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The Health Risks of Supplements & Alternative Medicine

A few weeks ago, a patient came to me complaining of nausea, muscle weakness and fatigue. Her urine was tea-colored despite drinking loads of water. A middle-aged woman, she seemed worried she had cancer or some deadly disease. Her lab tests revealed significant liver dysfunction. But her symptoms were not due to liver cancer, hepatitis or other disease. It turned out she had liver toxicity from a green tea supplement that she’d heard was a “natural” way to lose weight.

When she stopped taking the supplement at my suggestion, her liver tests gradually normalized and she felt better over the course of a few weeks

I’ve seen the green tea issue in patients before and often witness the real-life pitfalls of eschewing traditional medicine, science and facts in favor of supplements, herbs and cleanses in the name of “natural” healing.

In an effort to be healthy, patients can easily become ensnared in the potential dangers of alternative medicine or homeopathy.

Let’s be clear: Nature has a lot to offer patients.

The Greek physician Hippocrates is said to have reported on the use of St. Johnswort, a flowering plant, for mood disturbances in the 5th century B.C. Digoxin, a well-studied medicine used to treat heart failure, is derived from the foxglove plant. Parkinson’s patients are often commonly treated with the medication L-dopa, which comes from the plant Mucuna pruriens. Moreover, research repeatedly shows that consuming fruits and vegetables, getting adequate sleep and regular exercise, and spending time outdoors have myriad health benefits.

But nature isn’t always so well-intended.

Spoiler alert: Arsenic, cyanide, asbestos and snake venom derive from nature. Refined sugar, a naturally occurring substance and one that lives in most Americans’ pantries, is in large part responsible for our country’s obesity epidemic. Simply because a substance comes from nature does not mean it is good for us.

An important key to health is using nature appropriately.

And in the case of my patient, she was able to lose weight when we made a clear plan to alter her basic human behaviors. Before she started taking the green tea extract, she was skipping breakfast, drinking the equivalent of two Venti coffees before noon, eating takeout meals for lunch, washing down her late-night dinner with two glasses of wine, sleeping restlessly, and spending too much time sitting and indoors.

Green tea extract was never going to be the quick fix that she — and other patients I have seen — had hoped. It may be attractive as a natural cure for extra body fat, but this promise has not been shown in any studies, according to the National Center for Complementary and Integrative Health at the National Institutes of Health. The key to helping my patient was pretty basic: looking at her lifestyle, her stress, and creating some structure and accountability for important lifestyle changes.

While she wasn’t able to eat like Gwyneth Paltrow would recommend (who can eat Pinterest-perfect meals like that as a mere mortal?), my patient took my advice to heart that she begin eating breakfast, packing healthy leftovers for lunch at work, cutting back the wine to weekends only, and getting more exercise on weekends.

As a result, she started sleeping better and feeling more energetic. Eventually, the weight started coming off, too.

Particular patients seem to be more susceptible to the lure of “naturopathic” medicine or homeopathy. Patients who have vague symptoms that do not fit tidily into a box, for example, are often the ones combing the Internet for answers to their health woes and spending hundreds of dollars on unproven and insufficiently regulated supplements and herbs.

According to the 2012 National Health Interview Survey (NHIS), which included a comprehensive poll on the use of complementary health approaches by Americans, 17.7 percent of American adults had used a dietary supplement other than vitamins and minerals in the past year. That number is probably larger now: The total sales of herbal and dietary supplements in the United States were estimated to be more than $8 billion in 2017, the 15th consecutive year of sales growth, according to a market research report. And women were more likely than men to use these products — as well as people with more education.

Scientific data is often not the reason patients are drawn to herbal or “natural” supplements, Harvard School of Public Health researchers said. Of supplements users surveyed in 2001, 72 percent said they would continue using supplements despite a negative government scientific study. Patients reported getting much information about herbs from family, friends, advertisements and the Internet.

My patients often consider herbal remedies to be free of side effects, but many “natural” products can lead to toxicity and can dangerously interact with prescription medications.

Compounding the problem is that herbal and dietary supplements are not subject to the same strict regulatory standards as prescription drugs. On it’s website, NIH’s Office of Dietary Supplements says the products “are not required to be reviewed by the FDA for their safety before they are marketed because they are presumed to be safe based on their history of use by humans.”

Last year, another patient came in to see me complaining of fatigue, joint pains and abdominal bloating. She had seen a naturopath for these symptoms, who told her she had “chronic Lyme” disease and gave her multiple rounds of antibiotics and a bag full of daily herbal supplements. She said she didn’t feel any better.

When we met, she told me she was certain she had Lyme disease that wasn’t being adequately treated. In fact, the antibiotics she had been given had only worsened her abdominal issues and caused a new problem: an intestinal infection that causes bad diarrhea.

After 10 days of appropriate antibiotic treatment, her diarrhea was gone but she was back to her tired and achy self. At my recommendation, she stopped the supplements, and her fatigue abated somewhat.

When we discussed her situation further, she revealed to me she suffered from a love-hate relationship with sugar.

Like many of my patients, when she was stressed out she binged on sugar. For most people, ingesting sugar provides a quick hit of the pleasure hormone dopamine, and for some people that rush of dopamine and the accompanying instantaneous boost of energy can become addicting.

The problem is that a high sugar load causes a surge in the hormone insulin, which then results in a sudden drop in blood sugar — which can promote fatigue, weakness and irritability, among other symptoms. If consumed in excess over time, such dietary sugar can cause abdominal distress, bloating and joint aches. This is what was probably causing my patient’s symptoms.

So we made a plan for her to not only cut back on sugar but also fill her diet with healthy stuff to get ahead of hunger and avoid binges. I also recommended she work with a therapist to deal with stress-eating. Her joint aches went away and her energy improved after about two weeks, and she continues to see a therapist for stress-eating issues.

Food — and added support to use it properly — was the fix.

Symptoms such as fatigue, headaches, joint pains and irregular bowel movements are some of the most common complaints I see in my office. They can be challenging for physicians to figure out, largely because they require careful and attentive listening by the doctor.

And since more than 40 percent of patients do not tell their doctors about their use of complementary or alternative medicine (including 25 percent who take supplements and/or herbs), physicians can be bewildered when trying to pin down a root cause for a patient’s complaints. Indeed, these patients are not easily diagnosed after a single lab test — and they are not easily fixed with a supplement.

Occasionally, it takes time with the patient, careful attention to the patient’s story, and asking the right questions to get to the bottom of the problem. Often, the solution is right under our nose.

Nature is indeed wonderful, but it doesn’t always come in a pill.

Lucy McBride is an internist based in the District.

Source: The health risks of supplements and alternative medicine – The Washington Post

John Oliver outlines what, exactly is problematic about Dr. Oz and the nutrition supplement industry. Then he invites George R.R. Martin, Steve Buscemi, the Black and Gold Marching Elite, and some fake real housewives on the show to illustrate how to pander to an audience without hurting anyone. Connect with Last Week Tonight online… Subscribe to the Last Week Tonight YouTube channel for more almost news as it almost happens: www.youtube.com/user/LastWeekTonight Find Last Week Tonight on Facebook like your mom would: http://Facebook.com/LastWeekTonight Follow us on Twitter for news about jokes and jokes about news: http://Twitter.com/LastWeekTonight Visit our official site for all that other stuff at once: http://www.hbo.com/last-week-tonight-…

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The Science Behind Diet Trends Like Mono, Charcoal Detox, Noom & Fast800

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Every year a new batch of diets become trendy. In the past, the blood group, ketogenic, Pioppi and gluten-free diets were among the most popular. These have made way for the mono diet, charcoal detox, Noom, time-restricted feeding and Fast800.

So what are these new diets and is there any scientific evidence to support them?


Read more: Health Check: six tips for losing weight without fad diets


1. Mono diet

The monotrophic or mono diet limits food intake to just one food group such as meat or fruit, or one individual food like potato or chicken, each day.

The mono diet has no scientific basis and no research has been done on it. It’s definitely a fad and should not be followed.

It leads to weight loss because your food intake is so limited (one food per day) that you get sick of that food very quickly and so automatically achieve a reduced kilojoule intake.

If you ate three apples at each main meal and had another three as between-meal snacks then your total kilojoule intake from the 12 apples would be about 4,000 kilojoules (950 calories).

The mono diet is nutritionally inadequate. The nutrients most deficient will depend on the individual foods consumed, but if you follow the mono diet long term, you would eventually develop vitamin and mineral deficiencies.

2. Charcoal detox

The charcoal detox diet claims to help people lose weight by “detoxing” them. It involves periods of fasting and consumption of tea or juice drinks that contain charcoal.

It is definitely not recommended.

Medical professionals use activated charcoal to treat patients who have been poisoned or have overdosed on specific medications. Charcoal can bind to some compounds and remove them from the body.

There is no scientific evidence to support the use of charcoal as a weight loss strategy.

Avoid the charcoal detox diet. Andasea/Shutterstock

Read more: Five supplements that claim to speed up weight loss – and what the science says


Charcoal detox plans also include dietary restrictions or fasts, so people might lose weight because they’re consuming fewer kilojoules.

Charcoal is not selective. It can bind to some medications and nutrients, as well as toxic substances, so there is the potential for charcoal to trigger nutrient deficiencies and/or make some medications less effective.

Side-effects of using charcoal include nausea and constipation.

3. Noom diet

The Noom diet isn’t actually a diet at all. It is a smartphone app called Noom Coach that focuses on behaviour change techniques to assist with weight loss. It allows users to monitor their eating and physical activity, and provides support and feedback.

The Noom diet does not provide a diet plan, but it gets users to record within the app, all foods and drinks consumed. It then uses a traffic light system (red, yellow, green) to indicate how healthy the foods are.

One advantage of Noom is that is doesn’t eliminate any foods or food groups, and it encourages healthy lifestyle behaviour change to assist with weight loss.

A disadvantage is that while you can download the app for a free short-term trial, membership is about A$50 per month for four months. And additional services cost extra. So consider whether this approach suits your budget.

One study has examined the app’s effectiveness. In a cohort of 35,921 Noom app users over 18 months, almost 78% reported a reduction in body weight. About 23% of these people reported losing more than 10% of their body weight.


Read more: Health Check: should you weigh yourself regularly?


Although the data are observational and don’t compare Noom app users to a control group, the results are promising.

In other weight-loss interventions in adults at risk of developing type 2 diabetes, researchers found losing 5-10% body weight and being active for about 30 minutes a day lowered the risk of developing type 2 diabetes by more than 50%.

4. Time-restricted feeding

Time-restricted feeding is a type of intermittent fast that involves restricting the time of day that you are “allowed” to eat. This typically means eating in a window lasting four to ten hours.

While energy-restriction during this period is not a specific recommendation, it happens as a consequence of eating only during a shorter period of time than usual.

It’s unclear whether weight loss results from changes in the body after you fast, or if it’s just because you can’t eat as much in a short period of time. Best_nj/Shutterstock

The difference between time-restricted feeding compared to other intermittent fasting strategies is that recent research suggests some metabolic benefits are initiated following a fasting period that lasts for 16 hours, as opposed to a typical overnight fast of ten to 12 hours.


Read more: Health Check: what’s the best diet for weight loss?


Researchers have reported some promising effects on the amount of body fat, insulin sensitivity and blood cholesterol with time-restricted feeding windows, although some studies have reported benefits for weight but not for fat mass, blood cholesterol or markers of type 2 diabetes risk.

Further research is required to determine whether any health effects of time-restricted feeding are due to regular 16-hour fasting periods, or simply because eating over a small time window reduces energy intake.

If this approach helps you get started on a healthy lifestyle and your GP gives you the all clear, then try it. You will need to follow up with some permanent changes to your lifestyle so your food and physical activity patterns are improved in the long term.

5. Fast800

The Fast800 diet by Dr Michael Mosley encourages a daily intake of just 800 calories (about 3,350 kilojoules) during the initial intensive phase of the Blood Sugar Diet.

This lasts for up to eight weeks and is supposed to help you rapidly lose weight and improve your blood sugar levels. You can buy the book for about A$20 or pay A$175 for a 12-week online program that says it includes a personal assessment, recipes, physical and mindfulness exercises, tools, access to experts, an online community, information for your doctor and advice for long-term healthy living.

Michael Mosley’s diet program is based on a very low daily energy intake. Screenshot of https://thefast800.com/

Two recent studies provide some evidence that supports these claims: the DiRECT and DROPLET trials.

In these studies, GPs prescribed patients who were obese and/or had type 2 diabetes an initial diet of 800 calories, using formulated meal replacements. This initial phase was followed by a gradual reintroduction of food. Participants also received structured support to help them maintain the weight loss.

Both studies compared the intervention to a control group who received either usual care or treatment using best practice guidelines.

They found participants in the 800 calorie groups lost more weight and more of the adults with type 2 diabetes achieved remission than the control groups.

This is what you would expect, given the intervention was very intensive and included a very low total daily energy intake.

But the low energy intake can make the Fast800 difficult to stick to. It can also be challenging to get enough nutrients, so protocols need to be carefully followed and any recommended nutrient supplements taken.


Read more: What are ‘fasting’ diets and do they help you lose weight?


Fast800 is not suitable for people with a history of eating disorders or health conditions such as liver disease. So if you’re considering it, talk to your GP.

When it comes to weight loss, there are no magic tricks that guarantee success. Have a health check up with your GP, focus on making healthy lifestyle changes and if you need more support, ask to be referred to an accredited practising dietitian.

If you would like to learn more about weight loss, you can enrol in our free online course The Science of Weight Loss – Dispelling Diet Myths.

Professor in Nutrition and Dietetics, University of Newcastle

 

 

Postdoctoral research fellow, University of Newcastle

 

 

Postdoctoral Researcher, University of Newcastle

 

Clare Collins is affiliated with the Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle, NSW. She is an NHMRC Senior Research and Gladys M Brawn Research Fellow. She has received research grants from NHMRC, ARC, Hunter Medical Research Institute, Meat and Livestock Australia, Diabetes Australia, Heart Foundation, Bill and Melinda Gates Foundation, nib foundation, Rijk Zwaan Australia and Greater Charitable Foundation. She has consulted to SHINE Australia, Novo Nordisk, Quality Bakers, the Sax Institute and the ABC. She was a team member conducting systematic reviews to inform the Australian Dietary Guidelines update and the Heart Foundation evidence reviews on meat and dietary patterns.

Lee Ashton is affiliated with the Priority Research Centre for Physical Activity and Nutrition at the University of Newcastle, NSW, Australia.

Rebecca Williams is affiliated with the Priority Research Centre for Physical Activity and Nutrition at the University of Newcastle, NSW, Australia.

Debunking some common diets, and seeing which work! More Food and Health Science videos! https://www.youtube.com/watch?v=ztiHR… Subscribe for more! http://bit.ly/asap Eating Disorder Information: http://www.nedic.ca/ Created by: Mitchell Moffit and Gregory Brown Written by: Annik Carson, Rachel Salt, Greg Brown and Mitchell Moffit Illustrated: by: Max Simmons Edited by: Sel Ghebrehiwot GET THE ASAPSCIENCE BOOK: http://asapscience.com/book/ FOLLOW US! Instagram and Twitter: @whalewatchmeplz and @mitchellmoffit Clickable: http://bit.ly/16F1jeC and http://bit.ly/15J7ube AsapINSTAGRAM: https://instagram.com/asapscience/ Snapchat: realasapscience Facebook: http://facebook.com/AsapSCIENCE Twitter: http://twitter.com/AsapSCIENCE Tumblr: http://asapscience.tumblr.com Vine: Search “AsapSCIENCE” on vine! SNAPCHAT US ‘whalewatchmeplz’ and ‘pixelmitch’ Created by Mitchell Moffit (twitter @mitchellmoffit) and Gregory Brown (twitter @whalewatchmeplz). Send us stuff! ASAPSCIENCE INC. P.O. Box 93, Toronto P Toronto, ON, M5S2S6 Further Reading — Weight Loss Overview Studies http://ajcn.nutrition.org/content/66/… http://www.jstor.org/stable/25457080?… Low Carb http://annals.org/aim/article/717452/… http://www.nejm.org/doi/full/10.1056/… https://login.medscape.com/login/sso/… http://ajcn.nutrition.org/content/83/… http://content.onlinejacc.org/article… High Protein http://www.pnas.org/content/110/26/10… https://www.researchgate.net/profile/… Metabolic Slowing https://www.ncbi.nlm.nih.gov/pubmed/2… Biggest Loser http://www.nytimes.com/2016/05/02/hea… White Tongue http://www.mayoclinic.org/symptoms/wh…

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