Herbal remedies and vitamin supplements can be good, bad and ugly.

Cloud Gate, nicknamed The Bean, in Millenium Park, Chicago. (Dr. Noorali Bharwani)
Cloud Gate, nicknamed The Bean, in Millenium Park, Chicago. (Dr. Noorali Bharwani)

Recent CBC investigation report (Fifth Estate) revealed that herbal remedies and vitamins are frequently approved for sale in Canada with only minimal review. Even Health Canada acknowledges that their approval of these products is based on “weak evidence,” says the CBC report. That indeed is shocking.

The CBC report indicates that Health Canada approves more than 90 per cent of applications to sell new natural health products. And under updated rules, products can be approved in as little as 10 days.

Are we fully aware of the quality and safety of many of these supplements? The answer is no. We don’t. U.S. statistics show supplements send 23,000 people to hospital each year. Annual sales in Canada total about $1.4 billion, and Health Canada’s Natural and Non-Prescription Health Products directorate must approve supplements before they go on sale.

According to the CBC report, some leading researchers also say there is mounting evidence that many of the most popular supplements don’t live up to their claims and could even be dangerous. Common complaints about these products included contamination, purposeful adulteration, incorrect strength and incorrect identity.

Medically speaking a healthy individual, who eats a good diet, does not require vitamin supplements. But almost 30 percent of our population does not follow that dictum.

On the other hand, there is a consensus among medical experts that taking certain vitamin supplements on a daily basis does more good than harm.

Here are some examples:

  1. Folic acid (400 ug/day) reduces the risk of birth defects during pregnancy.
  2. Multivitamin tablet – one a day. Vitamin B such as B6 and B12, may help lower blood levels of a substance called homocysteine that may help reduce the risk of heart disease and stroke.
  3. Vitamin D (1000 – 2000 IU/day) minimizes the risk of osteoporosis and fractures and colon and breast cancer.
  4. Omega-3 fatty acids – 1000 mg/day or eat fish three times a week. This reduces the risk of sudden heart attack by 50 to 80 per cent. It can help ward off the serious heart rhythm disturbances associated with sudden cardiac death. It also appears to reduce the risk of strokes, mental decline in old age and prostate cancer.

In summary, one multivitamin, vitamin D and omega-3 should cover what you need if you are otherwise healthy. Remember, this is just a guideline. Discuss with your family doctor before you start these pills. If you opt to use herbal remedies for prevention or treatment of an illness check whether there is any science associated with the recommendation.

Vitamin supplement is just an icing on the cake – so to speak. Too much of icing and/or too much of cake is not good for your health!

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The Importance of Vitamins in Our Diet

Tablets. (iStockphoto/Thinkstock)
Tablets. (iStockphoto/Thinkstock)

In general, most people know the importance of vitamins in our diet. But many people do not know which vitamins are really important in maintaining good health.

I would like to revisit an article I had discussed about ten years ago on this topic. Not much has changed since. The topic was also discussed in a Clinical Practice article in the New England Journal of Medicine (NEJM) titled, “What vitamins should I be taking, doctor?”

Medical teaching says that a healthy individual, who eats a good diet, does not require vitamin supplements. He should be able to meet his vitamin needs from his healthy diet. But the public interest in vitamin supplements is enormous – sometimes due to misguided reasons. Almost 30 percent of our population takes vitamin supplements. And there is no control over it.

Because the food we eat contains too many nutrients, it would be almost impossible to conduct double blind trials to see if vitamins do have improved clinical outcomes. Also the users of vitamin supplements may have healthier lifestyles or behaviours than nonusers. This would distort any clinical trial results.

The good thing about vitamin supplements is that there is greater likelihood of good than harm and cost of supplements is not that high so the authors of the article in the NEJM recommend the following vitamin supplements for healthy individuals. There is substantial evidence that higher intake of:
1. folic acid (400 ug/day),
2. vitamin B6 (2 mg/day),
3. vitamin B12 (6 ug/day), and
4. vitamin D (400 IU/day) will benefit many people, and a
5. a multivitamin will ensure an adequate intake of other vitamins for which the evidence of benefit is indirect.

The authors say a multivitamin is especially important:
-for women who might become pregnant
-for persons who regularly consume one or two alcoholic drinks per day
-for the elderly, who tend to absorb vitamin B12 poorly and are often deficient in vitamin D
-for vegetarians, who require supplemental vitamin B12 and
-for poor urban residents, who may be unable to afford adequate intakes of fruits and vegetables.

It should be noted that recent recommendation for vitamin D suggests all adults should take 1,000 to 2,000 IU daily. The upper level for safe vitamin D intake has not been well defined but is probably as high as 250 μg (10,000 IU) daily but in clinical practice, supplementation with this dose of vitamin D is rarely required.

Physicians who encourage their patients to take vitamin supplements should also educate their patients regarding healthy lifestyle and about healthy nutritious diet. Foods contain many additional important components, such as fiber and essential fatty acids and vitamin pills cannot be a substitute. Vitamin pills do not compensate for the massive risks associated with smoking, obesity, or inactivity, say the authors of the NEJM.

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Eat Fruits and Vegetables to Produce Healthier Sperm

A sperm fertilizing an egg. (iStockphoto/Thinkstock)
A sperm fertilizing an egg. (iStockphoto/Thinkstock)

A study published in Fertility and Sterility reported men who consume a high amount of certain nutrients may produce healthier sperm than men who do not. The study also found this effect to be more pronounced in older men.

Dr. Andrew Wyrobeck and his colleagues from Lawrence Berkeley National Laboratory, Berkeley, California determined dietary micronutrient intake among 80 individuals aged 22 to 80 years. Examples of micronutrients are vitamin C, vitamin E, and zinc. These nutrients are required by the body in small quantities for a whole range of physiological functions. The human body does not produce these micronutrients. Sperms from these individuals were also analysed.

The study found men with a higher intake of vitamin C, vitamin E, folate, and zinc produced sperm that had significantly less DNA damage than men who consumed lower amounts. Analysis showed that older men with an intake below that of the population’s median levels for vitamin C, vitamin E, and zinc (but not β-carotene or folate) had significantly more sperm DNA damage compared with all other groups, including older men with above median intakes.

What does this mean? It means older men who are planning to father a child in the near future should start eating a healthy diet if they are not doing so already. Older fathers, with DNA-damaged sperm, may be contributing to the increasing rates of autism, schizophrenia and other diseases among children and adolescents.

Researchers say consuming micronutrients such as vitamin C, E, folate and zinc helps turn back the clock for older men. The analysis revealed that men older than 44 who consumed the most vitamins and micronutrients had 20 per cent less sperm DNA damage compared to men their own age who consumed the fewest nutrients.

In younger men, a higher intake of micronutrients didn’t improve the quality of the DNA in their sperm. The benefit was observed solely among the older men. But, of course, they are the ones most vulnerable to sperm DNA damage – and therefore have the most to gain from an improved diet.

Future studies are needed to determine whether increased antioxidant intake in older fathers will improve fertility, reduce risks for genetically defective pregnancies, and result in healthier children, concludes the team.

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Salty Advice About Dietary Salt

A spilled salt shaker. (iStockphoto/Thinkstock)
A spilled salt shaker. (iStockphoto/Thinkstock)

None of us are strangers to table salt. Everytime you eat something, you probably make a remark regarding the amount of salt in the food. Some people may think it is just right, some may find it too salty and some may feel extra salt is required.

Our body contains many salts. Table salt (sodium chloride) is a major one making up around 0.4 per cent of the body’s weight at a concentration pretty much equivalent to that in seawater. Somebody has calculated a 50 kg person would have around 200 gm of sodium chloride in his body. That makes around 40 teaspoons.

We continually lose salt when we lose water from our body as salt is in a solution. So when we are sweating, vomiting, having diarrhea or voiding water by act of urination, we are losing salt. Salt cannot be made in our body so we have to replenish it otherwise there can be serious consequences.

Salt is needed to maintain our blood volume and blood pressure. Sodium is also needed for nerves and muscles to work properly. Low levels of body sodium can make our brain swell and cause confusion.

Too much sodium is bad for us as well. Excessive consumption of sodium can increase blood pressure, and that salt is a major determinant of population blood pressure levels. Some research estimates suggest the numbers of deaths averted by moderate reductions in population salt consumption would be at least as many as those achieved by plausible reductions in population smoking rates (CMAJ June 12, 2012).

The fast food industry is making its own contribution towards increasing the general population’s salt intake. Fairly large population is relying on fast food industry to provide their daily food needs. Fast food tends to be more energy dense, contain more saturated fat and salt, contain fewer micronutrients and be eaten in larger portions than other foods, says the CMAJ article.

Fast food items such as fried potatoes, pizzas and sugar-sweetened soft drinks typically provide between one-third and one-half of daily energy intake but less than one-quarter of most micronutrients.

Now what? Too much or too little salt in the diet can lead to muscle cramps, dizziness, or electrolyte disturbance, which can cause neurological problems, or death. Generally, more emphasis is given to the evidence showing an association between salt intakes and blood pressure among adults. We also know reduced salt intake results in a small reduction in blood pressure. Evidence suggests that high salt intake causes enlargement of the heart and swelling of the legs.

There is a clear scientific evidence that a modest and long term reduction in population salt intake can result in a lower population blood pressure, and a reduction in strokes, heart attacks and heart failure.

Then what are we waiting for? Most of us consume more salt than we need. General recommendation is no more than six grams (about one teaspoon) of table salt a day. This includes salt used in cooking and at the table. If you have high blood pressure or heart disease then less than two grams of table salt per day will be helpful. Are you willing to try that?

So, how is your food tasting today?

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