The latest on multivitamin food supplements

According to the Journal of the American Medical Association, one in three U.S. adults take multivitamin supplements. (The Atlantic says three-quarters of Americans take at least one dietary supplement.)  Here’s what the Journal has to say about their value:

• Twenty years of studies that included almost 400,000 participants showed that taking multivitamin supplements was “…not associated with a mortality benefit.” In fact, they write, “…mortality risk was 4% higher among multivitamin users, compared with nonusers.”

• Beta carotene supplements, as well as vitamin C and E and zinc, are associated with slowing the progression of age-related macular degeneration. (Beta carotene is a natural pigment found in many fruits and vegetables, such as carrots, sweet potatoes, spinach, and apricots.)  

• Getting beta carotene from food is associated with reduced cancer risk. For at-risk people, such as smokers, taking beta carotene as a supplement increases the risk of lung cancer.

• In older people, multivitamin supplementation is associated with improved memory and slower cognitive decline.

• Taking iron as a supplement, which adds to the iron consumed in food, increases the risk of iron overload. Iron overload is associated with an increased risk of cardiovascular disease, diabetes, and dementia.

• Calcium and zinc may reduce the absorption of certain antibiotics.

Overall, the article says, “…there is little health rationale for the use of multivitamin supplements. Micronutrients come most healthfully from food sources.”

The dietary-supplement industry was valued at $40 billion in 2020. It is minimally regulated: the FDA doesn't review dietary supplements and manufacturers don't have to reveal their ingredients. 

I don't take supplements. Robert Kennedy Jr. says he takes a "fistful" of vitamins each day. You be the judge.

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Re-defining Alzheimer’s disease—maybe

Alzheimer’s disease is characterized by abnormal protein deposits in the brain. It begins with an asymptomatic phase and progresses—if the person lives long enough—to mild cognitive impairment and, eventually, a level of impairment that interferes with the daily process of living.

Researchers have developed two types of tests to diagnose Alzheimer’s before symptoms appear: blood tests that identify biomarkers, and genetic tests that identify the problematic genes. The tests show the full spectrum of the disease, beginning with the seeds of pathology deep inside the brain and ending with dementia.

Biomarker tests. A blood test can detect changes in the brain that predict Alzheimer’s disease up to 15 years before the first symptoms emerge.

Genetic tests: Genetic tests can identify a group of susceptibility genes—APOE—indicating an increased likelihood of developing Alzheimer’s disease by age 85. If you have a single copy of the APOE e4 gene, you are two to three times more likely than the general population to get Alzheimer’s by age 85. If you have two copies, you are 12 times more likely to develop the disease.  

Several groups are working to develop guidelines for diagnosing Alzheimer’s. It’s controversial. The working groups disagree on the word “diagnosis” when referring to the results of the blood test. Some prefer the word “risk,” believing that people should not be diagnosed with the disease based on biomarkers alone.

About drugs and treatment:

• Two drugs have been shown to reduce the disease progression by 27 percent, although their effectiveness in the later stages of the disease or in asymptomatic people, is unproven. The drugs cost $26,000 to $32,000 a year, with side effects that include a risk of swelling and bleeding in the brain.
• There are currently no treatments for those who have the biomarkers but not the symptoms.
• New guidelines discourage routine testing of asymptomatic people except in the context of research. But clinical trials of Alzheimer’s drugs are under way for treating people whose blood tests for the disease are positive. If such drugs prove successful, pre-symptomatic testing may become routine.  

About conflicting evidence:

• A substantial number of the people diagnosed with Alzheimer’s—based on blood and genetic tests—will die without ever having exhibited signs of dementia.
• Postmortem studies have found that up to 30 percent of people who received a clinical diagnosis of Alzheimer’s disease did not have the characteristic plaques and tangles in their brains.
• Many people have the plaques and tangles—as shown in postmortem dissections—but not dementia. In a famous study of 678 nuns, ages 75 to 107, postmortem dissections showed that the brains of many of the nuns had all the plaques and tangles of Alzheimer’s disease, but that their owners had shown no signs of dementia when they were alive. In fact, in 80% of the cases the pathology, as revealed in their brains, did not concur with the symptoms seen during life.

Something else is going on here. 

By the way, 23andMe gives you the choice of not looking at the results of the APOE gene test. I gathered up the courage, looked and got the following message: "Constance, you do not have the ε4 variant we tested." Whew!

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Walking

You’re supposed to engage your glutes (butt muscles) when you walk. As Esther Gokhale, the posture lady, writes, “The buttock and leg muscles contract strongly to propel the body forward, thus getting the exercise they need while the back is spared unnecessary wear and tear.” She says that for us in industrial cultures “walking consists of a series of forward falls blocked abruptly by the forward leg. The gluteal and leg muscles are underused.” This “forward fall” type of walking jams the hip joint and every other weight-bearing joint. Now she tells me.

I’ve found it’s hard to think about contracting my butt muscles to propel me forward. But what’s easier to remember is keeping my back leg straight and the heel on the ground. When you do that, your glute muscles engage.

Here's an illustration showing you (too) many things to think about when you walk. 

Now I'm going to think about "leg externally rotated." Maybe it will keep my hips from caving inward, which is what I think caused my knee problems. 

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The healing power of nature

A famous study, published in the journal Science, demonstrated that nature can promote healing. Researchers found that people in hospital beds who looked onto trees had shorter stays and took fewer painkillers than those who didn’t. Just looking at nature influenced their health, triggering physiological changes in their bodies.

It turns out that not only the sight of the natural world, but also its smell, sound, and feel slows our breathing and heart rates and lowers our blood pressure and adrenaline. In other words, its effects are calming. Apparently, when out in nature, we breathe in volatile molecules released from plants. The molecules enter our bloodstream and interact with biochemical pathways, triggering beneficial metabolic processes.

Sounds, like birdsong, the wind rustling leaves, and the trickling of a stream have similar benefits. Researchers found that people who were awake during surgery experienced much lower stress levels when listening to such natural sounds than when listening to other types of sounds.  

Japanese researchers have studied the effects of “forest bathing” (walking in the woods) and have found that this activity elevates the walkers' Natural Killer (NK) cells. (Natural Killer cells are white blood cells that fight tumors and infections in your body.) The researchers theorize that inhaling the aerosols emitted from the forest are responsible for the effect. A subsequent study, in which essential oils from cedars were emitted in a hotel room where people slept, also caused a significant spike in NK cells. 

I have a few diffusers in my house that emit the fragrance of fir trees. I like the way they smell. Until now, it never occurred to me that they were beneficial to my health. They’re expensive, but maybe worth it!

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The vagus nerve and inflammation

More than half of all deaths from disease are tied to inflammation, including heart disease, stroke, asthma, diabetes, and autoimmune and neurodegenerative conditions. About a third of people with major depression also have inflammation. Some inflammation is protective, such as the swelling and redness you get when stung by a wasp. This is your immune system dealing with the venom. In such cases, your spleen releases proinflammatory molecules (cytokines) into your bloodstream to activate your immune response, a complex system that includes regulation by the vagus nerve.

But sometimes the immune system can become overactive and damage tissues. In such cases—often the result of stress, chronic infection, or autoimmune disease—inflammation can cause the proinflammatory molecules to circulate continuously for months or years. Examples of an overactive immune system include Crohn’s disease, Parkinson’s disease and chronic pain.

The vagus nerve controls the inflammatory reflex, which includes the delivery of information about inflammation from your body to your brain. In response, your brain—via the vagus nerve—sends signals to your body to regulate its immune response. In the case of chronic, harmful inflammation, the nerve pathway that carries anti-inflammatory signals from the brain to the body may be impaired.  

As with treatment for treatment-resistant depression, scientists are exploring the use of vagal nerve stimulation (VNS) to treat chronic inflammation. The treatment looks promising, as the Pub Med medical journal stated: “Clinical applications have confirmed the efficacy of VNS in managing specific autoimmune diseases, such as rheumatoid arthritis, and chronic inflammatory conditions like inflammatory bowel disease.” This treatment is in its infancy, but worth exploring if you’ve got chronic inflammation.

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