When it comes to dietary supplements, talk with your health professional!

On the heels of this week's B-vitamin study, last month's calcium study, and last year's vitamin E studies, there has never been a more important time to look to your health professional, one that is an expert in dietary supplements, for advice. Sources such as the media and your health food store clerk should not be your consensus for decision making with regard to dietary supplementation. We thought you would find these two articles very interesting. They echo what we have said so many times before.

Living Well: Better advisers on dietary supplements are needed

Monday, March 13, 2006

By BOB CONDOR
Special to the Seattle Post-Intelligencer

There is a small part of Dean Neary that would like to see all dietary supplements classified as prescription only.

"But just a small part," said Neary, a naturopathic physician and chairman of the physical medicine department at Bastyr University in Kenmore.

The reason Neary offers up any hint of such potential heresy among natural health practitioners is that he worries too many Americans rely on health food store clerks -- "some of them are basically kids" -- and not professionals. He said most store clerks are mostly working off manufacturer sales and promotion materials.

"People need someone qualified to help them manage what supplements they take," Neary said.

The management has become even more complex in recent weeks as new research casts doubts on supplements such as calcium for bone health, saw palmetto to prevent prostate cancer and glucosamine to alleviate arthritis pain.

These findings point to an important flaw in our health-care system: There is no single group of professionals who are widely identified as advisers on dietary supplements.

Some nutritionists have embraced the supplement adviser role, which seems logical enough. But many other dietitians and nutritionists have steered clear. During the mid-1990s, large professional organizations, such as the American Dietetic Association, took the official stance that its members were not trained to dispense supplement advice. It seemed at the time like a missed opportunity, and nothing about the booming $20 billion annual supplement industry shakes that opinion.

As it turns out, naturopathic physicians, or N.D.s. like Neary are indeed qualified to guide patients on the use of dietary supplements. Problem is, they are not universally recognized as authorities. Too bad, because naturopathic physicians study plant medicine in great detail.

N.D.s work with hundreds of patients and keep up with the latest scientific literature -- and not just what is produced here in the States. There is a formidable body of research produced in England, Italy, and especially Germany, which is home to the esteemed Commission E that classifies and evaluates all sorts of dietary supplements. Herbalists, who can be valuable professional guides on plant-based supplements, also are grateful for the science coming from Europe. Scientific studies from Asia, especially China and its, oh, 5,000 years of using herbs as medicine, are similarly appreciated.

"I don't know if it's our American ego but almost literally when most mainstream professionals (meaning most M.D.s and medical researchers) see "herbs" and "European" they assume the study doesn't hold water," said Neary, who has private practices in Snohomish and downtown Seattle.

Let's consider glucosamine to illustrate the value that Neary and his colleagues can provide. Last month's findings published in the New England Journal of Medicine suggested the popular supplement (No. 7 in most recent U.S. sales rankings) makes no difference for individuals suffering from mild arthritic pain when compared to placebos. The researchers did report the supplement significantly helped participants with moderate to severe pain.

Patients visiting Neary in recent weeks have heard that the study's results are "ridiculous for a number of reasons." One major point of contention, he said, is this large government-sponsored study used glucosamine hydrochloride, even though most past studies employed glucosamine sulfate. A majority of over-the-counter products are made with the sulfate version.

Neary said the sulfate acts as an "agent" in generating cartilage repair in joints and that glucosamine hydrochloride doesn't introduce the same synergy. Another problem in Neary's mind, and one that cuts across his supplement advice, is that the study didn't allow enough time to achieve proper results: "If you come into my office," he said, "I don't want to talk about a supplement fully working for six months. This whole study was done in less than six months."

Neary said he has patients who see results in "four, six, eight weeks" and he is always happy to hear the success stories. One of his concerns is that some early results -- good news, no matter how you attribute it -- can be chalked up to placebo effect. He sees six months as proving the overall results (or lack of benefits).

"My question is, what is placebo?" said Neary. "We hear the word and think it means 'fake.' Well, the placebo effect works. The more I think about supplements, the more I think it is in part about me supporting the patient."

Part of the support is helping select the right supplements and doses, no small task as new research throws shadows and darts. Another support strategy is being upbeat about the chances of positive outcome. Too many of us face skepticism or flat-out cynicism when explaining our supplement use to medical professionals.

In the case of glucosamine, it translates to patients relying on instinct rather than a doctor's view that the New England Journal of Medicine study proves no value. Many glucosamine consumers are more than willing to spend the $25 to $30 per month to maintain an improved quality of life. In the past two weeks alone, I have heard from people who don't plan to stop using glucosamine for joint pain, stiffness or mobility. And that was without even bringing up the subject.

One more service that Neary and other supplement advisers can achieve is not taking too many supplements at one time. You don't figure out what is most effective with what Neary calls the "scatter-shot" approach.

For instance, Neary sees no reason to take chondroitin with your glucosamine. The two substances are often combined in the same supplement product, but Neary said the chondroitin is difficult to absorb because of its "massive" molecule size. He cited studies showing that zero to 13 percent of chondroitin is absorbed compared to 90 to 98 percent of the glucosamine.

"The scientist in me makes it my preference that you try one variable or supplement at a time for each medical problem," said Neary. "The exception is taking a multiple vitamin-mineral supplement. That's always a good idea."

TV health news comes up short

Trying to explain complicated medical subjects in a minute or less can lead to reports that lack context and are often inaccurate, a survey finds.

By Jia-Rui Chong
LA Times Staff Writer

March 13, 2006

Lemon juice is a good contraceptive. Exercise may cause cancer. And — this just in! — duct tape cures warts.

Local television stations often add health reports to their usual coverage of crime, sports and weather, but the information they dispense is not all that useful, according to a new study. Sometimes it's flat-out wrong.

In the first survey of health information in local television news, researchers found that about 40% of broadcasts in the top 50 markets around the country, including Los Angeles, aired at least one medical story in each news broadcast. But the median airtime for these stories was a slim 33 seconds.

The study also found that most of the health segments lacked important context, such as the prevalence rates for a disease or condition.

And in about 2% of the health reports, which were all taped during October 2002, the information was dangerously skewed, said Dr. James M. Pribble, an emergency physician at the University of Michigan Hospital and lead author of the study, which he conducted with colleagues at the University of Michigan and the University of Wisconsin at Madison.

Four broadcasts, for example, suggested that lemon juice could be used as a contraceptive or prevent HIV transmission, even though the original study, by a scientist at the University of Melbourne, was only conducted in a test tube.

Only one of the broadcasts mentioned that human tests had not been conducted.

Even more harmful, Pribble said, was the suggestion by one news segment that lemon juice could be a substitute for "costly HIV" medications.

"We just want people to understand that you need to take TV news with a grain of salt," Pribble said.

Pribble and his team chose to examine local television news for health information because previous studies have shown that most Americans' main source of information is local television news.

For their study, which was published last week in the American Journal of Managed Care, researchers reviewed 2,795 of the top-rated news broadcasts taken from the 50 metropolitan areas.

Among the 1,799 health stories that were aired during those broadcasts, the researchers found 27% included an interview with a health professional and 26% included specific recommendations for how to prevent or ameliorate a medical condition. Only 12% of the reports mentioned the prevalence of a disease, which is important in assessing the level of risk a disease presents.

Another major disappointment, said Pribble, was the choice of topics.

Though it was reasonable that breast cancer was the single most common topic because it is a significant cause of illness and death in America, he said, it was not appropriate that the second most common topic was West Nile virus.

Pribble said he understood the appetite for information about West Nile in October 2002 because then it was still a relatively unfamiliar disease. But he thought the disease was not placed in perspective. The danger of developing a severe disease from contracting West Nile is about 1%, a fact which was not mentioned in any health segment, he said.

There were also 23 reports on the effectiveness of duct tape in removing warts based on a study in the Archives of Pediatrics & Adolescent Medicine. This issue, said Pribble, was trivial compared to more serious and widespread problems such as heart disease and obesity.

Dr. Jonathan Fielding, public health director for Los Angeles County, said the study reminded viewers they should double-check TV information with websites for local public health agencies and other reliable sources such as the Centers for Disease Control and Prevention and the National Institutes of Health. People can also consult with their personal physicians.

"Generally speaking, the stations in Los Angeles do a credible job, but I don't think that they should be the only source of information," he said.

Marty Kaplan, an associate dean at USC's Annenberg School of Communication, saw the study as a call for stations to devote more time to health reporting and improve its accuracy.

"Thirty-three seconds is barely enough time to clear your throat, let alone to explain a public health issue and give people accurate advice," he said.

But, he added, "It's certainly enough time to scare you."