Jack Challem's Blog

I’ve been writing about nutrition for 30-some years. As I listen to people, I often hear less science and more of what could best be described as a variety of belief systems.

There are the vegetarian, vegan, and macrobiotic sects. There’s the church of low-fat eating. And there’s the pervasive belief that everything boils down to calories in and calories out, with exercise being the penance for overeating.

But the fact is, there’s very little science to support many common nutrition beliefs. They’re just beliefs. And having millions of adherents or thousands of experts repeat the same mantras doesn’t make these beliefs truer.

I know this sounds like heresy to many of you. And I’m not trying to offend anyone’s nutritional or religious sensibilities. But the only food we definitely know we were meant to consume is breast milk, in infancy.

In anthropology, the term “belief system” is usually used to describe a religion. And when it comes to nutrition, many scientists and consumers are so wedded to their beliefs that they’re not interested in adjusting their beliefs in response to new scientific findings.

I’ll give you three examples.

Saturated Fat. Millions of people believe that low-saturated fat diets will prevent heart disease. But the research now shows the opposite to be true. Saturated fat is either neutral or protective, according to an impressive body of research. It’s the refined carbs and sugars and the trans fats that seem to be the real problem in cardiovascular risk.

Why do so many people still believe that saturated fat is bad? It’s a matter of belief — shaped by studies that failed to factor in the effects of carbs, sugars, and trans fats, as well as publication bias favoring the sat-fat-is-bad belief.

Calories. Nearly everyone believes that, to lose weight, you have to either eat less or exercise more. But different types of calories prompt different biological responses. Nutrients that trigger insulin — think carbs and sugars — are more likely to result in weight gain, compared with protein. Protein has little effect on insulin.

The calorie idea was based on energy transfer in steam engines and the 1st Law of Thermodynamics. Biological systems — you are a biological system — are far less efficient and are governed by the 2nd Law of Thermodynamics.

Vegetarian diets. If you look at the history of human cultures, as anthropologists and other scientists have done, you’ll realize that there have been no completely vegetarian cultures. People simply didn’t have the luxury to be so picky about food until relatively recently. Yes, veggies are good for health, but so is unadulterated animal protein. Biologically, we’re designed as omnivores.

Vegetarianisms and its many forms are a belief system. Understand that I have no issue with any sensible vegetarian. However, I’ve met many vegetarians who don’t eat vegetables and prefer sugary soft drinks, bagels, and muffins. Should any of us be surprised that they are often overweight and have a lot of health problems?

Again, I’m not trying to offend anyone or their beliefs. Rather, I’d like to encourage people to gain a better understanding of what shapes their nutritional beliefs and to remain open to where the scientific evidence leads.

SOME REFERENCES:
Siri-Tarino PW, Sun Q, H FB, Krauss RM. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. American Journal of Clinical Nutrition, 2010;91:535-545.

Siri-Tarino PW, Sun Q, H FB, Krauss RM. Saturated fat, carbohydrate, and cardiovascular disease. American Journal of Clinical Nutrition, 2010;91:502-509.

Feinman RD, Fine EJ. “A calorie is a calorie” violates the second law of thermodynamics. Nutrition Journal 2004;3:9-13.

Feinman RD, Fine EJ. Nonequilibrium thermodynamics and energy efficiency in weight loss diets. Theoretical Biology and Medical Modelling, 2007;4:27 doi:10.1186/1742-4682-4-27.

Eaton SB, Eaton SB III, Konner MJ, et al. An evolutionary perspective enhances understanding of human nutritional requirements. Journal of Nutrition, June 1996;126:1732-40.

O'Keefe JH Jr, Cordain L. Cardiovascular disease resulting from a diet and lifestyle at odds with our Paleolithic genome: how to become a 21st-century hunter-gatherer. Mayo Clinic Proceedings, 2004;79:101-108.

I live in Tucson, Arizona, just a few miles from where Congresswoman Gabrielle "Gabby" Giffords was shot in the head at a public meet and greet on January 8. Six people were killed, including a nine-year-old girl, and 12 (including Giffords) were wounded. Giffords is one of the sweetest people imaginable, someone who somehow remained untainted by the vicious tone of American politics. A democrat, she always worked with the republican party to get things done. This is the way politics should operate in achieving something for the common good.

The gunman was obviously nuts - would a sane person praise both "Mein Kampf" and "The Communist Manifesto" and then shoot 20 people? Our county sheriff, Clarence Dupnik, summed things up accurately when he stated that Arizona had become a "mecca for prejudice and bigotry." This was the latest event that put Arizona's nuttiness on the national stage. Too many people here in Arizona and around the country now feel it's socially acceptable to be totally unhinged and scream and shove, call elected representatives names, and, in this case, shoot away. Arizona suffers from a serious case of hardening of the attitudes, and Sheriff Dupnik is a sane voice in an insane state.

My own politics are left of center on most issues. (If you disagree, simply respect my views.) I am, however, a gun owner - but I'm not a hothead or wacko or paranoid. (My guns are strictly for self-defense, something suggested decades about by the two most liberal people I knew back then.) However, I am critical of many gun owners and the gun-owner community, where paranoia runs deep. Arizona has always been on the fringe and has had more than it's share of wacky politicians.

Thanks to a right-wing dominated legislature, and a right-wing governor, it is now legal for anyone over 18 to carry guns openly or concealed in Arizona; no training is required. This means it's more difficult to get a driver's license or a bottle of beer than to buy a gun and carry it under your shirt. (I've opted to go through gun training twice.) Now, the republican state government wants to allow teachers and students to be able to carry guns on college campuses. It's totally insane. Welcome to the modern day Tombstone and the OK Corral.

In response, some local talk radio hosts ranted about how inappropriate Sheriff Dupnik's comments about hatred and bigotry were, and call-ins spouted their own vitriol about the Sheriff. Sadly, they were too dumb to realize they were proving Dupnik's point about hatred and intolerance.

The local paper related comments that were posted on latimes.com, and washingtonpost.com: "So, Congresswoman Giffords, how's that Obamacare working out for you?" and "Too bad it wasn't Howard Dean or Al Gore." Sarah Palin, who targeted democrats on her website, including gunscope crosshairs on Giffords' district, now claims those weren't gun crosshairs but those of a surveyor's scope. And Glenn Beck posted a statement on his website that he's against violence, next to a photo of him holding a gun. These people are out of touch and delusional.

If there will be any good that comes out of this tragedy, it will be that people and politicians will learn to turn down the level of vitriol and viciousness and political jingoism. After all, it could just as easily have been a republican who was shot. It's time to turn down the volume and look at the things we have in common, even when our political views differ. It's about respecting our differences the way you would want other people to respect your differences.

Turn down the volume folks. Listen with respect. Seek to understand rather than to persuade.

A recent article in the British Medical Journal, a news release from the publisher, and news stories published around the world was nothing less than misleading and alarming. The article, based on an analysis of nine previously published studies, reported that vitamin E supplements increased the risk of stroke.

Wait a minute! The study and all the negative publicity were deeply flawed.

First, none of the individual studies had found an increased risk of stroke. Second, the dosages varied from 300 IU to 800 IU of vitamin E daily, some using natural and others using synthetic vitamin E. The studies ranged from about a year and one-half to 10 years, the subjects varied from middle-age to seniors, and some were healthy while others were at high risk of cardiovascular disease (and whom were likely to be taking several medications). With this disparate data, the researchers concluded that one additional person in every 1,250 taking vitamin E would suffer a hemorrhagic (bleeding) stroke, whereas about 2.6 additional people in 1,250 would be less likely to suffer an ischemic (clotting) stroke.

You would think that the significantly greater reduction in ischemic stroke would be the subject of headlines. But it wasn’t. The researchers downplayed the benefits, and headlines warned that vitamin E increased the risk of stroke.

Here’s what else you need to know: you are far more likely to suffer an ischemic stroke. That’s because 90 percent of all strokes are related to blood clots. You are far less likely to suffer a hemorrhagic stroke; they account for only 10 percent of all strokes.
Even though this study was poorly designed, it showed that vitamin E supplements significantly reduced the risk of the most common type of stroke, whereas it slightly increased the risk of the least common stroke. You don’t have to be a rocket scientist – or a statistician – to figure out that the benefits:risk ratio of vitamin E supplements is strongly in your favor.

Two recent newswire stories caught my attention. One article noted that there will be a significant shortage of doctors as “baby boomers” hit their 60s and 70s. The other story noted that too much health care is unnecessary and harmful.
Am I the only one who saw a contradiction here?

The second story, sent to newspapers by the Associated Press, noted that “More medical care won’t necessarily make you healthier—it may make you sicker.” The article went on to report that as many as one in three medical tests and treatments aren’t needed.

Fewer medical tests might not be a popular idea among people who keep asking their doctors to identify the cause and then to treat their aches and pains and other health problems. But I would agree, at least to an extent – conventional medical tests and treatments are overused, while nutritional assessments and treatments are sorely underutilized.

In the United States, medicine is a “for profit” business, and most doctors earn a living through some sort of intervention, such as by prescribing a drug or doing surgery. When a patient asks for help, his expectation is that the doctor will do something. Of course, doctors are trained to intervene, and income is related to ordering more tests and doing more interventions. Sometimes the result is iatrogenic disease – physician-caused illness.

Although I believe most doctors are sincere and do want to help their patients, they also know the economic realities of medicine. But not everyone is so sincere. Some years back, I happened to be meeting with a hospital administrator on the morning the government announced that it was reducing Medicare payments to doctors. The administrator was livid. “Do you know what the doctors are going to do?” she asked rhetorically. “They’ve got big mortgages and boats and kids in college. They’re just going to wheel in more patients so they (the docs) don’t have to take a cut in income.”

So, do we really need more doctors? Or unnecessary tests and treatments? Or do we need more doctors who think in terms of more efficient and lower cost nutritional therapies?

In a report issued today by the Institute of Medicine, a committee of physicians and researchers cautioned against taking large amounts of supplemental vitamin D and calcium because they are unnecessary and potentially harmful. However, the committee did recommend slight increases in the Recommended Daily Allowances (RDAs) for calcium (1,000 to 1,300 mg/d) and vitamin D (600 IU/d).

If you follow the advice of the Institute of Medicine, you'll increase your long-term risk of disease.

It’s always safer for researchers and physicians to take the more conservative approach when recommending supplements—except that it reveals a naiveté about clinical nutrition and can lead to chronic nutritional deficiencies and harm to patients. That is the case with this cautious increase in the RDA for vitamin D, combined with a warning about high-dose vitamin D supplementation. Maintaining the status quo by saying “no” to higher dose supplements carries relatively little risk, at least for doctors. It's a very different story for the average person, though.

The truth is that three of every four Americans are deficient or marginally deficient in vitamin D, a number that most likely gets even worse during the winter months when people huddle indoors. (Ginde AA. Arch Intern Med, 2009;169:626-632.) By refusing to acknowledge the scale of vitamin D deficiency, and the easy and inexpensive means of treating it, the committee from the National Institute of Medicine is guilty of malpractice. The committee members have reversed the Hippocratic Oath, from “first do no harm” to “first do harm.” Their action, or lack of action, is simply unconscionable.

The situation was made even worse by incredibly sloppy reporting in newspapers, particularly by Gina Kolata of the New York Times. In her article in today's NYT, she simply related a summary of the Institute of Medicine’s report without critical comment by any expert on vitamin D, such as Michael Holick, M.D., Reinhold Veith, Ph.D., or Robert Heaney, M.D. No mainstream reporter would be so uncritical in echoing a self-serving news release from politicians or corporations. But then, the committee did not even include a recognized expert on vitamin D, so the cautious nature of report may have reflected the fact that the committee members were out of their depth.

The cost of ongoing vitamin D deficiencies will mount with susceptibility to infectious diseases and a greater risk of cancer, heart disease, and depression. But then, there is much more money to be made on treating these diseases than on preventing them.

Has it really been months since my last post?

Apologies. I've been very busy writing and traveling and lecturing about nutrition and health. And reviewing the edited manuscript of my next book, on fatigue and energy, to be published in March 2011.

Enjoy the blogs posted below.

Jack

I like to read what other newsletters and magazines write about vitamin supplements. The Tufts Health & Nutrition Letter, Reader’s Digest, and even Prevention recently published long articles attacking multivitamins. These rabid attacks cited widely criticized scientific articles, and by repeating misinformation, they may have misguided and harmed millions of people.

As one example, the Tufts newsletter claimed to investigate the “top 20” multivitamin supplements (apparently those sold in drug stores) and warned that they don’t contain enough calcium and vitamin D for bone health, not enough antioxidants for eye health, not enough DHA (one of the omega-3s), not enough ginkgo, not enough bilberry, and not enough probiotics.

First, I could quibble about ingredients in multivitamins, but these formulas have never been intended as the end all of
supplements. They’re basically a form of nutritional insurance, one that’s needed more than ever given the disastrous state of malnutrition in the United States and other Western nations. It’s physically impossible to pack ideal amounts of every nutrient into a capsule or tablet.

Second, in its diatribe against multivitamins, the nutritionally conservative Tufts newsletter indirectly suggested that, if people wanted higher potencies of some nutrients or herbs, they should go buy standalone supplements of calcium and D, lutein, antioxidants, DHA, ginkgo, bilberry, and probiotics. After all, if you can’t get enough of these nutrients in a multivitamin, it only makes sense to make up the difference with whatever individual supplements are important to your health.

There is so much good research supporting the benefits of taking a high-potency multivitamin. Taking a daily multi reduces inflammation and your risk of heart disease, cancer, mood problems and many other health problems.

I have long recommended that people take at least a high-potency multivitamin, and I continue making this recommendation. Given the millions of Americans (and others) who do not get adequate nutrition, it only makes sense.

A recent article on supplements in the New York Times said what we���ve all heard a hundred times before: ���Doctors and nutritionists say that people who eat a normal diet generally don���t need nutritional supplements, even if they exercise vigorously.���

The problem is such statements have absolutely no foundation.

First, what exactly is a normal diet? The definition varies among cultural and ethnic groups. Is it normal to eat the typical American (Western) diet, rich in sugars, starches, and unhealthy oils? Is it normal to eat on the run, out of boxes and microwave ovens?

Second, even if you assume that a normal diet is one consisting of fish, chicken, veggies, and other whole foods, are you really absorbing adequate amounts of the nutrients in foods? Eating healthy foods is certainly important, but poor absorption means you may not be getting those nutrients.

Third, drugs almost always interfere with nutrient absorption and utilization ��� and half of Americans take at least one prescription drug. Acid blockers (where prescription or over the counter products) reduce absorption of vitamins B12 and C and probably others. Antibiotics, oral contraceptives, and other common medications interfere with many of the B vitamins.
If you want to take the guesswork out of what you need and don���t need, find a nutritionally oriented doc who can measure your blood levels of nutrients. Such measurements aren���t perfect, but they do provide an idea of what you���re absorbing.

The idea that eating right means you don���t need supplements belongs in the wastebasket, along with another stupid idea: taking supplements and you���ll just make expensive urine. The truth is that everything that goes into the body eventually exits in one form or another. So if someone tells you that vitamins only make expensive urine, remind them that the $30 steak and $50 bottle of wine they had in a restaurant made even more expensive ���urine.

A recent article on supplements in the New York Times said what we’ve all heard a hundred times before: “Doctors and nutritionists say that people who eat a normal diet generally don’t need nutritional supplements, even if they exercise vigorously.”

The problem is such statements have absolutely no foundation.

First, what exactly is a normal diet? The definition varies among cultural and ethnic groups. Is it normal to eat the typical American (Western) diet, rich in sugars, starches, and unhealthy oils? Is it normal to eat on the run, out of boxes and microwave ovens?

Second, even if you assume that a normal diet is one consisting of fish, chicken, veggies, and other whole foods, are you really absorbing adequate amounts of the nutrients in foods? Eating healthy foods is certainly important, but poor absorption means you may not be getting those nutrients.

Third, drugs almost always interfere with nutrient absorption and utilization – and half of Americans take at least one prescription drug. Acid blockers (where prescription or over the counter products) reduce absorption of vitamins B12 and C and probably others. Antibiotics, oral contraceptives, and other common medications interfere with many of the B vitamins.
If you want to take the guesswork out of what you need and don’t need, find a nutritionally oriented doc who can measure your blood levels of nutrients. Such measurements aren’t perfect, but they do provide an idea of what you’re absorbing.

The idea that eating right means you don’t need supplements belongs in the wastebasket, along with another stupid idea: taking supplements and you’ll just make expensive urine. The truth is that everything that goes into the body eventually exits in one form or another. So if someone tells you that vitamins only make expensive urine, remind them that the $30 steak and $50 bottle of wine they had in a restaurant made even more expensive 
urine.

Each new year prompts millions of people to go on diets and sign up for gym memberships to lose weight and get back into shape. Within a month or two, most people resume their former eating and sedentary habits, leading to an annual weight gain.

Why are the vast majority of Americans now overweight or obese? There are many reasons, including the lipogenic effects of high-fructose corn syrup, trans fats, and simply eating too many empty calories, most of which are cheap mass-produced carbohydrates and fats.

A commentary in the Canadian Medical Association Journal focused on what I have long believed: that unrecognized food addictions are a major factor in overweight and obesity. The concept of food addictions, the authors wrote, is controversial – but there are many similarities to drug and alcohol addictions. Powerful cravings and withdrawals symptoms are signs of food addictions. And interestingly enough, anti-opioid drugs seem to reduce food cravings.

There are many factors behind food addictions. Some foods, such as wheat and dairy, contain trace amounts of natural opioids. Sweet foods stimulate the brain’s production of its own opioids. Some foods lead to increased dopamine levels – one of the brain’s pleasure neurotransmitters.

Breaking food addictions is like dealing with any other addiction: It’s going to be rough for a little while. But once an addiction is broken, most people gain a renewed sense of well being. During this process, it certainly helps to be mindful of what you put into your mouth – and to stop rationalizing that a little bit of this and a little bit of that won’t hurt. Just as a little bit of tobacco, alcohol, or cocaine will sabotage some people, little bits of problematic foods will reestablish food addictions.