These headlines are NOT TRUE - 

Always read the small print in supplement trials!

The results of 2 recent trials have caused international headlines – claiming multivitamins do not work nor does vitamin D.
This information actually comes from 2 studies which are far from conclusive.

Multivitamins and heart disease – this is a huge study (in part funded by Pfizer) looking at doctors in the United States aged 50 years and over. 13,316 doctors were either given multivitamins (Centrum Silver) or dummy tablets and followed for 13 years. Their conclusions was slightly strange – "there was no consistent evidence of various foods, nutrients, dietary patterns or multivitamins on cardiovascular disease in points. However there were statistically significant interactions between multivitamins and B6 and heart attacks, multivitamins and vitamin D on cardiovascular mortality, and multivitamins and B12 on cardiovascular and total mortality." Then commented however that these patterns were inconsistent, and thus ignore them. They also concluded that future studies are needed.
This is not the message that the public have received.

Questions that could be asked:
1. Doctors on the whole eat well if not perfectly, and are probably the least likely populations needing multivitamins.
2. Is Centrum the best multivitamin to recommend?
3. They did show benefits on heart attacks, heart and total deaths, why did they chose to ignore them?

The 2nd study is equally puzzling, it comes from a New Zealand group studied the benefits of vitamin D and heart disease. Just over 5000 people were in this general practice study, half received monthly vitamin D 100,000iu and the other half dummy tablets for 3 years. This appeared to have no effect on cardiovascular disease. They concluded "this result does not support the use of monthly vitamin D supplements, the effects of daily or weekly supplementation requires further study."
Again this is not the message that has been publicised.
Questions that could be asked:
1. Is 3 years ready long enough to have an effect?
2. The quality of general practitioner studies is often patchy.
3. Were we ever designed to receive 100,000 international units of vitamin D monthly? This equates to 71 tablespoons of cod liver oil or 19 L of milk drunk on the 1st of the month, and then none for 30 days!

Once again the publicity against supplements shows very biased reporting.

To Pee or not to Pee?

How to make bladder catheterisation less painful.

A strange title for a web page, but many or most of us will be catheterised or have friends undergoing what is often a very painful procedure. This little gem which I read in a recent medical Journal is something I thought I should share.
We have two muscuar valves leading out of the bladder stopping the urine from leaking, and usually these are closed. They open when we go to the toilet. They are not designed to allow a structure like a small snake to pass backwards up into the bladder, and tend to slam shut. Pushing past these closed valves causes most of the pain during urinary catheterisation.
Doctors, nurses, house surgeons, medical students have been instructed to tell patients to cough or breathe slowly and deeply when the catheter cannot get past the valves - none of these work. Why should they? Why not ask the patient to open the valves by peeing?
Nobody has ever suggested this before, how can we have been so obtuse? In a recent paper in the Journal Urology (April 2017) in just under 100 patients having a catheter inserted, half were asked to lie back and grin and bear it, and half were asked to try to pee while the catheter was being inserted. The pain in the Peeing group was less than half that of the others (41%).

Almost certainly none of the people trying to catheterise us with have read this article, so just share this information if you know that one of your friends or yourself will be having this procedure. While the doctors/nurses/medical students struggle down one end, you just lie there and gently try to pee, they will never know.

To continue Shakespeare's soliloquy – "whether tis nobler in the mind to suffer" – the answer is NO!

Phytochemicals

Phytochemicals 

These are chemicals from plants (phyto is Greek for plant)  Polyphenols, phytochemicals, flavanols, bioflavonoids etc are names which cause a lot of confusion.

Polyphenols:
The most studied class of phytochemicals are polyphenols because of their potential health benefits. There are numerous polyphenols (poly means many, phenols means benzene rings) which come from different plants and have different actions. 

• Phenolic acids – blueberries, tea, cereal grains.

• Stilbenes – the best known of these as resveratrol found in red wine, it is quite poorly absorbed.

• Lignans are found in flaxseed which may have some oestrogenic properties.

• Flavonoids (also called bioflavonoids) are named for the yellow colour and are found in flowering plants and fruit and vegetables. Flavonoids cause the colour and taste of foods, and have an antioxidant effect on fat, vitamins and enzymes.
  Flavonoids are divided into 6 subclasses many of which have confusingly similar names:
• Flavonols – found in onions, curly kale, leeks, broccoli blueberries, red wine and tea. Its production stimulated by sunlight and so its highest concentration is in the outer parts of the plants.
• Flavones - are found in parsley and celery
• Flavanones - are found in citrus fruits, tomatoes, and plants such as mint.
• Isoflavones - these have a structure similar to oestrogen, and are often called phytoestrogens. Most are made from soy and soy products.
• Flavanols - these are found in green tea, chocolate, red wine, apricots and other fruit. Also in fruits such as grapes, peaches and berries, and also cause the bitterness of chocolate.
• Anthocyanins - . These are pigments creating the blue purple red and pink colours of 4 hours fruits and vegetables.

Many variables affect the amount of polyphenols found in food, including the degree or ripeness at harvest, the rainfall, the sun exposure, how they are stored and how they are cooked.The polyphenols are designed to protect plants from oxidation, toxins and damage, and by consuming them, we can achieve some of these benefits.
The still is quite a lot of scepticism in conventional medicine on their value when taken the supplements, although there is no debate that we should all be eating plenty of fresh fruit and vegetables on a regular basis. The difficulty is to obtain polyphenols that have been growing correctly, picked at the right time, not over processed or over cooked and are available all year round. For this reason a quality supplement which is well absorbed containing these products should also be beneficial, but does not replace the need for fresh fruit and vegetables as well.

STATIN DRUGS

One of the most frequent questions I am asked as a Cardiologist and physician is – do I really need to take Statin drugs?  On one side doctors are suggesting they be incorporated in a polypill which everyone should take, to other more ‘naturally based’ experts saying they do not work and people should not take them (click here)

This article is my assessment from the current medical literature, and the advice I give to my patients.  Because the article is quite long, I will put my conclusion first as well as at the end, but I would recommend that you read the reasons for my conclusions as well.

My Conclusion – sifting through all of the data below, my recommendations are relatively simple:

1. If you have proven cardiovascular disease (heart attack, angina, stroke, angioplasty, high levels of calcium in cardiac CT scan) then you should take a statin drug preferably at a low dose. This would reduce your risk of a heart attack, stroke or death by about 20%.

2. If you get any side-effects – muscle pain, abnormal liver function tests, or you feel that your mental function has deteriorated, stop the drug for a couple of months, and then restart. Possibly consider restarting with a water-soluble statin such as pravastatin. If the symptoms recur then don't take the statins anymore.If you feel fine, then continue the statin. There is little evidence showing that any other cholesterol-lowering agent provides any benefit.

3. If you don't have cardiovascular disease (primary prevention) unless you have a very high cholesterol, diabetes or an extremely strong family history then I would not recommend that you take a statin drug. My advice would be to have a CT scan for calcium**  which will show early coronary artery disease, if this is strongly positive then maybe you should consider taking a statin drug. If it is negative or normal for age, then I would not take a statin.

4. For elderly people the benefits of statins do continue, but if there is any suggestion of impaired mental function, then stop taking the statin.

5. If you are taking a statin, you must be taking the supplement coenzyme Q 10, at least 100 mg daily.

Possible benefits of glutathione in the elderly

Glutathione is a very powerful antioxidant created within the body to prevent oxidative damage due to free radicals attacking and destroying cells. With age the amount of glutathione in the body particularly the brain decreases, and could set the stage for age-related health problems, particularly dementia, but also cardiovascular disease, diabetes and cancer.

Unfortunately glutathione cannot effectively be given as a supplement because it is poorly absorbed, but N-acetylcysteine (NAC) is converted into glutathione, and also helps the body to make more glutathione.
It is difficult in humans to trial this, but in a rather nice study (click here) the authors gave NAC to isolated liver cells in both young and old rats exposed to high levels of oxidants.  N-acetylcysteine was very protective and reduce the amount of damage greater than twofold.

Oxidative stress does appear to be a major cause of disease in today's world; antioxidants taken orally are relatively weak compared to the antioxidants created within the body (glutathione, catalase, superoxide dismutase etc.). The production of the latter tends to be less as we get older, and are frequently overwhelmed by our toxic world. It thus does seem reasonable to suggest that people should take products which could help the creation of these internal antioxidants, such as N-acetylcysteine.

Calcium supplements are safe! 

This is the conclusion from a new joint clinical guideline from the National Osteoporosis Foundation and the American Society for Preventive Cardiology (click here) . Over the years there have been many reports on the benefits and adverse effects of calcium both taken in the diet, and as supplements. Occasional studies have suggested that calcium in the diet has no effect on cardiovascular disease, but supplements might have. (The word might is in italics because in some trials there is only a suggestion but it is not clinically significant). There are also some studies which show benefit, including one which showed women taking more than 1000 mg of supplemental calcium per day had less cardiovascular disease than those who did not.  Because there are obvious benefits in bone and other health from taking calcium both in the diet and as supplements, these 2 bodies looked at all the evidence that was available, and concluded "dietary and supplemental calcium are safe for cardiovascular health when consumed in the recommended amounts. The recommendation applies to calcium consumed either alone or with vitamin D that does not exceed the National Academy of medicine is tolerable upper intake limit of 2000 to 2500 mg per day""  There will always be studies which so some benefit or lack of benefit, particularly the smaller studies, many of the studies are impure because patients report the amount of calcium they either consumer as supplements or diet during the day, and follow-up is incomplete. There is also a strong lobby against the use of supplemental calcium (in fact the use of supplements), but even if there is an indication rather than a statistically significant result, this will be reported out of proportion to its scientific evidence. When 2 major societies in the United States come to the conclusion that calcium supplementation is safe, there seems little point in individu
als debating the results of further studies.

The dangers of long-term PPI (Proton Pump Inhibitor)treatment.

Proton pump inhibitors (PPIs) like omeprazole, lantoprazole, are being used very frequently, and in many cases long-term, to treat peptic ulcers and gastro-oesophageal reflux, and "indigestion". They act by reducing the production of gastric acid. While they are incredibly effective in treating these conditions, they do have other less desirable and sometimes fatal effects:
By raising the gastric pH they can affect pepsin and other enzymes used to dissolve proteins.
The elevated pH also enables bacteria and viruses to survive where otherwise they would be killed, sometimes leading to infection in the lower GI tract.
Diseases resulting from prolonged use of PPIs include:

• Gastric and gut infections, especially traveller's diarrhoea.
• Pneumonia – the bacteria surviving in the stomach can migrate up the oesophagus and down into the lungs.
• Increasing fractures, presumably due to a direct effect of these drugs on bone architecture.
• Vitamin B12 deficiency – these drugs greatly affect the absorption of vitamin B12, particularly in the elderly. This can result in peripheral nerve problems, but also dementia.
• Heart disease and strokes, there is an increased incidence of heart disease and almost doubled increase in heart deaths according to a recent study from Stanford University. (http://www.ncbi.nlm.nih.gov/pubmed/26061035)

While there are many cases where these drugs are extremely useful, the need for long-term treatment needs to be carefully studied, and they should only be used if necessary. Like all drugs, they have significant side-effects.