Chairman, Medical Affairs, Health Sciences and Education
You can learn more about my credentials, education, and philosophy of healing on my biography page.
The Importance of Supplementation
Research has increasingly validated the connection between nutrition and health, between the types and amounts of foods that we eat and the likelihood of developing certain diseases as well as the likelihood of maintaining good health or increased longevity. We know that excesses in the diet are clearly linked to certain diseases. For instance, obesity and high fat diets are both well established risk factors in the development of coronary artery disease, many types of cancer, ischemic stroke and Type 2 diabetes. These four conditions account for approximately 85% of all deaths in the United States and a very large portion of our health care dollar. It is estimated that 28 million Americans live with heart disease. 56 million Americans are being treated for hypertension. It is well established that just by losing as little as 10 pounds, one can see drops in blood pressure, cholesterol and blood sugar. The excesses in our American diets have been linked to these disease risks for more than 30 years and yet we have yet to see significant improvements in primary prevention--i.e. not in lessening complications from hypertension or reducing the risk of a second myocardial infarction due to the prescription of ACE inhibitors or statin drugs--but rather improvements in diets and normalization of weight leading to normalization of blood pressure and cholesterol levels without medication. The medical profession has focused almost entirely upon treatment. I would like to have a discussion of the use of supplementation and dietary interventions towards a goal of prevention.
I have always approached healthcare from a perspective of prevention. I have employed nutritional and lifestyle strategies to 1) optimize health, 2) decrease the morbidity and complications of existing diseases--especially those that are directly linked to diet and obesity, and 3) attempt to reverse existing disease. I have found that when people are empowered with information and inspired into action--dramatic improvements in health and physical function can occur as well as actual reversal or improvement in disease states. There are three primary ways for physicians to utilize supplementation with patients. The first way is to utilize supplements as a way to assure that their patients' diets are replete with all essential nutrients that are scientifically validated, with the understanding and acceptance that the majority of Americans are NOT even reaching minimums of nutrition via their food intake. Dr. Gladys Block of UC Berkeley School of Public Health states that surveys confirm that American adults consume less than 2 servings of fruits and vegetables per day--certainly far less than the Institute of Medicine's most recent recommendation of 7 servings for women and 9 servings for men. The second way is to utilize supplementation to actually treat certain specific conditions---usually in an integrative fashion along with more traditional therapies. For instance, supplementation with omega-3 fatty acids has been shown to decrease the amount of lithium needed for treatment of bipolar disorder. The third way to utilize supplementation is to assist their patients in weight loss. We will discuss this in a future article that addresses incorporation of a scientifically advanced, clinically validated weight management program into the healthcare professional's office.
So, let us discuss the current state of knowledge--the research, the Epidemiologic data--what is quite clear and where we still need further information before guidelines can be truly universally acceptable. What is clear is that it is not just dietary excesses that lead to disease. Deficiencies in our modern diets are also being recognized--along with their connection to various health conditions. Indeed, cancer may be "the ultimate deficiency condition"! Many cancer research experts estimate that more than 80% of cancer are tied to dietary factors--both excesses and deficiencies. The American Cancer Society (and essentially all wellness experts) recommends 9 servings of fruits and vegetables for men, 7 servings for women, and 5 servings for teens per day to reduce one's risk of cancer. We know that antioxidants, such as Vitamins C, E, beta-carotene and other carotenoids, and selenium help protect our DNA from damage from oxidative stress and help to support our immune system in a more general fashion. It is generally well accepted that poor diets, stress, obesity, alcohol intake, lack of adequate sleep all decrease the function of the immune system and make our DNA more susceptible to the effects of oxidative stress---and if abnormal cells exist, will be less likely to recognize and destroy them.
So, let's talk about the excesses in the diet in greater detail, and then we will discuss deficiencies as well. I believe there are 3 main factors fueling the excesses in the diets and the resultant obesity epidemic we are seeing in the United States and around the world.
- The easy availability of fast foods, convenience foods and take-out meals, which tend to be high in calories, saturated and trans-fats, salt and sugar.
- The processing and refinement of our foods (especially these convenience foods) leading to dietary deficiencies when they are consumed regularly.
- The resultant cravings creating a vicious cycle of overeating and a sad reality of overweight and obese individuals who are actually malnourished!
Let's talk about these excesses, with a focus primarily on macronutrients. As a general statement, I believe that we must, as physicians, take responsibility for educating patients as to the healthy types as well as the amounts of macronutrients to consume. I am a firm believer in the old adage of "moderation in all things"---including moderation! We have seen focus on extreme low fat diets, extreme low carbohydrate diets, extremely high protein diets---none of which are really effective in the long run because it is a healthy balance of macronutrients that will provide the breadth of nutrients required for good health as well as lead to the highest likelihood of compliance. Yo-yo dieting will be discussed in a different segment---but clearly dieting cycles lead to lowered metabolism and directly contribute to a person's increasing weight over time.
Let's look at Fats. In the late 1970's, the very low fat diets proliferated, largely due to emerging data related to the connection of hypercholesterolemia and hypertriglyceridemia to coronary artery disease. But ongoing research and data leads us today to have a clearer understanding that it is decreases in saturated and trans-fats and increased intakes of monosaturated fats that will lead to the greatest improvements in cardiovascular risk factors. The research on omega-3 fatty acids has increased our understanding dramatically. The current theories related to our ancestors having consumed diets with ratios of 2:1 Omega-6:Omega-3, while our modern diets are 15-20:1 Omega-6:Omega-3 as an explanation for the proliferation of autoimmune and other inflammatory conditions today. . Our ancestors consumed diets rich in nuts and seeds, good sources of omega-3's, while modern man and woman eat processed and often fried foods that contain large amounts of vegetable oils that are high in omega-6. Our intake of nuts and seeds are minimal. Omega-6 oils are pro-inflammatory and enhance platelet stickiness, whereas omega-3 fats are naturally anti-inflammatory and tend to help the blood flow and promote healthy heart rhythms. So, our fat intake is actually an example of both dietary excesses (omega-6) and deficiencies (omega-3). We are now seeing labeling of trans-fats, but we must continue to reinforce label-reading with patients. To correct the deficiencies of omega-3 fatty acids, we can urge the inclusion of almonds, walnuts, fatty fish and flax in the diet---but nuts tend to be high in calories, so I am a firm believer in the daily intake of fish oil capsules to provide these essential and health-conferring fats in the lowest calorie delivery.
See below for the American Heart Association's recommendations on Omega-3 fats.
|Patients without documented coronary heart disease (CHD)||Eat a variety of (preferably fatty) fish at least twice a week. Include oils and foods rich in alpha-linolenic acid (flaxseed, canola and soybean oils; flaxseed and walnuts).|
|Patients with documented CHD||Consume about 1 g of EPA+DHA per day, preferably from fatty fish. EPA+DHA in capsule form could be considered in consultation with the physician.|
|Patients who need to lower triglycerides||2 to 4 grams of EPA+DHA per day provided as capsules under a physician's care.|
Patients taking more than 3 grams of omega-3 fatty acids from capsules should do so only under a physician's care. High intakes could cause excessive bleeding in some people.
Carbohydrates have also received much media and consumer attention. The simple reality is that we are eating higher amounts of refined carbohydrates than ever in history. We eat highly sweetened foods--breads, pastries, pastas and desserts---and rarely consume the necessary servings of fruits, vegetables and dark whole grains that provide important micronutrients and antioxidants as well as the necessary fiber for good colon health. While the evils of HFCS (high fructose corn syrup) have been almost demonized in the media---again, I will come back to the concept of balance. I would not put anyone into a panic mode because something has HFCS as an ingredient, but I would strongly urge all physicians and healthcare professionals to counsel their patients to not drink sodas at all!! These cola and similar beverages demineralize teeth and bones as well as provide pounds of extra sugar (or artificial sweeteners) to our society. Soft drink consumption has increased by more than fivefold in the past 50 years, and soft drinks are now the leading source of refined sugars in the American diet, with nearly half of the added sugars came from high fructose corn syrup. Soft drinks provide excess calories and contribute to the obesity epidemic but have no nutritional value.
The lion's share of carbs need to come from fresh fruits and vegetables. Adults should not consume fruit juice regularly as it contains too much simple sugars and relatively empty calories---reserve the juice for your children (or grandchildren). Eat whole fruit instead--it is more filling and more nutritious. I want to encourage all of you to eat the required servings of fruits and vegetables (9 daily servings for men and 7 servings for women)---and reinforce that message to patients at every visit.
Now, let discuss protein. Because amino acids are the building blocks of hormones, neurotransmitters and enzymes in the body, a healthy intake of protein is incredibly important. Adequate protein plays a role in our mood, our sleep and thought patterns, as well as playing critical roles in cellular energy production. While most Americans consume adequate protein, there are 3 key points to consider:
- Americans tend to eat too much animal protein and protein sources that are high in saturated fat (red meat and full-fat dairy products). The addition of fish (especially omega-3 rich choices such as salmon and tuna) and soy foods are great ways to add proteins that will not compromise health.
- Millions of American women have become "chronic dieters" who tend to skip the protein foods, eating fruits, vegetables and starches. These habits can lead to a vicious cycle of dieting that leads to loss of bone mass as well as lean muscle mass resulting in increasing difficulty in maintaining a healthy weight as well as a risk for osteoporosis.
- Weight loss is far easier if the diet is adequate in protein content. Protein helps to control hunger, helps mood and helps to support metabolism. I highly recommend protein shakes as meal replacements---they are nutritious, satisfying and incredibly effective as a basis for calorie reduction without sacrificing nutritional adequacy. In fact, meal replacement shakes often provide more nutrition than the great majority of people are currently getting in their breakfast or lunch!
The reasons for deficiencies:
- The processing and refinement of our foods leading to dietary deficiencies and the resultant cravings creating a vicious cycle of overeating
- the realities of modern agriculture techniques and our global economy leading to crops that are grown in deficient soil and harvested before they reach full maturity
The Institutes of Medicine, a division of the National Institutes of Health now recommend that all adults can benefit from taking a multivitamin and mineral supplement on a regular basis for optimum health. Additionally, certain subsets of the population, including the aging, pregnant women and those on weight loss diets are singled out as being especially needy of additional specific micronutrient supplementation. As we age, we tend to absorb nutrients from food less efficiently. A number of studies have confirmed that older people absorb certain vitamins and minerals more efficiently from a multivitamin tablet than from food! Women who are considering becoming pregnant should be sure they are taking in adequate amounts of folic acid to prevent one of the most common birth defects---neural tube defects. Folic acid is better absorbed from supplements than from food. And, of course, people on diets should always take a multivitamin-mineral product.
And what about specific supplements to reduce one's risk of certain diseases? Well, from cataracts to age-related macular degeneration to certain cancers to osteoporosis, there is excellent scientific validation of the connection between supplementation and disease prevention. We know that Vitamins C and E (in the range of 250-500 mg and 400 IU respectively has been shown to reduce one's risk of both cataracts and AMD. Additionally, consuming greater than 10 mg lutein may also assist in risk reduction and disease progression with AMD.
The connection between calcium and Vitamin D intake and diminishing one's risk of osteoporosis has been well established for more than 25 years. More recent research and Epidemiologic data is leading us to increase the recommendations for Vitamin D. And there is widespread concern that the elderly, people who work indoors and those living in the Northern latitudes may indeed be deficient in natural production of Vitamin D due to limited sun exposure.
The Vitamin D Adequate Intake (AI) for children, adolescents and adults is as follows in
|Vitamin D (IU/day)||Pregnancy & Lactation|
|9 to 13 years||200||N/A|
|14 to 18 years||200||200|
|19 to 50 years||200||200|
|51 to 70 years||400||N/A|
|71 + years||600||N/A|
Source: IOM Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D,
For further specifics on research and recommendations related to specific nutrients, please see our additional segments we have provided through links to 3rd party data within the Health Conditions, Dietary Supplement ingredients and Drug/ Nutrient Interaction segments.
Certainly, the old adage from our moms or grandmothers continues to be valid: "we are what we eat." And in 2007, that means McDonalds, Taco Bell and Starbucks. Let us, as medical professionals, set an example of healthy eating and a thoughtful lifestyle. Eat plenty of fresh vegetables, fruits and adequate amounts of lean protein, mainly from non-hormone-fed beef and fowl, wild (not farmed) fish and soy. Additionally, at the very least, take a balanced, divided dose multivitamin-mineral supplement, 1 gram of fish oil, 250 mg Vitamin C, 200-400 IU Vitamin E and, if you are a woman, 1000-1500 mg calcium each day! Continue to school yourself on the benefits (and lack of risk) of usage of nutritional and herbal supplements. We will provide you references on this site to further your knowledge and increase your comfort level with the benefits of supplementation for yourself, your family and your patients.
Chairman, Medical Affairs, Health Sciences and Education