Ep. 26 - Experts, Science, and Sensational Headlines
Today Dr. Chet Zelasko checks out two opinion pieces that caught the attention of some listeners and examines the science behind them. Who got it right? Who just wanted the spotlight? Dr. Chet looks into it on this edition of Straight Talk on Health
Welcome to Straight Talk on Health, I’m your host Dr. Chet Zelasko. Together with WGVU in Grand Rapids MI, I examine the world of health research and news. Whether it’s research that makes the news, another miracle diet, a new food fad or an exercise trend, I look at the science behind them, and let you know whether it’s real or not. You can check out other things that I do on my website Drchet.com and sign up for my free emails.
The set up – I received links to articles from two physicians blog posts. They both used research as the cornerstone for what they had to say. The question is, how well did they use it?
Start with Modernity and Health written by John Mandrola MD FEB 19. Cardiac rhythm specialist. He reviews whether modernity is helping or hurting health
Define modernity – the advancement of technology in medicine to monitor, diagnose, and treat diseases. But does it? These three questions need to be answered.
Does it help reduce morbidity?
Does it reduce mortality?
Does it raise or lower health care costs?
He reviews two studies to see if there have been. The first paper from
Reference: Lancet 2021. Implantable loop recorder (ILR) detection of atrial fibrillation to prevent stroke (The LOOP Study): a randomized controlled trial. They implanted HR rhythm trackers in several hundred people. They were followed for just over 5 years. What happened?
Conclusions by the researchers: In individuals with stroke risk factors, ILR screening resulted in a three-times increase in atrial fibrillation detection and anticoagulation initiation but no significant reduction in the risk of stroke or systemic arterial embolism. These findings might imply that not all atrial fibrillation is worth screening for, and not all screen-detected atrial fibrillation merits anticoagulation.
They were elderly. The idea of the tracking is to identify and treat people before incidents occur. The problem as he sees it is that it will identify people with, in this case, AF, put them on blood thinners, yet see no difference in outcomes. Why, he ponders?
In Another paper from the same study: Prevalence and Prognostic Significance of Bradyarrhythmias in Patients Screened for Atrial Fibrillation vs Usual Care
Post Hoc Analysis of the LOOP Randomized Clinical Trial. JAMA Online 2/23/23. Researchers examined the data from that LOOP study further. What they found was that more people were diagnosed with bradycardia, a very low HR, and received pacemakers. What did the researchers find? ILR screening led to a 6-fold increase in bradyarrhythmia diagnoses and a significant increase in pacemaker implantations compared with usual care but no change in the risk of syncope or sudden death.
Mandrola explains modernity: picking up (and treating) low heart rates in people without symptoms has no benefit. The reason is that the norms of heart rate were determined in a time before modern devices could have ever been thought of. “Normal” and “abnormal” heart rates were set down when all that doctors had were basic ECGs and 24-hour recording devices. And, crucially, these were only deployed on people who had symptoms.
No symptoms? No reason to treat. Did he accurately portray what the research said? Yes. Is he an expert in the field? Yes. Are his explanations reasonable? I think so.
Let’s contrast that with another blogpost on supplementation on COVID long haulers and COVID vaccine heart damage. Written by Who is John Malone? He claims to be the discoverer of mRNA tech. Therefore, that allows him to comment on mRNA damage from the COVID vaccine. In reality, he was one of a large group of scientists who contributed to mRNA technology but left the research field long before the COVID vaccine was developed.
In this post, he recommends the use of vitamin K2, magnesium, and taurine to treat the symptoms of long-haulers and COVID vaccine damaged individuals.
Examining the papers recently published on those two conditions, the number of people are few in either case of infection or vaccine damage. What I found interesting is that many viruses can cause myocarditis, the heart inflammation, and other vaccines can contribute to myocarditis as well. It is not unique to COVID or the COVID vaccine. He did not mention that in the blog post.
Support for the supplements. No time to review all supplements so I focused on vitamin K2.
The first paper was Molecular Pathways and Roles for Vitamin K2-7 as a Health-Beneficial Nutraceutical: Challenges and Opportunities. Front Pharmacol 2022 Jun 14;13:896920. doi: 10.3389/fphar.2022.896920. eCollection 2022. He cites this paper a as justification for using K2 in supplement form. It is a review paper written by scientists who worked for companies in India that manufacture and sell K2. It does extol the benefits of K2.
The second paper was published in Open Heart. 2021; 8(2): e001715. Please note the date. Published online 2021 Nov 16. doi: 10.1136/openhrt-2021-001715. “Vitamin K2—a neglected player in cardiovascular health: a narrative review”
He uses a quote from the paper abstract, part of which he has the reader read twice, from the .
“Although its (K7) direct effects on delaying the progression of vascular and valvular calcification is currently the subject of multiple randomized clinical trials, prior reports suggest potential improved survival among cardiac patients with vitamin K2 supplementation. Strengthened by its affordability and Food and Drug Administration (FDA)-proven safety, vitamin K2 supplementation is a viable and promising option to improve cardiovascular outcomes.”
However, this is what is found in the discussion within the article:
“Although the data presented in this review are encouraging, most of the included studies were limited by their non-randomized design, heterogeneity in results, variable dosages and formulations of vitamin K used, small sample sizes, short duration of follow-up and restricted ability to accurately assess vitamin K intake, in turn precluding our ability to infer causality of clinical endpoints. With evidence mounting, the definitive role of vitamin K2 supplementation in delaying progression of vascular and valvular calcification remains the subject of multiple randomized clinical trials.”
About those multiple randomized clinical trials. The citations for those clinical trials that were going to happen in 2015 and 2018 were as follows:
The first on K2 – clinical trials - VitaK-CAC Trial – was never completed nor published anywhere I could find. The only reference that comes up over and over is the trial proposal.
The second published in 2018 described a trial of vit K2 on Aortic Valve Stenosis. That study was done and the results published in April of last year in Circulation. 2022 May 3;145(18):1387-1397. Epub 2022 Apr 25.
Vitamin K2 and D in Patients With Aortic Valve Calcification: A Randomized Double-Blinded Clinical Trial.
“The results in elderly men with an AVC score >300 AU, 2 years MK-7 plus vitamin D supplementation did not influence AVC progression.”
Not questioning the potential benefits of K7 for CVD nor any of the other claims in the papers. But given the researchers admittance that studies were small and full of questions, the two studies cited as “hope benefits will be confirmed” either did not happen or did not prove what every paper claimed would happen, were important. They were not checked by the researchers in the Open Heart paper that was just published.
Dr. Malone did not check it either. He went ahead and gave his recommendations anyway. What will checking sources on magnesium and taurine show? For all he claims to be, Dr. Malone is not an expert in dietary supplements.
When you’re going to try to answer big questions, you need to have the support of the science to back it up. It seems clear that one physician did while the other did not. It’s up to you to decide what’s fact and what’s hype.