this form less able to remove heavy metals from the bloodstream and more susceptible to toxin exposure.

Regardless of the mechanism, antioxidants such as beta-carotene, seem to play an important role in helping to manage the oxidative stress observed in AD.

In a recent study, Italian researchers found that southern Europeans consuming the highest amounts of onions and garlic had a significant reduction in risk for many cancers.

Listed below in parentheses are the percent declines in cancer risk that researchers found for high onion and garlic consumption, respectively:

• Oral cavity & pharynx (84%, 39%)
• Esophageal (88%, 57%)
• Colorectal (56%, 26%)
• Laryngeal (83%, 44%)
• Breast (25%, 10%)
• Ovarian (73%, 22%)
• Prostate (71%, 19%)
• Kidney (38%, 31%)

The results are consistent with other studies that have found beneficial effects for these vegetables in helping to prevent cancers of the digestive tract, prostate, and breast.

Garlic and onions are both members of the allium vegetable family. Organosulfur compounds found in these vegetables are believed to help prevent cancer development by:

• Promoting metabolism of carcinogens by promoting Phase II and slowing Phase I detoxification pathways in the liver.
• Enhancing cellular production of glutathione, the body’s primary and most important antioxidant.
• Arresting unregulated cell growth, which is seen with cancer, and promoting apoptosis (normal programmed cell death).
• Inhibiting microbial growth (yeast, bacteria, viruses), which may be involved in cancer development.

So, mangia! Grab the (xylitol-sweetened) breath mints and get going…

When grocery shopping, it’s often difficult to identify healthy food choices, especially with packaged foods that consumers increasingly seek for sake of convenience.

(See last week’s post discussing convenience as the primary driver of food choice.)

Now it seems that at least one grocer is trying to help consumers sort through all the health claims made by different food manufacturers. A New England grocery chain, Hannaford Brothers, has developed a system that assigns each food in its stores a health rating from zero to three stars.

The results were interesting, to say the least:

Of the 27,000 products that were plugged into Hannaford’s formula, 77 percent received no stars, including many, if not most, of the processed foods that advertise themselves as good for you.

These included V8 vegetable juice (too much sodium), Campbell’s Healthy Request Tomato soup (ditto), most Lean Cuisine and Healthy Choice frozen dinners (ditto) and nearly all yogurt with fruit (too much sugar). Whole milk? Too much fat — no stars. Predictably, most fruits and vegetables did earn three stars, as did things like salmon and Post Grape-Nuts cereal.

Of course, food manufacturers were not pleased with this rating system and its results.

Hannaford assembled a panel of nutritionists and evaluated foods using a more stringent and broader set of criteria than those set by the F.D.A. and used by food manufacturers to make health claims.

Hannaford formed a seven-member advisory panel of nutritionists and a physician to develop a formula for evaluating the healthiness of food. That algorithm evaluates a 100-calorie serving of each product using only the information that is available on the “nutrition facts” panel and the ingredients list. A product receives credit for vitamins, minerals, dietary fiber and whole grains, but is docked points for trans fat, saturated fat, cholesterol, added salt and added sugar…

…The food agency sets standards that food manufacturers must use when they define a product as, say, low in fat or high in fiber, and companies may use those designations even if the product is loaded with less desirable ingredients……Many packages trumpet the benefits of a few attributes — high fiber, for instance, or no trans fats — while ignoring negatives like too much sodium…

Even the FDA acknowledges that its guidelines can only go so far:

“The thing is, a lot of claims we see out there are puffery,” said Joseph R. Baca, director of the office of compliance at the F.D.A.’s Center for Food Safety and Applied Nutrition. “But they don’t get to the point where we can call them fake or misleading.”

What do the ratings results say about the food industry and consumers? The article concludes:

Nutritionists and food industry analysts said that Hannaford’s findings highlight some unpleasant truths about Americans and their eating patterns. People want to be healthier but do not want to change their behavior, and so marketers have stepped in with products that improve on the originals but still leave something to be desired.

I definitely agree, but I also think there is a segment of the population that is focused on consistently selecting healthy food choices. AND, importantly, that that segment is growing. Ratings systems like this one can help busy people to make better choices. Hopefully more grocery chains will use such a system in the future.