In a study published on Jan. 31 in the New England Journal of Medicine, researchers investigate the myths, facts and assumptions associated with losing weight in obese patients (N Engl J Med. 2013;368:446-454). This study has deservedly received a substantial amount of attention, both in the medical news and the layman’s press, such as The New York Times.

The authors brought up really good points, but — and this is the keyword: but — are their conclusions obfuscated or confusing?

Let’s address some of the specific points in the study and the perspective from which they are made. Following are some of the assumptions that they examine.

Adding fruits and vegetables to the diet results in weight loss

The authors highlight that this statement is inconclusive. That while fruits and vegetables may be good for your health, they don’t help with weight loss.

But you have to analyze this statement more closely. They are not saying that fruits and vegetables don’t help with weight loss. They say that adding them is not helpful. I agree that if you add these items to a diet of cheeseburgers and fries, you are certainly not going to lose weight.

However, if you shift your diet to one that involves a vegetable-rich, plant-based approach, this has a much different effect than just adding fruits and vegetables without making any other changes. There are a number of studies showing significant long-term weight loss with this type of diet. For instance, in a small, retrospective study, patients on a plant-based, nutrient-dense diet involving a significant amount of fruits and vegetables, lost an average of 33 pounds in the first year and 59 pounds in the second year (Altern Ther Health Med. 2008;14:48-53). Granted, this is not the best-designed study, but it suggests that vegetable-rich diets are effective for significant and sustained weight loss.

Slow, gradual weight loss is best for long-term success

The authors debunk this as a myth. However, what do they mean by this statement? Using a meta-analysis, the results show that ultra-low calorie diets are more effective for losing weight than a slow, gradual approach (Int J Behav Med. 2010;17:161-167). This all seems to make sense.

But, the authors compare weight loss of 16 percent to 10 percent over six months. While this may be statistically significant, it is not necessarily clinically rapid versus slow weight loss. For instance, a 200-pound obese patient who loses 16 percent of her weight has lost only 12 pounds more than someone who loses 10 percent of her weight in six months. This is roughly two extra pounds a month.

A diet primarily focused on severe calorie restriction, rather than nutrient density, may work for the short term, but it may throw the homeostasis of the body’s hunger-inducing hormones, such as ghrelin and leptin, into disarray. This creates an environment that may actually cause weight to be regained in the long term (N Engl J Med. 2011; 365:1597-1604).

Another thing to consider is that a low-calorie diet may not necessarily increase life span, as we once thought. This was demonstrated in a study using rhesus monkeys (Nature online Aug. 29). In my Sept. 13, 2012 article, entitled “Calorie restriction disappoints in longevity and quality of life,” I addressed that fact that there may be better ways to lose weight than calorie restriction. One option is the DASH diet, which reduces the risk of heart disease and other chronic diseases (Arch Intern Med. 2008;168:713-720).

Bariatric surgery is valuable for some patients for long-term weight loss

The authors conclude that this may be true, and they support their statement with a prospective trial (N Engl J Med. 2004;351:2683-2693). I agree that it may be appropriate for some patients.

But, what is not mentioned is that at least 50 percent of patients who have bariatric surgery tend to regain weight within 24 months, so that the original BMI change is no longer significant (Obes Surg. 2008 Jun;18(6):648-651). There are also significant side effects for some patients who undergo bariatric surgery, such as the dumping syndrome, which can occur especially with high levels of simple carbohydrates in as many as 50 percent of patients, and the inability to properly absorb nutrients, such as B12, calcium, iron and folate (Surgery. 1960;48:185-194; Obes Surg. 2005;15(2):145-154).

Weight-loss pills and prepackaged meals may be effective tools

According to the author, weight-loss pills and packaged meals may be the best options for weight loss.

But, the history of weight-loss pills is tarnished. So many of them have been pulled off the market after being approved, because of untoward side effects. Also, once patients discontinue the drugs, they appear to regain the lost weight.

I don’t disagree that diets providing packaged meals are effective ways to lose weight.

But, just like with drug therapy, once patients discontinue the meals, they tend to regain weight. Just like the old saying, it is better to teach a man to fish than to provide the fish for him.

Is this study potentially biased?

There may be some bias involved as well, since the authors are not without conflicts of interest. Most of them are associated with pharmaceutical companies as paid speakers, or they consult as well as associate with food manufacturers and prepackaged meal providers. It is true that disclosing this information is important, but take note when reading any study of the authors’ affiliations — they tend to color their perspectives.

Benefit of small energy changes

Small, sustained changes in energy-intake or expenditure will produce large, long-term weight changes.

The authors conclude that this is a myth. I emphatically disagree. In fact, last week I wrote about the positive effects of exercise on weight loss. Those that lost the most weight and sustained that loss not only did moderate activities, about 30 minutes a day, four to five times per week, but also were less sedentary the rest of day, as demonstrated by a pedometer (Am J Prev Med. 2012;43(6):629-635).

The authors do bring to light some very pertinent points. They address some other assumptions that really are not based on any scientific evidence. I would encourage people to read the article in its entirety.

But know that not all of the points have been flushed out completely, and keep in mind that the authors have their distinct perspectives and quite a few conflicts of interest.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, go to the website www.medicalcompassmd.com and/or consult your personal physician.

When we make our New Year’s resolutions to exercise regularly, the goal for many is to change body composition, to lose weight or at least to maintain weight, but is this reality or myth?

It is a hotly debated topic. You would think the answer would straightforward, since exercise helps us prevent and resolve a great many diseases. For example, in last week’s article, I wrote about the value of exercise before the flu shot in improving immunity.

At the same time, we hope exercise impacts our weight. Does it? This is something that we should know, and rightfully so, before we start exercising. It is important to manage our expectations. There are some new and intriguing studies that address whether exercise has an impact on weight management. The short answer is yes, however, not always in ways we might expect.

Then the questions become: what type of exercise should we be doing, how frequently and for how long? Let’s look at the evidence.

Duration

It makes sense that the more we exercise to lose weight, the better, or at least that is what we thought. In a recent small randomized controlled trial (RCT), the gold standard of studies, the results showed that the moderate group in terms of duration saw the most benefit for weight loss (Am J Physiol Regul Integr Comp Physiol. 2012 Sep 15;303(6):R571-R579). There were three groups in the study — a sedentary group (low), a group that did 30 minutes per day of aerobic exercise (moderate) and a group that did 60 minutes per day of aerobic exercise (high).

Perhaps obviously, the sedentary group did not see a change in weight. Surprisingly, though, the group that did 30 minutes of exercise per day experienced not only significantly more weight loss than the sedentary group, but also more than the 60-minute exercise group. The aerobic exercises involved biking, jogging or other perspiring activities. These were healthy young men that were overweight, but not obese, and the study duration was three months.

The authors surmise that the reason for these results is that the moderate group may have garnered more energy and moved around more during the remainder of the day, as sensors showed. The highest exercise group was sedentary through most of the rest of day, probably due to fatigue. Also, it seemed that the highest exercise group ate more than the moderate group, though the difference was not statistically significant. While this study is of impressive quality, it is small and of short duration. Nonetheless, its results are encouraging.

Postmenopausal women

As a group, postmenopausal women have considerable difficulty losing weight and maintaining weight loss. In a secondary analysis of a RCT, there were three aerobic exercise groups differentiated by the number of kcal/kg per week they burned: 4, 8 and 12 (Am J Prev Med. 2012;43(6):629-635). All of the groups saw significant reductions in waist circumference. Interestingly, however, a greater number of steps per day outside of the training, measured by pedometer, were primarily responsible for improved waistline circumference, regardless of the intensity of the workouts.

But it gets more intriguing because the group that exercised with the lowest intensity was the only one to see significant weight loss. More is not always better, and in the case of exercise for weight loss, less may be more. This study reinforces the suppositions made by the authors of the previous men’s study: exercise to a point where it is energy inducing and not beyond.

Premenopausal women

Not to ignore younger women, those who were premenopausal also saw a significant benefit with weight maintenance and exercise after having intentionally lost weight.

In a prospective (forward-looking) study, young women who did at least 30 minutes of exercise four to five days per week were significantly less likely to regain weight that they had lost, compared to those who were sedentary after losing weight (Obesity 2010;18(1):167-174).

Some of the strengths of this study were its substantially long six-year follow-up period and its large size, involving over 4,000 women between the ages of 26 and 45. Running and jogging were more impactful in preventing weight gain than walking with alacrity. However, all forms of exercise were superior to the sedentary group.

Aerobic exercise and resistance training

In another RCT with 119 overweight or obese adults, aerobic exercise four to five times a week for about 30 minutes each was most effective for weight loss and fat reduction, while resistance training added lean body mass. Lean body mass is very important. It does not cause weight reduction, but rather increased fitness (J Appl Physiol. 2012 Dec;113(12):1831-1837).

With weight loss, it’s important to delineate between thin and fit. Fitness includes a body composition of decreased body fat and increased lean muscle mass. To help achieve fit level, it’s probably best to have a combination of aerobic and anaerobic exercise (resistance training). Both contribute to achieving this goal.

In conclusion, exercise can play a significant role in weight, whether with weight reduction, weight maintenance or increasing lean body mass. It appears that 30 minutes of exercise four to five times a week is best. Longer is not necessarily better.

What is most important, however, is to exercise to the point where it energizes you, but doesn’t cause fatigue. This is because it is important not to be sedentary the rest of the day, but to remain active. We should also include a complete package of lifestyle modifications in general — diet, exercise and stress reduction — to get the most compelling results.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, go to the website www.medicalcompassmd.com and/or consult your personal physician.

If you have been on a distant planet, you may not know that we are in the middle of the flu season. The rest of us by now have had colleagues, friends, family members, and possibly ourselves, who have confronted the influenza virus.

If you think the flu season has been worse than in recent years, you’re right. The centers for disease control preliminary data indicate outpatient visits for the flu have been more than twice the baseline (CDC.gov). The good news is that the most recent comments from the director of the CDC, Dr. Thomas Frieden, suggest that we are over the hump.

According to the CDC the present vaccine is 62 percent effective. The statistic for this year’s vaccine is derived from a case study involving 1155 children and adults (MMWR Morb Mortal Wkly Rep. 2013;62). Though this is moderate, it is still reducing the risk by more than half. However, by no means is the vaccine’s coverage perfect.

I know some have hesitancy toward the vaccine because it contains eggs and thimerosal, a preservative that is organic mercury-based. A concern is that this preservative may increase neurotoxicity risk. There are trace amounts in the flu vaccine. Those with allergies to eggs should also not receive the standard vaccine.

If you are uncomfortable with the egg or thimerosal, there is good news. The FDA has recently approved a flu vaccine, Flublox, that is both eggless and does not contain the preservative thimerosal (www. FDA.gov). It uses a recombinant DNA technology that does not require inactivated virus. It is available this year in limited quantities and will be readily available for next year’s flu season. Currently, Flublox is approved for patients 18 to 49 years old.

So what can we do to decrease the chances of getting the virus following vaccination? Actually, there are several studies that show that exercise helps boost the vaccine’s effects.

Impact of exercise

We know that exercise plays an important role in altering and improving disease processes in general, but did you know that exercise may increase the effectiveness of the flu vaccine? In particular, elderly patients tend to have weaker immune responses to pathogens, such as the flu. In a study looking at the older population, those who walked with alacrity regularly for 10 months demonstrated higher antibody levels 24 weeks after getting the flu vaccine, compared to those who stretched and did balancing exercises (J Am Geriatr Soc. 2009 Dec;57(12):2183-91). This helped boost their immunity and improved the results from the vaccine.

So what if you haven’t exercised for almost a year and are not in cardiovascular shape? Is it too late for this year’s flu season? The answer is a resounding no.

Another study showed that people who did 20 minutes of eccentric exercise using the arm that would receive the vaccine on that same day also had higher titers of antibodies several weeks later, compared to those who were sedentary (Brain Behav Immun. 2007 Feb;21(2):209-17). Women had an increase in B-cell activity, part of the immune response, six and 20 weeks later. In men, there was an increase in cell-mediated activity, another part of the immune system, which includes T-cell activity, natural killer cells and phagocytes, with levels measured eight weeks after vaccination. Participants were given the vaccine six hours after exercising.

The exercises included several sets of weighted bicep curls and lateral arm raises for the shoulders. Eccentric exercises involve lowering weights, rather than lifting them. For example, if you are doing shoulder exercises, you slowly lower the weight from your shoulder to your side. This helps to elongate the muscles.

This was a randomized controlled trial, the gold standard of studies, in 60 young, healthy adult participants. The authors surmise that the inflammation due to exercises may have been the mechanism that helped boost the effect of the vaccine.

Green tea

The great thing about green tea is that it may have benefits for many diseases and their prevention. But, did you know that green tea may actually help prevent the influenza virus? In an observational study involving over 2,000 Japanese elementary schoolchildren, those who drank green tea at least six days a week were 40 percent less likely to get the flu than those who drank green tea three or fewer days per week (J. Nutr. 2011;141(10):1862-1870). Results were confirmed using an antigen test to detect the virus.

In a separate study, health care workers who took daily green tea supplements in an RCT saw a significant reduction in the incidence of the influenza virus than the placebo group (BMC Complement Altern Med. 2011 Feb 21;11:15). The supplements contained two compounds in green tea: 378 mg of catechins and 210 mg of theanine. There were 197 participants in the study.

Hand sanitizers

Many of us use hand sanitizers regularly. Are they beneficial or dangerous? It turns out that hand sanitizers may help reduce the transmission of the flu vaccine by breaking down the lipid envelope of the virus.

In a small study, healthy participants were subjected to the flu H1N1 strain on their fingertips. They were then randomly given wipes, foam or gels that contained at least 60 percent alcohol (Am J Infect Control. 2012 Nov;40(9):806-9). It did not matter which vehicle was used to deliver the sanitizer, they all worked equally well to reduce the viral load significantly.

Be careful not to overutilize sanitizers as they may dry out the skin and cause cracking, allowing pathogens to invade the body. Sanitizers should not replace washing your hands with soap and water, but rather be an additional defense.

Although this year’s flu season seems like it is one of the more dramatic, there are ways to reduce the risk. Exercise is a great way to improve your immunity, particularly in combination with the vaccine. It may also help those who are obese, and thus may have decreased immune functioning. And drinking green tea should be easy, since flu season is during the cold weather.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, go to the website www.medicalcompassmd.com and/or consult your personal physician.

This week, I thought it would appropriate to talk about the significance of low iron, since I wrote about iron overload last week. The major causes of low iron are anemia of chronic disease, iron deficiency anemia, sideroblastic anemia and thalassemia. Of these, iron deficiency anemia is the most common.

However, there is a much less known, but not uncommon, form of low iron. This is called iron deficiency without anemia. Unlike iron deficiency anemia, the straightforward CBC (complete blood count) that is usually drawn cannot detect this occurrence since the typical indicators, hemoglobin and hematocrit, are not yet affected.

So how do we detect iron deficiency without anemia? Not to despair, since there is a blood test done by major labs called ferritin. What is ferritin? I mentioned in my pervious article that ferritin is a protein that is involved in iron storage. When ferritin is less than 10 to 15 ng/ml, the diagnosis of iron deficiency is most likely indicated. Even healthy people with ferritin slightly higher than this level may also have iron deficiency (Br J Haematol. 1993;85(4):787-798). The normal range of ferritin is 40-200 ng/ml.

You should be asking at this point, who does low ferritin affect and what are the symptoms? Women and athletes are affected primarily, and low ferritin levels may cause symptoms of fatigue. It is also seen with some chronic diseases such as restless leg syndrome (RLS) and attention deficit hyperactivity disorder (ADHD) in children.

Effect on women

In a prospective (forward-looking) study done in 1993 looking at primary care practices, it was determined that 75 percent of patients complaining of fatigue were women (BMJ 1993;307:103). Interestingly, less than 10 percent of these women had abnormal lab results when routine labs were drawn, most probably without a ferritin level. Many of them had experienced these symptoms for at least three months.

There was a recent randomized controlled trial (RCT), the gold standard of studies, that showed women who were suffering from fatigue and low or low normal ferritin levels (less than 50 ng/ml), but who did not have anemia, benefited from iron supplementation (CMAJ. 2012;184(11):1247-1254). When comparing women with these ferritin levels, many of those that were given 80 mg of oral prolonged release ferrous (iron) sulfate supplements daily saw a significant improvement in their fatigue symptoms when compared to those women who were not given iron.

Almost half the women taking iron supplements had a significant improvement in fatigue symptoms. The results were seen in a very short 12-week period. This is nothing to sneeze at, since fatigue is one of main reasons people go the doctor. Also, although this was a small study, there were 198 women involved, ranging from 18 to 53 years old.

There are caveats to these study results. There was no improvement in depression or anxiety symptoms, nor in overall quality of life. Even though it was blinded, stool changes occur when a patient takes iron. Therefore, the women taking supplements may have known. Nonetheless, the study results imply that physicians should check ferritin level, not only a CBC, when a premenopausal woman complains of fatigue. Note that all of the women in the study were premenopausal. This is important to delineate, since postmenopausal women are at much higher risk of iron overload, rather than deficiency. They are no longer menstruating and therefore do not rid themselves of significant amounts of iron.

Athletes

According to a recent article, athletes’ endurance may be affected by iron deficiency without anemia (Am J Lifestyle Med. 2012;6(4):319-327). Low ferritin levels are implicated, as in the previous study. Iron is important for exercise motivation and may play a role in peak mental functioning, as reported in “Iron: Nutritional and Physiological Significance.” In animal studies, iron deficiency without anemia is associated with reduction in endurance, because of a decrease in oxygen-based enzymatic activity within the cells. However, this has not been shown definitively in human athletes and remains an interesting, but yet to be proven hypothesis.

Interestingly, female endurance athletes are more likely to be affected by iron deficiency without anemia, which occurs in about 25 percent of this population, according to studies (J Am Diet Assoc. 2005;105:975–978). Low ferritin is not seen as much in male athletes. This difference in gender may be due to the fact that women not only menstruate, losing iron on a regular basis, but also their intake of dietary iron seems to be lower (J Pediatr. 1989;114:657–663).

However, male athletes are not immune. At the end of the season for high school runners, 17 percent had iron deficiency without anemia (J Adolesc Health Care. 1987;8:322–326).

Do not take iron supplements without knowing your levels of hemoglobin and ferritin and without consulting a doctor. Studies are mixed on the benefits of iron supplementation without anemia for athletes.

Impact on restless leg syndrome

Iron deficiency with a ferritin level lower than 50 ng/ml affects approximately 20 percent of patients who suffer from restless leg syndrome (Am Fam Physician. 2000;62(4):736). Restless leg syndrome (RLS), classified as a neurologic movement disorder, causes patients to feel like they need to move their legs, most commonly about a half hour after going to bed. In a very small study, patients with restless leg syndrome who had ferritin levels lower than 45 ng/ml saw significant improvement in symptoms within eight days with iron supplementation (Sleep Med. 2012;13(6):732-735). Before you get too excited, the caveat is that 75 percent of restless leg patients have high ferritin levels.

Ferritin levels — both high and low — may play a role in a number of diseases and symptoms. If you are suffering from fatigue, a CBC blood test may not be enough to detect iron deficiency. You may want to suggest checking your ferritin level. Though iron supplementation may help those with symptomatic iron deficiency without anemia, it is very important not to take iron supplements without the direct supervision of your physician.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, go to the website www.medicalcompassmd.com and/or consult your personal physician.

Iron is contained in most of the foods that we eat. It is needed for proper functioning of the body and plays an integral role in such processes as DNA synthesis and adenosine triphosphate (ATP) production, which provides energy for cells (Proc Natl Acad Sci USA. 1997;94:10919–10924). It is very important to maintain iron homeostasis, or balance.

When we think of iron, we associate it with reducing fatigue and garnering energy. In fact, many of us think of the ironman triathlons — endurance and strength come to mind. If it’s good for us, then the more we get the better right? It depends on the circumstances. But for many of us, this presumption is not grounded in reality.

Iron in excess amounts is dangerous. It may contribute to a host of diseases, including diabetes, diabetic retinopathy, age-related macular degeneration (AMD), glaucoma, Parkinson’s disease and even heart disease. These diseases are perpetuated because when we have excess iron it may cause reactive oxygen species, or free radicals, which cause breakdown of DNA and tissues, ironically, the very things that iron homeostasis tends to preserve (Clin Haematol. 1985;14(1):129).

So what helps us differentiate between getting enough iron and iron overload? It is a good question and depends on the type of iron we ingest. There are two main types: heme iron and nonheme iron. Dietary heme, or blood, iron primarily comes from red meat and is easily absorbed into the gut. Dietary nonheme iron comes from other sources, such as plants and fortified foods, which are much more difficult sources to absorb. By focusing on the latter source of dietary iron, you may maintain homeostasis, since the gut tends to absorb 1-2 mg of iron, but also excretes 1-2 mg of iron through urine, feces and perspiration.

Not only does it matter what type of iron we consume, but also the population that ingests the iron. Age and gender are critical factors. Let me explain. Women of reproductive age, patients who are anemic and children may require more iron. However, iron overload is more likely to occur in men and postmenopausal women because they cannot easily rid the body of excess iron.

Let’s investigate some of the research that shows the effects of iron overload on different chronic diseases.

Impact on diabetes

In a recent meta-analysis (a group of 16 studies), results showed that both dietary heme iron and elevated iron storage (ferritin) may increase the risk of type 2 diabetes (PLoS One. 2012;7(7):e41641). When these ferritin levels were high, the risk of diabetes increased 66 percent to 129 percent. With heme iron, the group with the highest levels had a 39 percent increased risk of developing diabetes. There were over 45,000 patients in this analysis. You can easily measure ferritin with a simple blood test. Also these levels are modifiable through blood donation and avoidance of heme iron. Thus, reducing the risk of iron overload.

Diabetic retinopathy

Diabetic retinopathy is a complication of diabetes that occurs when glucose, or sugar, levels are not tightly controlled. It affects the retina, or the back of the eye. Iron excess and its free radicals can have detrimental effects on the retina (Methods Enzymol. 1990;186:1-85). This is potentially caused by oxidative stress resulting in retinal tissue damage (Rev Endocr Metab Disord. 2008;9(4):315-327).

So how is iron related to uncontrolled glucose levels? In vitro studies (preliminary lab studies) suggest that high glucose levels may perpetuate the breakdown of heme particles and subsequently raise the level of iron in the eye (Biophysical Chemistry. 2003;105:743-755). In fact, those with diabetic retinopathy tend to have iron levels that are 150 percent greater than those without the disease (Indian J Ophthalmol. 2004;52:145-148). Diets that are plant-based and, therefore, nutrient-dense are some of the most effective ways to control glucose levels and avoid diabetic retinopathy.

Age-related macular degeneration (AMD)

Continuing with the theme of retinal damage, excessive dietary iron intake may increase risk of AMD according to the Melbourne Collaborative Cohort Study (Am J Epidemiol. 2009;169(7):867-876). AMD is the number one cause of blindness for people 65 and older. People who consumed the most iron from red meat increased their risk of early AMD by 47 percent, however, due to the low incidence of advanced AMD among study participants, the results for this stage were indeterminate.

I have been frequently asked if unprocessed red meat is better than processed meat. Well, this study showed that both types of red meat were associated with an increased risk. This was a large study with over 5,000 participants ranging in age from 58 to 69.

Cardiovascular disease

Though we have made considerable headway in reducing the risk of cardiovascular disease and even deaths from these diseases, there are a number of modifiable risks that need to be addressed. One of these is iron overload. In the Japan Collaborative Cohort, results showed that men who had the highest amount of dietary iron were at a 43 percent increased risk of stroke death, compared to those who ate the least amounts. And overall increased risk of cardiovascular disease death, which includes both heart disease and stroke, was increased by 27 percent in men who consumed the most dietary iron. There were over 23,000 Japanese men who were between the ages of 40 to 79 that were involved in this study.

In conclusion, we should focus on avoiding heme iron, especially for men and postmenopausal women. Too much iron creates a plethora of free radicals that damage the body. Therefore, the best way to circumvent the increased risk of chronic diseases with iron overload is prevention. Significantly decreasing red meat consumption and donating blood on a quarterly basis, assuming that one is not anemic, may be the most effective strategies for not falling into the trap of iron overload.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, go to the website www.medicalcompassmd.com and/or consult your personal physician.

Milind Diwan

Continued from page B15

“If you measure their properties in this far-away detector, there will be differences,” Diwan predicts. “I suspect those differences will be quite large and … can be directly linked to the way the universe evolved in its first few microseconds” when antimatter was annihilated.

“We have been struggling to understand this miraculous event,” Diwan explained. “This is one of the key problems in all of science.”

While scientists plan to send the neutrinos on a long journey through the Earth, the researchers themselves are expecting their own long trek.

Based on the current plan, the LBNE will start producing data in 2022. By then, would-be scientists who are planning to graduate from high school this year may contribute to the research.

While that might seem like a slow build for a long range project, there are competitive time pressures.

“Japanese physicists want to perform a similar experiment with a shorter distance and Europeans want to perform a bigger experiment with almost the same experimental features,” Diwan explained. “At this point, there is agreement that in terms of planning, we are ahead of them.”

A resident of Port Jefferson Station, Diwan and his wife Sucheta, an engineer at Hauppauge-based Parker Hannifin, have a 14-year old daughter, Renuka, and a 10-year old son, Yashodhan.

His wife’s job is “much more important than mine,” he offers. Her company makes fuel gauges for jumbo jets.

As for his work, Diwan has been in the physics department at BNL since 1994. He is eager to see the LBNE project through.

“I feel very fortunate that I am working on a question that is important,” he offered. “It is extraordinary that we have the tools to actually perform this experiment.”

Most of us have experienced a difficult night’s sleep. However, those with obstructive sleep apnea may experience a lack of restful sleep much more frequently. OSA is an abnormal pause in breathing, while sleeping, that occurs at least five times an hour There are a surprising number of people in the United States who have this disorder. The prevalence may be as high as 20 percent of the population, and 26 percent are at high risk for the disorder (WMJ. 2009;108(5):246).There are three levels of OSA: mild, moderate and severe.

The risk factors for OSA are numerous and include chronic nasal congestion, large neck circumference, being overweight or obese, alcohol use, smoking and a family history. Not surprisingly, about two-thirds of OSA patients are overweight or obese. Smoking increases risk threefold, while nasal congestion increases risk twofold (JAMA. 2004;291(16):2013). Fortunately, as you can see from this list, many of the risk factors are modifiable.

The symptoms of OSA are significant: daytime fatigue, loud snoring, breathing cessation observed by another, impaired concentration and morning headaches. These symptoms, while serious, are not the worst problems. OSA is also associated with a list of serious complications, such as cardiovascular disease, high blood pressure and cancer.

There are several treatments for OSA. Among them are continuous positive airway pressure — known as CPAP — devices; lifestyle modifications, including diet, exercise, smoking cessation and reduced alcohol intake; oral appliances; and some medications.

Cardiovascular disease

In a recent observational study, the risk of cardiovascular mortality increased in a linear fashion to the severity of OSA (Ann Intern Med. 2012 Jan 17;156(2):115-22). In other words, in those with mild-to-moderate untreated sleep apnea, there was a 60 percent increased risk of death, and in the severe group, this risk jumped considerably to 250 percent. However, the good news is that treating patients with CPAP considerably decreased their risk by 81 percent for mild-to-moderate patients and 45 percent for severe OSA patients. This study involved 1,116 women over a duration of six years.

Not to leave out men, another observational study showed similar risks of cardiovascular disease with sleep apnea and benefits of CPAP treatment (Lancet. 2005 Mar 19-25;365(9464):1046-53).There were more than 1,500 men in this study with a follow up of 10 years. The authors concluded that severe sleep apnea increases the risk of nonfatal and fatal cardiovascular events, and CPAP was effective in stemming these occurrences.

In a third study, this time involving the elderly, OSA increased the risk of cardiovascular death in mild-to-moderate patients and in those with severe OSA, 38 percent and 125 percent respectively (Am J Respir Crit Care Med. 2012;186(9):909-16). But, just like in the previous studies, CPAP decreased the risk in both groups significantly. In the elderly, an increased risk of falls, cognitive decline and difficult-to-control high blood pressure may be signs of OSA.

Though all three studies were observational, it seems that OSA affects both genders and all ages when it comes to increased risk of cardiovascular disease and death, and CPAP may be effective in reducing these risks.

Cancer association

In sleep apnea patients under 65 years old, a recent study showed an increased risk of cancer (Am J Respir Crit Care Med. 2012 Nov. 15). The authors believe that intermittent low levels of oxygen, which are caused by the many frequent short bouts of breathing cessation during sleep, may be responsible for the development of tumors and their subsequent growth. The greater the percentage of time patients spend in hypoxia (low oxygen) at night, the greater the risk of cancer. So, for those patients with more than 12 percent low-oxygen levels at night, there is a twofold increased risk of cancer development, compared to those with less than 1.2 percent low-oxygen levels.

Sexual function

It appears that erectile dysfunction may also be associated with OSA. CPAP may decrease the incidence of ED in these men. This was demonstrated in a small study involving 92 men with ED (APSS annual meeting: abstract No. 0574). The surprising aspect of this study was that, at baseline, the participants were overweight — not obese — on average and were young, at 45 years old. In those with mild OSA, the CPAP had a beneficial effect in over half of the men. For those with moderate and severe OSA, the effect was still significant, though not as robust, at 29 percent and 27 percent respectively.

Dietary effect

Although CPAP can be quite effective, as shown in some of the studies above, it may not be well tolerated by everyone. In some of my patients, their goal is to discontinue their CPAP. Diet may be an alternative to CPAP, or may be used in combination with CPAP.

In a small study, a low-energy diet showed positive results in potentially treating OSA. It makes sense, since weight loss is important. But even more impressively, almost 50 percent of those who followed this type of diet were able to discontinue CPAP (BMJ. 2011;342:d3017).The results endured for at least one year. Patients studied were those who suffered from moderate-to-severe levels of sleep apnea. Low-energy diet implies a low-calorie approach. A diet that is a plant based and nutrient rich would fall into this category. Recently, one of my patients who suffered from innumerable problems was able to discontinue his CPAP machine after following this type of diet.

The bottom line is that if you think you or someone else is suffering from sleep apnea, it is very important to go to a sleep lab to be evaluated, and then go to your doctor for a follow-up. Don’t suffer from sleep apnea and, more importantly, don’t let obstructive sleep apnea cause severe complications, possibly robbing you of more than sleep. There are effective treatments for this disorder, including diet and/or CPAP.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, go to the website www.medicalcompassmd.com and/or consult your personal physician.

Statins are one of the most commonly prescribed medications in the United States. Yet, some in the medical community believe that more patients should be on this class of drugs while others think it is one of the most overprescribed medications. Suffice to say, this is one of the most polarizing topics in medicine — probably rightfully so.

The debate is over primary prevention with statins. Primary prevention is treating people with high cholesterol and/or inflammation who may be at risk for a cardiovascular event, such as a stroke or heart attack. Fortunately, most physicians would agree that statins have their place in secondary prevention — treating patients who have had a stroke or heart attack already or have coronary artery disease.

We are going to look at benefits and risks for the patient population that could take statins for primary prevention. On one side, we have the statin as Rocky Balboa, coming out to fight off cancer risk, both overall and esophageal, as well as improving quality of life and eye disease (glaucoma). On the other, we have the statin as Evel Knievel, demonstrating that being reckless doesn’t provide longevity, promotes fatigue and increases eye disease (cataracts). Let’s look at some of the evidence.

Effect on cancer

A recent study published in The New England Journal of Medicine involved 300,000 Danish participants and investigated 13 cancers. It showed that statin users may have a 15 percent decreased risk of death from cancer (N Engl J Med 2012;367:1792-1802). This is exciting news.

However, there were major limitations with the study. First, the researchers did not control for smoking, which we know is a large contributor to cancer. Secondly, it was unknown which of the statin-using population might have received conventional cancer treatments, such as radiation and chemotherapy. Thirdly, the dose of statins did not correlate to risk reduction. In fact, those who took 1 percent to 75 percent of prescribed statin levels showed more benefit in terms of cancer-mortality risk than those who took more. There needs to be a better-designed trial that is prospective (forward looking) to determine whether there really is an effect. I would say that Rocky Balboa came out of this fight pretty banged up.

Another study showed that statins may play a role in reducing the risk of esophageal cancer. This is important, since esophageal cancer, especially adenocarcinoma that develops from Barrett’s esophagus, is on the rise. The results showed a 30 percent risk reduction in this type of cancer. The authors of the study surmise that statins may have a protective effect. This was meta-analysis of 13 observational studies. The study abstract was presented at the American College of Gastroenterology 2012 Annual Scientific Meeting (Abstract 1 May 22, 2012).

Although there is an association, these results need to be confirmed with randomized controlled trials. Remember, aspirin has about the same 30 percent reduction in colorectal cancer, yet is not recommended solely for this use because of side effects.

Eye diseases: mixed results

In two common eye diseases, glaucoma and cataracts, statins have vastly different results. In one new study, statins were shown to decrease the risk of glaucoma by 5 percent over one year and 9 percent over two years (Ophthalmology 2012;119(10):2074-2081). It is encouraging that the longer the duration of statin use, the greater the positive effect on preventing glaucoma.

Statins also help to slow glaucoma progression in patients suspected of having early-stage disease at about the same rate. This was a retrospective study (backward-looking) analyzing statin use with patients at risk for open-angle glaucoma. There is a need for prospective (forward-looking) studies. With cataracts, it is a completely different story. Statins increase the risk of cataracts by over 50 percent, as shown in the Waterloo Eye Study (Optom Vis Sci 2012;89:1165-1171). Statins exacerbate the risk of cataracts in an already high-risk group: diabetes patients. For more details on this topic, see my Oct. 18 article, “Taking cataracts seriously to maintain good health.”

Quality of life and longevity: a mixed bag again

In a meta-analysis involving 11 randomized controlled trials, considered the gold standard of studies, statins did not reduce the risk of all-cause mortality in moderate to high-risk primary prevention participants (Arch Intern Med 2010;170(12):1024-31). This study analysis involved over 65,000 participants with high cholesterol and at significant risk for heart disease.

However, in this same study in Archives of Internal Medicine, participants at high risk of coronary heart disease saw a substantial improvement in their quality of life with statins. In other words, the risk of a nonfatal heart attack was reduced by more than half and nonfatal strokes by almost half, avoiding the potentially disabling effects of these cardiovascular events.

Fatigue effect

Some of my patients who are on statins ask if statins can cause fatigue. The answer is “maybe,” but now there is a randomized controlled trial that reinforces the idea that statins increase the possibility of fatigue (Arch Intern Med 2012;172(15):1180-1182).

Women, especially, complained of lower energy levels, both overall and on exertion, when they were blindly assigned to a statin-taking group. The trial was composed of three groups: two that took statins, simvastatin 20 mg and pravastatin 40 mg; and a placebo group. The participants were at least 20 years old and had LDL (bad) cholesterol of 115 to 190 mg/dl, with less than 100 mg/dl considered ideal.

In conclusion, some individuals who are at high risk for cardiovascular disease may need a statin, but with the evidence presented it is more likely that statins are overprescribed in primary prevention. As www.update.com points out, evidence of the best results points to lifestyle modification, with or without statins, and all patients with elevated LDL (bad) cholesterol should make changes that include a nutrient-dense diet and exercise.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, go to the website www.medicalcompassmd.com and/or consult your personal physician.

Diabetes seems to be getting more and more unclear in terms of the appropriate path to treat and prevent the disease. The Accord trial, a large, randomized controlled trial, which I wrote about in my Jan. 25, 2011 article, showed that intensive lowering of glucose (sugars) with medications disappointingly showed no improvement in cardiovascular disease. Even worse, there was an increase in fatalities in the treatment group, compared to the placebo group (NEJM 2008;358:2560-2572).

So what about intensive lifestyle modification? We are constantly told that diet and exercise are very important for preventing and treating Type 2 diabetes. Many of us can relate to being told we need to lose 10 or 20 pounds. But the problem is that we are not given a road map as to how to best go about this process. Are all diets the same? How about exercise — does it matter how much and what we do? What does the evidence tell us?

Diet’s impact

We know that not all diets are equal and that diets fail patients all the time. In fact, there was a recent randomized clinical trial, the gold standard of studies, called the Look Ahead study, that looked at Type 2 diabetes patients and dietary effects. This trial involved intensive lifestyle modifications — dietary changes and increased fitness for one group were compared to a group given only diabetes support and education. The trial was halted because of its failure to impact cardiovascular disease.

We expect dietary trials to fail, but not one that is large, following 5,000 overweight or obese patients over 11 years, and funded by the National Institutes of Health. Part of the problem was that the amount of weight loss was less than 5 percent. The goal had been 7 percent, which should not be difficult to achieve when the patients’ mean starting weight was high. We know that the impact is greater with the more weight lost.

Worse still is that the interim analysis at year four of this study, published in 2010, showed encouraging results for reducing cardiovascular risk. There were significant improvements in parameters such as HbA1c (a three-month history of sugar levels), blood pressure, weight, HDL (“good cholesterol”), triglycerides, and number of medications. This is because patients had lost more weight at this point (Diabetes Care. 2010 Jun;33(6):1153-58; Arch Intern Med. 2010;170(17):1565-75).

At year one, analysis of the Look Ahead trial showed substantially more effect on reducing cardiovascular risk factors in Type 2 diabetes patients, with greater weight loss in the intensive treatment group. Those who lost 5 percent to 10 percent of their body weight saw results similar to the year four analysis above. And those who had a 10 to percent 15 percent loss of body weight experienced even greater risk reduction (Diabetes Care. 2011;34(7):1481-6).

However, there was good news with the trial: according to the authors, patients had lost weight and their physical conditioning had improved. The authors note that there was a low incidence of cardiovascular events (nonfatal heart attacks, nonfatal strokes, hospitalization from angina (chest pain), and death) for both groups, which made it difficult to observe a difference between the groups. Thus, this trial may have not been large enough to show an effective difference. I would argue that the weight difference may not have been great enough.

The treatment group with intensive lifestyle changes was following a calorie-restricted diet. This is not the same as a nutrient-rich, plant-based diet. Calorie restriction may help you lose modest amounts of weight, but trials have shown it does not necessarily add to longevity nor reduce risk factors for cardiovascular disease in Type 2 diabetes patients.

What is the message that this study is conveying? Does this mean that all diets are ineffective? Should we, to quote Marie Antoinette, “Let them eat cake”? I know some patients would like to be told that, but diet can play a significant role in Type 2 diabetes and its cardiovascular risk.

What is more important is diet composition. It appears to have more of an impact than just calorie restriction. In my Sept. 11, 2012 article, I go into much more detail on diet composition and an example of a nutrient-rich diet, with its beneficial impact on cardiovascular disease (Arch Intern Med. 2008;168:713-720).

In another recent trial, a meta-analysis (a group of 24 studies) with a dietary approach that involved a high-protein group compared to standard-protein group, the results disappointed (Am J Clin Nutr. online Oct 24, 2012). Though a high-protein diet showed a very modest reduction in weight, 1.8 extra pounds over three months, there was not a corresponding change in cardiovascular risk parameters, such as blood pressure, cholesterol and insulin levels. This analysis involved over 1,000 patients.
Again, it goes to the composition of the diet. In this case, the focus was on macronutrients, such as protein and carbohydrates, rather than micronutrients, including phytochemicals (plant nutrients).

Sedentary lifestyle

Though we are encouraged to exercise for 150 minutes per week — or five days a week for 30 minutes each — this does not take into account what we do the other 23.5 hours on the days that we are exercising.

In a meta-analysis (a group of 18 trials), there was a greater than two-fold increased risk of developing Type 2 diabetes in those who were most sedentary, compared to those who were least sedentary (Diabetologia. 2012;55:2895-2905). If that is not enough, there was also a greater than two-times risk of having a cardiovascular event, such as a heart attack or stroke, in those most sedentary. It is a good idea to at least stand up, but also to walk around, for a few minutes every hour if possible during your waking hours.

Therefore, if there is one message I could hammer home, it would be that diet and movement do play significant roles in treating, preventing and reversing Type 2 diabetes and reducing its risk for complications. Weight and diet composition are very important to achieving these goals. Even very little exercise can have a substantial effect on diabetes risk reduction.

Dr. Dunaief is a speaker, author and local lifestyle-medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, go to the website www.medicalcompassmd.com or consult your personal physician.

Most of us would like to achieve longevity, as long we also maintain a good quality of life. We are finding, however, as I mentioned in my Sept. 20 article, that calorie restriction alone may not be the route to achieving this goal.

There was a very interesting article published in the New York Times Magazine on Oct. 28 entitled, “The Enchanted Island of Centenarians,” by Dan Buettner, a modern-day explorer and educator who focuses on longevity. Of course, there was no way I was going to pass up an opportunity to read an in-depth article on this subject. He wrote about a man named Stamatis Moraitis who was born on Ikaria, a small Greek island.

At this point, you may ask yourself, “What does this have to do with me, since there are numerous stories about the Greek lifestyle?” Well, Moraitis immigrated to the United States around 1943 and lived initially in Port Jefferson. He eventually moved to Florida, where he was diagnosed with lung cancer and given less than a year to live. In response, he decided to move back to Ikaria to get his affairs in order.

Approximately 35 years after his diagnosis, he is 97 years old and fully functional, with no signs of lung cancer. One might say he overcame advanced lung cancer. The skeptics at this point are probably thinking that he was misdiagnosed initially and never had cancer. However, he had received multiple second opinions from physicians, and they all concurred on his diagnosis.

So what was on this island that helped him not only recover from his disease, but live a long and prosperous life? His recovery involved a multitude of factors, such as diet, social support, sleep, physical activity and regular sex.

While his story is anecdotal, we have seen these same results in studies looking at other societies, such as the Okinawans, the Seventh-day Adventist community of California and some provinces of China. What does the research tell us?

Diet and physical activity impact

The Women’s Health and Aging Studies I and II, one of the most recent studies on lifestyle modification, suggests that substantial disease and mortality risk reductions are possible. There were 713 participants ranging in age from 70 to 79 (J Am Geriatr Soc. 2012;60(5):862-868).

The results showed that women who were more physically active, compared to those who were least active, were significantly less likely to die with a 72 percent reduction in five-year mortality risk. And in terms of diet, there was a 50 percent reduction in death for women in the highest third of fruit and vegetable consumption compared to the lowest third. This is important, since the most rapidly expanding age group in the U.S. is those 65 and over (Demographic Res. 2000;3:1–20).

To confirm fruit and vegetable consumption in the different groups, the researchers measured carotenoid levels in the participants’ blood. Carotenoids are phytochemicals, or nutrients, found in a plant-based diet. This is the same technique I use to measure whether my patients are achieving a vegetable-rich diet. The Ikarians’ diet is also composed of vegetables, with an emphasis on greens and a variety of beans and a de-emphasis on dairy and other animal products. According to Dan Buettner, who spent time in Ikaria, most Ikarians walked up at least 20 different hills throughout the day.

The role of napping

While we have heard conflicting reports about napping, recent studies suggest that it may have beneficial effects. In the Greek portion of the European Prospective Investigation into Cancer and Nutrition (EPIC) trial, there was a 34 percent reduction in the risk of death from heart disease when taking a siesta (midday nap), regardless of frequency and duration (Arch Intern Med. 2007;167(3):296-301). This study involved 23,681 participants. For men, those who were working saw more significant results in mortality reduction than those who were not. In the Ikarian society, most of the individuals took naps in the middle of the day.

The influence of social connections

Who you associate with may have a significant effect on your health. In the Framingham Heart Study, the chance of becoming obese (BMI of greater than 30) increased if you had a friend who had become obese (N Engl J Med. 2007;357:370-379). In this study, which involved 12,067 participants, there was a 57 percent increased risk of obesity if your friend was obese well. The authors describe this phenomenon as a social contagion, much like how a virus spreads. Among Seventh-day Adventist communities, Buettner observed that there is a positive social contagion: at picnics you see a predominance of fruit and vegetable dishes, rather than the typical American barbecue with beef or chicken.

Though there are no formally published studies on the Ikarian society, there are studies on other societies with increased longevity, such as the Okinawans, the Seventh-day Adventists and Sardinians. Unlike many of the other society studies, which are mainly international, the Seventh-day Adventists studied live in Loma Linda, Calif., outside Los Angeles.

In a study looking at approximately 34,000 Californian Seventh-day Adventists, those at age 30 had a considerably higher life expectancy than other Caucasian Californians (Arch Intern Med. 2001;161(13):1645-1652). For men, there was a 7.28 year increase in life expectancy, and for women, there was 4.42 year advantage. The factors that play a role are similar to those that are important to the Ikarians: diet, physical activity and not smoking.

What do all of these different societies have in common? They eat a high-nutrient, plant-rich diet, physical activity is a given and strong societal networking is integral to their lifestyles.

Though we may not be able to emigrate to Ikaria or many of the other societies with greater lifespans, we can modify our lifestyles to emulate many of the benefits. We can improve our diet, make sure we get enough sleep – naps should be encouraged, rather than frowned upon – and strengthen our social connections. These changes will help to foster prevention and reversal of chronic disease and potentially increase our longevity.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management.  For further information, go to the website www.medicalcompassmd.com and/or consult your personal physician.

Multivitamins are one of the most commonly consumed supplements in the United States, taken by at least one-third of the population (J Nutr. 2011;141(2):261-266). We are bombarded by vitamin advertising. Yet we hear so much conflicting information about them from physicians and marketers. Are they beneficial or are they detrimental? At least with multivitamins, I will attempt to address these questions with several studies.

The quick and dirty answer is that it appears to depend on the demographics utilizing them and also the content of the multivitamins themselves. So the real question becomes, who should and who should not be taking them? There are studies that have been done on men and women looking at mortality risk and chronic diseases, such as cancer and age-related macular degeneration.

Cancer benefit in men

The Physicians’ Health Study II is the only well-designed, randomized, double-blinded, placebo-controlled trial (RCT), the gold standard of studies, to date that looks at multivitamins. This study was published in JAMA and indicates that multivitamins may be beneficial for men to prevent the overall risk of cancer (JAMA online Oct. 17, 2012). The results showed that men who took a daily multivitamin were 8 percent less likely to develop cancer overall compared to the placebo group. Even though this is a modest effect, the results were statistically significant.

For those who did have cancer, there was also a trend toward reduction in cancer mortality of 12 percent, but it did not reach the threshold of statistical significance. When they analyzed cancers individually, such as prostate and colorectal cancers, there was no difference with the placebo group. The duration of the study was considered substantially long at 11 years. The demographics included 14,641 healthy male U.S. physicians who were at least 50 years old. The multivitamin used in the study was Centrum Silver.

It may be well worth the effort for men over the age of 50 to take a multivitamin, since it is an easy way to reduce the risk of a broad category of chronic diseases, including cancer that is difficult to treat in many circumstances. The authors stressed that this should not replace a good diet and exercise, which are more likely to have larger beneficial effects on cancer.

Cancer effect for postmenopausal women

In the Women’s Health Initiative, a large observational study, there was neither an increase nor a decrease in the risk of cancer with multivitamins (Arch Intern Med. 2009(3);169:294-304). Does this mean that multivitamins don’t have the same effect in women? Not necessarily.

The design of each of the two studies was different. The previous study was a randomized controlled trial comparing a group of males who took a multivitamin to those who took a placebo, whereas this study was large, but observational — participants were observed over time — and thus is not as well designed. Therefore, the Physicians’ Health Study II had a better design and more definitive results. Interestingly, the authors of this study concluded that diet, with an emphasis on fruits and vegetables, and exercise are more beneficial than a multivitamin. This conclusion is a similar to the previous study.

Mortality effect for postmenopausal women

For postmenopausal women, taking a multivitamin may be detrimental. There was an increased risk of mortality of 6 percent in women taking a multivitamin which, though modest, is still statistically significant, according to the Iowa Women’s Health Study (Arch Intern Med. 2011;171(18):1625-1633).

However, according to this study, copper was found to have a 45 percent increased risk of mortality in postmenopausal women. I described this study in more detail in my Oct. 25, 2011 article.
So why do I mention this study? To emphasize the fact that, though this is a large observational study like the Women’s Health Initiative, it is not as well designed, nor are the results as definitive as a RCT like the Physician’s Health Study II mentioned above. For instance, I could not find details about the dose of copper nor whether one standard multivitamin was used.

Regardless, there needs to be a RCT to determine if multivitamins are harmful in postmenopausal women. What I might suggest is that postmenopausal women think twice about taking the multivitamin in the Physician’s Health Study II, since it contained copper. It is important to ask your doctor whether multivitamins are appropriate for you and, if so, which one.

Age-related macular degeneration (AMD) and multivitamins

A multivitamin was shown to be beneficial in preventing the progression of AMD to advanced stage disease. This was a well-designed RCT called the AREDS study (Arch Ophthalmol. 2001;119:1417-1436). The results showed a significant 28 percent reduction in risk of worsening disease in patients between the ages of 55 and 80 years old. The study’s duration was 6.3 years. The multivitamin used contained a combination of vitamin C (500 mg), vitamin E (400 IU), beta carotene (15 mg), zinc (80 mg) and copper (2 mg).

This multivitamin combination also prevented visual acuity loss by 27 percent. These results are impressive, since advanced AMD is the leading cause of central vision loss in patients 65 years and older (Arch Ophthalmol. 1998;116(5):653-658). The study’s conclusion suggests that patients with AMD take this multivitamin combination as long as they don’t have contraindications, such as smoking. Before starting this type of multivitamin, please consult an ophthalmologist.

To review or summarize, multivitamins in the right population have substantial risk reduction effects, such as in cancer with men. However, benefits may be dependent on the population, for with postmenopausal women, multivitamins may actually increase the risk of mortality. They may also depend on the multivitamin’s composition — not all multivitamins are created equal. For example, a certain combination of elements is beneficial for macular degeneration, not just any multivitamin. Thus, one size does not fit all. And remember, a supplement is just that, it should supplement a healthy diet.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management.  For further information, go to the website www.medicalcompassmd.com and/or consult your personal physician.