China's emergence as a leading ingredient supplier for the supplement industry has raised new fears since pet deaths from pet food were traced back to contaminated Chinese wheat gluten. Soon after, Chinese-made fake Colgate toothpaste was found to contain an antifreeze ingredient and was being sold in discount stores in the USA and in South America. A shipment of bacterial contaminated vitamin A that was to be added to infant formula was also traced back to China earlier this year. In fact, things got so bad that the Chinese government went to the extreme of executing one of their drug officials.
According to William Obermeyer, a co-founder of the independent testing firm ConsumerLab.com which tests thousands of supplement products, about 1 in 4 dietary supplements tested don't meet quality or safety standards. He found some are tainted with pesticides, salmonella, glass, bacteria, lead or cadmium. Others failed due a lack of ingredients or improper ingredients. Because most manufacturers seek low-cost ingredients, Obermeyer said it's a safe bet that some of the tainted products contain ingredients from China.
At the Preventive Medicine Center we deal with supplement companies that are the best in the industry -- companies such as Biotics Research, Metagenics, Thorne Labs, and Integrative Therapeutics. Each of these companies adheres to the strictest quality assurance and control to ensure purity and safety of their products. Because of the specialized nature of many of their products, they deal directly with health care providers only. Before I began dealing with Biotics Research, I flew out to their facility in Texas and spent several days with the owners, touring their facility and talking with their staff and chemists. All of their products are manufactured on site, and are not “farmed out” to another supplier. They have complete control over the raw ingredients and use both independent labs and in-house chemists to verify the quality of their products. If a raw ingredient is not just right, it is rejected and sent back to the supplier. Thorne labs also uses both independent labs and in-house labs to assure the highest quality. They are known for being truly hypoallergenic in their ingredients. Metagenics uses outside auditors to verify adherence to GMP standards (Good Manufacturing Standards) and this is expensive to implement. The products of each of these companies may cost a bit more, but you get what you pay for. If you are trying to regain health, my advice to is to buy the best quality food and food supplements from a reputable source. At the Preventive Medicine Center, we've already done the research for you.
In this issue of the Newsletter I will be sharing information from the spring 2007 ACAM (American College for Advancement in Medicine) Conference that I attended in Chicago, IL.
Vitamin D is Not Just for Bones
Most people realize vitamin D is important in calcium absorption and prevention of osteoporosis. Foods that commonly have significant amounts of vitamin D include milk, egg yolk, liver, and fish. Of course, exposure to sunlight causes vitamin D production in our skins. What is not known is vitamin D deficiency is a worldwide problem and is surprisingly common in North America. Vitamin D occurs as 25 hydroxy vitamin D in the blood, and is converted by the tissues into its active form, 1, 25 hydroxy vitamin D. It used to be thought vitamin D conversion occurred in the kidney, but now researchers know that it also exists in numerous tissues such as the colon, breasts, and prostate. In these tissues, vitamin D controls cell proliferation by increasing apoptosis (programmed cell death that is lacking in cancer cells), decreases angiogenesis (new blood vessel proliferation seen in cancer cells), and promotes cell differentiation (this is lacking in cancer cells).
In the mid 1600s in Northern Europe there was a high incidence of rickets in the cities. By 1919 Huldschinsky discovered childhood rickets was cured with sunlight. In the 1930s vitamin D was added to foods and even put in Schlitz beer. The main source of vitamin D is from production in our skins from exposure to sunlight. If a person were to stay in the sun for 1 hour in a bathing suit (without sunblock), 20,000 IU of vitamin D would be produced on average. Using a SPF15 sunblock, 99.9% of vitamin D production is blocked, and if a SPF 8 is used, 97.5% is blocked. So using sunblock basically eliminates the benefit of sun exposure.
Vitamin D deficiency is associated with obesity, and studies have shown that in obese patients with UV light exposure from a tanning bed, only 33% of the vitamin D concentration is produced compared to normal weight individuals. Vitamin D produced in the skin becomes trapped in the subcutaneous fat. Also, after 50,000 IU of vitamin D2 was given, levels in obese patients were 50% of that of normal weight individuals in one study.
A study published in Lancet stated that at a vitamin D blood level of at least 20ng/mL, prostate, colon and breast cancers would be reduced by 30 - 50%. There is an especially strong correlation between digestive organ cancers and vitamin D deficiency. It has also been shown that a combination of vitamin D and calcium reduces the risk of pre-cancerous colonic adenomatous polyps. In this study (JNCI 2003), 1200mg of calcium + serum levels of vitamin D equivalent to 29.1 ng/mL stopped the development of colonic polyps. A study from the University of California at San Diego showed that in the USA, breast cancer rates would decrease by 50% and colon cancer rates by 66% if a person took 2000 IU of vitamin D3 daily.
Low vitamin D levels have also been shown to affect survival in cancers of the breast, colon, prostate, early-stage lung, melanoma, and non-Hodgkin's lymphomas.
Up until recently, the RDA (recommended daily allowance) for Vitamin D has been 400 IU. How was this arrived at? In the 1930s cod liver oil was given to children at a dose of 1 teaspoon daily during the winter to prevent rickets. There are approximately 400 IUs of vitamin D in a teaspoon of cod liver oil, so the RDA became 400 IU. The current government stated upper tolerated dose is 2000 IU/day, but we know from reviews of the medical literature that no toxicity has been seen in doses less than 10,000 IU and no major toxicity occurs in doses below 40,000 IU.
25 hydroxy vitamin D levels are easy to measure by a simple blood test. I would recommend patient's take in enough vitamin D to keep their levels in the upper reference range (around 50ng/dL). Lifeguards have an average vitamin D level in the 80s, and I haven't seen very many unhealthy looking lifeguards. The Center carries both an emulsified vitamin D3 from Biotics Research that has 400 IU per drop, and a capsule from Thorne Labs that has 5000 IU of vitamin D3 per capsule.
IV Vitamin C Update from the ACAM Conference and its use in Cancer Treatment
Dr. Mark Levine is a graduate of Harvard Medical School and also worked at Johns Hopkins Hospital for a number of years. He is a physician-scientist and a senior investigator at NIH (National Institutes of Health). Information from his research on intravenous vitamin C as a cancer therapy is simplified and summarized in the following paragraphs.
Dr. Levine did basic research on the pharmacokinetics of oral vitamin C and IV vitamin C. He wanted to find out whether there was a difference taking vitamin C orally vs. intravenously, and also because there is conflicting information about the usefulness of vitamin C as a cancer therapy.
The first thing he did was to study healthy adults to see what would happen if progressively increasing doses of oral vitamin C were given, and the effect this would have on the plasma ascorbic acid concentration. What he found was from 30mg to 200mg, there was a very steep increase in plasma concentration of ascorbate. In going past 200mg this curve flattened out. In fact, going up to 2000mg orally didn't really increase the plasma concentration by much. It was his conclusion that taking 200mg of vitamin C a day orally was an optimal dose, and that past this dose a person was not affecting the plasma concentrations of the vitamin significantly.
He then gave IV vitamin C intravenously and what he found was that this acted totally differently. Tight control is bypassed until renal filtration restores plasma vitamin C concentrations to a steady-state. In fact, what he found was that the plasma concentrations of ascorbic acid may be 50 to 70 fold higher compared to maximal concentrations from oral administration. “Concentrations achieved only by intravenous administration kill cancer but not normal cells. It is likely the killing occurs because pharmacological extracellular ascorbate concentrations generate ascorbate radical selectively in the extracellular fluid, but not in blood. Ascorbate radical in the extracellular fluid may then generate hydrogen peroxide, followed by the formation of other reactive species.” In other words, IV vitamin C was acting like a drug rather than a vitamin.
Dr. Levine found not all cancer cells were responsive to IV Vitamin C, but the most sensitive ones were lymphoma, followed by breast and prostate cancers and bladder cancers. The hydrogen peroxide produced diffuses into cells where it blocks the ATP (energy production) in cancer cells, but not in normal cells for some reason. His studies were done using both animal and human cells in test tubes. Dr. Levine felt human clinical trials were overdue, especially since CAM physicians have been using intravenous vitamin C for years in thousands of patients with good results and with no ill effect if patients were properly screened for kidney disease and G6PD deficiency.
Several other physicians at the conference were involved with small clinical trials using high doses of IV vitamin C in cancer patients at their respective hospitals, and their observations were that IV Vitamin C was useful as a cancer therapy in some cancers.
I would also add that several years ago I was in a conference with Sir Arnold Takimoto, M.D.. This physician was the medical director of several cancer treatment centers on the West coast and it was his observation (as well as that of other physicians) that some vitamin C products did not work as well as others in their patients. He discovered that corn-derived vitamin C was not as effective as non corn-derived e.g. from beet root or cassava root source. His opinion was that this was due to genetic modification of much of the corn in this country. Most vitamin C is a by-product of the high fructose corn syrup industry. At the Center, we carry only non-corn derived vitamin C powder, liquid, and tablets, and use only non corn-derived vitamin C in our IV therapy.
Toxic Metals In The Environment & Cardiovascular Disease
Although the use of chelation therapy in the treatment of cardiovascular disease has been controversial among traditional physicians, going as far back as WWII it was observed that patients with coronary artery disease being treated for lead toxicity with EDTA chelations had significant improvement in angina and exercise tolerance. A 35 million dollar government study called the TACT trial (Trial About Chelation Therapy) is currently underway to answer this question in a double blind, placebo controlled prospective manner. There are published studies in Alternative Medicine journals supporting the efficacy of IV EDTA chelations in the treatment of cardiovascular disease. The mechanism of action of EDTA is the chelation or binding of toxic metals so that they may be removed from the body. We are now learning that toxic metals such as cadmium, mercury and lead cause significant oxidative stress in the body. Oxidative stress in the arteries and arterioles may lead to cholesterol deposition and plaque formation. We have also learned that coronary artery disease is an inflammatory disease rather than a disease where high cholesterol just “plugs up” the arteries like a clogged drain.
Dr. Eliseo Guallar is an Associate Professor of Epidemiology and Medicine at Johns Hopkins University. He also trained at the University of Minnesota and Harvard School of Public Health. His main field of interest is cardiovascular disease epidemiology. He is conducting several studies of the association of different environmental and dietary exposures with cardiovascular risk. He is especially interested in the effects of fatty acids and heavy metals such as arsenic, mercury, lead and cadmium. Highlights from his presentation are summarized in the following paragraphs.
Cardiovascular disease is the leading cause of death, accounting for 37.3% of all deaths. Exposure to toxic metals can have a profound effect in the development of this disease. Lead is an established cause of elevated blood pressure and hypertension. Several studies have established an association between low level lead exposure and coronary heart disease, stroke, peripheral arterial disease, left ventricular hypertrophy and chronic kidney disease. Lead is also probably carcinogenic (cancer causing). These associations have been identified at blood levels below 5ug/dL of lead. In fact, there is no “safe” lead level, below which it doesn't adversely affect blood pressure or stroke risk. Lead is found in air, food, drinking water, old plumbing and paint, dust and soil.
Cadmium is a highly toxic metal and is a by-product from mining and smelting. It is used in batteries, pigments, coatings, platings and plastic stabilizers. Exposure occurs through smoking cigarettes (or exposure to secondary smoke), inhalation of ambient air near coal-fired power plants and municipal waste incinerators, and from consumption of some foods. Cadmium has a very long half-life of 15-20 years, leading to accumulation in the kidney. It is associated with carcinogenesis, emphysema, kidney disease, osteoporosis, cardiovascular disease and endocrine alterations.
Mercury is also a highly toxic metal. Exposure to methylmercury is primarily through fish consumption. Exposure to inorganic mercury in non-occupational settings is primarily through dental amalgams. Mercury is associated with cardiovascular disease, and is both neurotoxic (poisonous to nerve and brain tissue) and nephrotoxic (poisonous to the kidneys). One hypothesis is the reason an increased mercury level is associated with an increased risk of heart attack is because it blocks the beneficial effects of omega 3 oils.
The conclusion of Dr. Guallar's lecture was that there is increasing evidence that exposure to toxic metals at levels currently considered safe is associated with a variety of cardiovascular risks in the general population.
Action to take:
1) If you have hypertension, consider undergoing a CA EDTA challenge test to assess body burden of lead, even if your hair analysis screening was negative. This test will also screen for an increased body burden of cadmium and aluminum, but not mercury.
2) If you have heart disease, consider undergoing a mixed CA EDTA/DMPS challenge test, even if your hair analysis screening was negative. This test screens for an increased body burden of lead, cadmium, arsenic, mercury, aluminum and other toxic metals.
3) Reduce oxidative stress by supplementing your diet with anti-oxidant vitamins and minerals. Eat organic vegetables. Bio Cardio Pak from Biotics Research and Heart Option Powder from Dr. Takimoto are products that are formulated for heart nutrition that you may wish to consider if you have heart disease or are at risk for developing heart disease.
4) Take a mercury-free fish oil supplement daily and eat only low mercury containing fish such as wild (not farm raised) salmon and sardines. Avoid large predatory fish that contain high amounts of mercury (tuna, shark, swordfish, tilefish, king mackerel.)
Success Story --Inability to gain weight in athlete; Joint pain relieved with bio-identical hormones; IV Vitamin C and chronic fatigue
Mr. G is a 17 year old black male basketball player who initially saw me when he was 16 years old. He had a history of a seizure disorder, inability to gain weight, and fatigue during basketball practice, especially in the 2nd half of his games.
After a comprehensive evaluation, including a physical exam, CRA analysis, and nutritional analysis, the only finding was that of multiple nutritional deficiencies, including a B12 deficiency.
Mr. G was placed on a combination of vitamin and mineral supplements, and also ProGain powder and Whey Protein Isolate. He was encouraged to eat a balanced diet with fruits, vegetables, and protein foods, and avoid saturated fats or fast foods. Within a year he was excelling at his basketball games and had stamina throughout the games. His mother stated “his coaches were amazed at the change in performance.” His weight went up to 188 pounds from 177 pounds and this was all muscle.
Success Story -- Joint and Muscle Pain relieved with Bio-identical Hormonal Replacement
Mrs. M is a 69 y.o. licensed massage therapist who came to see me in January 2007. In taking her medical history I found that she went into menopause at age 57. In the past, when she would take HRT, her symptoms would improve. She was having pain mostly in the large joints and in the hands and fingers. She was told by one physician that she needed surgical correction of her carpal tunnel symptoms.
After a comprehensive physical exam, laboratory and nutritional assessments, Mrs. M was placed on bio-identical hormonal replacement therapy with a combination of estradiol, estriol, and progesterone. She was taken off the Boniva she was previously placed on to treat mild osteopenia, and begun on a program of calcium, minerals, and strontium therapy to increase bone mass (see the June 2007 issue of the newsletter regarding the emerging problems with biphosphonate drugs such as Boniva).
Within 4 weeks, the majority of her joint and muscle pain resolved, she was sleeping better, and her carpal tunnel symptoms totally resolved without surgery.
Success Story -- IV Vitamin C and Chronic Fatigue
Mrs. S is a 30 year old lady who saw me in March 2007 with a one year history of severe fatigue. “No matter how much sleep I get I feel tired all the time.” She also had low grade depression and her eating habits were not the best, where she was eating fast foods for lunch and canned vegetables, rather than fresh or frozen. She also felt “shaky” at times, but a 3 hour glucose tolerance test had previously been normal, so these symptoms were not related to low blood sugar.
After a comprehensive evaluation and after ruling out causes such as anemia, thyroid disease, or diabetes Mrs. S was found to have a reactivated Epstein-Barr viral infection. This is the same type of virus that causes infectious mononucleosis. Because her symptoms had been going on for one year I offered IV Vitamin C therapy for this. It has been my experience that IV Vitamin C is a marvelous therapy for this problem. Mrs. S began a series of 4 weekly IVs with non-corn derived vitamin C. After the second IV her energy had improved to the point she didn't come back to the Center for 2 weeks, and by the completion of all 4 IVs she felt well for the first time in one year.
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