


  • Taking Supplementation Seriously Part II:


  • Controversy is no stranger to vitamins and herbs, albeit there are periods of more and of less attention. Popular news sources recently have been making much of a couple of issues: To start, there has been a regular drumbeat regarding the uselessness of vitamins, either alone or in combination, for either preserving or improving health. Multi-vitamin/mineral supplements are common targets, but so are vitamins such as vitamin D and a number of popular herbs. Next, we are warned routinely of possible interactions between various supplements, especially herbal extracts, and prescription drugs. In particular, blood-thinning medications and certain immuno-suppressants used to treat HIV have been emphasized as being incompatible with a number of popular plant products, including St. John's wort and Chinese ginseng. Both sets of issues are real, to be sure, and need to be considered for safety's sake. Nevertheless, the ensuing controversy over supplements is perhaps just as important for what it reveals about American dietary and other habits as for what it reveals about the safety of vitamins and herbs.

    In point of fact, many common foods have as great or greater an impact upon numerous medical conditions as do the vitamins and herbs that have been singled out. Examples of this will be given shortly. In considering these examples, the reader should be aware they are not exhaustive. They are being offered as evidence for a number of points worth pondering. First, what is revealed by the current focus upon the medical interactions of popular supplements? Second, if quite a number of foods pose the threat of similar interactions, does a lack of focus on or concern with dietary factors suggest that the diet of the average American is highly restricted in terms of food choices? Third, is it the case that many conditions for which drugs are readily prescribed for chronic use in this culture might be better treated by simple changes in the diet and/or the use, as first choice, of vitamins, herbs and other supplements which have negligible side effects?

    Vitamin D One More Time
    TotalHealth magazine over the past few years has been vigilant in examining controversial attacks on vitamin supplements and it is disappointing to many of us that wrong-headed analyses continue to be picked up and presented uncritically by both professional journals and the popular press. USA Today (January 23, 2014) is a good example of this as it states unambiguously that studies and reviews of vitamin D have found no "significant benefits for heart health, cancer prevention or even bone health in healthy people." The journal article that prompted these comments, large meta-analysis just published in the British medical journal Lancet is blunt in its assessment of vitamin D:1 "Available evidence does not lend support to vitamin D supplementation and it is very unlikely that the results of a future single randomized clinical trial will materially alter the results from current meta-analyses."

    The response from a number of primary vitamin D researchers to this and other recent meta-analyses has been withering. This includes the remarks of Dr. Michael Hollick, the scientist responsible for identifying the major circulating form of vitamin D in serum â€”25-hydroxyvitamin D3â€”which is the form of vitamin D measured medically to assess vitamin D status. Dr. Hollick terms the recent papers flawed and "silly." Dr. Hollick's views are reported by Dr. Mercola at his website ( which provides an elaborate critique of the recent vitamin D papers. Another researcher who roundly dismisses the recent studies is Dr. Cedric Garland of the University of California at San Diego Moores Cancer Center. His comments cover both the Lancet paper already mentioned and another recent meta-analysis:

    This meta-analysis is nothing new and is already obsolete since it is mainly based on old papers that used too little vitamin D to expect any effect. A New Zealand study saying we should only supplement people with vitamin D deficiency and evidence of bone loss is equally wrong. Virtually everyone in New Zealand, and most adults in the U.S., are vitamin D deficient by modern criteria, being below 32 ng/ml.


    In other words, the studies culled and used as the basis of the recent meta-analyses of vitamin D were themselves inadequate because designed around totally inadequate vitamin D daily dosages. Moreover, one does not need to look far for at least one very major review that disagrees with the conclusions of the negative meta-analyses in the most fundamental way. A Cochrane review published just this year on vitamin D and mortality gives an answer that seems more than sufficient to warrant another look at vitamin D, at least in its D3 form:2


    Blood Thinning Drugs
    Another point of current controversy involves both vitamins/ vitamin-like compounds and various herbs. Many aging individuals are treated with anti-coagulants or "blood thinners" to reduce the risks of stroke and blood clots. One popularly prescribed such drug is Coumadin (warfarin). Drug interactions with any of the anticoagulants are quite common, including with such everyday items as alcohol and aspirin. The usual side effects involve too free bleeding and show up as such things as easy bruising, frequent nosebleeds, dark urine and tarry stools. Needless to say, excessive bleeding can be life-threatening under certain conditions. Interactions with anticoagulants are so common that some pharmaceutical experts caution against taking any new drug, including overthe- counter items such as aspirin, without first speaking with a doctor or pharmacist.

    Ginkgo biloba extracts, particular examples of which in a number of clinical trials currently are being reaffirmed for cognitive health (but only in the case of certain extracts)3, possibly present a problem for those taking anticoagulant drugs largely because these extracts perform many of the same tasks as those drugs and much more. Ginkgo extracts improve the blood flow through the artery which serves the heart, improve circulation in the brain and more generally throughout the body, increase the clearance of toxins from the system, and protect the body against what is known as platelet-activating factor (PAF). PAF was only discovered in 1972, and since that time scientists have come to realize that it is involved in disturbances ranging from internal blood clots (often leading to heart attacks and strokes) to allergic reactions and asthma.4

    Problems with excessively "sticky" blood are much more common in the United States than they are in many other countries around the world, such as in Japan. Diet appears to be by far and away the most significant factor in this. A quite large number of foods "thin" the blood. Food sources of omega-3 fatty acids, which include many coldwater ocean fish as well as walnuts and a few other items, all tend to increase clotting time. All members of the onion and garlic families act as blood thinners, especially if eaten regularly and in quantity. The same is true of the mo-er (black tree fungus) and reishi mushrooms, both of which can be purchased in markets, which carry specialty mushroom and Asian vegetables. Another natural blood thinner is hawthorn. Hawthorne, which is found primarily as an extract in this country, is the basis for some popular beverages in Asia and often taken as a tea in Europe. Red wine, especially if it is high in the antioxidant resveratrol, may increase coagulation time. The quinine found in tonic water will increase or prolong the actions of Coumadin and may have its own blood thinning effects. Grapefruit is notorious for reducing the clearance of warfarin-like compounds and therefore increasing the risk of hemorrhage.5,6

    A great many herbs, spices and digestive aids can exercise significant anticoagulant effects. These include cayenne pepper, bromelain from eating pineapple fruit and stem, papain from papaya, and likely paprika and most chili peppers. Ginger root, which is eaten in quantity in Indian and Oriental cuisines, can strongly inhibit clotting. So can its relative, tumeric, which is used widely in curries and a source for purified curcumin. Vitamins and vitamin-like compounds, as mentioned above, can lead to similar problems. These compounds include vitamin E, tocotrienols, omega-3 fatty acids, lipoic acid and many more.

    Both Chinese and Indian (Ayurvedic) medicine would greatly expand these lists of foods and herbs which can increase clotting time, but, even as things stand, it should be clear that diet likely is the predominant factor by far in determining the activity of several elements in the blood which control clotting time. Of course, there are at least as many dietary factors which can influence blood coagulation in opposition to Coumadin as those which are additive.

    Changing the Rate of Drug Clearance
    Many drugs (including some protease inhibitors, calcium channel blockers, and oral contraceptives) are metabolized by the cytochrome P450 3A4 (CYP3A4) metabolic pathway, which is active in the liver. Grapefruit has already been mentioned as influencing this pathway; it contains the compound naringenin, which is one of the most powerful of common compounds in affecting CYP3A4. The herbal supplements, which presently are the most strongly implicated are goldenseal (Hydrastis canadensis), St. John's wort (Hypericum perforatum), and cat's claw (Uncaria tomentosa).7 Black pepper extracts, similarly, influence cytochrome P450 and other elements involved in drug clearance.

    The ability to zero-in on this enzyme system through special research techniques, unfortunately, in many ways is a bit misleading. How much difference does it make in practice whether the clearance of a drug is delayed as opposed to its absorption being greatly enhanced? Black pepper, cayenne pepper, ginger and long pepper all either strongly increase absorption of other compounds and/or influence cytochrome P450. Some sources of lecithin, such as eggs, may similarly increase the uptake of certain drugs. Alcohol typically enhances the effects of many drugs, whether by increasing absorption, producing its own additive effects, or delaying clearance.

    Quite a remarkable number of items in the diet can interfere with many drugs. Some interfere directly with absorption, as do the tannins and fibers found in many fruits and vegetables. Others do so indirectly by activating overall metabolism, liver and/or kidney functions.

    Why Look to Dietary Choices Last?
    Herbs, of course, do have many powerful effects upon the body and should not be treated as if they are innocuous merely because they are "natural." However, also missing in American culture at large is an awareness that it is relatively easy to intervene in many common conditions without resorting to prescription drugs. In point of fact, other than a quite narrow range public health messages regarding primarily fats and fiber in the diet, we do not tend to think of diet as having much of an impact upon health at all. There is no reservoir of knowledge in everyday American culture regarding the health uses of foods and herbs, unlike the cultures of Asia and even Europe. Moreover, the U.S. heavily subsidizes the growth and production of many foodstuffs used in "fast foods" (corn, wheat, sugar beets, etc.) while doing nothing to reduce the cost to consumers for fresh fruit and vegetables, i.e., items that are healthful rather than being merely sources of calories.

    Indeed, there are entire classes of medications sold extremely widely in the United States for which there appears to be no need in many other cultures. One class which immediately comes to mind is that of the acid reflux / heartburn /antacid medications, whether over-the-counter or prescription. The entire notion that there are health problems stemming from the production of excess stomach acid is surely an odd one given the fact that we typically have no such problems when we are young and produce plenty of stomach acid, yet such problems in this culture are common in middle age and later, i.e., at the point at which the ability to produce stomach acid has already begun to decline markedly. What has really happened is that the muscle that closes off the top of the stomach and prevents its contents from flowing back up the esophagus has weakened. Items that reduce the production of stomach acid at the same time prevent the complete digestion of proteins in the stomach, but, again, do nothing to strengthen the muscle that controls acid reflux. Interestingly enough, acid reflux is virtually unknown in much of Asia where ginger is commonly used as a part of meals. Ginger just happens to strengthen the esophageal sphincter.

    In truth, the American diet tends to be extremely narrow in the range of the foods eaten. "Fast foods" such as a burger and fries garnished with a little bit of cold slaw have become increasingly important sources of dinner and supper for the average American, and therefore it is hard to argue that our range of foods consumed daily is large. Some authorities estimate that one half of all meals are eaten outside the home, mostly at fast food restaurants. Aside from the obviously poor nutrition supplied by such choices, it is also the case that most of the otherwise readily available foods that might be used to influence many health conditions are either missing or very badly represented. We grow these foods, we just don't eat them. Hence the observation by one Tibetan doctor to the effect that we seemed to have only two flavors in this culture, salty and sweet.8

    This returns us to our starting point. Were the average American consuming a truly varied diet, the American medical profession likely would be more aware of the impact of foods upon health. Likewise, there is the curiously dichotomous thinking of many of those who are medically trained to the effect that herbs are either without any benefit, on the one hand, or likely to be a threat to prescribed pharmaceutical drugs, on the other hand. According to this way of thinking, items are either foods or drugs. Foods support the structure and functions of the body, whereas drugs intervene. As long as herbs could be seen as being without effect, they could be relegated largely to the foods category, i.e., at best innocuous and a waste of money in terms of health benefits. Once it is admitted that herbs might have benefits, they must be treated like drugs and viewed as possessing a host of powerful side effects and drug interactions.

    The problem is that even everyday foods can have quite powerful effects upon the body. So why not make use of these food effects as a first line of treatment, herbs as a second line, and drugs only when all else fails?


    3. Lewis JE, Melillo AB, Tiozzo E, Chen L, Leonard S, Howell M, Diaz J, Gonzalez K, Woolger JM, Konefal J, Paterson E, Barnes D. A double-blind, randomized clinical trial of dietary supplementation on cognitive and immune functioning in healthy older adults. BMC Complement Altern Med. 2014 Feb 4;14(1):43.
    4. Murray, Michael T. "The Healing Power of Herbs," 2nd edition (Prima Publishing, Rocklin, California: 1995.)
    5. Brinker, Francis. "Herb Contraindications and Drug Interactions." Revised 2nd edition. (Eclectic Medical Publications, 1998.)
    6. Mindell, Earl and Hopkins, Virginia. "Prescription Alternatives." (Keats Publishing, 1998.)
    7. Budzinski JW, Foster BC, Vandenhoek S, Arnason JT. An in vitro evaluation of human cytochrome P450 3A4 inhibition by selected commercial herbal extracts and tinctures. Phytomedicine. 2000;7(4):273-82.
    8. Yeshi Donden. "Health Through Balance." Snow Lion Publications, 1986.)
  • Taking Supplementation Seriously Part III




















  • Total Health Online continues to share with readers the precepts of “self-managed natural health.” From the basics to the cutting-edge, we present nutrition through diet and supplementation, coupled with a regular exercise program, a positive mental attitude and an active philosophical commitment as the keys to achieving optimum health, natural healing and a productive lifestyle. While each ingredient in the proactive prescription for natural health is integral, nutritional supplementation is at its core. As total health science adviser Parris Kidd, Ph.D. States: “Vitamins aren’t a luxury or an invention of the vitamin industry. Vitamins are substances the body must have to survive. Taking vitamins is not a choice for humans. The only question is, how much vitamins should we take?

    “This is important for the health conscious consumer to grasp, as week by week science demonstrates that vitamins and other nutrients are not just safer to take but can actually work better than do many drug treatments.

    “Most of the vitamin supplementation over and above what we get from our diet is necessary, since the ‘Standard American Diet’ (SAD) fails to provide amounts sufficient for us to derive the maximum benefits to our health that vitamins can provide. Hence the rationale for developing a personal vitamin program, one crafted as carefully as a career development plan or an investment planning program.”

    Dr. Kidd presents a compelling case for incorporating nutritional supplements in our daily diet to counteract the insidious impact of environmental toxicity on our systems. He states, “We live in a toxic world. Wherever we reside, wherever we work, wherever we play, wherever our kids go to school, our bodies encounter substances that can damage us, make us sick, even kill us. So many of the things in our lives that we take for granted—the food we eat, the water we drink, the air we breathe—can betray our health. Other things we read warnings about—prescription drugs, recreational drugs, lawn and garden chemicals—turn out to be more toxic than we would have guessed. Toxic substances poison our organs, drain our energy and cause cancer and other killer diseases.”

    Dr Kidd also explains that in addition to supplying the basic nutrients necessary to sustain life and combat environmental insults, supplements as nutraceuticals and immunoceuticals play an important role in avoiding disease.

    The term “nutraceutical” refers to a nutrient that can be taken by mouth to treat a disease condition. For instance, nutraceutical therapies are used in conjunction with other therapies as part of a truly integrative strategy for cancer management. The excellent benefit-risk profile characteristic of the nutraceutical now makes possible a truly integrative strategy for cancer management. In some cancer cases nutaceuticals would be used as stand-alone treatment, while in others nutraceuticals would be used in combination with surgery, chemotherapy, radiation, heat treatment, psychosocial intervention and other treatment strategies.

    Nutrients are now in the process of being transformed from fringe curiosities to center stage players in the medical management of cancer and other killer diseases. In many countries nutraceutical medicine already is in the mainstream people’s medicine. Now in North America, a great reintegration of people’s medicine with modern high-tech medicine is a foot, with all of us likely to benefit. We must each do our part to hasten this much-needed transformation while steadfastly protecting the rights of the health consumer.

    Immunoceuticals are nutraceuticals which can potentiate the immune system to move from the defense mode into the offensive mode to go after the cancer cells and kill them.

    The immune system is the body’s major defense against any and all agents that threaten its survival. The healthy immune system is a highly integrated network of single cells, cells grouped together in tight coordination. Acting as sentries for the system are macrophages, single cells which are distributed throughout the tissues. The macrophages are trained to detect mutated or other abnormal cells as the pop-up on the radar, then immediately alert the other immune system warrior cells to go on the attack against these cells and eliminate them. The immune system, if damaged, weak or misdirected, is likely to be poorly self-regulating and hampered in its efforts to eliminate cancer foci, whereas if potentiated by immunoceuticals, it could attack more aggressively and buy time for the body to further mobilize against the cancer.

    By potentiating the immune system, that is raising its functioning to a higher level, immunoceuticals can help the body mobilize a lifesaving response against cancer. The driving force of immunoceuticals is helping the body’s immune system to help itself: The Chinese traditional healers called this Fu-Zheng therapy. The best immunoceuticals help the immune system to attack cancers, as well as to re-build and re-mobilize following chemotherapy or radiation therapy, interventions which are immunotoxic and damage immunity.

    With nutritional supplementation being recognized as an imperative to establishing and maintaining optimum health, as effective and fortifying the immune system against disease, it is also being proven as a viable, intelligent alternative to many conventional medical and pharmaceutical therapies.




    What is Quality in a Dietary Supplement?





    Identifying Quality in a Supplement







    strong>Adherence to pharmacopoeial monographs









