February 24, 2012

Warning on Supplements from Best-Selling "The End of Illness" Author

Earlier this month, a series of pieces about dietary supplements on this blog ended with a post reviewing the lack of evidence supporting their use. We hear this concern more and more these days. For example, I just finished reading the chapter on vitamins and supplements in the current, well-reviewed best seller The End of Illness by Dr. David Agus, a professor of preventive medicine at the University of Southern California Keck School of Medicine. According to the book blurb, Dr. Agus is a leader in cancer care, and in new approaches to personalized health care.

His chapter on supplements, titled "The Truth About Synthetic Solutions," has this subtitle: "How to Save Hundreds of Dollars a Year and Rethink the Need for Supplements and Vitamins."

Dr. Agus writes "About half of U.S. adults, maybe more, take vitamins and other dietary supplements, spending over $25 billion a year on dietary supplements." But he thinks there's precious little evidence to demonstrate the products' efficacy. Moreover, Agus claims some of these products can shorten -- not prolong -- life.

Agus asserts that the body is a complex organism, and changing one variable will have many effects... most of which we have no ability to truly understand. For all we know, taking vitamins and supplements may push the complex and delicate chemistry in the wrong direction.

Much of his discussion focuses on the use of vitamins and antioxidants. Here are the major subjects he explores:

Vitamin D
Since Vitamin D has become a media darling in recent years, Dr. Agus devotes a full chapter to it. He reviews the many studies and notes that virtually all of them have been observational rather than based on controlled trials -- which are virtually impossible to conduct with vitamin D. Since the substance is obtained naturally from sunlight, and foods like wild salmon, herring, fortified cereals, and milk, it's difficult to draw unequivocal conclusions. Perhaps the people who take vitamin D are already more conscious about taking good care of themselves, thus skewing the results.

Surprisingly, Agus claims that 75 percent of American adults -- and a whopping 97 percent of African-Americans -- are deficient in vitamin D. But he also claims that age-adjusted hip fractures (associated with vitamin D deficiency) have declined over the last two decades. He concludes the vitamin D chapter with this observation:
In my opinion, vitamin D cannot explain all the gaps and contradictions in the story. Before we make grand leaps and wild claims about its potential benefits, we must conduct further tests and push for refinements to our current measuring methods.
Vitamin C
Vitamin C keeps the nervous system functioning, Dr. Agus notes. But "if you want to send extra vitamin C to the brain, popping tablets is a waste, because most of it will be passed in the urine and little will get tot the brain."

With additional research and development, manipulating vitamin C levels in the brain may turn out to be helpful in combating all sorts of neurological disorders. Vitamin C is an antioxidant, and oxidants are linked to Parkinson's, Alzheimer's, and to brain damage caused by strokes. "Oxidants are also known to be players in general aging, hence their infamy in anti-aging circles and the popularity of antioxidants," Dr. Agus writes.

But for people with cancer, vitamin C can become an arch-enemy, because tumors seem to like vitamin C. "They devour vitamin C like candy, so you would be feeding your cancer rather than fighting it if you consume excess vitamin C," he cautions.

Antioxidants, Multivitamins, Vitamins in General
Truth be told, I found The End of Illness a disorganized mishmash. The chapter on supplements and vitamins, for example, mixes together information about antioxidants, multivitamins, and specific vitamins and supplements in a way I found confusing. But there is a consistent and constant theme: our bodies are extraordinarily complex systems we dont't yet fully understand, and "by taking copious vitamins, especially those touted as antioxidants, you block your body's natural ability to control itself."

Here are some of Dr. Agus's recommendations:

  • If you look at all the vitamin studies involving 1,000 or more people over the past couple of decades, almost all of them have shown an increased risk of cancer.
  • Moreover, the studies about antioxidants and vitamins "tend to conflict so much with one another as to be meaningless."
  • A mega-analysis by the Cleveland Clinic on studies about antioxidants, specifically vitamin E and beta-carotene, concluded that their findings did "not support the routine use of vitamin E." While taking vitamin E didn't seem to make much difference one way or the other, the researchers warned that taking vitamin supplements containing beta-carotene should be "actively discouraged" because of the increased risk of death. Beta-carotene is commonly included in most multivitamin supplements, according to Dr. Agus.
The Bottom Line
This is the "Health Rule" that Dr. Agus offers at the end of the chapter:
Ditch shortcuts to nutrition and health, which can shorten your life. Unless you are correcting a specific deficiency or addressing a condition such as pregnancy, then you likely don't need to be taking multivitamins and other supplements.
Should You Buy The End of Illness?
Well, I did when I saw it labeled fourth best-selling non-fiction book at my favorite bookstore, DC's beloved Politics and Prose. And I'm glad I had the print version (with my underlinings and paper clips) as I wrote this blog piece. Maybe you'd like to read this review by "LuvUrPets," that I found at  Amazon.com:

For once, I fell for the hype surrounding a book but after reading "The End of Illness" I realized I should have stuck with my original plan to check it out from my library. There is absolutely nothing groundbreaking or particularly significant about anything contained in this book. So why give it three stars? It does contain basic, medically supported info that some older person who has had no tv, no internet, no newspaper, and no radio access for the last 30 years and refuses to go to the doctor or listen to his doctor would need to know. As for the rest of us, all this book does is confirm what you already knew or suspected.
I am assuming though that you're interested in this book because you want to: (a) avoid an illness, particularly a life threatening illness or (b) you already have an illness and think this book will give suggestions on how to improve your life and get control of your illness. Learning about new advances in medicine which may or may not lead to anything that will help you during your lifetime is just a bonus but not high on your list of priorities. To be truthful, even if you read the book for that last purpose, you'd still be disappointed. I'm one of those unlucky people who was diagnosed with a chronic illness at the tender age of 13. Before then, nothing major happened in my life to kick start the illness - no drug use, no past illnesses/accidents, no lack of exercise, no atrocious diet, no lack of sleep habits, not a genetic disease. Sometimes $%&@ happens. As a mid 30s person, I'm pretty well versed in health matters but not an expert by far. I suspect many people my age and slightly older already know about the "tools" Dr. Agus "details" in this book and probably have been using them for years. It's the same "tools" you can learn about in any of the pithy little "Live to be 100" yahoo health articles the site spouts off every few weeks - and today.
Since the table of contents is available, I don't think I'd be breaking any rules or providing any spoilers by mentioning these tools:
(1) Don't believe every health study that comes out (duh)
(2) Taking vitamins is not as good as eating healthy food (duh)
(3) Try to avoid or lessen inflammation in the body (big Duh) - doesn't really tell you how except to get flu shots and wear comfortable clothes. Basically anytime you injure yourself or get sick there is inflammation. Not really a way to avoid all that esp. if you were a rambunctious kid since apparently things that happened to you as a kid can have a long lasting effect on your health today. From the anecdotes he tells in this section, I think Monk would be the only person capable of pulling this suggestion off successfully from birth to death. Even so, he could still get an illness because $%#@ Happens!
(4) Exercise (really?!)
(5) Keep a regular schedule for eating, sleeping, exercising (you don't say)
(6) Overall theme, keep track of how you are health-wise. Find out what's normal for you (done and
Rest of the book is filler on historical discoveries you learned in high school and hopes for the future, particularly with proteomics. He does seem to have a love affair with statins. Not being in the age range or having the type of illness to require these meds, I have absolutely no opinion on that.
There were only two things I took away from this book - that it's better to exercise in spurts than all at once (read about that earlier somewhere but it doesn't hurt to reinforce it) and you may want to get a DNA test to show your susceptibility to certain illnesses .... tests which coincidentally are offered by a company co-founded by Dr. Agus. Imagine that. Regardless, it does sound helpful esp. the ability to tell which drugs will work best for you. My doctor would probably say it's a waste of time and money but I'll make that decision after further research.
That's the book in a nutshell. He could have just written that in a two page internet article but I guess it wouldn't get much attention or money. Oh, and although the book is called "The End of Illness," it of course does not say a thing about "ending" illness now or in the future. A more truthful title would be "The Possible Downgrading of Terminal Diseases and Chronic Diseases that Substantially Lower Your Quality of Life into Easily Manageable Minor Diseases that You'll Still Suffer From But Will Have Better Control Over than Previous Generations." Reminds me of the Chris Rock joke where he says doctors will never cure AIDS but they'll make it manageable so all you have to do is take a pill everyday. The money's in the medicine. Not the cure. Prevention is the biggest weapon we have but you don't need this book to tell you that.


Austin Tice said...

Hi.  I just stumbled on your blog after taking some photos of the old trolley trestle that crosses the park west of Georgetown University.  Your writing is graceful and inspirational.  Thanks for sharing. 


Rise2topp said...

sad man,with bitter end.