Warning about natural supplements

I second 142's request to keep things civil but, at the same time, I'd like to thank you guys for mostly managing to do that on this thread. This topic area has historically been difficult on the forum but despite the heavy seas we've been navigating we seem to have been able to right the boat when it wobbled, keeping it barnacle side down and pelican poop on top... for the most part.

I will also observe that when the Tall one started this thread he was talking about one thing and the discussion promptly veered off in a different direction. I'd like to briefly revisit that original topic since it seems to me to offer some chance at consensus. I think we would mostly agree that there are some products sold as dietary supplements for which all of the negatives that Tall Allen listed are apt. Some "dietary supplements" have lousy quality control, claim absurd benefits, and cite research that is either of low quality or is simply irrelevant. Often such products will present themselves as "Natural" because the vagueness of the term makes it difficult to refute.

Dietary supplements form a continuum with the garishly useless male potency boosters sold exclusively in gas stations at one end and Vitamin D3 at the other. There is simply no way for the purchaser to know what is in the potency booster capsules or to have any idea what, if anything, it does. It's fairly likely that the manufacturer doesn't know, from batch to batch, what is in his own pills. Vitamin D3, on the other hand, is quite standardized in its manufacture and is at least as well studied at this point as is the average prescription drug approved by the FDA. There are controversies in the research about vitamin D and prostate cancer but they strike me as eerily similar to the controversy about Avodart for the same use, and at least with Vitamin D we have a pretty good idea what is in the bottle.

My point -- and, yes, I have one, thank you very much -- is that while we argue about one end of the continuum we shouldn't lose track of our general agreement on the other end.

Dreamer, I would suggest that as far as vitamin type supplements go, the best course of action is to (a) purchase a reputable brand (at least one has USP certification) and (b) don't take more than the recommended daily amount. (which is based on legit research)

Beyond that, if it is what our grandmothers called a patent medicine, stay away.

Dreamerboy said...
Is every single study that purports positive effects from supplements so unreliable as to not deserve any consideration?

It certainly depends on the study. That's why I posted about levels of evidence above. Some studies are more worthy of consideration than others. At the bottom end, we have things like professional opinions and lab studies. At the top end, we have replicated large scale randomized clinical trials (RCT). To my knowledge there has never been, and probably will never be again, an RCT as well done as the SELECT trial on Vitamin E and Selenium. They expected, based on a cohort study (lower level of evidence) that both Vitamin E and Selenium supplementation, as used in most popular supplements, would be beneficial. What they found was the opposite. This led to further research on the importance for cancer control of NOT suppressing oxidants and free radicals. Our innate cancer control depends on those things.

It also led many of us to question whether all those vitamins and supplements that we think may be beneficial may, in fact, be harming us. Because the level of evidence in all of those studies on supplements never rises to the level of the SELECT trial (which was an NIH trial), and learning the lessons of the SELECT trial, we have to proceed with caution. So while a lower level of evidence study may suggest a benefit worth exploring in higher level of evidence studies, they never guarantee a clinical benefit to a patient. However, if a lower level of evidence study indicates that there may be a hazard to a supplement, that is usually enough to recommend to the patient that he avoid it.

Most supplements have been found to be merely ineffective when subjected to higher levels of evidence (e.g., pomegranate, green tea catechins). It's certainly possible that harms that emerge on lower levels of evidence may disappear at higher levels of evidence - but who would be foolhardy enough to take that chance with no evidence?

Dreamerboy said...
Is he saying that we should absolutely never take supplements? My best example would be vitamin D which is synthesized by the skin from sunlight. Most of us in northern climates are either indoors or covered up for most of the winter.

I'm saying proceed with caution. Look at the way PDA found the right level of Vitamin D supplementation for himself. He took progressively higher doses until he achieved a normal serum level. I did it in the opposite direction -- I started at a higher dose and reduced it while maintaining my serum level. What we both did is work with our doctors and check serum levels to assure it stayed in the normal range. What is dangerous, is taking high doses without checking serum levels. Those several studies that I shared links to suggest (but do not prove) that high serum levels may be harmful. That should be enough for us to avoid doing that.

Vitamin D, unlike other Vitamins, is a steroidal hormone with ubiquitous receptors and all kinds of feedback mechanisms. Possibly it can activate androgen receptors in castration-resistant men - the opposite of what we hope to achieve. We also know that high doses can increase testosterone levels. Steroidal hormones in our bodies are very interactive.

There are one, maybe two, supplements I remain hopeful about. One is sulforaphane - extracted from cruciferous vegetables. In small RCTs so far, it seems to be beneficial and has no apparent harms so far. As with all food-derived supplements, bioavailability is an issue. Taking a pill along with a broccoli floret may provide the enzymes needed for digestion. The other is mixed soy isoflavones - it seems to work with gut bacteria to create compounds that may be beneficial. Interestingly, isolated soy isoflavones (rather than mixed) may be harmful. These are estrogenic molecules.

The other thing I would (but don't) supplement is probiotics - there are countless "decisions" made by our gut bacteria about which molecules to allow in and which to keep out. Sometimes, as when we take antibiotics, our gut bacteria get depleted and need augmentation. This is an area that's just beginning to be explored by oncologists.

I don't have much to share. Here's an interesting article about it:

www.the-scientist.com/?articles.view/articleNo/45616/title/Microbes-Meet-Cancer/

This addresses the prostate specifically:

The Microbiome of the Prostate Tumor Microenvironment

Last year, the Microbiome Initiative was begun by the White House, but I don't know if it is continuing under the present administration:

/arstechnica.com/science/2016/05/the-white-house-announces-121-million-microbiome-initiative/

The reason I supplement Vitamin D is because my natural levels are lower than normal, and lower than the level the FDA has determined is necessary to maintain good health. It is not related to prostate health specifically for me. There have been several RCTs on Vitamin D, just not for prostate cancer.

/ods.od.nih.gov/HealthInformation/dailyvalues.aspx

I don't know how many of us have read or listened to Douglas Adams' Hitchhiker's Guide to the Galaxy but the section on the Babble Fish seems apropos to the discussion of supplements.

In his radio drama, later released as a novel, Douglas Adams said...
"The argument goes something like this: 'I refuse to prove that I exist,' says God, 'for proof denies faith, and without faith, I am nothing.' 'But, says Man, the Babel fish is a dead giveaway, isn't it? It could not have evolved by chance. It proves you exist, and, by your own arguments, you don't. QED.' 'Oh dear,' says God, 'I hadn't thought of that,' and vanishes in a puff of logic. 'Oh, that was easy,' says Man, and for an encore goes on to prove that black is white and gets himself killed on the next zebra crossing.

Many of us take supplements because we believe they will have beneficial effects. Lower levels of evidence enhance this faith. But when we encounter Level One evidence we think too much and the lovely placebo effect vanishes in a puff of science.

Tall Allen said...
Bob-
The FDA evaluates all such evidence in making their determinations of the healthful levels of all micronutrients. Here, for example, is just some of the evidence (including the Level 1 evidence) they evaluated just on the topic of the level of Vitamin D needed for bone health:

/www.fda.gov/ohrms/dockets/dailys/04/oct04/102004/04p-0464-cp00001-02-vol1.pdf

This is what the staff of the FDA does - they collect all the studies and evaluate them. If whatever it is you're looking for is not available online, you can do a public record request and pay the (possibly high) copying costs. There are probably many hundreds of pages.

There is a reason that the FDA recommendations are taken by most countries around the world - they are very thorough. It should give anyone a sense of humility that he probably does not know better. Anyone can have an opinion, but as far as laying out the facts, the FDA is second to none.

Allen,
Thank you.

Tall Allen said...
Even when the labels are correct, we have to be cautious about taking supplements. There is nothing "natural" about supplements. Our bodies evolved to process foods, not isolated and concentrated ingredients. We, and our microbiomes, can extract what we need and handle the limited amounts of toxins that occur naturally. The internet is full of sites like "Life Extension" and daytime TV is full of shows like "Dr Oz" that promote supplements while playing fast and loose with medical evidence. They spin research to make it sound scientific, but it is usually fake medical news.

Wise words.

Bubbatc said...
Yeah, I'm the problem here.

Maybe.

Tall Allen, a highly respected contributor to HW/PC has left us with some wise words about the pseudoscience frequently associated with supplements, urging members wisely to be cautious. Wise words.

Post Edited (Blackjack) : 1/25/2019 4:04:52 PM (GMT-7)

Bubbatc Allen is gone. Why beat a dead horse?

I didn't see Allen's posts as rhetoric - I saw them as reasoned and helpful; consider me a follower and someone who wishes he had not left here.

His advice on supplements? Dead on the money.