In the past year, several studies have been published that suggest the lack of efficacy of several popular nutritional supplements, including policosanol, garlic and antioxidants.The policosanol and garlic studies showed that neither supplement had a cholesterol-lowering effect1,2 and the antioxidant study suggested that taking antioxidant supplements may increase mortality.3 These outcomes do not really surprise me, and I would actually expect them, and so should you. Regarding studies with supplements and medications, we should consider poor outcomes in the context of the subjects’ health status, and from the perspective of dietary habits, the health status of most Americans is dismal.
Consider the March 16, 2007 issue of the Centers for Disease Control’s Morbidity and Mortality Weekly Report, which contained an article that reviewed consumption of fruits and vegetables within the U.S. population. In short, about 70 percent of adults did not eat at least two fruit and three vegetable servings per day.4 Frankly, this pattern of eating is terrible and speaks to one’s pursuit of future goals. Indeed, eating this way represents the “pursuit of disease.”
We need to appreciate that our present behavior represents the “present-time” manifestation of our future goals. If you do not eat adequate fruits and vegetables, your dietary goal is one of chronic disease. For example, if you have breast cancer or prostate cancer in your family, and you eat only one fruit and one vegetable serving per day, then your dietary goal is breast or prostate cancer expression, or whatever disease to which you may be genetically disposed.
Many clinicians are aware of Healthy People 2010. Some of the objectives include getting 75 percent of Americans to eat at least two daily servings of fruit, and to get 50 percent of the population to eat at least three daily servings of vegetables.4 Is this goal realistic, and how difficult is it to eat two fruit and three vegetable servings per day?
In fact, it is very easy to consume five servings of fruits and vegetables per day, especially when we consider that a serving is typically considered to be a 1/2 cup of non-leafy vegetables or fruit, and one cup of leafy vegetables. From a caloric perspective, a 1/2 cup of broccoli provides 22 calories; one cup of romaine lettuce gives us about 10 calories; and a 1/2 cup of blueberries is about 40 calories. So, the caloric content of three vegetable and two fruit servings per day is less than 150 calories, yet Americans are somehow confused by the complexity of achieving this goal, as represented by the fact that only 30 percent of us manage to pull it off each day.
In reality, we should probably be eating five to 10 times the recommended amount of vegetables and fruit, which would put us at about 750-1,500 calories per day. However, most people currently do not get even 100 calories worth of fruits and vegetables per day – abit scary.
Which “foods” make up the remaining calories in a 2,000- to 3,000-calorie diet? Research suggests that about 75 percent of the average American’s caloric intake comes from dairy products, refined cereals, refined sugars and flours, refined vegetable oils, and alcohol.5 We also eat a lot of meat. Accordingly, we need to consider the nature of wild game versus modern domestic meat. Only about 2 percent to 4 percent of wild game is fat by weight, which contains relatively high levels of omega-3 fatty acids. In short, it is a very healthy meat to consume. In contrast, our modern pro-inflammatory meat is about 20 percent to 25 percent fat by weight, much of which is saturated fat. At such high levels, it raises total cholesterol levels. Our modern meat is also rich in n-6 fatty acids, with very little anti-inflammatory n-3s.6
If we look at our overall consumption patterns, we can make a somewhat amazing discovery. For a 2,000-calorie diet, about 5 percent of calories come from anti-inflammatory fruits and vegetables, while 9 percent of calories come from pro-inflammatory refined foods and fatty animals. For a 3,000-calorie diet (which is probably more accurate for most), 100 calories of fruit and vegetables make up a mere 3.3 percent of the total caloric intake.
Regretfully, our diets really are this dismal, and this fact must be taken into consideration when looking at supplement and drug trials in the treatment or prevention of disease. With this in mind, I am surprised when any nutritional supplement study shows a beneficial outcome. From a realistic perspective, how can giving a few milligrams of policosanol or allicin (from garlic) function to counteract 2,500 calories worth of disease promotion?
When it comes to antioxidants, it is important to understand the human body has a built-in antioxidant defense system, which requires support from 1) proper blood sugar regulation; and 2) the numerous substances found in fruits and vegetables. Without proper dietary support of the antioxidant system, we develop a “pro-oxidant” state.7,8 Antioxidants such as beta-carotene and vitamin E are naturally oxidized by free radicals, and they are supposed to be reduced back to an antioxidant state by the antioxidant defense system and by diet. This process is not likely possible when 95 percent of calories are derived from substances that are pro-oxidant and pro-inflammatory; so I always expect antioxidant trials to be unsuccessful. I am rarely disappointed.
In summary, urge your patients to eat better. Supplements cannot counteract the volcano of inflammation created by a pro-inflammatory diet. This is not to say that supplements should not be used. On the contrary, I take a multivitamin, magnesium, fish oil, coenzyme Q10, lipoic acid, acetyl-L-carnitine, ginger/turmeric, garlic, glucosamine/chondroitin, probiotics and vitamin D. However, I add these supplements in moderate amounts to a diet rich in fruits and vegetables, for the purpose of reducing the pro-inflammatory dietary state.
References
- Berthold HK, Unverdorben S, Degenhardt R, et al. Effect of policosanol on lipid levels among patients with hypercholesterolemia or combined hyperlipidemia: a randomized controlled trial. JAMA, 2006;295(19):2262-9.
- Gardner CD, Lawson LD, Block E, et al. Effect of raw garlic vs commercial garlic supplements on plasma lipid concentrations in adults with moderate hypercholesterolemia. Arch Intern Med, 2007;167(4):346-53.
- Bjelakovic G, Nikolova D, Gluud LL, et al. Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta-analysis. JAMA, 2007;297(8):842-57.
- Blanck HM, Galuska DA, Gillespie C, et al. Fruit and vegetable consumption among adults – United States, 2005. MMWR Morb Mortal Wkly Rep, 2007;56(10):213-7.
- Cordain L, Eaton SB, Sebastian A, et al. Origins and evolution of the western diet: health implications for the 21st century. Am J Clin Nutr, 2005;81(2):341-54.
- O’Keefe JH Jr, Cordain L. Cardiovascular disease resulting from a diet and lifestyle at odds with our Paleolithic genome: how to become a 21st-century hunter-gatherer. Mayo Clin Proc, 2004;79(1):101-8.
- Evans JL, Goldfine ID, Maddux BA, Grodsky GM. Oxidative stress and stress-activated signaling pathways: a unifying hypothesis of type 2 diabetes. Endocrinol Rev, 2002;23(5):599-622.
- Seaman DR. The diet-induced pro-inflammatory state: a cause of chronic pain and other degenerative conditions? J Manip Physiol Ther, 2002;25(3):168-79.
