Counter-Response to the Multivitamin Controversy

This post was originally written for Apothecary By Design in December 2013 http://www.apothecarybydesign.com/blog/

Stop Wasting Money on Vitamin and Mineral Supplements! 5 medical doctors cried out in an editorial piece first released in the Annals of Internal Medicine, and then circulated through all major newspapers and social media outlets early this week.  The articles released in the New York Times, Wall Street Journal, LA Times, and countless other newspapers pointed out that multivitamins have failed to show benefit in several large scale studies; however, the evidence reviewed was not as clear as we were led to believe. As with every evidence based study, it is important to look at the information behind the research, the studies cited, and the actual information the studies gathered.

The quality of multivitamins IS a true concern for consumers. The studies supporting multivitamins have been mixed, and we acknowledge this. If you are going to take a multivitamin it is not an effective use of money to buy a low quality product (like the one illustrated below) that is not well absorbed and/or is coated in toxic chemicals and fillers. A very good diet may reduce or eliminate the need for a daily dose of essential nutrients. Some multivitamins may be a waste of money, not because studies illustrate a lack of benefit, but because of the abysmal quality of the product itself. Choosing an appropriate multivitamin is another question – one that Apothecary by Design’s wellness specialists welcome.

The following studies were used to support the evidence that multivitamins are not worth taking:

fmgt4Yi09-XGE8j8WdSI0z2key4wGe5glRyJ-QC8wH2_S3x8dxi0mHnxUERU0zmV047v=s1001.     Multivitamins and cognitive decline in men 65 or older

For example, in the first study on cognition, the multivitamin assessed was a well-known  common multivitamin that provides low level nutrients in the cheapest, least bioavailable forms. These poor quality minerals generally include  oxides and sulphates. For example, magnesium sulfate is epsom salt, like you would use in a bath. Magnesium citrate is a better quality, more absorbable mineral. (See label) Check out the “other ingredients” as well – 3 artificial colors including the noxious FD&C Red #40.

Regardless of the supplement quality, cognition issues are not primarily related to vitamin/ mineral deficiencies, but are a long term response to heavy metal toxicity, poor cerebral perfusion (not enough blood to the brain), omega 3 deficiency, hormone deficiency, environmental contamination, stress and elevated cortisol levels, head trauma, prescription medication side effects and many more individual variants.

For example, how many of the physicians studied were also taking statin drugs? These ubiquitous prescription medications are known to have memory impairment, loss of memory and amnesia as potential side effects.

When presenting strong statements like multivitamins are a waste of money, it is responsible to use evidence that considers a straighter line between cause and effect.

2.     Multivitamins failed to reduce cardiovascular events in men and women with previous myocardial infarction

The second study cited as proof that multivitamins are a waste of money was a 2012 study evaluating the effects of chelation therapy on men and women over 65 with history of a heart attack.

This study had significant setbacks.  Chief among them were the high drop-out rates due to the strenuous protocol of 30 weekly chemical chelation infusions followed by 10 maintenance infusions two to eight weeks apart.

It is difficult to assess the effect of a multivitamin on long term health with such invasive chemical and vitamin therapies being administered at the same time, and it certainly clouds what is presented as a black and white result.

Antioxidants, nutritional counseling and botanical therapies are also first line treatments in the Integrative health world to repair myocardial function. Once again, the true nature of the study being cited is obscured by the dramatic headlines.

2.     Multivitamins did not prevent the development of chronic disease or death.

If only a simple, cheap, low dose, poor quality multivitamins could save the world from chronic disease….

Quality matters in the food we eat, the medications we take and the supplements we buy. Chronic disease is a complex, multifactorial health concern whose cure cannot be reduced to oversimplified statements like these.

Finally – the original article states “….beta carotene, vitamin E and possible high dose vitamin A supplements increase mortality.” What they leave out, is that high dose beta-carotene increases risk of … lung cancer in smokers (only.) And alpha-tocopherol vitamin E increases the risk of heart disease …but full spectrum vitamin E with both tocopherols and tocotrienols reduce the risk.  Limiting the information sensationalizes the story, obscures the evidence and limits its relevance.

The great thing about this editorial is that it exposes the poor quality multivitamins out there for what they can be: a sense of false security. No one can eat fast food regularly, take a poor quality low dose multivitamin, not practice any preventative measures, and not develop chronic disease eventually. That much IS true.

A multivitamin needs to be able to be absorbed, with high quality minerals and therapeutic dosages of vitamins at the very least to offer prevention and protection. These remain a worthwhile investment for people wanting to maximize their nutritional value. Furthermore, high quality children’s multivitamins remain a good nutritional adjunct for picky eaters and kids with behavioral or health issues. Multivitamins are not a substitute for a healthy lifestyle with good quality food choices, exercise, and stress reduction.

http://www.mayoclinic.org/medicalprofs/trial-to-assess-chelation-therapy-cvuv10n4.html

http://www.ncbi.nlm.nih.gov/pubmed/10359235

http://www.medscape.org/viewarticle/501471

http://www.nleducation.co.uk/resources/reviews/the-next-generation-vitamin-e-how-tocotrienols-benefit-the-heart-brain-and-liver/

Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements. Annals of Internal Medicine. Eliseo Guallar, MD, DrPH; Saverio Stranges, MD, PhD; Cynthia Mulrow, MD, MSc, Senior Deputy Editor; Lawrence J. Appel, MD, MPH; and Edgar R. Miller III, MD, Phd p. 850

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Naturopathic Trans Health 101

** This is a handout from PTHC June 2013 – Please email me at thewrightnd@gmail.com with your experiences using natural medicines in transition! **

Naturopathic Medicine is: licensed in the state of Maine and many other states and Canadian provinces. We provide primary care using medical and alternative medicine. Naturopathic philosophy is based on the premise your body knows how to heal itself, and medicines from nature can help you overcome obstacles to health.

Naturopathic Doctors tools are: Botanical Medicine, Homeopathy, Nutrition, Lifestyle Counseling, Stress Management. Some ND’s also provide hands-on treatments (Chiropractic, Massage, CranioSacral Therapy,) Prescription medication (thyroid and female hormones, antibiotics, some Lyme medications, topical products),  Acupuncture, Traditional Chinese Medicine and IV Therapies.

FOUNDATIONAL NATUROPATHIC SUPPORT – FOR ALL GENDERS

  • Green tea 1-2 cups daily– anti-cancer, antioxidant, immune system support
  • Adrenal support – adrenals are a major source of hormone production when the gonads are taken out of the picture as is evidenced in menopause and andropause. B5, vit C, Siberian ginseng, Ashwaganda, Rhodiola, Licorice.
  • Probiotics – the digestive tract is the seat of our vitality and overall health.
  • Cruciferous vegetables, fresh ground flax seeds, green tea, sprouts all enhance excess (endogenous and environmental) estrogen elimination – important for every body!

GENERAL TRANSMALE SUPPORT

–       Support adrenals with herbs known to increase testosterone production.

–       Testosterone metabolizes into Dihydrotestosterone (DHT) – a biologically active metabolite of testosterone 30x more potent because of its increased affinity for T receptors. DHT is known to promote hair loss. This conversion can be modulated with SAW PALMETTO – stops the conversion of T –> DHT. PLus ZINC 10-30mg daily.

–       Nettle Tea – decreases bound T/ increases free (active) T, lymphatic support.

–       Reservage Keratin Booster  – prevention of baldness.

GENERAL TRANSWOMAN SUPPORT

–       Breast health! Reduce methylxanthine chemicals found in coffee, black tea, caffeine, and chocolate. At least monthly breast massage for lymphatic health using herbal oils.

–       Aerobic exercise.

–       Freshly ground flax seeds help the body eliminate excess estrogen – add to smoothies or yogurt with fresh fruit and maple syrup. Cancer prevention.

–       What is a phytoestrogen? Plant compounds that bind to estrogen receptors throughout the body.  Soy Isoflavones, Alfalfa (Medicago Sativa), Burdock (Arctium Lappa), Dong Quai (Angelica Sinensis), Evening Primrose, Pau D’arco (Tabebuia Avellanedae), Red Clover (Trifolium Pretense), Saw Palmetto (Serenoa Repens.)

–       Organic non-GMO soy 1-3 times week if tolerated.

–       HRT Companion by Vitanica** Great prevention product for long term use.

–       Reduce systemic inflammation for optimal long-term health – estrogen is protective for heart and bone health, but it can also be inflammatory. How to reduce inflammation? (CRP, homocysteine measures on bloodwork.)

SEXUAL TONIC HERB REVIEW– from The Male Herbal by James Green

Ashwaganda – WITHANIA SOMNIFERA Withanaloid chemicals resemble steroids biochemically. They are classified as an adaptogens to enhance libido and restore fertility and sexual potency.

PANAX QUINQUEFOLIUM – American ginseng.  PANAX GINSENG – Asian Ginseng. All ginsengs provide ginsenoside compounds that effect hormonal balance. Their overall chemistry supports strong sexual function through tonifying activity. They can also increase nitrous oxide levels, improving blood flow where needed. Panax ginseng is classically only used for men as it is too Yang for women’s health unless specifically prescribed.

Horny Goat Weed – EPIDEMIUM SAGITTATUM, EPIDEMIUM GRANDIFLORUM Exhibits moderate androgen-like effect.  Contains flavonoid ICARIIN which is a cGMP-specific PDE-5 inhibitor (like Cialis, Viagra and Levitra)

Muira Puama  – PTCHOPETALUM OLACOIDES Increases circulation, nervous system tonic, improves sexual weakness and diminished sexual desire in all genders.

Maca – LEPIDIUM MEYENII, L. PERUVIANUM ** Nutritive tonic for all genders. Simulates ovarian and erectile functions. **  – Could restore fertility for FTM’s who decide to want to conceive after testosterone use.

Gokshura  – TRIBULUS TERRESTRIS ** Prostate and urinary system tonic. Contains saponin, a steroidal plant chemical to improve libido with impotence. Improves sexual desire, fantasy life and sexual self-confidence. May prolong duration of intercourse before ejaculation. Increases endogenous LH levels. May stimulate endogenous testosterone production in men and women.  ** May also stimulate ovarian or testicular action in ways that are not desired. Use with caution.

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Resolving an Arthritis Flare – for My Dad

Chronic inflammation can cycle into snowballs of pain that catch us off guard. For those with a familial tendency towards rheumatism, arthritis can become quite severe. Joint inflammation usually takes the autoimmune form of rheumatoid arthritis or the inflammatory/ immune joint presentation of osteoarthritis.

An acute osteoarthritis presentation can be effective managed with Naturopathic Medicine. To follow is a recipe for resolution of an acute (meaning, immediate or aggressive) flare up of arthritis that may be causing moderate to extreme pain and inhibiting mobility.

1.You will need to rest as much as possible for 7-10 days. Plan to stay home and lay low whenever possible. Get up every 2-3 hours (except while sleeping) for 10-20 minutes of stretching and gentle exercises like walking in nature, Pilates, or gentle yoga. Wii Fit balance and core strength exercises are fun and support rehabilitation.  Plan your life accordingly. You may need to work from home if possible, reschedule activities, and modify your lifestyle during this time. Remember that this is necessary to address the pain. It is likely your pain and inflammatory levels will be up to 50% resolved by the tenth day of treatment. During this time, also take a daily bath, soaking the affected joints for up to 20 minutes.  I recommend using Epsom magnesium bath salts with 10-15 drops of lavender essential oil or a bath salt of your choice. Follow with 20 minutes of icing the affected joint.

This plan will not cure your arthritis. Your will continue all conventional medications used during the treatment although you may be able to decrease pain medication as needed. This does not replace the need for surgery or other scheduled plans prescribed by your physicians and specialists.

1. For the 7-10 days spent at home, you will follow an Anti-Inflammatory Diet. This is best continued until joint replacement is successful; however, it is crucial during the initial rest window. Studies have proven that nutrition is directly linked with inflammation. By eliminating foods known to increase systemic inflammation, you can reduce your own inflammatory load. This allows your body to begin healing. For more information on The Inflammatory Diet set up an appointment with Dr. Masina Wright ND. http://thewrightdoctor.com/contact-information/

2. Zyflamend Nighttime- 2 capsules 3 times daily. This is a modern formulation of 6-10 botanicals to treat inflammation, joint pain and rheumatism using herbal medicine. New Chapter has combined these into an effective and well researched formula called “Zyflamend.” http://www.newchapter.com/zyflamend The PM version also contains a small amount of relaxing herbs which are helpful for supporting a restful attitude during your healing. You may continue this for up to one year’s duration before a break is needed.  This product is safe to take with most narcotic and non-narcotic pain medication including Vicodin, Oxycodone, Ibuprofen, Tylenol 3 and Ibuprofen. However, do not drive while taking this formulation. If you must drive, use the Zyflammend original formula.

3. Nordic Naturals Omega Joint Plus – 3 capsules daily with or without food. This is a premium joint care formula containing the required daily 1500mg of glucosamine sulphate as well as anti-inflammatory levels of EPA and DHA. The product is expensive at ~$50/bottle for one month supply however, it is worth it. Switch to this product during your first month of resolution treatment for best results, even if you have other fish oil or glucosamine supplements. http://www.nordicnaturals.com/en/Products/Product_Details/514/?ProdID=1548

During your 7-10 day rest time, you can take your other supplements as well, or take a supplement vacation and focus on the above products only to streamline your protocol.

This is the skeleton treatment plan. This is a great place to start! As a Naturopathic Doctors, we individualize every treatment plan to fit each patient’s unique identity. If you do not get the results you are looking for or have trouble adhering to the program, consider seeing a ND in your area. In addition to the above protocol, specific neutraceuticals to address sleep, anxiety, digestion, or other issues may also be prescribed in a consultation. Classical homeopathy is also extremely useful in complex cases. It is safe with complicated pharmaceutical treatments and provides lasting results.

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Recovering from Laser Eye Surgery

I am 13 days post Lasik Eye Surgery, and I can happily say the surgery was a complete success. The journey hasn’t nearly been as simple as they would have suggested at the first consultations though. As a Naturopathic Doctor, I certainly have quite a few more recommendations than they suggest!

First, and foremost, my clinics literature suggested that the day after surgery I could “go to school or work.” And, while I did indeed see two patients the following day (IVF acupuncture that was time sensitive) my eyes would have been Much Happier had I Stayed home and Rested them. Therefore, my recommendation to all future patients would be to book a minimum of 2 days off work post surgery for R&R. Its also very important especially the day of the surgery to have someone to bring you food and check in on you. I found my left eye especially was *very* scratchy and sore, and I just needed to lie quietly with my eyes shut. Cooking or preparing snacks, or even being up and walking around wasnt much of an option. Schedule a friend to come over and hang out for the 5-6 hours after surgery. I wasnt in pain, but just needed to lie quietly with sunglasses and closed eyes…. Take Out Thai was delicious!

I wasnt able to watch TV or read for a good week after the procedure – then again I had some inflammation and complications. I suggest getting a book or two on audio for entertainment. Its hard to lie quietly for hours on end! I greatly enjoyed Elizabeth Peters Amelia Peabody detective book “The Mummy Case.”

Finally, I have a few therapeutic suggestions based on my experience. First, for about 2 weeks pre and post surgery, its helpful to take a supplement to promote eye health. The one I liked best after surveying the options was NFH Vision SAP. http://www.nfh.ca/en/products.html. NFH is a Canadian company and may not be available in the US. This improves blood flow to the eye and helps promote ocular health overall. Several studies also suggest Omega 3 and 6 are important for post-surgical recovery. EPA and DHA in fish oils were evidenced to increase tear volume and decrease inflammation as well as assist in regeneration of corneal nerves.(see references at end of article.) I took 2 tsp daily of Metagenics EPA:DHA 1:1. For omega 6 oils I use olive oil, and increased my sunflower and sesame seed intake (on salads.)I also increased blueberries for the week before and after surgery for their proanthocyanadins – chemicals for the blood vessels of the eyes –  and carrots for the carotinoids, long associated with good vision!

Finally, Homeopathic medicine is brilliant for post surgical recovery for several reasons. The primary reason is that there is no risk of interaction between medications. Secondarily, and as important, they work fantastically well. I recommend 2 remedies post-surgery.

  • Symphytum 200ch – This is a first line trauma remedy, and is “the arnica of the eyeball.” 2 pellets 4 times a day for the first 2 days. This will be the same as your eyedrop schedule from the MD.
  • Euphrasia 30ch – 2 pellets twice daily from day 3 until your eyes stop feeling inflammed. This remedy is for corneal inflammation and redness.

No one talks about the Psychological effect of the surgery; however, this has been an unexpectedly important part of my recovery. I didnt know how much I appreciated my “bedroom eyes” or soft vision until it was gone. Having sharp as a tack vision 24-7 is a new experience, and others who have had the same surgery have told me it takes up to 6 months for the brain to really adjust to the change in eyesight. I believe it! It was also quite scary to have my vision be blurry at times for the week following the surgery. I ended up having to go back daily for follow-ups to assess my vision and recovery as my eyes were inflamed. Waking up each morning with scratchy blurry eyes and having to lie there and apply drops and rest was stressful! However, with time and rest, my eyes did heal on their own, and as of today (day 13) I barely needed the morning lubrication.

All in all, I am so grateful that I gave myself this surgery. Many times I have reached up as if to remove my glasses before doing something like lying down or getting in the tub and behold! No Glasses! It Is a surgery though, and as such there needs to be some time and space carved out of your daily life for recovery.

Summary of Key Points:

  • Take a Vision support formula for 2 weeks before surgery and finish the bottle.
  • Take 1200mg EPA & DHA for 2 weeks before and 1 month after surgery.
  • Take  2 days off work post surgery.
  • Have a friend to help you at home after the surgery.
  • Symphytum 200ch for day of and day after
  • Euphrasia 30ch for days 3+ after surgery
  • Make sure to rest and give yourself recovery time for 2 weeks after.
  • Enjoy your fantastic vision!

Prostaglandins Leukot Essent Fatty Acids. 2010 Apr-Jun;82(4-6):319-25. Epub 2010 Mar 3.

Curr Opin Clin Nutr Metab Care. 2011 Mar;14(2):132-7.

J Fr Ophtalmol. 2008 Mar;31(3):282-6.

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