Welcome to Straight Talk on Health. I’m your host Dr. Chet Zelasko. Straight Talk on Health is a joint production with WGVU in Grand Rapids MI. I examine the world of health. Nutrition. Exercise. Diet. Supplementation. If there’s something new, 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.
If I told you that dietary supplements are under attack yet again, would you be surprised? I hope not because it seems like I talk about it more often than I want to. The reason is the misinformation that goes along with the attacks. For example, dietary supplements are unregulated by the Food and Drug Administration. I finally saw someone criticizing the industry that actually got it right. Dietary supplements are regulated through the Food and Drug administration and the Federal Trade Commission. It's just that the regulation is different from pharmaceuticals and from over the counter medications. You cannot claim that a dietary supplement will diagnose, treat, cure, or prevent any disease. You can talk about how it may contribute to heart health or joint health but that’s it.
That doesn't mean that supplement manufacturers, especially those that have zero scruples, won't play loose or even lie about the benefits of what they’re pitching. Let me give you an example of one supposed dietary supplement that just made headlines. When I first read about it, the title was Gas Station Heroin. The focus was that several products, mostly sold at gas station and convenience store registers, promised energy and staying chill at the same time.
The products contained an anti-depressant called ti-a-nep-tine, which is approved in some countries as a prescription drug for the treatment of depression. It is a tricyclic antidepressant. In some cases, it has a mood elevator effect. While the products have been pitched as dietary supplements, they are most definitely not dietary supplements. You are not allowed to put pharmaceuticals in dietary supplements no matter whether they are approved in the US or not. It’s just not allowed. However, that doesn’t mean that some companies won’t do it if they can make a buck or two or millions before they are banned.
Here are three rules to follow when considering a dietary supplement:
First, know the active ingredient you’re looking for whether it’s a vitamin, mineral, herb or other supplement like glucosamine. If you’re not sure, don’t make a spur of the moment purchase because a friend recommended it. My recommendation is that you believe it unless you do the research behind it.
Second, check the label for a certification from a legitimate testing company like NSF or the USP, the two most prominent certification companies. These are not companies that just grant approval Willy nilly. A supplement company must apply and provide documentation, allow inspection of its facilities on a random basis, and be subjected to spot checks of ingredients. Fly by night companies just don't do that. They probably don't want you to know what's actually in what they're selling. Legitimate companies will not only have in-house checks and balances on the quality of their ingredients but allow outside companies to double check and verify the results.
Third, and most importantly, don’t buy dietary supplements from convenient stores or gas stations. What the heck are you thinking? That area around the cash register can be a minefield of promises from more energy to increased libido. Don’t fall for it!
Let's turn to a well-known B vitamin called niacin. Niacin (also known as vitamin B3) is one of the water-soluble B vitamins. The Food and Nutrition Board defines 1 NE as 1 mg niacin or 60 mg of the amino acid tryptophan as the body can convert it to niacin when needed. The DRI is 16 mg for men and 14 mg for women. Niacin has been used at therapeutic levels, meaning 5,000 mg per dose, to reduce cardiovascular disease by reducing LDL Cholesterol. Bodybuilders have used it to increase the “flush” to their skin that makes them look tanner than they actually are. That enhances the way muscles look under competition lighting. The downside is that whether it was for cardiovascular disease or for athletic competition, niacin can cause extreme itching because of all of the blood flow to the skin.
Why this primer on niacin? In a recent press release, a research group found an increase in a specific breakdown product of niacin called 4PY. Increased levels of 4PY were associated with Major Adverse Cardiac Event over 3 years in over 3000 subjects from the US and Europe who had present CVD. The focus of the press release was that over consumption of niacin may contribute to the development of CVD as the breakdown products may damage blood vessels and contribute to inflammation.
This was a complicated study with hundreds of blood analyses that must have taken forever in that many subjects. It’s not my specialty but the way I read the results, the increase in 2PY and 4PY were associated with a genetic mutation. That means that there are many people who would not be subject to overproducing the metabolite even with high niacin intake. While the researchers did cite the fortification of foods with niacin, the one thing they didn’t appear to do is measure food intake. If they didn’t do that, how do they know how much is too much? I didn’t see many body builders dropping dead on stage in the past 50 years. How do you know if you don’t measure it?
That wasn’t was bothered me the most. The lead research spokesperson said that everyone should consult with their doctor before taking any dietary supplement and that they should eat more vegetables and fruit but eat fewer carbohydrates. I guess he meant fortified carbohydrate products otherwise, what does it matter?
I hate to say this but the last people you would want to consult about nutrition or dietary supplements are physicians. This is not a critique of their ability to practice medicine; but it is an assessment of my experience with listening to and consulting with many physicians and their lack of knowledge of nutrition and dietary supplements. I've watched the videos and read the materials that have been provided to physicians from the FDA and AMA. The only two things that they have been taught is that dietary supplements are not regulated. I've already talked about that and that's incorrect. The second is that they are to report any symptoms to the adverse reporting arm of dietary supplements for the FDA. In other words, when dealing with patients, everything is the fault of any dietary supplements that they are taking. Maybe that's an exaggeration. Probably not.
Let's say that you're suspicious of my observations. Why don't you pick up the phone and schedule a telemedicine call related to your niacin intake? You know what I've said in my analysis of the study. There is an association between niacin and people who have a potential genetic inability to process niacin. We don't know if that applies to over consumption or whether even less than normal consumption might trigger the breakdown products in some people. Why? Because there's a lot of research to go before some of the things the researcher said in the press release should be a concern. He's already talking about finding treatments when we don't even know what the niacin intake was in the subjects that they've already examined. How can you treat what you haven’t studied?
Find out what your physician thinks about this latest study on niacin published in Nature Medicine and how it might affect your risk of developing cardiovascular disease. And then let me know what kind of answer that you get. You can't practice medicine by press release; you shouldn't give nutritional information that way either. And remember, don't buy any dietary supplements from the register counter of convenience stores and gas stations. I'm all out of time for this podcast so remember that health is a choice. Choose wisely today and every day. I'm Dr. Chet Zelasko.
