August 23, 2011, Washington Post, Jennifer LaRue Huget

In an ideal world, no one would need dietary supplements. Our balanced diets would provide all the vitamins, minerals and other nutrients our bodies need.

Alas, the world of American eating is far from ideal. And that, some nutrition experts and supplement advocates argue, is why we need dietary supplements.

The latest federal data show that more than half of U.S. adults use dietary supplements, mostly multivitamins. But do we really need all those pills?

Depends on whom you ask. The latest version of the federal Dietary Guidelines for Americans urges us to get our nutrients primarily from food:

“A fundamental premise of the Dietary Guidelines is that nutrients should come primarily from foods. Foods in nutrient-dense, mostly intact forms contain not only the essential vitamins and minerals that are often contained in nutrient supplements, but also dietary fiber and other naturally occurring substances that may have positive health effects.”

This “food first” approach is based on the emerging understanding that our bodies may process nutrients in food differently from those supplied by supplements and that foods contain scores of compounds whose synergy may be what makes them good for us.

The document also points out that “sufficient evidence is not available to support a recommendation for or against the use of multivitamin/mineral supplements in the primary prevention of chronic disease for the healthy American population.”

But, as I wrote in 2009, meeting your daily dietary needs without using supplements is a challenge, even when you’re choosing ultra-healthful foods under a professional dietitian’s guidance.

It’s a widespread challenge. Society has “invested a lot in the science behind the Dietary Guidelines for Americans,” says Duffy MacKay, vice president for scientific and regulatory affairs for the Council for Responsible Nutrition, a dietary supplement trade group. “When you think about people and what they’re eating, a significant number are not meeting those benchmarks.”

Robert Post, deputy director of the U.S. Department of Agriculture’s Center for Nutrition Policy and Promotion, says too few Americans are meeting all their nutritional requirements and that dietary supplements, used sensibly, can help fill gaps in our diets. In particular, he notes, the guidelines single out four “nutrients of concern” that most of us need more of to maintain good health: potassium, Vitamin D, calcium and fiber (see chart).

But Post, like the guidelines, calls for people to get their fill of those four nutrients from food and to consider supplements only for a handful of dietary deficiencies related to our stage of life and dietary preferences. Those include:

Iron: Women who are able to become pregnant need more iron, especially heme iron, which the body absorbs more readily than non-heme iron. Heme iron is found in lean meat and poultry; non-heme iron is in white beans, lentils, spinach, enriched breads and cereals. Foods rich in Vitamin C can aid iron absorption. Adult males need just 8 mg of iron per day; women need 18 mg, and pregnant women need 27 mg.

Read more at Dietary supplements: Do we need them, or can we get all our nutrients from food? – The Washington Post.

The New York Times, Jane E. Brody, October 18, 2010

Esther Tuttle is nearing the end of the 10th decade of a remarkably productive and adventurous life. If all continues to go as well as it has to date, next July 1 she will join the rapidly growing clan of centenarians, whose numbers in the United States have increased to 96,548 in 2009 from 38,300 in 1990, according to the Census Bureau.

At age 92, Mrs. Tuttle (best known as Faity, her childhood nickname) wrote a memoir with the prescient title “No Rocking Chair for Me” (iUniverse) displaying an acute memory of events, names, dates and places that she retains as she approaches 100.

At 30 years her junior, I couldn’t begin to recall the kinds of details that remain fresh in her still very active mind. I can only hope, should I live that long, to be as vibrant and physically fit as she is.

What, I asked, is the secret to her longevity? Is it genetics? Perhaps, but it’s hard to say. Her parents died at ages 42 and 50, leaving her an orphan at age 11, along with three siblings, one of whom did live to 96.

Genes do play a role in longevity. Dr. Nir Barzilai, a geneticist at the Albert Einstein College of Medicine in New York, reports that centenarians are 20 times as likely as the average person to have a long-lived relative. But a Swedish study of identical twins separated at birth and reared apart concluded that only about 20 to 30 percent of longevity is genetically determined. Lifestyle seems to be the more dominant factor.

As Mrs. Tuttle said in clarion tones that belie her advanced age: “I am blessed and I’ve worked on it. You’ve got to work, be cheerful and look for something fun to do. It’s a whole attitude.

“If you respect what the doctors tell you to do, you can live a long life, but you have to do it. You can’t ignore the advice.”

Her memoir and replies to my queries revealed three critical attributes that might be dubbed longevity’s version of the three R’s: resolution, resourcefulness and resilience. Throughout her long life, she’s taken hardships in stride, traipsed blithely over obstacles and converted many into building blocks. And she has adhered to a regimen of a careful diet, hard work, regular exercise and a very long list of community service, all while raising three children.

Like many if not most other centenarians, according to the findings of the New England Centenarian Study at Boston University, Mrs. Tuttle is an extrovert who has many friends, a healthy dose of self-esteem and strong ties to family and community. She continues to enjoy her youthful passions for the theater and opera.

A study of centenarians in Sardinia found that they tend to be physically active, have extensive social networks and maintain strong ties with family and friends. They are also less likely to be depressed than the average 60-year-old.

Do optimists live longer than pessimists? Yes, studies indicate. Dr. Hilary A. Tindle of the University of Pittsburgh Medical Center, found that among 97,000 women followed for eight years, those deemed optimistic were significantly less likely to die from heart disease and all causes than were pessimistic women, whom she described as “cynically hostile.”

The optimists were also less likely to have high blood pressure, diabetes or high cholesterol, suggesting they take better care of their health. Indeed, the pessimists were more likely to be overweight, smoke cigarettes and avoid exercise, indicating, Dr. Tindle says, that negative thinkers make poorer lifestyle choices than positive thinkers.

A Walking Example

Faity Tuttle could serve as a model for that study’s findings. Each morning, she does an hour of yoga and other floor exercises, then dresses and goes out on the street or to the top of her Manhattan apartment building for a half-hour walk before breakfast. Her usual breakfast: orange juice, oatmeal, a banana and black coffee. Then she works at her desk, mostly corresponding with her 11 grandchildren, 21 great grandchildren and one great-great-grandchild, now 3. “So many birthdays — one or two a month,” she said.

Lunch may be soup or leftover meat, a “very thin” slice of rye toast, with tea and Jell-O or fruit for dessert. The afternoon includes an hour’s nap and another walk, often combined with grocery shopping.

At 6:30 every evening, she enjoys a cocktail before a home-cooked dinner of perhaps lamb, pork chops, roast chicken or “a very good stew” she makes herself. Mrs. Tuttle, whose husband, Ben, died in 1988, lives with a dear friend, Allene Hatch, 84, an artist and author affectionately known as Squeaky, with whom she shares K.P. “Most days I do the cooking, and Squeaky cleans up afterward.”

Stay-at-home evenings are spent reading or watching “a good movie” on television, she said.

Mrs. Tuttle recently gave up a lifelong passion for horseback riding, but she still drives, though not on public roads, only on a 300-acre farm in upstate New York that the Tuttles had the wisdom to acquire when land was cheap. Her children built homes on the property and now live there in retirement, providing Mrs. Tuttle with nearby loving company all summer and during the spring and fall weekends she spends at the farm.

The Benefits of Coping

As good as her health is (no high blood pressure, high cholesterol or diabetes), it is not perfect. She describes herself as “a bionic woman from the waist up,” with an artificial breast to replace the cancerous one removed 20 years ago, a heart pacemaker installed about a decade ago, a hearing aid and contact lenses.

Although she has spurned dairy foods for most of her life (she still follows the advice of a predecessor of Dr. Robert Atkins who told her to avoid dairy and follow a diet low in carbohydrates and rich in meats and fats), she was only recently found to have osteoporosis, for which she now takes a monthly pill along with daily supplements of calcium and vitamins C and D.

Nor has she always enjoyed an affluent lifestyle. Though born into an accomplished, well-to-do family, her parents’ early death (the children were taken in by an aunt with limited means) and her decision to pursue an acting career led to a hardscrabble existence that persisted through the early years of her marriage and life on a farm with three small children and no electricity and makeshift indoor plumbing. According to one study, survivors of traumatic life events learn to cope better with stress and poverty and are more likely to live to 100.

In lieu of trauma, there are many measures one can take to facilitate a long, wholesome and productive life. Why live to 100 if those last years will be marred by physical and emotional misery?
Personal Health – Three R’s for Extreme Longevity – NYTimes.com.

The New York Times, Pauline Chen, September 16, 2010

Within days of being accepted into medical school, I started getting asked for medical advice. Even my closest friends, who should have known better, got in on the action.
“Should I take vitamins?”

“What do you think of this diet?”

“Is yogurt good for me or not?”

Each and every time someone posed such a query, I became immediately cognizant of one thing: the big blank space in my brain. After all, even with medical school acceptance in hand, I was no more a doctor than they were.

But I also soon realized that many of their questions had nothing to do with medications or operations, or even diseases. With all the newspaper and television reports about newly discovered carcinogens and the latest diets and miracle nutrients, what my friends and acquaintances really wanted to know was just what they should or should not eat.

Years later, as a newly minted doctor on the wards seeing real patients, I found myself in the same position. I was still getting a lot of questions about food and diet. And I was still hesitating when answering. I wasn’t sure I knew that much more after medical school than I did before.

One day I mentioned this uncomfortable situation to another young doctor. “Just consult the dietitians if you have a problem,” she said after listening to my confession. “They’ll take care of it.” She paused for a moment, looked suspiciously around the nursing station, then leaned over and whispered, “I know we’re supposed to know about nutrition and diet, but none of us really does.”

She was right. And nearly 20 years later, she may still be.

Research has increasingly pointed to a link between the nutritional status of Americansand the chronic diseases that plague them. Between the growing list of diet-related diseases and a burgeoning obesity epidemic, the most important public health measure for any of us to take may well be watching what we eat.

But few doctors are prepared to effectively spearhead or even help in those efforts. In the mid-1980s, the National Academy of Sciences published a landmark report highlighting the lack of adequate nutrition education in medical schools; the writers recommended a minimum of 25 hours of nutrition instruction. Now, in a study published this month, it appears that even two and a half decades later a vast majority of medical schools still fail to meet the minimum recommended 25 hours of instruction.

Researchers from the University of North Carolina at Chapel Hill asked nutrition educators from more than 100 medical schools to describe the nutrition instruction offered to their students. While the researchers learned that almost all schools require exposure to nutrition, only about a quarter offered the recommended 25 hours of instruction, a decrease from six years earlier, when almost 40 percent of schools met the minimum recommendations. In addition, four schools offered nutrition optionally, and one school offered nothing at all. And while a majority of medical schools tended to intersperse lectures on nutrition in standard, required courses, like biochemistry or physiology, only a quarter of the schools managed to have a single course dedicated to the topic.

“Nutrition is really a core component of modern medical practice,” said Kelly M. Adams, the lead author and a registered dietitian who is a research associate in the department of nutrition at the university. “There may be some pathologists or other kinds of doctors who don’t encounter these issues later, but many will, and they aren’t getting enough instruction while in medical school.”

For the last 15 years, to help schools with their nutrition curriculum, the University of North Carolina has offered a series of instruction modules free of charge. Initially delivered by CD-ROM and now online, the program, Nutrition in Medicine, is an interactive multimedia series of courses covering topics like the molecular mechanism ofcancer nutrition, pediatric obesity, dietary supplements and nutrition in the elderly.

“Physicians have enough barriers trying to provide their patients with nutritional counseling,” Ms. Adams said. “Inadequate nutritional education does not need to be one of them.”

Ms. Adams and her colleagues believe that the fully developed online curriculum helps address two issues that frequently arise: the relative dearth of faculty in a medical school with appropriate expertise and the lack of time in an already packed course of study.

The flexibility of the online program has already helped students at the Texas Tech School of Medicine in Lubbock. Medical school teachers at Texas Tech, which has one of the best nutrition education programs in the country, were finding that they had difficulty maintaining the intensity and quality of instruction once more senior medical students began working in hospitals scattered across the school’s widely dispersed campuses. Students at a hospital that had the luxury of a trained faculty member, for example, would be immersed in a diabetes workshop that involved “becoming diabetic” for a week and regularly checking blood sugar readings and self-administering “insulin” through a needle and syringe, while students at another hospital would be left with no instruction at all. The online Nutrition in Medicine course allowed all the students to continue learning about diet and counseling patients despite their disparate locations and resources.

“We didn’t have to reinvent the wheel at other campuses when we already had these online courses that are so well done,” said Katherine Chauncey, a registered dietitian and a professor of clinical family medicine at Texas Tech.

More recently, Ms. Adams and her colleagues have begun working on online nutrition education programs geared toward practicing physicians. “Many of them are realizing that their training wasn’t adequate enough to make them feel comfortable counseling patients,” Ms. Adams said. Short, focused and relatively easy to navigate, these courses are meant to help fill in those gaps in knowledge for older doctors. Eventually, practicing physicians may even be able to earn continuing medical education credits, a requirement of many hospitals, state licensing boards and specialty boards.

“It’s extremely difficult to get people to change their diets and their habits around food,” Ms. Adams said. “Anything that improves a doctor’s confidence and skill set will go a long way in helping patients.”

Added Dr. Chauncey: “You can’t just keep writing out script after script after script of new medications when diet is just as important as drugs or any other treatment a patient may be using.”

Doctor and Patient – Teaching Doctors About Food and Diet – NYTimes.com.

Every five years the American public gets a newly tweaked directive on what we’re supposed to be eating.

And every five years the American public largely ignores it.

For example, the 2005 Dietary Guidelines for Americans recommend we eat 2 1/2 cups of vegetables and 2 cups of fruit a day. But according to the Centers for Disease Control and Prevention, only about 14 percent of adults are even coming close.

Special interest groups, however, watch the guidelines closely and are speaking out. Just last week, nearly 50 speakers from industry and the science and health communities went to Washington to provide oral comments on the proposed guidelines for 2010, which will be released at the end of the year.

The proposed recommendation to reduce salt intake dramatically drew a statement from Morton Satin, Salt Institute vice president of science and research, that “no modern society consumes so little salt.”

The Healthy Eating Pyramid displayed here is the one created by Harvard School of Public Health, and is the only pyramid solely based on scientific evidence.

Dr. Richard Feinman, on behalf of the Nutrition and Metabolic Society, invited members of the federal Dietary Guidelines Advisory Committee to a debate on the guidelines’ proposed decrease in saturated fat consumption, saying that carbohydrates eaten with saturated fats were the real problem. The Weston Price Foundation, which advocates the healthful properties of fat from pastured animals, also took issue.

A dietary supplements industry group called the Council for Responsible Nutrition objected to the proposed statement that “a daily multivitamin/mineral supplement does not offer health benefits to healthy Americans.” The council said the committee’s report implies “it’s reasonable to allow people to live with nutrient inadequacies.”

If the guidelines are largely ignored by the average American, why do health and industry groups care so much about influencing them?

“I think to a certain extent they are followed,” said Weston Price Foundation President Sally Fallon, whose organization also supports the consumption of whole, rather than processed, foods. “Schools who get federal money and prisons are supposed to be following them for their menus.”

Have questions about the new food guidelines? Many do. Reporter Monica Eng answers some of them at Trib Nation.

Dr. Robert Post, deputy director of the U.S. Department of Agriculture’s Center for Nutrition Policy and Promotion, said all public comments are taken into consideration along with scientific reviews and lively debate within the committee’s meetings.

He noted that last month the department debuted something called the Nutrition Evidence Library, a new online resource cataloging the latest science on nutritional matters and the ways the USDA interprets it to create policy.

But some observers still worry that the guidelines may be too influenced by industry concerns.

“I believe that by supporting low-fat products and grain products, rather than actual low-fat foods and whole grains like quinoa and teff, they are just trying to support the food industry,” said Adele Hite, a University of North Carolina public health graduate student who represented the Committee for a Healthy Nation during last week’s meeting.

The USDA started giving out nutritional advice more than 100 years ago with a table of food composition and dietary standards that later morphed into food shopping guides for various income levels. In 1992 the agency developed the food pyramid, an image in which horizontal bars represented food groups.

In 2005 the pyramid was given a new look (and renamed My Pyramid) in which the bars were replaced by vertical stripes that some argued made it hard to read at a glance.

“The new pyramid is not so much an information image as something to send people to the mypyramid.gov Web site,” explained USDA spokesman John Webster.

“While making it, there was a concern that it was not specific enough,” Webster said. “But as we added more information it started to look like a Christmas tree. Finally we said we can’t continue to add more information and still make it meaningful, and so decided to put the information on the Web.”

Congress mandates that a committee on the dietary guidelines convene every five years to review the latest science and state of the American diet to make adjustments, but the pyramid usually does not change as often. It will likely get another makeover in early 2011 as part of the national Let’s Move campaign against childhood obesity.

The main changes proposed for the dietary guidelines include reducing daily sodium intake from 2,300 milligrams to 1,500 milligrams, reducing the percentage of saturated fat in the diet from 10 percent to 7 percent, reductions in foods with added sugars and an avoidance of artificial trans fats altogether. The report also highlighted the importance of vitamin D, calcium, potassium and dietary fiber, and it recommends eating 8 ounces of seafood a week.

Because most Americans already consume more sodium than was recommended in the last version of the guidelines, the new target of 1,500 milligrams is likely to pose formidable challenges to American consumers, not to mention food processors who rely on sodium as a flavor enhancer, preservative and binder.

Some experts acknowledge that although the proposed guidelines may force manufacturers to reformulate processed foods for schools and prisons that follow the standards, they may have little effect on what consumers eat at restaurants or at home.

“I think people ignore them when it comes to eating more fruits and vegetables and reducing refined sugars, but they will listen when they see the permission to eat six to 11 servings of grain per day,” Fallon said.

The proposed 2010 guidelines are the first to acknowledge America’s dire obesity epidemic and the roles environment and communication play in actually getting the public to follow the suggestions.

They cite “powerful influences that currently promote unhealthy consumer choices, behaviors and lifestyles” in our environment and call for cooperation with the Department of Health and Human Services to encourage improvements in areas including health, nutrition and physical education in schools; greater financial incentives to purchase, prepare and consume healthful food; more health-promoting foods and portions offered in restaurants and by manufacturers; and more exercise-friendly communities.

Among the questions the committee considered for this year’s guidelines was how much and what kinds of fish consumption it could endorse given the latest research on mercury contamination.

Unlike the current food pyramid, the government’s latest proposed advice takes into consideration the health threats posed by mercury, a toxic metal that taints certain types of fish and can trigger learning difficulties in children and neurological and heart problems in adults.

The proposed guidelines reflect a 2004 joint advisory from the Food and Drug Administration andEnvironmental Protection Agency that cautions young children, pregnant women, nursing mothers and women of childbearing age not to eat swordfish, shark, king mackerel and tilefish because of high mercury levels. It also advises those groups to consume no more than 12 ounces of fish a week, including no more than 6 ounces of canned albacore tuna.

An online version of the current food pyramid continues to recommend swordfish and tuna, four years after the Tribune first reported on the government’s contradictory advice. The National Academy of Sciences has sharply criticized the government for not doing enough to advise consumers about which fish are safest to eat, a job that has fallen to nonprofit health groups.

Based on the government’s own testing, Consumers Union, the publisher of Consumer Reports magazine, says the chances that any type of canned tuna will contain high levels of mercury are great enough that pregnant women should never eat it.

“You can get all of the benefits of fish and avoid the dangers of mercury by eating low-mercury fish,” said Jean Halloran, the group’s director of food policy initiatives. “It’s been distressing to see the government isn’t doing a better job helping women make smart choices.”

The seafood industry has argued that advising women about high- and low-mercury types of fish would scare them away from eating seafood altogether. Yet a 2008 federal study found a decline in the number of women nationwide with high levels of the toxic metal in their bodies, even though those women were eating the same amount of seafood. The finding suggested that consumer advisories about mercury had started to work.

via Food pyramid: New dietary guidelines coming from U.S. government – chicagotribune.com.

Vitamin D promises to be the most talked-about and written-about supplement of the decade. While studies continue to refine optimal blood levels and recommended dietary amounts, the fact remains that a huge part of the population — from robust newborns to the frail elderly, and many others in between — are deficient in this essential nutrient.

If the findings of existing clinical trials hold up in future research, the potential consequences of this deficiency are likely to go far beyond inadequate bone development and excessive bone loss that can result in falls and fractures. Every tissue in the body, including the brain, heart, muscles and immune system, has receptors for vitamin D, meaning that this nutrient is needed at proper levels for these tissues to function well.

Studies indicate that the effects of a vitamin D deficiencyinclude an elevated risk of developing (and dying from) cancers of the colon, breast and prostate; high blood pressure and cardiovascular disease; osteoarthritis; and immune-system abnormalities that can result in infections and autoimmune disorders like multiple sclerosis, Type 1 diabetes and rheumatoid arthritis.

Most people in the modern world have lifestyles that prevent them from acquiring the levels of vitamin D that evolution intended us to have. The sun’s ultraviolet-B rays absorbed through the skin are the body’s main source of this nutrient. Early humans evolved near the equator, where sun exposure is intense year round, and minimally clothed people spent most of the day outdoors.

“As a species, we do not get as much sun exposure as we used to, and dietary sources of vitamin D are minimal,” Dr. Edward Giovannucci, nutrition researcher at the Harvard School of Public Health, wrote in The Archives of Internal Medicine. Previtamin D forms in sun-exposed skin, and 10 to 15 percent of the previtamin is immediately converted to vitamin D, the form found in supplements. Vitamin D, in turn, is changed in the liver to 25-hydroxyvitamin D, the main circulating form. Finally, the kidneys convert 25-hydroxyvitamin D into the nutrient’s biologically active form, 1,25-dihydroxyvitamin D, also known as vitamin D hormone.

A person’s vitamin D level is measured in the blood as 25-hydroxyvitamin D, considered the best indicator of sufficiency. A recent study showed that maximum bone density is achieved when the blood serum level of 25-hydroxyvitamin D reaches 40 nanograms per milliliter or more.

“Throughout most of human evolution,” Dr. Giovannucci wrote, “when the vitamin D system was developing, the ‘natural’ level of 25-hydroxyvitamin D was probably around 50 nanograms per milliliter or higher. In modern societies, few people attain such high levels.”

A Common Deficiency

Although more foods today are supplemented with vitamin D, experts say it is rarely possible to consume adequate amounts through foods. The main dietary sources are wild-caught oily fish (salmon, mackerel, bluefish, and canned tuna) and fortified milk and baby formula, cereal and orange juice.

People in colder regions form their year’s supply of natural vitamin D in summer, when ultraviolet-B rays are most direct. But the less sun exposure, the darker a person’s skin and the more sunscreen used, the less previtamin D is formed and the lower the serum levels of the vitamin. People who are sun-phobic, babies who are exclusively breast-fed, the elderly and those living in nursing homes are particularly at risk of a serious vitamin D deficiency.

Dr. Michael Holick of Boston University, a leading expert on vitamin D and author of “The Vitamin D Solution” (Penguin Press, 2010), said in an interview, “We want everyone to be above 30 nanograms per milliliter, but currently in the United States, Caucasians average 18 to 22 nanograms and African-Americans average 13 to 15 nanograms.” African-American women are 10 times as likely to have levels at or below 15 nanograms as white women, the third National Health and Nutrition Examination Survey found.

Such low levels could account for the high incidence of several chronic diseases in this country, Dr. Holick maintains. For example, he said, in the Northeast, where sun exposure is reduced and vitamin D levels consequently are lower, cancer rates are higher than in the South. Likewise, rates of high blood pressure, heart disease, and prostate cancer are higher among dark-skinned Americans than among whites.

The rising incidence of Type 1 diabetes may be due, in part, to the current practice of protecting the young from sun exposure. When newborn infants in Finland were given 2,000 international units a day, Type 1 diabetes fell by 88 percent, Dr. Holick said.

The current recommended intake of vitamin D, established by the Institute of Medicine, is 200 I.U. a day from birth to age 50 (including pregnant women); 400 for adults aged 50 to 70; and 600 for those older than 70. While a revision upward of these amounts is in the works, most experts expect it will err on the low side. Dr. Holick, among others, recommends a daily supplement of 1,000 to 2,000 units for all sun-deprived individuals, pregnant and lactating women, and adults older than 50. The American Academy of Pediatrics recommends that breast-fed infants receive a daily supplement of 400 units until they are weaned and consuming a quart or more each day of fortified milk or formula.

Given appropriate sun exposure in summer, it is possible to meet the body’s yearlong need for vitamin D. But so many factors influence the rate of vitamin D formation in skin that it is difficult to establish a universal public health recommendation. Asked for a general recommendation, Dr. Holick suggests going outside in summer unprotected by sunscreen (except for the face, which should always be protected) wearing minimal clothing from 10 a.m. to 3 p.m. two or three times a week for 5 to 10 minutes.

Slathering skin with sunscreen with an SPF of 30 will reduce exposure to ultraviolet-B rays by 95 to 98 percent. But if you make enough vitamin D in your skin in summer, it can meet the body’s needs for the rest of the year, Dr. Holick said.

Can You Get Too Much?

If acquired naturally through skin, the body’s supply of vitamin D has a built-in cutoff. When enough is made, further exposure to sunlight will destroy any excess. Not so when the source is an ingested supplement, which goes directly to the liver.

Symptoms of vitamin D toxicity include nausea, vomiting, poor appetite, constipation, weakness and weight loss, as well as dangerous amounts of calcium that can result inkidney stones, confusion and abnormal heart rhythms.

But both Dr. Giovannucci and Dr. Holick say it is very hard to reach such toxic levels. Healthy adults have taken 10,000 I.U. a day for six months or longer with no adverse effects. People with a serious vitamin D deficiency are often prescribed weekly doses of 50,000 units until the problem is corrected. To minimize the risk of any long-term toxicity, these experts recommend that adults take a daily supplement of 1,000 to 2,000 units.

Personal Health – What Do You Lack? Probably Vitamin D – NYTimes.com.

The Huffington Post, Michelle Locke, July 15, 2010

It’s not hard to figure out that stocking school vending machines with sugary sodas and salty, fatty snacks is a bad idea. Replacing those culinary culprits with something more nutritious is tougher.

But a growing number of school districts around the country are trying anyway.

“I can’t say enough for what it does for the kids to have the junk out of the machines,” says Patricia Gray, who as former principal of San Francisco’s Balboa High School oversaw a switch to healthier snacks.

“It was not an easy task,” says Gray, now an assistant superintendent with the district, “it was a re-education process.”

Efforts to get empty calories out of students’ hands are being made in almost every state, according to the Centers for Disease Control. A 2008 School Health Profiles Survey found that fewer secondary schools were selling less nutritious snacks compared with two years before.

Among the findings: Across 34 states, the median percent of secondary schools that ditched non-nutritious snacks increased from 46 percent in 2006 to 64 percent in 2008.

Still, the report found more progress needs to be made.

How big a deal is what kids eat at school?

According to the Institute of Medicine and the National Center for Health Statistics, the average young person gets more than 10 percent of his or her calories from saturated fat, takes in less than two-thirds the recommended intake of calcium and more than double the recommended amount of sodium. And for boys and girls ages 9 to 13, 21 percent get more than one-fourth of their energy intake from added sugars.

Food in the lunch and breakfast programs must meet nutritional standards to qualify for federal reimbursement, but food sold in other school venues, including vending machines, aren’t subject to those requirements.

Some states have passed their own laws regulating vending machines, including California, which forbids some non-nutritious snacks. In San Francisco, the school board has a stricter policy, passing a wellness policy implemented in the 2003-04 year that banned sodas (this is now part of the state standard, too) and nixed snacks like baked potato chips.

“It may be less bad for you, but that doesn’t mean that it’s good for you,” says Dana Woldow, a leader in the push for better snacks and co-chair of the district’s Student Nutrition and Physical Activity Committee.

Things aren’t perfect now, but they’re “a million times better,” than the past when sodas, candy and fried chips were the rule, Woldow said.

Starting this fall, one machine is being piloted in a San Francisco high school that will offer full, reimbursable, meals – fruit, vegetable, milk, sandwich. The “smart” machine will tally up when a student has selected enough items to qualify as reimbursable.

Drinks allowed in San Francisco school vending machines include water, juice, milk and juice/water blends with no added sweeteners, caffeine or herbal supplements. Snacks include yogurt bars, tuna salad and crackers, fruit bars and sunflower seeds.

Healthier snack machines are showing up all over. Jolly Backer, CEO of San Diego-based Fresh Healthy Vending, says the company has machines in 1,700 locations, including schools, across the United States. Offerings include items such as yogurts and fresh fruit. “All the top-selling drinks and snacks that you’d find in a Whole Foods Market you’ll find in our machines,” says Backer.

Some, like food activist Marion Nestle, say the idea of healthier vending machines is flawed.

“It depends how you define healthy,” she said. “If you define healthy as slightly better for you than junk food, they’re doing a really good job.”

She advocates taking out vending machines and focusing on improving school lunch options.

But Woldow notes that the school day is long with extracurricular activities that can go on for hours after the cafeteria closes, which means students might dash out to corner stores for high-fat, high-sugar snacks. “Isn’t it better to offer them healthy choices which are also convenient?” she says.

For those working to boost the nutrient value of vending machines, one issue is that machines are often under independent contract, perhaps to the PE department or the English department, making it hard to centralize control.

Bringing about change requires a comprehensive approach, says Gray. In addition to working on vending machine content she stopped the sale of candy for fundraisers, a very unpopular decision for a while, and curtailed bringing in junk food from home. “If you don’t have a principal that’s totally committed to (healthier snacks), it won’t work.”

And be patient, she says. Passing out fresh fruit started out as a novelty and turned into a treat. “They will eat it if it’s available and you don’t have the bad stuff. Kids get hungry. They’re going to eat one way or the other.”

Schools Trying To Expel Junk Food.

A federal advisory committee voted narrowly against endorsing a drug vying to become the first new prescription medicine for obesity in more than a decade, signaling heightened concerns for possible health risks associated with a new generation of diet pills.

The advisory committee to the Food and Drug Administration voted 10 to 6 that the safety concerns, like increased heart rate, possible birth defects and psychiatric problems, overrode the potential benefits of the drug, called Qnexa and developed by Vivus.

The meeting was closely watched by both the medical community and Wall Street as a sign of how the F.D.A. might handle new obesity drugs. Typically, the agency has paid extraordinary attention to safety because weight-loss drugs have a history of safety problems and because the medicines are likely to be used by millions of people for long periods of time.

The committee vote suggests that drug safety will continue to be paramount.

“No one wants to conduct a large public health experiment on the population,” one panel member, Elaine H. Morrato of the University of Colorado, Denver, said.

The F.D.A. is scheduled to decide by late October whether to approve Qnexa. It usually abides by the advice of its advisory committees. But a split vote like this one is often viewed by the agency as less definitive. Indeed, several panel members said they could just as easily have voted the other way.

The outcome of the meeting could portend a more difficult time for two other new obesity drugs that will face advisory committee hearings this year — lorcaserin from Arena Pharmaceuticals and Contrave from Orexigen Therapeutics.

The F.D.A. and most panel members did not question the effectiveness of Qnexa. Results from clinical trials suggested that in reducing weight, Qnexa was superior to the currently approved drugs and to the other two possible new ones.

Those getting the highest dose of Qnexa lost an average of 10.6 percent of their weight after one year, compared to 1.7 percent for those on a placebo.

The F.D.A. had five safety concerns that the panel spent most of the day addressing: possible psychiatric problems like depression and suicidal thinking, impaired memory and concentration, acid buildup in bodily fluids that could increase the risk of kidney stones, an increase in heart rate that could portend cardiac problems and possible birth defects.

Qnexa is a combination of two already approved drugs: phentermine, the part of the fen-phen combination that remained on the market after fen-phen was withdrawn in 1997 for causing heart valve problems, and topiramate, an epilepsy and migraine drug sold as Topamax by Johnson & Johnson. Phentermine, a stimulant, is responsible for the faster heartbeat, and topiramate causes the other side effects.

Leland F. Wilson, the chief executive of Vivus, said the company was disappointed with the vote but not deterred from trying to win approval. “The advisory committee vote is a recommendation, not a final step,” he said in a brief conference call.

Trading in Vivus, based in Mountain View, Calif., was halted on Thursday during the panel’s meeting, but shares plummeted 56 percent, to $5.27, in early after-hours trading. Shares of both Orexigen and Arena fell late in the day after the committee vote.

In after-hours trading, however, Arena was up somewhat. That could be because investors see its drug as having a better safety profile than Qnexa, although it is less effective in reducing weight.

About one-third of American adults are obese and another third overweight, so a successful diet drug could garner sales of billions of dollars a year.

Yet there have been few, if any, successful obesity drugs. The two existing drugs approved for long-term use — Meridia from Abbott Laboratories and Xenical from Roche — have modest sales, in part because of side effects and limited efficacy. Three years ago, the F.D.A. declined to approve rimonabant from Sanofi-Aventis because of concerns about suicide risk and depression.

Vivus argued on Thursday that obesity itself was a health risk, associated with a higher risk of diabetes, heart disease and other problems. “Obesity treatment can improve health and save health care dollars,” Dr. Louis J. Aronne, an obesity expert at Weill Cornell Medical College and a consultant to Vivus, told the committee. “Weight loss now appears to be like a gift that keeps on giving.”

In the trial, Qnexa improved blood pressure, blood sugar and cholesterol levels. But Dr. Mary Roberts, the F.D.A. reviewer of the drug, said it was unclear if the improvements would translate into what really matters, a reduction in heart attacks, strokes and death.

Bariatric surgery, which can produce weight loss of 15 percent or more, has been shown to reduce risk of heart attacks and prolong lives. But the only study that tested this for a diet drug — Meridia — actually found an increase in heart attack risk.

Most of the committee members spent two days this week on another panel weighing whether the diabetes drug Avandia should be removed from the market because of suggestions it raises the risk of heart attack.

That seemed to color the debate on Qnexa a little. Some committee members said that the yearlong trials of Qnexa did not provide enough information to judge long-term risks and that it was better to keep the drug off the market than to have problems arise later.

via F.D.A. Panel Votes Against Obesity Drug Qnexa From Vivus – NYTimes.com.

The Wall Street Journal, Shirley Wang, June 22, 2010

Americans increasingly view the food they eat as medicine to help lower cholesterol, reduce high blood pressure and control blood sugar. But as with prescribed drugs, the health-improving qualities of foods such as olive oil, nuts and fruit can interact with other medications, causing possible problems.

Pharmacists often warn people not to mix anti-cholesterol drugs known as statins with grapefruit juice. Newer research suggests that other fruit juices, including cranberry and pomegranate, as well as olive oil may also interfere with how statins work in the body. Other laboratory studies show that certain popular teas can block the effect of some medications, including the flu drug Tamiflu. And switching to a low-fat diet, itself a healthy lifestyle change, could reduce the potency of some medications.

Diet can interact with medicine in two main ways. Some foods block the body’s ability to absorb certain medications, effectively reducing the dose a person receives. Other foods enhance the absorption of some drugs, which can lead to a possible overdose.

In general, diet will only interact with medications when a person is consuming exceptionally large portions of certain foods, pharmacology and medical experts say. A few teaspoons of olive oil on pasta typically doesn’t pose any problems, for instance.

Still, as Americans increasingly select foods based on their health benefits, or take supplements with high doses of nutrients, the likelihood of adverse interactions with medications rises. U.S. sales of supplements, natural and organic foods and functional foods, or foods enhanced beyond normal use like calcium-fortified orange juice, grew to $93.5 billion in 2008 from $47.9 billion in 2000, according to Nutrition Business Journal, a nutrition-industry trade publication.

“For every drug there is, there are unintended side effects. You should expect the same thing when taking nutrients at drug levels,” says Patrick Stover, director of the division of nutritional sciences at Cornell University in Ithaca, N.Y.

Other factors also can affect how medicines are absorbed in the body, including a person’s age, weight and gender. Such variations, combined with possible interactions with the food we eat, can increase or reduce the effective dose of a medication by as much as 5- to 10-fold, which are “huge effects,” Dr. Stover says.

Grapefruit is one of the most extensively studied foods for its impact on medication. Compounds in the fruit can increase the potency of statins and other medications to potentially dangerous levels by inhibiting cytochrome P450, a family of enzymes that break down the drug. Research indicates that drinking just one eight-ounce cup of grapefruit juice a day increases the strength of the drug.

Recently, animal and laboratory studies have suggested that other fruits, including pomegranates, oranges (especially those from Seville), cranberries, grapes and black mulberries, could have a similar, although less robust, effect on statins in the body. Pomegranates and cranberries are frequently touted as healthy foods because of their high quantities of antioxidants, which supposedly remove free radicals from the body and slow the onset of disease and aging.

The scientists continue to study potential food-drug interactions, as do other researchers world-wide.John Thor Arnason, a biologist at the University of Ottawa, and his colleague Brian Foster of Health Canada, a government ministry, have investigated the effect on drugs of more than 450 food products, mainly in animal and laboratory studies.

In one recent study, Dr. Arnason’s team examined dozens of different kinds of beers. They found that the “hoppier” or more bitter beers reduced the effect of the cancer drug Tamoxifen, when compared with beers that were less hopped. The study was published this year in the Journal of Agricultural and Food Chemistry.

Another popular compound, the anti-oxidant resveratrol found in red wine, nuts and dark chocolate, is touted for its anti-aging benefits. But resveratrol in large quantities appears to potentially enhance the potency of drugs, other laboratory studies show.

People, especially older adults taking multiple medications, should tell their doctor about dietary supplements, if they are using high-potency juices and teas and drinking lots of wine, Dr. Arnason says. He says that drugs whose labels contain lots of conditions and warnings about possible interactions with other medications are probably more likely also to interact with foods. If a food-drug interaction is suspected, patients should stop taking the food and talk to their doctor immediately.

In work published this year, Drs. Arnason and Foster showed that various herbs including chai hu, Labrador tea, echinacea and goldenseal, can reduce the potency of Tamiflu. The researchers incubated Tamiflu by itself or along with herbs, together with human liver tissue, which is responsible for processing the medication in the body. They found that the drug was less activated in the presence of the herbs.

The herbs are believed to proffer different health benefits. Labrador tea is thought to benefit the nervous system, Chai Hu to treat common cold and fever, and Echinacea is thought to prevent colds and have anti-tumor benefits. Goldenseal is an anti-microbial and anti-inflammatory product.

Others researchers have investigated spices. In one study, piperine, one of the main components of black pepper, increased the potency of the antihistamine Allegra in rats by two-fold compared with animals that took the medicine alone, according to a report in April’s Journal of Food Sciences.The researchers also have studied black tea, which is touted for lowering blood pressure, and found that it appears to inhibit an enzyme responsible for the body’s processing of many drugs. The result, the researchers found, is that consuming large quantities of black tea could potentially increase the potency of a wide range of medications.

Much of the research on teas and other foodstuffs—with the exception of grapefruit—haven’t been well-studied in humans, so the exact amount that may cause a harmful effect isn’t yet known, say researchers.

Whether the alcohol from beer or wine affects the processing of other drugs isn’t clear, says Cynthia Kuhn, a professor of pharmacology at Duke University Medical Center. It is dangerous to use alcohol in combination with sedating drugs like antihistamines, or narcotic pain medicines, because of the additive effect in the brain.

But despite strong warnings on some other drug labels that alcohol can interact in the liver to inhibit metabolism of other medications, the evidence “is not strong,” says Dr. Kuhn. Alcohol is mainly metabolized by an enzyme called alcohol dehydrogenase, which “has nothing to do with the metabolism of most drugs,” she says.

Some drugs, like dilantin, an epilepsy medication, appear to be affected by the amount of fat in the diet, according to a 2004 study.

Such medicines are dissolved only in fats and could therefore become less effective by a significant reduction in fat consumption.

Experts suggest that patients considering major dietary changes, such as switching to a much lower fat diet from a high-fat one, should discuss the move with their doctor.

Fresh Concerns on How Foods and Medicines Interact – WSJ.com.

weight loss supplements

Sale of drugs that do NOT (I repeat do NOT) make you thinner is expected to grow 11.5% per year.

Kathlyn Stone, January 24, 2010

They were right about the growth in vaccine sales. Now industry analysts predict anti-obesity drugs will be the next big success story in the pharmaceutical industry.

GlobalData’s newest report  predicts the global market for anti-obesity drugs – now valued at $1.4 billion – will grow 11.7 percent each year over the next seven to reach $3.1 billion by 2016.

Fueling the industry’s interest is the alarming obesity epidemic and a persistent public expectation that pharmaceutical companies will  eventually develop a pill that is safer, shows greater results, and has fewer negative side effects than drugs currently on the market.

By 2015, approximately 2.3 billion adults will be overweight and more than 700 million will be obese, according to projections from the World Health Organization (WHO).

The United States is currently the biggest single market for weight loss drugs, with around 68 percent of the population either overweight or obese, followed by the UK and other European countries. However, China, Russia, India and Brazil could soon begin to eclipse Western countries in terms of its obese populations. For example, China’s obesity and overweight levels are predicted to reach 665 to 670 million in 2015.

Yet, there are few options for the growing numbers that would consider pharmaceuticals to help shed pounds.

Two prescription anti-obesity drugs dominate the market: Roche’s Xenical (orlistat), a lipase inhibitor, and Abbott’s Meridia (sibutramine hydrochloride), an appetite suppressant.

Together they represent two-thirds of the $1.4 billion prescription anti-obesity market in terms of revenues. Generics and off-label drugs represent the other third. (Xenical lost its patent in December 2009 so will soon lose share to cheaper generics.)

Sibutramine, the key ingredient of Xenical, is the latest of a long line of anti-obesity drugs to be approved and later taken off the market. While still approved for sale in the United States, sibutramine has just been banned in the UK and France where health agencies concluded that its risks outweigh its benefits.

A third class of drugs promotes weight-loss by speeding up metabolism but it is only effective on a short-term basis.

via Flesh and Stone – Anti-obesity drug market to reach $3.1 billion by 2016.

OVER the course of a year, Alex Feintuch, a 20-year-old sophomore at the University of South Carolina, spent more than $1,000 on fitness supplements.

Mr. Feintuch wanted to add size and definition to his muscles, and to “see results as quickly as possible.” He did research and tried dozens of products, with mixed results.

“Of the products that I have bought, I’ve found many that work well,” he said. “But some don’t and were a waste of money.”

The fitness supplements industry is primarily aimed at young men like Mr. Feintuch. Bodybuilding-related products — powders and pills with names like Muscle Milk, Amplified Mass XXX and N.O.-Xplode — represented a $2.7 billion industry in 2008, but one whose benefits are in serious dispute.

The products are a subset of the more-familiar category of nutritional supplements, which includes mainstream items like vitamin-infused waters and energy bars. That market represented $25 billion in revenue in 2008, according to Nutrition Business Journal, a trade publication.

Athletes seeking peak performance are often concerned about eating right, choosing foods that allow their bodies to function at their best — everything from bananas to Peak bars. But going the next step to taking a pill or powder elicits more skepticism. Young female athletes, for example, are more apt to stick with multivitamins, energy drinks and bars, doctors and trainers say.

Male-oriented fitness supplements are not hard to find, but they are hard to figure out. Top-selling products like creatine, whey powder and nitric oxide are widely available under many brand names at drugstores and chains like G.N.C., but they are also minimally regulated, with a majority going untested by the Food and Drug Administration.

And that, sports medicine doctors say, points to the problems: there is little or no uniformity among products, the labels are confusing and the ingredients are arcane. Often, the main active ingredient is simply caffeine.

“It’s frustrating to not know exactly what I am putting in my body,” said Mr. Feintuch, who used a personal — and expensive — trial-and-error approach to come up with three products that seemed to work for him.

Doctors and nutritionists say that people who eat a normal diet generally don’t need nutritional supplements, even if they exercise vigorously. But among the subset of people who already eat healthfully and want to bulk up in the gym, some supplements, when taken in sensible doses, can provide a lift.

For instance, whey protein and creatine, which are meant to add bulk to muscles and raise the body’s ability to lift heavier weights, can, in some cases, help dedicated athletes become stronger faster, doctors and trainers say.

But the dose recommended on the bottle may be much higher than the dose recommended by doctors. And for this reason and others, doctors emphasize that only adults should take fitness supplements (although high school athletes often do). A policy statement by the American Academy of Pediatrics advises children under 18 to avoid them.

“Schools and other sports organizations should be proactive in discouraging the use of performance-enhancing substances,” said Dr. Teri M. McCambridge, who practices pediatric sports medicine in Towson, Md., and is the chairwoman of the American Academy of Pediatrics’ Council on Sports Medicine and Fitness.

Dr. McCambridge distinguishes between whey protein, which she considers to be a dietary supplement, and performance-enhancing substances like creatine and nitric oxide. Even so, she said, “the teenage diet already has more than enough protein.”

“They don’t need the extra amount” that a whey protein powder would provide, she said.

Further, most high school students “don’t know the importance of a recommended dose,” she said, and “there is a slippery slope when it comes to using other performance-enhancing drugs, like anabolic steroids and human growth hormone.”

And taking more than the recommended doses of fitness supplements can be harmful. Too much creatine in the system can lead to stomach upset and muscle cramps, among other things. And most people are familiar with the side effects of too much caffeine.

Jose Antonio, who edits a magazine called Sports Nutrition Insider and leads a nonprofit group called the International Society for Sports Nutrition, divides the popular supplements into three main categories: amino acid-based products, like whey protein and creatine; caffeine-based stimulants, and healthy fats like omega-3 acids.

Dr. Antonio is a proponent of several supplements, including whey protein and creatine, but says an athlete’s goals should determine his or her “strategy for use.” Creatine helps add size quickly, so it is good for people who want to bulk up, he said. Whey protein is more of a general fitness supplement and helps hasten the recovery of muscles after a workout, he said.

Some personal trainers recommend nutritional supplements to their clients. “If you’re looking to bust through a plateau, taking five grams of creatine before your workout might help you do that,” said Steve Hoffman, a trainer in Cherry Hill, N.J. “It adds water weight to your muscle and helps you lift more.”

For clients who want to intensify their workouts, Mr. Hoffman recommends products with arginine (an amino acid) or caffeine. He has experimented with such products and researched their effects, but he recommends caution for people who have not. “They’re awesome for working out — just be careful,” he said.

via Fitness – Fitness Supplements – When the Gym Isn’t Enough – NYTimes.com.