June 2000 -
The American Journal of Clinical Nutrition, in June 2000 reported on the long term cholesterol lowering effects of psyllium. Psyllium is a seed husk which has been ground and is high in soluble fiber (see Fiber & Your Diet). Psyllium seed is the main component in Metamucil®, Konsyl®, and other products.

This multicenter study evaluated the long-term effectiveness of psyllium husk fiber as an aid to diet in the treatment of people with high cholesterol. Treatment with 5.1 grams of psyllium twice daily reduced serum total and LDL-cholesterol concentrations in both men and women in the 5 to 7% range.

Psyllium therapy is an effective addition to the dietary approach for lowering cholesterol and may provide an alternative to drug therapy for some patients.

Sept 2001 -
In the Journal of the American Medical Association Sept 12, 2001 the prevalence of obesity and diabetes among US adults was evaluated. Following are excerpts from the article.

During the 1990s, epidemics of obesity and diabetes developed among US adults. Our current findings indicate that most US adults (over 56%) are overweight and about 1 in 5 is obese. It is likely that almost 10% of US adults have diabetes. Our estimates of the extent of the 2 epidemics of obesity and diabetes in US adults are conservative.

Both BMI and weight gain (see Overeating and Overweight) are major risk factors for diabetes. Body mass index is one of the strongest predictors of diabetes, and previous studies have shown that changes in BMI at the population level foreshadow changes in diabetes.

For every 1-kg (2.2 pounds) increase in measured weight, the risk of diabetes increased by 4.5% in a national sample of adults.

Both obesity and diabetes are largely preventable. Previous studies have demonstrated that changes in lifestyle are effective in preventing diabetes and obesity.

In a recent clinical trial from Finland, lifestyle changes significantly reduced the risk of diabetes in middle-aged, overweight subjects. After a modest (4.7%) weight loss, those in the intervention group had a 58% reduction in incidence of diabetes over 4 years. Moreover, blood pressure, triglycerides, and high-density lipoprotein cholesterol levels also improved significantly. Therefore, increasing physical activity, improving diet, and sustaining these lifestyle changes can reduce the risk of both diabetes and increased weight.

The weight-related behaviors of US adults are clearly linked to these continuing epidemics. We found that 27% of US adults in 2000 did not engage in any leisure-time physical activity, and another 28% were not regularly active. In 2000, 39% of US adults were trying to lose weight, 36% were trying to maintain weight, and 25% were doing neither. Furthermore, only 24% of US adults met recommendations for fruit and vegetable consumption in 2000 (see Ideal Diet).

While overweight and obese individuals need to reduce their calorie intake and increase their physical activity, many others must play a role to help these individuals and to prevent further increases in obesity and diabetes. That is, health care professionals must counsel their overweight and obese patients; workplaces must offer healthy food choices in their cafeterias and provide opportunities for employees to be physically active on site; schools must offer more physical education that encourages lifelong physical activity; urban policymakers must provide more sidewalks, bike paths, and other alternatives to cars; and parents need to reduce their children's television and computer time and encourage active play (see Fitness). In general, restoring physical activity to our daily routines is crucial to the future reduction of diabetes and obesity in the US population.

To control these dual epidemics, now is the time for implementing multicomponent interventions for weight control, healthy eating, and physical activity.

October 2001 -
The American Journal of Clinical Nutrition, in October 2001 Harvard and Northwestern University researchers looked at data collected from 20,885 men in the Physicians Health Study during eleven years of follow-up. They found that prostate cancer was 32% more likely in men who consumed milk products containing 600 mg or more of calcium daily. The final paragraph of the article follows:

In conclusion, this report supports and extends previous observations that high intakes of dairy products, and of calcium from dairy foods specifically, are associated with an increased risk of prostate cancer. These findings may serve to interject a note of caution into the current enthusiastic promotion of a higher intake of calcium in the United States. Additional prospective investigations of this hypothesis, including a more comprehensive assessment of diet and supplement usage, are warranted.

COMMENT: I think this article points up the fact that the surface has just been scratched on the question of how different foods and supplements may affect health over many years. I think that excesses of anything are likely to have adverse affects. That is why I feel people should be careful not to take herbal remedies that are not indicated for them specifically and should avoid high vitamin and mineral intake except for specific reasons.

December 2001 -

A study printed in the November 29, 2001 New England Journal of Medicine was quoted widely in a press release on November 28, 2001 concerning the potential danger of taking antioxidants. The sketchy information provided has caused confusion and concern among many people who are taking antioxidants. "Physicians should question their patients and have them stop using [antioxidant vitamins]. It is the opposite of what I used to say," according to lead author Dr. B. Greg Brown. This sentence is misleading and not supported by the study. Although the article qualifies the sentence to some extent the reader is left with considerable apprehension.

Too often sweeping statements are made to the press by authors and advocates of certain studies without a needed balance of scientific scrutiny presented from other experts in the field. Conclusions from a single reseach study only rarely are definite enough to change the way medicine is practiced. This study is definitely not conclusive.

Let me try to sort out the facts as I see them in this particular study.

It was reported by the University of Washington, the Oklahoma Medical Research Foundation, and the University of British Columbia. It involved 160 patients with documented coronary heart disease (146 completed the study). They all had normal LDL ("bad cholesterol") levels and low HDL ("good cholesterol") levels. This is a highly select group of people.

They were divided into four groups and treated for three years with either:

1. A placebo.

2. "Antioxidants" (a combination of vitamin E 800 IU, natural beta carotene 25 mg, vitamin C 1,000 mg and selenium 100 mcg). The upper limit established by the Institute of Medicine for vitamin E is 1,000 IU and for vitamin C 2,000 mg. The amounts. given in this study are considerably above the recommended daily doses (RDA) or the doses recommended in other important studies. Vitamin C has been shown to have a pro-oxidant effect at 500 mg per day in some studies.

3. A cholesterol lowering drug (simvastatin [Zocor]) and niacin. The statin drugs are known to decrease risk in people with coronary heart disease and high "bad cholesterol" levels. Niacin also is known to decrease risk by raising "good cholesterol" levels.

4. A combination of 2. and 3..

Based on the occurrence of angiographic findings and cardiovascular events after three years the placebo and "antioxidant" groups had about the same results. To me this is not surprising. The dosage of vitamin C and E chosen was much higher than most researchers would recommend. In any case there was no harm done by the "antioxidants".

The simvastatin and niacin results were the best. The simvastatin, niacin, "antioxidant" combination was better than placebo or "antioxidants" alone but not as good as simvastatin and niacin alone. The authors conclude that "antioxidants" are detrimental in this group of patients with severe coronary heart disease taking a potent anti-cholesterol drug. Their selection of antioxidants appeared to decrease the effect of simvastatin and niacin when given alone.

The study has many merits and is quite interesting. Unfortunately they chose to mix several antioxidants in unusual dosages. Only vitamin E has been postulated to protect against coronary heart disease so it would have been much better if they had used vitamin E in the 50 to 200 IU range and left the others out.

In the same issue of the New England Journal of Medicine was a study showing the value of lowering homocysteine levels by using vitamin B-12 400 mcg, folic acid 1,000 mcg, and vitamin B-6 (pyridoxine) 10 mg daily. 205 patients were given the vitamins for six months following coronary angioplasty. The subsequent complication rate and re-narrowing of their coronary arteries was much better in the treated than the non-treated group. Here is a copy of the conclusions:

Conclusions: Treatment with a combination of folic acid, vitamin B12, and pyridoxine significantly reduces homocysteine levels and decreases the rate of restenosis and the need for revascularization of the target lesion after coronary angioplasty. This inexpensive treatment, which has minimal side effects, should be considered as adjunctive therapy for patients undergoing coronary angioplasty.