Update on California’s Mandatory Vaccination Bill

6/16/15 On 2/19/15 California State Senators Richard Pan (a pediatrician) and Ben Allen introduced SB 277, called by some the Mandatory Vaccination Bill, which requires all children in both public and private schools, with the exception of certain types of homeschools (those that do not have classrooms as part of the curriculum, but most homeschools do have classrooms) to be fully vaccinated with more than 40 doses of 10 different vaccines in order to attend school (and attending school is mandated by California law).

I have previously written about this bill here. Please read https://drrandybaker.com/2015/04/17/measles-hysteria-and-california-sb-277/ first if you have not read it yet for an overview of this important and complex issue.

This post is an update, as there have been some important developments since my previous blog post. On 5/14/15 the California State Senate passed SB 277 by a 25 to 10 vote. On 6/9/15 SB 277 was considered by the State Assembly Health Committee. Hundreds of concerned citizens attended the hearing and voiced their opinions, with those opposing it (including many doctors, scientists and teachers) outnumbering those in favor by at least 5 to 1. There was extensive testimony by experts both in favor and against the bill, the most notable expert against it being Dr. Jay Gordon. While those who testified against the bill made many valid points as to why this bill is unnecessary and unlikely to significantly have any positive impact on public health, the testimony of citizens and scientists appeared to make no impact upon the Assembly members, who apparently already had their minds made up, and the Committee voted yes by a 12-6 margin along party lines (the Democrats voting yes and Republicans no). That means that the State Assembly is likely to vote on the bill next week (probably on 6/25) and the odds of it passing appear quite strong, given the strong majority of Democrats in the Assembly.

I was rather amazed when Senator Pan said at the Assembly Health Committee hearing (with a straight face) that “Thimerosal has been studied and found to be safe.” Even though this is a side issue, as thimerosal has been largely removed from vaccines and aluminum and other adjuvants are currently of greater concern, I wanted to examine the science on this and was stunned to see that in a sense Pan does have a leg to stand on. Remarkably, the CDC claims that thimerosal is safe, despite dozens of studies in the peer-reviewed medical literature demostrating its toxicity. This excellent journal article from 2014 explains why the CDC makes this claim and is another great example of why the CDC, unfortunately, can not be trusted due to its many conflicts in interest: http://www.hindawi.com/journals/bmri/2014/247218/

Below is a letter that I co-wrote with some other doctors who oppose SB 277 and SB 792, a bill mandating vaccination for all workers in all private and public school early childhood education programs (Headstart, Private preK and preschools), family daycares and daycare centers) addressed to our State Assemblymen:

Dear California Elected Officials,

I write to you as a member of a coalition of Medical Doctors who believe in Medical Freedom, which is why we are joining to oppose SB 277 & SB792. We operate under the American Medical Association Code of ethics that states: “the patient should make his or her own determination about treatment… Informed consent is a basic policy in both ethics and law that physicians must honor…” The mandatory vaccine interventions being proposed in this legislation violates our code of ethics as medical professionals.

Furthermore, we are not in a current state of epidemic. The Disneyland Measles outbreak affected only 24 out of the 6.7 million school-aged children in California. This equates to just 18% of the total 134 cases of measles. The outbreak was not centered in schools and there was not a single documented transmission of the disease in a school setting. The majority of cases occurred near the epicenter and where measles spread to communities removed from the epicenter it was well contained with a small handful of cases per county. On April 17, 2015 the measles outbreak was declared over and did not result in any deaths. Does mandating 10 different vaccines for every child attending public school in response to this minor outbreak seem justified?

There is no current nor forseeable public health crisis related to vaccine-preventable diseases. Currently about 2.5% of students entering kindergarden have parents who filed a Personal Belief Exemption (PBE) . This number has steadily declined since the introduction of AB2109 just last year. Most of those who file a PBE are partially vaccinated but have parents who opt out of particular vaccines such as the Hepatitis B vaccine that have little scientific justification. OUR CURRENT SYSTEM IS WORKING and there is no public health rationale for the draconian measure of mandating vaccines.

Vaccination does not come without risk. Every year, almost 4000 severe reactions are reported to the Vaccine Adverse Reporting System (VAERS), which result in prolonged hospitalization, permanent disability, or death. Since VAERS is a passive reporting system, many reactions aren’t even reported. The FDA says that as few as 1% of serious adverse reactions are reported while the CDC and American Association of Physicians and Surgeons both state that about 10% of serious adverse reactions after vaccination are reported. It is clear that there are tens of thousands of serious adverse reactions to vaccines each year. The Supreme Court has ruled that vaccines are “unavoidably unsafe.” Over 3 billion dollars have been paid out to victims of vaccine reactions while many others who have suffered serious reactions have been denied compensation by the poorly-designed and run Vaccine Court. Knowing this, how can we take away a parent’s right to choose in the absence of any real public health crisis?

The main argument by proponents of SB 277 is that it will protect those who can not be vaccinated because they are immunocompromised. However, a child who is immunocompromised is at substantially greater risk of becoming seriously ill from a classmate with a cold, flu or stomach virus than from vaccine-preventable diseases transmitted by a classmate who is not fully vaccinated. Thus, most children who are seriously immunocompromised stay home from school.

Even if one believes that the benefits of vaccines outweigh the risks (which, surprisingly, has NOT been scientifically proven), many of the vaccines mandated by SB 277 make absolutely no sense from a public health perspective. For example, tetanus is not a transmissable disease. The Hemophilus influenzae Type B (HiB) vaccine is only recommended by the CDC for children through the ages of 59 months. An excellent case can be made for the benefits of this vaccine in young children but there is no good reason to force a child entering elemetary or junior high school who has not received this vaccine to get it. However, a 12 year old who has not previously had the HiB vaccine will be forced to get it, risking serious adverse reactions for no significant benefit. Another required vaccine is for  Hepatitis B, which is only transmissable through blood contact such as sharing needles and certain unsafe sexual practices. There is no good reason to mandate this for entrance to elementary school.

Doctors take an oath to “First, do no harm.” It is our responsibility to protect the interest of our patients, first and foremost. The ethical principle of informed consent to medical risk taking must be respected, especially when the procedure has been legally classified as “unavoidably unsafe.” We should not take a “one size fits all” approach when we know some individuals are at greater biological risk than others for suffering vaccine reactions. Ultimately, medical decisions for children should be made between a parent and doctor.

This country was founded in the spirit of freedom. Let’s not allow fear motivate us to begin chipping away at our most basic freedom to choose what medical procedures are best for ourselves and our children. Please protect a parent’s right to choose, and oppose SB277 & SB792.

Sincerely, Randy Baker MD

Since I co-wrote this letter, much to my dismay and disappointment, on June 8th the AMA voted in favor of new policy that “recommends that states have in place an established decision mechanism that involves qualified public health physicians to determine which vaccines will be mandatory for admission to schools and other public venues. States should only grant exemptions to these mandated vaccines for medical reasons.”

Obviously I disagree with this policy that violates informed consent. I am not optimistic about the prospects of stopping SB 277 from passing, but if our representatives in the Assembly are inundated by calls, letters and faxes by constituents asking them to vote no perhaps they will reconsider.

For another well-written commentary please see http://www.smallfootprintfamily.com/why-vaccine-mandates-are-dangerous-to-democracy#ixzz3Wn8WaYTd

Addendum on 6/17/15:

The current Vaccine Schedule is set by the CDC and most doctors trust the CDC as an impartial authority that has the public’s best interest at heart. Unfortunately, while that is the way it once was as well as, of course, the way it should be, it is no longer the case.

Robert F. Kennedy Jr. recently said
“”There are four federal studies that have looked at CDC and said the vaccine program at CDC is a cesspool of corruption.”

On 5/15/15 one of the most respected medical journals in the world, the British Medical Journal, published a very important article which received scant media attention,
“Centers for Disease Control and Prevention: protecting the private good?”
by Jeanne Lenzer an associate editor of the Journal.
Quoting from this article:

“The Centers for Disease Control and Prevention (CDC) includes the following disclaimer with its recommendations: “CDC, our planners, and our content experts wish to disclose they have no financial interests or other relationships with the manufacturers of commercial products . . . CDC does not accept commercial support.”

The CDC’s image as an independent watchdog over the public health has given it enormous prestige, and its recommendations are occasionally enforced by law.

Despite the agency’s disclaimer, the CDC does receive millions of dollars in industry gifts and funding, both directly and indirectly, and several recent CDC actions and recommendations have raised questions about the science it cites, the clinical guidelines it promotes, and the money it is taking.”

For the full article see http://cfstreatment.blogspot.com/2015/05/conflict-of-interest-cdc-accepts.html

Measles Hysteria and California SB 277

We live in a polarized nation with major schisms of Democrat vs. Republican, religious vs. secular, pro-life vs. pro-choice, believers in mainstream medicine vs. adherents of alternative medicine, those who trust our government and authority vs. those who question our government and authority, etc. The current widespread debate about vaccination is a near-perfect storm that brings many of these into collision, igniting strong feelings, anger and fear in many quarters.

People have passionate views on this subject. Many of those who are “pro-vaccination” seem to believe the “anti-vaxers” are paranoid conspiracy theorists who are unaware that Dr. Andrew Wakefield’s research has been (supposedly) debunked (as if that is the entire body of science that questions vaccine safety) and who base their beliefs on the teachings of Jenny McCarthy; after all, how can a former Playboy Bunny who gets most of her information from the internet possibly have anything valid to say about vaccine hazards? (it is nearly impossible to find an article critical of “anti-vaxers” that does not mention Jenny McCarthy).
Most proponents of vaccination and SB 277 appear to have an attitude of smug arrogance as they believe that science is on their side and that it has been firmly proven that vaccines are “safe and effective.” They generally believe those those who question vaccine safety are emotional and “anti-science.” (for a wonderful article that explores the complexities and sublteties of the modern scientific process, both in general and with regards to vaccines, I highly recommend 
http://thinkingmomsrevolution.com/anti-science-you-keep-using-that-word-i-do-not-think-it-means-what-you-think-it-means/ ).

Some people believe this issue is so black and white that any doctor who questions vaccine safety and efficacy should have his or her medical license taken away. In reality, studies have found that those who question the safety and efficacy of vaccines as a group have a higher level of education and income than those who champion vaccination and these “vaccine-skeptics” include many thousands of well-credentialed doctors and researchers.

Vaccine skeptics tend to see the pro-vax community as mindless people who do not question authority and have been gullible enough to believe the narrative of government officials and the fear-mongering mainstream media which is unduly influenced by Big Pharma, which stands to profit handsomely from more widespread vaccination. Of course those who are pro-vaccine are genuinely afraid and concerned for the health and well-being of themselves and their loved ones and see people who do not
vaccinate as directly threatening their safety. Thus, many in the pro-camp are calling for mandatory vaccinations, which has the “anti-vax” camp extremely fearful of the prospect of being forced to have something toxic and hazardous administered against their will.    
No wonder people are so upset!

In the midst of all of this polarizing conflict I would like to take this opportunity to look at the actual facts and examine both what is known and not known about this issue. I am going to focus on what we know for sure, and one thing I know for sure is that not all vaccines are created equal. While many in both camps may see all vaccines as good or bad, the reality is that each vaccine has its own unique sets of risks and benefits, so I going to focus a great deal upon the MMR vaccine and on Measles, as this is the current focus of people’s concerns.

Before delving into this topic I want to briefly review my background and
qualifications. I earned my undergraduate degree in Biology at Stanford University.
I studied Biology because I am fascinated by biochemistry, physiology and
understanding how our bodies work.
I then attended medical school at the University of Michigan where I also completed my residency in Family Medicine. While mainstream Western medicine is often miraculous, it has very few cures to offer for most chronic disease, instead treating superficially and symptomatically with expensive and often-hazardous pharmaceuticals. I thus studied nutrition, herbal medicine, mind-body medicine, homeopathy and other complementary therapies which I integrate with conventional therapies as appropriate. I was a founding diplomate of the American Board of Integrative Holistic Medicine in 2000. I have had a solo family practice in Soquel, CA since 1988. I do not consider my self pro or anti-vaccination but, as mentioned, I look at the potential risks and benefits of each vaccine as well as the health of
the potential recipient. Because these issues are so charged and controversial I encourage my patients to study the research and be involved making in these decisions.

Currently 20 states allow for exemptions from vaccination based on personal beliefs or philosophy, while 48 states allow exemptions based upon religion. Shortly after the “measles outbreak” that started at Disneyland in December 2014 legislation was introduced in several states including California, Illinois, Maine, Maryland, North Carolina, Oregon, Texas, Vermont and Washington to eliminate exemptions based on personal beliefs and, in some cases, religious beliefs. As of 4/17/15 this legislation has already been withdrawn in Maryland, North Carolina, Oregon and Washington after encountering public opposition.

Currently the California State Assembly is considering SB 277, a bill that requires ALL children, even if they are home-schooled (with very rare exceptions) be FORCED to receive vaccines for
“(1) Diphtheria.
(2) Hepatitis B.
(3) Haemophilus influenzae type b.
(4) Measles.
(5) Mumps.
(6) Pertussis (whooping cough).
(7) Poliomyelitis.
(8) Rubella.
(9) Tetanus.
(10) Varicella (chickenpox).
(11) Any other disease deemed appropriate by the department, taking into consideration the recommendations of the Advisory Committee on Immunization Practices of the United States Department of Health and Human Services, the American Academy of Pediatrics, and the American Academy of Family Physicians.”

(for the complete text of SB 277 see http://tinyurl.com/n7w7h7p )

The current personal belief and religious exemptions would be removed. The only exemptions allowed would be medical exemptions (more on these below).

SB 277 was recently approved by the California State Senate after being approved by the Health, Education and Judicial Committees despite many hundreds of concerned citizens who came to the hearings to ask the Senators to oppose it (those who attended to oppose it dramatically outnumbed those who expressed support).

(On a personal note, I have been a life-long liberal Democrat. To the dismay of myself and many others who oppose this bill, it is the Democrats who are strongly pushing SB 277 and the Republicans who are questioning its wisdom.)

Our local State Senator, Bill Monning, played a key role in the passage throught the Senate because he sat on all 3 committees that approved it. I am among Senator Monning’s many local constituents who requested to meet with him to discuss this important bill. To the great disappointment of many in our community, Senator Monning refused to personally meet with any of his constituents about this issue despite many pleas to listen to our views.

As Senator Monning is my district’s representative, I wrote him a letter before the 4/8 vote summarizing why I feel SB 277 would be a huge mistake. I am sharing that letter here:

Dear Senator Monning,

I am writing to express my concerns about SB 277 as a Family Physician who has practiced in California since 1984. I am a graduate of Stanford University (where I earned a degree in Biology) and the University of Michigan Medical School, where I also completed my residency in Family Medicine.

As most members of the Senate Health Committee probably already know, in 1970 the normal childhood vaccination schedule included 23 doses of 7 vaccines. There are currently 68 doses of 16 vaccines recommended by age 18 (35 of which are given in the first 18 months). There are currently nearly 300 new vaccines in development. If Senate Bill 277 passes, we are agreeing to not only to most of the current schedule without any adjustments, but we are also agreeing to force children to take any future vaccines that are introduced to the schedule and “deemed appropriate by the department” without giving parents or doctors the option to choose.

A central tenet of SB277 is the elimination of all exemptions from any vaccination on the state’s prescribed schedule except for “medical reasons.” These medical reasons are not further defined in the bill as currently written, but the CDC contraindications for vaccines, which many doctors would likely use as guidelines for issuing medical exemptions, are extremely restrictive. I believe that doctors will feel quite constrained in their abilities to approve medical exemptions, so virtually all school-aged children and those in daycare will be forced to comply. Conscientious doctors who believe that some of their patients might benefit from an altered vaccination schedule, beyond the narrow contraindications in the CDC’s “Pink Book,” will either feel they can not grant exemptions or might very well come under attack for deviating from “standards of care”. This troubles me deeply.

One of the primary tenets of medical ethics is voluntary informed consent. Quoting the American Medical Association, “Informed consent is a basic policy in both ethics and law that physicians must honor, unless the patient is unconscious or otherwise incapable of consenting and harm from failure to treat is imminent.” This means explaining to a patient the risks and benefits of any medication or procedure before administering it,
especially when the risks include serious injury or death, and then allowing the patient a choice whether to receive the treatment.

Every medication has inherent risks. Anyone with online access can quickly find a list of 20-30 common and/or serious potential reactions to any vaccine, including in the manufacturers’ own product information pamphlets. The adverse reactions listed tend to be only those that are obvious within a few days of vaccination (generally only reactions obvious within 4 days) and the frequency of serious long-term effects such as autoimmune diseases are unknown. There are, of course, also risks with any illness so it is also important to educate people about those as well. When I meet with patients, we discuss, for example, the hazards of high blood sugar or obesity or measles and then discuss the risks and benefits of various treatments. Then I allow my patients to choose whether a particular treatment or medication is right for them. SB 277 TAKES AWAY INFORMED CONSENT. I find this an outrageous assault on personal liberty, and it is deeply disturbing to me that, due to this legislative action, I will be prevented from helping a parent make an educated, informed, and appropriate decision for one of my patients.

The reason given by proponents of this bill is that those who do not get vaccinated are endangering others, but over 90% of children in California are fully vaccinated and most of the rest are partly vaccinated. Only 3% of children have parents that file the personal belief exemptions that this bill outlaws. Unfortunately, vaccines are not universally effective. For example, up to 15% of those who are fully vaccinated for measles are not immune to it, and some of the 3-5% of children who have not gotten measles vaccines are likely immune because those who have not been vaccinated may catch the vaccine version of the virus from their friends and become immune (while it has been documented that some children can shed the attenuated measles virus in the MMR, it is not known how commonly this occurs). The 5-15% who have been vaccinated but are not immune are a greater risk of spreading measles than the unvaccinated, since they outnumber those who are unvaccinated. Even fully vaccinating everyone will probably not wipe out measles and many other diseases such as whooping cough due to limitations of the effectiveness of vaccines (there have been documented measles outbreaks in populations that are 99% vaccinated).

As for the measles outbreak that apparently precipitated SB 277, as of 3/27/15, in a nation of over 300 million people there have been 178 cases of measles (120 in California), with 74% related to the Disneyland case. Less than half of those infected are known to have not been vaccinated (see http://www.cdc.gov/measles/cases-outbreaks.html). Not one single person has died; in fact there have been no confirmed deaths from measles in the US since 2003.

As a medical doctor I have additional concerns. Every disease is different and every medication is different. Thus, each vaccine has a unique set of risks and benefits so it makes little sense to mandate all 10 that are mandated in SB 277. For example, the Hepatitis B Vaccine is typically given during the first day of life. However, a young child can only contract Hepatitis B from IV drug abuse, sexual activity with an infected partner, a blood transfusion using contaminated blood (and all blood is first screened) or from its mother. Thus, the only significant risk is if the mother has Hepatitis B infection. If a mother has been screened for this (as most mothers have), there is NO rational reason to expose a newborn to this vaccine, which is not without risk (see pages 5-7 for a lengthy list of adverse reactions from the official package insert:
https://www.gsksource.com/pharma/content/dam/GlaxoSmithKline/US/en/Prescribing_Information/Engerix-B/pdf/ENGERIX-B.PDF
Many studies in the peer-reviewed medical literature have documented that receiving the Hepatitis B vaccine is associated with increased risk of an autoimmune disorder similar to Multiple Sclerosis as well as arthritis and other serious hazards ( see
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4266455/ and
http://www.ncbi.nlm.nih.gov/pubmed/11164115 and
http://shoemakerassociates.com/documents/girard-autoimmiunehazardsofhepbvaccine.pdf).

The CDC states “There is no confirmed evidence which indicates that hepatitis B vaccine can cause chronic illnesses.” I believe the studies I just cited are “confirmed evidence” of this and this is evidence why the CDC, unfortunately, can not always be trusted. Quoting French vaccine researcher Dr. Marc Girard “hepatitis B vaccine is remarkable for the frequency, variety and severity of complications from its use. The toxicity of this vaccine is so unusual that, even if crucial data are regrettably concealed or covered by Court order, scientific evidence is already far higher than normally needed to justify severe restrictive measures.“
The objectivity of the CDC in these matters has been questioned by many including US Congressman Bill Posey who criticizes “the incestuous relationship between the public health community, vaccine makers, and public officials” including the CDC (see http://nsnbc.me/2014/04/17/congressman-blasts-cdc-incestuous-relationships-vaccine-makers/ ). Mandating that all newborns receive the Hepatitis B vaccine, even when their mother is proven to not have Hepatitis B, makes absolutely no sense from a public health perspective. I can think of no rational reason to mandate this vaccine (other than to increase the profits of Merck and GlazoSmithKline).

As for the side effects of vaccines, while a medication may be safe for most, I am not aware of a single medicine, herb or supplement that is safe for everyone. For example, penicillin clearly saves lives and is safe and well-tolerated by most, but many also have life-threatening reactions so it would be unwise to mandate that everyone who has an infection must get penicillin. While some would counter that medical exemptions are allowed, it is likely one could only obtain a medical exemption for someone who has
already had a severe reaction. While a reaction to penicillin will not have long-term consequences (if one survives the acute reaction), reactions to vaccines can result in life-long disabilities.

One of the many things that can contribute to the toxicity of vaccines is that many of them contain aluminum as an adjuvant (including 5 of the 10 currently mandated by SB 277). Quoting from “Aluminum Vaccine Adjuvants: Are They Safe?” by Dr. Lucija Tomljenovic and Dr. Chris Shaw, a Neuroscientist and professor at the University of British Columbia, “Aluminum is an experimentally demonstrated neurotoxin and the most commonly used vaccine adjuvant. Despite almost 90 years of widespread use of aluminum adjuvants, medical science’s understanding about their mechanisms of action is still remarkably poor. There is also a concerning scarcity of data on toxicology and pharmacokinetics of these compounds. In spite of this, the notion that aluminum in vaccines is safe appears to be widely accepted. Experimental research, however, clearly shows that aluminum adjuvants have a potential to induce serious immunological disorders in humans. In particular, aluminum in adjuvant form carries a risk for autoimmunity, long-term brain inflammation and associated neurological complications and may thus have profound and widespread adverse health consequences. In our opinion, the possibility that vaccine benefits may have been overrated and the risk of potential adverse effects underestimated, has not been rigorously evaluated in the medical and scientific community. (see http://www.ncbi.nlm.nih.gov/pubmed/21568886 ).
One of the reasons I mention this is that the toxic effects of aluminum do not manifest within the 4 days after vaccination during which adverse reactions to vaccines are typically studied.

Another concern about vaccine safety is that, just as two medications can be reasonably safe when given individually, they may have serious and even fatal interactions when given together. There have been NO research studies on the safety of the current schedule of 16 different vaccines. There have been NO studies comparing the health of vaccinated vs. unvaccinated populations, so there is no research proving that there is a benefit to the current schedule. Clearly, most authorities and doctors, as well as the authors of this bill, simply assume that the vaccination schedule is beneficial but this should not be mandated for everyone without clear unequivocal scientific evidence, and this is, unfortunately,
completely lacking. While vaccination almost certainly has reduced the incidence of many serious infections, many highly-credentialed scientists and researchers believe that there is strong evidence that vaccines increase the incidence of a variety of chronic autoimmune diseases.

In 2011, the U.S. Supreme Court ruled that vaccines are “unavoidably unsafe.”
(Bruesewitz v. Wyeth LLC131 S. Ct. 1068, 179 L.Ed.2d 1)

Another important consideration that is often overlooked is that naturally acquiring certain infections such as measles may result in significant long-term benefits to immune function and thus health. There are several studies in the peer-reviewed medical literature showing that adults who had measles in childhood have significantly lower rates of several common forms of cancer than those who did not have measles (see
http://thinktwice.com/Measles_and_Cancer.pdf ).
While there is an approximately 1 in 7000 risk of death in those who get measles, of the 7000 who do not get measles due to getting the MMR vaccine, there might be literally hundreds of cases of cancer that they would not have gotten if they had gotten measles instead of the vaccine.

I am not saying that vaccines do more harm than good. Clearly most who have been fully vaccinated enjoy good health. However, there is no denying that a significant number of children have had serious disabling and even fatal adverse reactions to certain vaccines. Until there is a quality study comparing the health of vaccinated to unvaccinated populations, it is impossible to know for certain if the benefits of vaccination outweigh the risks. And since we can not yet be certain that the current vaccine schedule ultimately improves the health of our population, it is premature to mandate it for those who would prefer to be cautious and exercise their rights to decide whether they or their children should do a particular medical treatment that has known risks.

Thus, I can find very little scientific rationale for mandating universal vaccination. There is no current imminent (or foreseeable) threat to public health drastic enough to warrant such a draconian, intrusive law that is such an extreme violation of individual liberty and informed medical choice. The state legislature enacted AB2109 very recently to encourage more conversation between doctors and parents who wish to have their children on an adjusted vaccination schedule or to forgo some vaccinations. This type of law has been effective in other states at reducing exemption rates, and it appears to be working in California as well. Doctors can be very persuasive with parents, and we are also able to note differences in individual situations that can’t be accommodated by a forced, one-size-fits-all mandated vaccination schedule.

Please drop this proposed bill, as states like Washington, Oregon, Maryland and North Carolina have recently done, and please focus on other ways to achieve the public health goals that do not infringe upon the relationship between doctor and patient. A better approach would be one that focuses on education and encouragement (as the federal government recommends in its National Adult Immunization Plan), particularly targeting areas of concern that parents have regarding vaccine safety.
Lobbying the federal government to fund more scientific work to better understand why some children experience serious adverse effects from vaccines could be an excellent long-term component of such an “educate and encourage” approach, as well as conducting overdue research on the long-term health outcomes of vaccinated vs. unvaccinated populations. Gathering better data about our actual public health situation is important before considering any change in vaccination legislation.

While there is a great deal of misinformation and inflammatory rhetoric on both sides of this heated issue, I believe every statement I have made is both factual and verifiable. Thank you for considering my perspective. I would be happy to speak or correspond with any members of the Health Committee about any of these points.

Sincerely,
Randy Baker M.D.
Soquel, CA 95073

As you can see, I covered quite a bit of ground in my letter but there are a few more points I wish to make and a few articles I wish to share for any of you readers who have been interested enough to read this far (and if you are among those, I appreciate your time and interest!).

One of my first thoughts when I learned about this bill is that some people believe vaccines are safe and effective while some question this. Those who support this bill obviously believe vaccines are safe and effective. If this is the case, why are they so concerned that a small percentage of their children’s classmates are not fully vaccinated? If they believe vaccines are effective, then they should have faith that their fully-vaccinated children are fully protected from any exposures they might get from unvaccinated classmates.
However, Dr. Pan and other proponents say they are concerned about immunocompromised children, such as those who are receiving chemotherapy for cancer and who are thus unable to be immunized and who might have serious illness if they got an illness such as measles. However, such immunocompromised children are far more at risk from getting common viruses like cold and flu viruses that their fully-vaccinated classmates often get. Typically children who are significantly immunocompromised do not attend classes at their public schools and the schools provide teachers who visit them at home. This is wise, as immunocompromised children are more likely to be exposed to live vaccine viruses shed by classmates recently immunized with the MMR or varicella or live influenza vaccine than a classmate ill with “wild measles.”
As an interesting aside, there is research being done showing that modified versions of the measles virus can be very effective in treating certain forms of cancer! See
http://www.mayoclinic.org/medical-professionals/clinical-updates/neurosciences/update-measles-virus-novel-therapy-glioblastoma

If SB 277 passes, children will be required to get a large number of vaccines in a relatively short amount of time as advised by the CDC’s “catch-up schedule,” the safety of which has not been studied.

Even if one agrees that it is wise to vaccinate children for infectious diseases, some of the requirements of SB 277 make no sense. For example, all children would be required to be immunized for Haemophilus influenza Type B (Hib), even though the Advisory Committee on Immunization Practices does not recommend routine Hib vaccination of healthy children 59 months of age or older, even if they have no prior history of Hib vaccination. So why does SB 277 mandate this?

Update: on the afternoon of 4/17/15 some anti-SB 277 constituents had an opportunity to briefly chat with Senator Monning at a reception at his office. One reported that he said something to the effect that “the needs of the few are outweighed by the needs of the many.” Even if one agrees with this, one can say that the vast majority of the population that wants the protection of vaccines are fully vaccinated and thus not significantly threatened by the 8% or less who are not fully vaccinated. So if one considers the needs of those who can not be vaccinated because they are immunocompromised, those few are FAR outnumbered by those whose parents would rather decline full vaccination. So the needs of the few who can’t be vaccinated should be outweighed by the needs of the (relative) many who do not want to be vaccinated.

In my letter I mentioned evidence that getting actual measles as a child reduces risks of adults getting several types of cancer. There is also evidence that getting measles can prevent lifelong allergies:

http://www.ncbi.nlm.nih.gov/pubmed/19255001
Info on Measles and how much of a threat it really is:
http://tinyurl.com/kvgbw5j

A good review of the research on how effective (and ineffective) the MMR vaccine is:
http://tinyurl.com/n9rtnj4

An Open Letter to Legislators Currently Considering Vaccine Legislation from Tetyana Obukhanych, PhD in Immunology:
http://thinkingmomsrevolution.com/an-open-letter-to-legislators-currently-considering-vaccine-legislation-from-tetyana-obukhanych-phd-in-immunology/

It has been interesting to observe media coverage of SB 277 and those who are opposing it. Major papers like the Los Angeles Times, San Jose Mercury News and Sacramento Bee have run editorials and opinion pieces in favor of SB 277, which invariably mention scientifically-proven safe vaccines and emotional opponents who are “science-deniers” such as this quote from an editorial by the Sacramento Bee urging the passage of SB 277: “It simply makes it harder for a vocal, misinformed minority of science deniers to endanger the health of the majority’s children.” (see
http://www.sacbee.com/opinion/editorials/article18729762.html#storylink=cpy )
I was honestly surprised that no one at these papers seems concerned about how obtrusive this bill is but this excellent article may explain why there is such uniformly biased coverage in the mainstream media. This article explains why this issue is symptomatic of the insidious corporate takeover of American politics:

http://themomstreetjournal.com/2015/04/15/does-big-pharma-own-america/

Some additional commentary on the politics of this debate and how this could even lead down the slippery slope of a totalitarian state; at first that may sound extreme but is a country where people are forced to have toxic chemicals and biological agents injected into them against their will a free country?

http://www.theblaze.com/contributions/so-should-we-just-round-up-the-anti-vaccine-parents-and-ship-them-to-guantanamo/

http://vaccineimpact.com/2015/dr-lee-hieb-m-d-vaccine-hysteria-could-spark-totalitarian-nightmare/

 

Thanks for reading!
PLEASE feel free to share this essay with anyone who you believe would be interested…
Those who want to read my overview about the Vaccine Debate written in 2012 can visit
https://drrandybaker.com/2012/05/04/the-vaccination-debate-7/

Randy Baker MD 4/17/15t

Multivitamins are NOT a “waste of money”! Beware of flawed studies and biased conclusions!!!

Multivitamins are in the news again with the publication of 3 studies in the 12/17/13 issue of the Annals of Internal Medicine purporting to show that multivitamins do not prevent cognitive decline in men, do not reduce risk of heart disease in those who already have it and do not prevent heart disease and cancer, along with an accompanying editorial. These articles were reported on with headlines like “New Study: Daily Multivitamins, Supplements ‘A Waste Of Money.’” A sharply-worded editorial in the same issue titled
“Enough is enough: Stop Wasting Money on Vitamin and Mineral
Supplements,” stated “We believe that the case is closed — supplementing the diet of well-nourished adults with (most) mineral or vitamin supplements has no clear benefit and might even be harmful. These vitamins should not be used for chronic disease prevention. Enough is enough.”

However, as many researchers have stated, the case is FAR FROM CLOSED, in fact there is very good reason to believe, based on the preponderance of evidence, that it is wise for nearly every adult to take a good-quality multivitamin. This essay explains why.

Before doing so I would like to give some context.
I am a Family Practitioner certified by the American Board of Holistic Medicine who has been practicing for over 25 years in Soquel, CA. I have a special interest in nutrition and preventive medicine. In my spare time I volunteer on HealthTap, a website where people can ask questions of doctors. HealthTap gave me an award as the Top Family Physician in California in 2011 and Awarded me as the “Top Holistic Medical Practitioner” in the entire US in both the Winter and Summer of 2013. My fellow physicians on HealthTap have voted me to be the leading expert (among the 53,000+ physicians on HealthTap) in the U.S on Lyme Disease, Supplements, Herbal Supplements, Vitamin Deficiency, Vegetarian Diet and Vitamin C, as well as the 2nd leading expert on Vitamin D and Homeopathy. I invite readers here to visit me on HealthTap, where you can see my answers to hundreds of questions, at

https://www.healthtap.com/#experts/10003096/feed

While I enjoy participating on HealthTap, I was recently contacted by a fellow physician there who is quite upset that I still counsel people to take multivitamins despite the recent studies. I am thus writing this in response to him and the many others who have been fooled by the recent studies.

Before discussing the studies in the 12/17/13 Annals I want to discuss why it makes sense to take multivitamins. But one thing that I want to make very clear is, however beneficial vitamins may be, taking vitamins is never a good substitute for a healthy diet. It is always best to get our nutrients from food whenever possible. Given a choice between someone eating a healthy diet and taking no supplements and someone who eats an unhealthy diet (rich in junk food/fast food/GMO’s/sugar etc.) who takes hundreds of dollars of supplements I would say the person with no supplements but a healthy diet will likely experience far better health. But judicious use of supplements in addition to a healthy diet is the best choice for everyone.

One of the greatest reasons it is wise to take supplements is that most people do not have a particularly healthy diet. For example, there is a large body of evidence that eating Genetically Modified Food is unhealthy, but most of us eat it every day. The only way to be sure to avoid these hazardous “foods” is to eat only organic foods and only eat at restaurants that use only organic ingredients. I would estimate that less than 1% of the population does this (and, health-conscious as I am, I am not among that group). For a more detailed discussion of the hazards of eating GMO food see my essay “Why Eat Organic Food?’ at

https://drrandybaker.com/2013/04/22/organic-food-diet/

Those who say that vitamins are a waste of money seem to have the delusion that most people get adequate vitamins from their diets, so let’s examine the average American diet. The Standard American Diet (appropriately abbreviated SAD) is one of the main causes of our epidemics of obesity, cardiovascular disease, cancer, autoimmune disease and other chronic degenerative diseases. Some frightening facts about the Standard American Diet: Only 7% of calories consumed by Americans are from fruits and vegetables. Half of the vegetables are potatoes and half of those are chips and fries. 23% of the calories consumed by Americans are from white sugar and about 20% from white flour. (see
http://alaskaveg.org/SpookyFacts/SpookyFacts.pdf ).

Authorities have enumerated the DRI or Dietary Reference Intake levels for vitamins and minerals. This is similar to the RDA or Recommended Dietary Allowance. While many authorities feel that getting the DRI’s of nutrients is adequate for good health, it can be argued that they are far from perfect. The DRI’s are generally the level that will prevent an otherwise healthy person from having gross deficiency symptoms but do not apply to people who are ill, do not take into account the wide range of genetic variation of the population and do not reflect the amount of a nutrient that supplies optimal health. There are many cases where doses of vitamins and minerals far above the DRI’s have been shown to have therapeutic benefits. For a further discussion of DRI’s see

http://www.diet.com/g/dietary-reference-intakes

So, given that the DRI’s represent the minimum most people need for health, let’s look at how many Americans get the DRI’s of various nutrients from their diets.The source of this information is at

http://www.ars.usda.gov/Services/docs.htm?docid=11043

According to the US Dept. of Agriculture, only 24.9% of Americans get the DRI of Folate (which appears to lower risk of heart disease and cancer), only 14.1% get the DRI of Vit. E, 27.1% get the DRI of Calcium, 32% for Magnesium, 45.3 % for Vit A, 51.7 for Vit C, 58% for Zinc, 64.7% for B6, 65.7% for Iron, 69.3% for Copper, 70.1% for B12, 71.7 % for Vit B1. You can see the whole list at

http://www.ars.usda.gov/Services/docs.htm?docid=11043

In summary, over 2/3 of Americans are deficient in Folate, Vitamin E, Calcium & Magnesium and over 1/3 are deficient in Vitamins A, C and B6 as well as Zinc and Iron. Thus, these deficiencies are widespread and can have serious long-term consequences. Vitamin D deficiency, not measured by the USDA, is also extremely widespread, probably affecting most Americans who do not take at least 1000 iu/day in fall and winter months.

In 2002 the American Medical Association released a groundbreaking position paper published in the JAMA titled “Vitamins for Chronic Disease Prevention in Adults”
(http://jama.jamanetwork.com/article.aspx?articleid=195039)
Quoting from this review  “In the absence of specific predisposing conditions, a usual North American diet is sufficient to prevent overt vitamin deficiency diseases such as scurvy, pellagra, and beriberi. However, insufficient vitamin intake is apparently a cause of chronic diseases. Recent evidence has shown that suboptimal levels of vitamins, even well above those causing deficiency syndromes, are risk factors for chronic diseases such as cardiovascular disease, cancer, and osteoporosis. A large proportion of the general population is apparently at increased risk for this reason…

We recommend that all adults take one multivitamin daily. This practice is justified mainly by the known and suspected benefits of supplemental folate and vitamins B12, B6, and D in preventing cardiovascular disease, cancer, and osteoporosis and because multivitamins at that dose are safe and inexpensive.”

Now let’s examine the recent studies that lead some to conclude that multivitamins are “a waste of money.” Many of these conclusions are based on the Physician’s Health Study. This same study was in the news in Nov. of 2012 when it was claimed that this study showed multivitamins don’t prevent cardiovascular disease in men. The current conclusion from the same study is that multivitamins don’t prevent cognitive decline in men as they age.
I analyzed this same study in 11/12- see

https://drrandybaker.com/2012/11/11/vitamins-really-do-prevent-heart-disease-beware-of-bad-studies/

The criticisms I had then are the same I have now. The first thing to realize is that not all multivitamins are created equal. I will mostly quote much of my previous essay with a few minor changes.

It took quite a bit of searching to discover what the multivitamin used in this study was, as it is buried in the fine print. The multivitamin used was Centrum Silver. This is considered a perfectly adequate multivitamin by those with only cursory knowledge of nutrition, those who believe that the RDA is perfectly adequate, but for doctors who are knowledgeable about nutritional medicine it leaves a great deal to be desired.

Below is a list of the nutrients in the multivitamin used in this study:

Vitamin or Mineral Amount
Vitamin A (IU) 5000*
Vitamin C (mg) 60
Vitamin D (IU) 400
Vitamin E (IU) 45
Vitamin K (mcg) 10
Thiamin (mg) 1.5
Riboflavin (mg) 1.7
Niacin (mg) 20
Vitamin B6 (mg) 3
Folic Acid (mcg) 400
Vitamin B12 (mcg) 25
Biotin (mcg) 30
Pantothenic Acid (mg) 10
Calcium (mg) 200
Iron (mg) 4
Phosphorus (mg) 48
Iodine (mcg) 150
Magnesium (mg) 100
Zinc (mg) 15
Selenium (mcg) 20
Copper (mg) 2
Manganese (mg) 3.5
Chromium (mcg) 130
Molybdenum (mcg) 160
Chloride (mg) 72.6
Potassium (mg) 80
Boron (mcg) 150
Nickel (mcg) 5
Vanadium (mcg) 10

More detail as to the form of the vitamins/minerals and excipients is here: calcium carbonate, potassium chloride, dibasic calcium phosphate, magnesium oxide, ascorbic acid, microcrystalline cellulose, dl-alpha tocopheryl acetate, pregelatinized cornstarch and modified food starch.

Centrum Silver contains less than 2 percent of the following ingredients: acacia, ascorbyl palmitate, beta-carotene, bht, biotin, boric acid, calcium pantothenate, calcium stearate, cholecalciferol, chromium picolinate, citric acid, cornstarch, crospovidone, cupric sulfate and cyanocobalamin. More ingredients include FD&C blue no. 2 aluminum lake, FD&C red no. 40 aluminum lake and FD&C yellow no. 6 aluminum lake.

Further, Centrum Silver contains folic acid, gelatin, hydrogenated palm oil, hypromellose, lutein, lycopene, manganese sulfate, medium-chain triglycerides, niacinamide, nickelous sulfate, phytonadione, polyethylene glycol, polyvinyl alcohol, potassium iodide and pyridoxine hydrochloride. It also contains riboflavin, silicon dioxide, sodium ascorbate, sodium benzoate, sodium borate, sodium citrate, sodium metavanadate, sodium molybdate, sodium selenate, sorbic acid, sucrose, talc, thiamine mononitrate, titanium dioxide, tocopherols, tribasic calcium phosphate, vitamin A acetate and zinc oxide.

The amount of Vitamin C used in the study was 60 mg a day. I believe everyone should take a minimum of 500 mg twice a day to get the benefits of Vitamin C, and many people may need to take 5-10,000 mg a day in divided doses for optimal health. Taking a form of vitamin C known as  lypsospheric C is likely to be much more effective due to enhanced absorption, in which case 1,000 mg/day may be adequate for most. See http://www.livonlabs.com/
For more on the benefits of Vit C see

http://lpi.oregonstate.edu/infocenter/vitamins/vitaminC/  &

http://www.drpasswater.com/levy.htm

The 60 mg of Vitamin C used in this study likely has virtually no benefit in preventing heart disease (and no benefit in preventing cognitive decline).

Another key nutrient in preventing cardiovascular disease is Vitamin E. Everyone knows that cholesterol plays a role in heart disease. However, the role is a bit more complex than commonly thought. Cholesterol only causes problems if the wall of the arteries are damaged (via inflammation/oxidative stress in situations where Vitamin C levels are suboptimal) and if LDL cholesterol is oxidized, in which case the LDL will bind to or enter the arterial wall. Vitamin E prevents LDL cholesterol from being oxidized and also protects the arterial wall from oxidative stress.

This study used 45 IU of Vitamin E in the form of dl-alpha tocopherol, a synthetic form of Vit E that has been shown to be toxic in several previous research studies. Unlike synthetic E, which contains the synthetic chemical l-alpha tocopherol, natural E has only d-alpha
tocopherol as well as delta, beta and gamma tocopherols. Doses of 400-1200 units of natural E with mixed tocopherols have been proven to be highly effective in preventing heart disease. 45 units of synthetic E may do more harm than good! Taking only d-alpha tocopherol can lower our levels of gamma tocopherol which can have adverse health consequences, so even supplements with “natural E” that do not have mixed tocopherols may be harmful.

See http://www.healthy.net/scr/article.aspx?Id=557 for more on the research proving that Vit. E prevents heart disease.

Another key factor in the cause of heart disease (and preventing cognitive decline) is homocysteine, a toxic metabolite of the amino acid methionine. Vitamins B6, B12 and Folate have been shown to significantly lower homocysteine, reducing risk of both heart attack and stroke. The amount of B6 used in this study was a woefully inadequate 3 mg. A much more reasonable dose to reduce homocysteine is 25-50 mg. Many people may benefit even more from pyridoxal-5-phosphate, the activated form of B6. The form of B12 used in this study was 25 mcg of the cyanocobalamin form of B12. B12 is poorly absorbed by many, and cyanocobalamin is the least beneficial of the 3 common forms of B12. At least 1000 mcg of the methycobalamin form is advisable. While the 400 mcg dose of folic acid used is relatively reasonable, about one-half of the population has genetic difficulties converting folic acid to the active form, L-5-methyltetrahydrofolate (L-5-MTHF). There is also evidence that folic acid, a synthetic chemical, may increase risk of certain cancers including breast, prostate and colon. I thus advise taking at least 800 mcg of L-5-MTHF to prevent heart disease and stroke.

For more on homocysteine and heart health see

http://www.lef.org/protocols/heart_circulatory/homocysteine_reduction_01.htm

Vitamin D has also been shown to dramatically lower heart disease risk. A recent study done in Denmark involving more than 10,000 people found that those with the lowest levels of vitamin D experienced a 64 percent higher risk of heart attack, 57 percent higher risk of early death, 40 percent higher risk of ischemic heart disease and at least an 81 percent higher risk of death from heart disease. See

http://www.naturalnews.com/037372_vitamin_D_deficiency_cardiovascular_disease_risk.html

This study used the RDA of 400 IU of Vitamin D. However, to achieve optimal levels of  45-80 nanomoles per liter most adults need to take 5000-8000 IU/day of Vitamin D3.
It is also wise to take Vitamin K along with Vit. D for synergistic benefits.

Minerals can also be very helpful. Magnesium deficiency is extremely common and taking Magnesium has many proven benefits but Centrum Silver has only 100 mg of magnesium oxide, which is very poorly absorbed (approximately 4% absorbed). At least 200 mg of a well-absorbed form like taurate, citrate or glycinate would undoubtedly help more.

Selenium is also a useful antioxidant but the 20 mcg of sodium selenate is not nearly as beneficial as 100 mcg of selenium monomethionine might. 15 mg of zinc is reasonable but the zinc oxide form is, once again, relatively poorly absorbed compared to other forms of zinc.

Centrum silver also contains 4 mg of iron. This is, fortunately, a tiny amount, as iron is a pro-oxidant that is best avoided by all men and post-menopausal women as the evidence suggests that iron actually increases cardiovascular risk!

Added to the inadequacies of the quantities and forms of the nutrients in Centrum Silver, it also contains FD&C blue no. 2 aluminum lake, FD&C red no. 40 aluminum lake and FD&C yellow no. 6 aluminum lake, hydrogenated palm oil, polyethylene glycol, polyvinyl alcohol, sodium benzoate, pregelatinized cornstarch (undoubtedly of GMO origin), sucrose, talc and titanium dioxide, ingredients that I strongly recommend avoiding. Hydrogenated oils are among the greatest known risk factors for cardiovascular disease.
Aluminum in particular has been linked by many studies to Alzheimer’s disease. Giving a pill with 3 different aluminum-containing chemicals in an attempt to prevent cognitive decline is questionable at best!

As for the study “Oral High-Dose Multivitamins and Minerals After
Myocardial Infarction: A Randomized Trial” I have not yet learned the exact doses and vitamins used in this study but know that they gave only 100 iu of Vit D when, as discussed above, 5000 iu would be a much more reasonable dose. They also only gave 100 mcg of Vit B12, an inadequate dose for many due to its poor absorption. They also only gave the alpha tocopherol form of Vit E (I don’t know if it was natural or synthetic) and that is known to reduce levels of gamma tocopherol, which is probably more important in reducing cardiovascular disease. A study using mixed tocopherols would be more likely to show benefits.

Other flaws in this study include the fact that an astounding 46% of subjects discontinued the multivitamins during the study, making any conclusions questionable. Also, the group taking multivitamins had a higher rate of diabetes (which dramatically increases heart disease risk) than the control group, tending to bias the study against the treatment group.

In this study all subjects had already suffered a heart attack. They were only given vitamins for an average of 31 months (2 1/2 years). It is much easier to prevent than reverse heart disease and one might expect it would take a longer time to see clear benefits. Despite all of the above limitations, the group receiving vitamins had an 11% reduction in their primary endpoint (composite of time to death from any cause, heart attack, stroke, coronary revascularization or hospitalization for angina). This was not considered statistically significant but that may be a product of the size of the study and does not mean that multivitamins may not have been beneficial!

The third study in the 12/17 Annals was a review study titled “Vitamin and Mineral Supplements in the Primary Prevention of Cardiovascular Disease and Cancer: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force” which is available here:

http://annals.org/article.aspx?articleid=1767855

It concluded “Limited evidence supports any benefit from vitamin and mineral supplementation for the prevention of cancer or CVD. Two trials found a small, borderline-significant benefit from multivitamin supplements on cancer in men only and no effect on CVD.”
One of those 2 trials that found significant benefit for multivitamins preventing cancer is the same Physician’s Health Study using Centrum Silver that found little benefit in preventing cardiovascular disease and cognitive decline. That study showed an 8% reduction in cancer incidence and 12% reduction in cancer death after 11.2 years of follow-up. If there can be such good results using such a poor quality multivitamin I would expect much more impressive results with a good-quality multivitamin.

Another fine doctor who is also a friend and mentor, Alan Gaby, recently wrote an editorial in the Huffington Post commenting on the Annals editorial. His article is much more succinct than this one and he makes several good points that I have not because I want everyone reading this to read his fine article at

http://www.huffingtonpost.com/alan-r-gaby-md/vitamins-study_b_4481739.html

(PS in the few hours since I’ve posted this article WordPress tells me 75 people have read this post so far and only 1 of them has clicked on the link to Dr. Gaby’s article. It is REALLY worth taking a gander at it!)

Quoting Dr. Gaby “Multivitamin-mineral preparations have been shown in published research to have a wide range of benefits, including increasing energy and stress tolerance, improving pregnancy outcomes, decreasing infection rates, slowing bone loss, and improving cognitive function in schoolchildren. Some studies have also demonstrated protection against cardiovascular disease and cancer, although the evidence is conflicting. Furthermore, various individual nutrients or combinations of nutrients have been used successfully for the prevention and treatment of many other health conditions, including migraines, congestive heart failure, rheumatoid arthritis, kidney stones, diabetes, and depression.”

For another extensive critique of the Annals studies and editorial see http://bit.ly/18BeFJw
That article also discusses many studies that do show benefits of vitamin therapy.

A meta-analysis published in the Feb.-March 2013 issue of Psychosomatic Medicine, a peer-reviewed journal, titled “Effects of Vitamin and Mineral Supplementation on Stress, Mild Psychiatric Symptoms, and Mood in Nonclinical Samples: A Meta-Analysis” analyzed eight double-blind,placebo-controlled studies on the effects of multivitamins on aspects of mood in 1,292 men and women. Quoting http://bit.ly/1lu4AOU “When the research duo looked at trials that examined stress, supplemented subjects had a 65 percent lower risk of perceived stress compared to those that received a placebo. The analysis uncovered a 70 percent lower risk of mild psychiatric symptoms, a 68 percent lower risk of anxiety, a 73 percent reduction in experiencing fatigue and a 77.25 percent lower risk of confusion among supplemented participants. Happiness and decreased hostility levels were also likelier among supplement users in analyses of studies that analyzed these factors. Supplements that contained high doses of B vitamins tended to elicit greater benefits than those that had lower amounts.

“It is difficult to avoid the conclusion that the diets of the samples in the studies evaluated did not provide optimal nutrition,” the authors write. “The fact that there was a greater response to the supplements that offered doses higher than those suggested by RDAs calls into question whether RDAs or dietary reference values (DRVs) provide intakes that adequately meet the needs of the brain. The present findings also call into question the existing wisdom that, in industrialized societies, the consumption of diets containing sufficient energy and protein will naturally provide sufficient levels of micronutrients.”

“Multivitamin/mineral supplementation has a beneficial effect on many aspects of mood and mild psychiatric symptoms in healthy populations,” they conclude.

I find this study particularly significant because as a holistic practitioner it is clear that stress and anxiety are among the greatest and most common contributors to physical health problems, so any treatment that reduces stress and anxiety is certain to benefit our physical as well as our emotional health.

I could go on and on about the well-conducted studies that do show significant benefits of multivitamins but will limit myself to one more. This study,”Reduction in the Frequency of Arrhythmic Episodes in Patients with Paroxysmal Atrial Arrhythmia with a Vitamin/Essential Nutrient Supplementation Program,” was authored by Matthias Rath, M.D., Tatiana Kalinovsky, MSRN, and Aleksandra Niedzwiecki, Ph.D. and published in the Nov. 2005 issue of the peer-reviewed Journal of the American Nutraceutical Association. This double-blind placebo-controlled study showed very impressive reductions in cardiac arrhythmias in patients who took a multivitamin vs. a placebo. For a detailed report on this study see http://www4.dr-rath-foundation.org/pdf-files/arrhythmia_brochure.pdf

So is it reasonable to conclude that “the case is closed — supplementing the diet of well-nourished adults with (most) mineral or vitamin supplements has no clear benefit and might even be harmful. These vitamins should not be used for chronic disease prevention. Enough is enough.”?

I believe it is reasonable to conclude that incredibly inadequate/subtherapeutic doses of vitamins in poorly absorbed forms mixed with a variety of toxic excipients are mostly ineffective. I could have told you that before this study. It is also reasonable to conclude that the authors of the quoted editorial are either extremely misinformed and/or incredibly biased against supplements.
But, unfortunately, the message the general public is receiving is that “Vitamins are a waste of money” This is, as demonstrated, TOTALLY WRONG and I am concerned that the blind acceptance/uncritical reporting of studies like this will lead many people who are taking one of the many high quality multivitamins that do have reasonable doses and forms of these nutrients to stop taking them out of the mistaken belief that they have been shown to be ineffective. This would be tragic.

Addendum: If you have concluded that it is wise to take a multivitamin, you may wonder which one to take, as clearly some are MUCH better than others. There are many good choices and no single one is best for everyone. I advise looking for one that contains the L-5-MTHF form of folate as at least 40% of the population has difficulty converting folic acid to folate. I also advise choosing one that has the methylcobalamin or hydroxycobalamin forms of Vitamin B12 rather than the cyanocobalamin form. Ideally it should have relatively well-abosrbed forms of minerals. For example, if it has magnesium oxide I consider that a sign of a poor-quality vitamin, whereas if it has magnesium glycinate, taurate, malate, citrate or aspartate it is better quality. The best have natural Vitamin E with mixed tocopherols. I also like vitamins that have auxiliary nutrients such as Coenzyme Q10, Alpha Lipoic Acid, Lutein etc. I personally prefer capsules, are GMO-free and like those with minimal fillers, binders and excipients.
Some of my favorite multivitamins are UltraNutrient by Pure Encapsulations, Basic Nutrients (and other multivitamins) from Thorne Research and DFH Complete from Designs For Health.
Some protein powders such as UltraClear by Thorne also contain all the ingredients of a multivitamin combined with protein and other nutrients.

WHY EAT ORGANIC FOOD?

This essay is part of my ongoing series of essays on Diet and Health but I thought I would also give it its own section here so it does not get lost in the shuffle!

ORGANIC FOOD DIET

A common concern regarding diet is the importance of choosing organic food. While I am a strong supporter of organic food, it is significantly more expensive than conventional food. Also, if one eats at restaurants many of them do not have organic food (or only some of their food is organic). So a common question is “Is organic food really worth the extra expense? What is the risk of eating non-organic foods?” And, like everything related to the complex realm of diet and health, the answers are not black and white.

Many people question whether there are even any benefits to eating organic foods. Indeed, in Sept. of 2012 the media was awash with reports of a major study at Stanford University that claimed that organic food was not substantially different than factory-farm foods in terms of its nutritional content. These results are actually highly questionable (see below) but even if true, totally ignores the main reason most people originally have chosen organic foods, which is to minimize exposure to pesticides. These days, however, I feel there is a much more important reason to eat mostly organic foods, which is to avoid genetically modified (GMO) foods.

While natural substances like sulphur were used as pesticides since about 2500 BC, pretty much all food grown would have met modern organic standards until after World War II, when DDT use became widespread. In the 1960’s DDT was found to cause environmental havoc as it spread through the food chain and its use in the US was curtailed, but by then many other pesticides had come into widespread use.

Over 600 registered pesticides are in use in the US currently. In 2007 877 million pounds of pesticides were used in the US. Also, 150 million pounds of the toxic herbicide Round-Up are used annually in the US. Significant amounts of pesticide and herbicide residues are found in many non-organic foods.

Those who choose organic generally believe that organic foods contain no pesticides, except, perhaps, trace amounts that might have drifted from adjacent fields being sprayed. However, as my favorite nutrition blogger Denise Minger writes in her post The Lowdown on Organic Food,
unknown to most, organic farmers can and do often use pesticides- it is just that the pesticides they use are natural “organic” pesticides like pyrethrum and rotenone. Just because something is natural does not mean it is non-toxic- consider mercury, cyanide and death-cap mushrooms as natural substances that are harmful. Some of the natural pesticides used in growing organic foods can be more hazardous than many of the synthetic pesticides used, some of which break down rapidly and are gone by the time you eat the food!

See http://rawfoodsos.com/2010/04/30/the-lowdown-on-organic-foo/#more-175

Despite the findings of the “Stanford Study” ( “Are Organic Foods Safer or Healthier Than Conventional Alternatives?: A Systematic Review”, Crystal Smith-Spangler et. al. Annals of Internal Medicine, 9/4/2012, http://annals.org/article.aspx?articleid=1355685 ) that purported to find no significant difference in the nutritional content of organic vs. conventional foods, a similar large-scale review of the literature, “Agroecosystem management and nutritional quality of plant foods: The case of organic fruits and vegetables” by Kirsten Brandt et. al. published in Critical Reviews in Plant Sciences 4/29/11 ( http://www.ncl.ac.uk/afrd/research/publication/168871) found a significantly higher level of beneficial nutrients such as flavanols. Quoting from Lynne Peeples’s article “Stanford Organics Study: Have Faulty Methods, Political Motivations Threatened Kids’ Health?” (http://www.huffingtonpost.com/2012/09/13/stanford-organics-study-public-health_n_1880441.html) “Brandt wondered how the Stanford team, led by faculty from the School of Medicine and Center for Health Policy, could have found no difference in total flavanols between organic and conventional foods when her own results showed organics carried far more of the heart-healthy nutrient. Upon further inspection, she noticed that the team had actually calculated the difference in total flavonols, a different nutrient, and reported the result with the swap of an “o” for an “a”.

Many of the other nutrients Brandt analyzed and found to be greater in organics were also missing altogether from the new review, she noted. “The choices they made don’t seem to make sense — they seemed to include ones where the difference was smallest to begin with,” said Brandt. “I’d like to know why they chose these and not others that were just as well-described in the same papers they included.””
Quoting Ms. Peeples more, “Further obscured in the review…are organics’ more important selling points. Organic farming methods encourage soil and water conservation and reduce contamination of air, water, food and human bodies by avoiding antibiotics, hormones, synthetic pesticides and chemical fertilizers. Genetic engineering, under increased scrutiny by health experts, is also prohibited for organics.
While the researchers didn’t address many of these health concerns, they did note lower levels of pesticide residues and antibiotic-resistant bacteria in organic compared to conventional foods. But critics suggest that these points were glossed over or manipulated.
For example, the authors reported that organic produce had a 30 percent lower risk of pesticide contamination compared to conventional fruits and vegetables. Not included in the publicly-available abstract or press release was the fact that pesticide residues were found in 7 percent of organics and 38 percent of conventional foods. In relative terms, that’s a more impressive 81 percent difference.
“Come on, that’s simple math” ”
For more critiques of the Stanford Study see http://opinionator.blogs.nytimes.com/2012/10/02/that-flawed-stanford-study/ and http://www.motherjones.com/tom-philpott/2012/09/five-ways-stanford-study-underestimates-organic-food
Another fascinating though completely unrelated study, done as a 10th Grade Science project, gives strong evidence that an organic diet increases longevity: http://well.blogs.nytimes.com/2013/04/17/is-organic-better-ask-a-fruit-fly/

Another recent meta-analysis of 343 peer-reviewed studies by researchers at Newcastle University University in England published in Sept. of 2014 concluded “the concentrations of a range of antioxidants such as polyphenolics were found to be substantially higher in organic crops/crop-based foods, with those of phenolic acids, flavanones, stilbenes, flavones, flavonols and anthocyanins being an estimated 19%, 69%,28%,26%,50% and 51% higher, respectively. Many of these compounds have previously been linked to a reduced risk of chronic diseases, including CVD and neurodegenerative diseases and certain cancers…Additionally, the frequency of occurrence of pesticide residues was found to be four times higher in conventional crops, which also contained significantly higher concentrations of the toxic metal Cd (cadmium).”
See http://earthweareone.com/scientists-reviewed-343-studies-to-see-if-organic-food-is-better-for-you-heres-what-they-found-out-2/

The bottom line is that Organic Foods are more nutritious and have an 81% lower chance of having measurable pesticide residues and even when such residues are present are likely to have much fewer pesticides. Organic meats are less likely to harbor antibiotic-resistant bacteria. Organic farming is also, of course, much better for our environment and for the health of farmworkers.
Not all foods are equally prone to pesticide contamination. The Environmental Working Group has compiled a list of the “Dirty Dozen” foods with the highest level of pesticide contamination, as well as the “Clean Fifteen” that tend to have few if any residues. The worst of the Dirty Dozen are Apples, Strawberries, Grapes, Celery, Peaches & Spinach. The best are Onions, Pineapple, Avocado and Cabbage. For those who can not afford to eat exclusively organic (or for when one is eating at restaurants) this list can be a helpful guide. See http://www.ewg.org/foodnews/list.php

An excellent recent article on the science of how even tiny amounts of pesticide residues well below the levels considered “safe” by the EPA may still cause very serious health problems is “Stealth Attack” in the 10/12 issue of Psychology Today and also here: http://www.psychologytoday.com/articles/201208/stealth-attack

THE HAZARDS OF GENETICALLY-MODIFIED FOODS (GMO’S)

While I believe it is optimal to eat organically to avoid pesticide exposures both personally and for our planet, these days a far more compelling reason to choose organic produce is to avoid Genetically-Modified Foods, also known as GMO’s. GMO foods have permeated the American food supply. Over 80% of processed foods contain GMO’s. The most common GMO foods are corn, soy, sugar beets, canola & papaya- see http://www.nongmoproject.org/learn-more/what-is-gmo/
Most processed foods contain GMO corn, soy or canola oil- the corn and soy is often present as vegetable oil, high fructose corn syrup, corn starch, dextrose, soy sauce, lecithin etc.- even “natural flavoring.” Of great concern to me is that most animal-derived foods- meats, dairy and eggs, comes from animals fed GMO corn and soy. I don’t want to eat cheese from cows fed GMO corn or eggs from chickens fed GMO soy. I don’t care if a chicken is “All-Natural Free-Range Hormone & Antibiotic Free.” If it is not certified organic it has almost certainly been raised on a diet of GMO corn and/or soy! There is an old saying, “You are what you eat.” In the case of dairy, eggs and meats, you are also the food that what you eat eats! I don’t believe that an animal fed GMO corn and soy can possibly be healthy and I certainly don’t want to eat it (or its products like eggs and dairy).

Unfortunately, most restaurant food is cooked with GMO oils.
Thus, the only way to avoid GMO’s is to choose whole foods that are not yet genetically modified, choose foods such as corn, soy and papayas that are certified organic and choose processed foods that are organic or labelled as GMO-free and, besides wild fish, to only have meats, dairy & eggs that are certified organic.
So, given how much an effort it takes to avoid GMO’s, why should we make the effort? Let’s examine the most commonly eaten GMO food, corn. In his superb book, The Omnivore’s Dilemma, Michael Pollan discusses evidence that most of the carbon in our bodies ultimately comes from corn, either from eating corn directly, high fructose corn syrup, corn oil, or from eating dairy, eggs & meats fed on corn. The way corn is genetically modified is by inserting a gene from soil bacteria called Bt (Bacillus thuringiensis) that produces a chemical called Bt-toxin. Bt-toxin is a pesticide; when certain insects eat Bt-toxin it breaks open their stomachs and kills them.
Think about this- normally pesticides are sprayed onto plants. If we are lucky only traces of it remain and perhaps some of the residues can be washed off, but not in this case. Each ear of corn has been turned into a pesticide factory. Pesticides permeate the entire plant; there is no removing them. Thus, it would be nice if there was evidence that Bt toxin was safe for human consumption. Such evidence does not exist. Monsanto claimed that the Bt toxin would be completely destroyed by the human digestive system. However, research in 2011 found that Bt toxin can be found in the blood of 93% of pregnant women and in the umbilical cord blood of 80% of their babies.
Incredibly, there have not been any safety studies done on this powerful toxin that now permeates our food supply, but animal studies show it can trigger allergies and autoimmune disease. See http://articles.mercola.com/sites/articles/archive/2011/10/06/dangerous-toxins-from-gmo-foods.aspx for a more thorough discussion. A  recent study found that Bt toxin may cause anemia and be a cause of leukemia. See http://www.greenmedinfo.com/blog/new-study-links-gmo-food-leukemia

For more on the animal studies demonstrating the hazards of ingesting GMO’s see this position paper by the American Academy of Environmental Medicine see http://www.aaemonline.org/gmopost.html

and this recent assessment by the European Network of Scientists for Social and Environmental Responsibility: http://www.ensser.org/increasing-public-information/no-scientific-consensus-on-gmo-safety/

Here is an article from 9/24/14 by Thierry Vrain, a former research scientist for Agriculture Canada. Part of his job was to address public groups to assure them that GMO foods were safe. Quoting his essay, “I have in the last 10 years changed my position. I started paying attention to the flow of published studies coming from Europe, some from prestigious labs and published in prestigious scientific journals, that questioned the impact and safety of engineered food.

I refute the claims of the biotechnology companies that their engineered crops yield more, that they require less pesticide applications, that they have no impact on the environment and of course that they are safe to eat.”

http://earthweareone.com/former-pro-gmo-scientist-speaks-out-on-the-real-dangers-of-genetically-engineered-food/

Here is a link to the second edition of GMO Myths and Truths, co-authored by genetic engineers Dr John Fagan and Dr Michael Antoniou and researcher Claire Robinson, released on 19 May 2014 as a free online download by the sustainability and science policy platform Earth Open Source:

http://earthopensource.org/earth-open-source-reports/gmo-myths-and-truths-2nd-edition/

THE HAZARDS of ROUNDUP

The other main food source of GMO’s is soy, which  has been modified to be “Roundup Ready.” Other crops that have been genetically modified to be “Roundup Ready” include corn, sugarbeets and canola. Roundup is a powerful herbicide manufactured by Monsanto. GMO soy is modified so that huge amounts of Roundup, which would otherwise kill the plant, won’t affect it. However, the resultant crop contains large residues of Roundup. The “active ingredient” in Roundup, Glyphosate, has been shown to cause DNA damage, endocrine disruption and cell death at levels that are legal in our food (see http://www.motherearthnews.com/Sustainable-Farming/Roundup-Weed-Killer-Toxicity.aspx#axzz2REHtZpu6 ). There is also evidence that the glyphosate in Roundup kills much of our friendly gut flora which can create many adverse consequences- see http://www.naturalhealth365.com/dangerous_chemicals/roundup.html
Glyphosate is also dramatically reduces the mineral content of plants sprayed with it- see http://articles.mercola.com/sites/articles/archive/2011/12/10/dr-don-huber-interview-part-1.aspx
According to this review “Glyphosate’s Suppression of Cytochrome P450 Enzymes and Amino Acid Biosynthesis by the Gut Microbiome: Pathways to Modern Diseases” published 5/13 in the journal Entropy, Glyphosate disrupts Cytochrome P450 and the “Consequences are most of the diseases and conditions associated with a Western diet, which include gastrointestinal disorders,obesity, diabetes, heart disease, depression, autism, infertility, cancer and Alzheimer’s disease.” (see http://www.scribd.com/doc/136964468/New-GMO-Review-Links-Roundup-Glyphosate-to-Diabetes-Autism-Infertility-and-Cancer ). However, science is not black and white but often controversial, so I will also link this article that is highly critical of the aforementioned review: http://skeptoid.com/blog/2013/05/04/roundup-and-gut-bacteria/

Recent research shows that one of the “inactive ingredients,” POE-15, may be much more toxic than Glyphosate. See http://www.sott.net/article/260165-New-Study-Roundup-more-toxic-than-officially-declared

I recently learned that the VAST MAJORITY of conventionally-grown wheat (that is, virtually all wheat that is not certified organic) is drenched with Roundup to kill the wheat plants prior to harvesting! Thus, the huge number of people who have discovered that they feel worse when they eat wheat and attribute their problems to gluten sensitivity may actually be feeling worse due to the Roundup residues in conventional wheat! Based upon this I strongly advise not eating wheat products unless they are organic. See

http://www.thehealthyhomeeconomist.com/real-reason-for-toxic-wheat-its-not-gluten/

for more on this important concern.

SUMMING UP

There are NO research studies demonstrating that GMO foods are safe for humans to eat. ZERO. NONE AT ALL.

However, there are many quality studies on the effects of GMO foods on the health of animals that consume them. Quoting http://www.globalresearch.ca/potential-health-hazards-of-genetically-engineered-foods/8148, “independent studies showed stunted growth, impaired immune systems, bleeding stomachs, abnormal and potentially precancerous cell growth in the intestines, impaired blood cell development, misshaped cell structures in the liver, pancreas and testicles, altered gene expression and cell metabolism, liver and kidney lesions, partially atrophied livers, inflamed kidneys, less developed organs, reduced digestive enzymes, higher blood sugar, inflamed lung tissue, increased death rates and higher offspring mortality as well.”
Here is another well-written article on the hazards of GMO foods: “Why genetically engineered food is dangerous: New report by genetic engineers” : http://earthopensource.org/index.php/news/60-why-genetically-engineered-food-is-dangerous-new-report-by-genetic-engineers

61 countries including the European Union, Russia, China, Brazil and Australia require the labeling of GM foods (see http://www.centerforfoodsafety.org/issues/976/ge-food-labeling/international-labeling-laws)

In a March  2013 survey, 82% of the American public think GMO foods should be labeled while only 9% say they should not (http://www.huffingtonpost.com/2013/03/04/gmo-poll_n_2807595.html ). It would seem that in a democracy this wish would be honored, but Monsanto has an undue influence on government agencies through lobbying and having many of their former executives now put in charge of regulating Monsanto! See http://openyoureyessheeple.wordpress.com/2011/01/28/monsantos-government-ties/  
Given how unlikely it is that our leaders will respond to the   public’s desire for GMO labeling, the best hope is the action of individual states. However, in the November 2012 election, California State Proposition 37 to label GMO foods was narrowly defeated after Monsanto and companies that produce GMO-containing foods outspent proponents five to one with a very deceptive advertising campaign. Prior to the campaign 91% of Californians said they supported GMO labeling!  A similar proposition was narrowly defeated in Washington State in Nov. 2013 after another massive and deceptive advertising campaign by opponents. And another proposition was defeated 50.5% to 49.5% in Oregon in Nov. 2014. However, in April of 2014 the Vermont legislature passed the first law requiring GMO labeling, slated to take effect in 2016, though 4 national organizations have filed a lawsuit challenging the law as unconstitutional!

Unfortunately due to the current lack of labeling, the only way to avoid GMO exposure is to eat mostly organic!!!

Diet and Health

WHAT IS THE BEST DIET???

We are early into the new year. Among the most common New Year resolutions are those to lose weight and/or follow a healthier diet.
Indeed, it is my belief that the two most important factors that influence
our health are stress and diet. Hippocrates, the father of modern
medicine, famously said “Let food be your medicine, and medicine be your
food.”
It is of great interest and concern that even though Americans are among the most affluent societies and we spend more on health care than any other nation, the health of the American people is rather poor compared to other developed countries. A recent report by the Institute of Medicine and National Research Council titled “U.S. Health in International Perspective: Shorter Lives, Poorer Health” concluded “Although life expectancy and survival rates in the United States have improved dramatically over the past century, Americans live shorter lives and experience more injuries and illnesses than people in other high-income countries. The U.S. health disadvantage cannot be attributed solely to the adverse health status of racial or ethnic minorities or poor people: even highly advantaged
Americans are in worse health than their counterparts in other, “peer” countries.”
(see
http://www.nytimes.com/2013/01/10/health/americans-under-50-fare-poorly-on-health-measures-new-report-says.html?_r=3
and
http://sites.nationalacademies.org/DBASSE/CPOP/DBASSE_080393#deaths-from-all-causes )

This report examines many of the factors that contribute to this imbalance and concludes that high caloric intake and “high intake of saturated fats and inadequate intake of fresh produce and other healthy foods could explain a variety of diet-related non-communicable diseases that are more prevalent in the United States than in comparable countries.”
(http://www.nap.edu/openbook.php?record_id=13497&page=146)

There is a great deal of debate about which diet is the healthiest, but there should be no debate that the Standard American Diet (appropriately abbreviated SAD) is one of the main causes of our epidemics of obesity, cardiovascular disease, cancer, autoimmune disease and other chronic degenerative diseases. Some frightening facts about the Standard American Diet: Only 7% of calories consumed by Americans are from fruits and vegetables. Half of the vegetables are potatoes and half of those are chips and fries. 23% of the calories consumed by Americans are from white sugar and about 20% from white flour. (see http://alaskaveg.org/SpookyFacts/SpookyFacts.pdf ).

So one of the most important questions we can ask is “What is the best diet?”

I don’t think there is one single answer to this extremely important question. There is great variety in the human genome and the old saying “one man’s meat is another man’s poison” is quite true. But there are general principles that are reasonable for almost everyone to follow, which I will arrive at as this essay progresses.

PRINCIPLE #1:
There is no single “best diet” for everyone! Treat any claim that everyone should follow a specific diet with skepticism.

Obviously I am not the only person who has asked this question. There are
a huge number of diets out there and experts who advocate them. One of the biggest divides in recent decades has been the split between Low-Fat diet advocates (including Nathanial Pritikin, Dean Ornish and John McDougall) and the Low-Carb diet advocates (like Robert Atkins and more recently Gary Taubes). Other popular diets in recent times are the Paleo Diet, Vegetarian and Vegan Diets, Raw Food Diets, the Fat Flush Diet, the Body Ecology Diet, Alkalinizing Diets etc.
There are many people who have thrived on each of these diets. So how does someone looking to improve his or her health determine which diet is best for them? I will now examine the pros and cons of some of the main divides in the world of dietary debate:

LOW FAT VS. LOW CARB

In his book Good Calories, Bad Calories
(http://www.amazon.com/Good-Calories-Bad-Controversial-Science/dp/1400033462/ref=sr_1_1?s=books&ie=UTF8&qid=1357207041&sr=1-1&keywords=good+calories+bad+calories),
science writer Gary Taubes reviews the research on low-carb vs. low-fat
diets and makes an excellent case for the low carb school. His main point
is that carbohydrates induce the production of insulin and excess insulin
alters metabolism to cause obesity. A column by Mr. Taubes titled “What
Really Makes Us Fat” from the 7/1/12 New York Times is here:
http://www.nytimes.com/2012/07/01/opinion/sunday/what-really-makes-us-fat.html?_r=0
It is hard to dispute the evidence he cites that simple carbohydrates are
a primary cause of the epidemic of obesity. The average American gets
about 23% of calories from white flour and 20% of calories from refined
sugars and drinks over 600 12 oz. servings of soda each year! Undoubtedly this is a recipe for disaster, one that is evidenced by the epidemics of obesity and diabetes.
Another Low Carb crusader is Dr. Robert Lustig, author of the recent book
“Fat Chance”- see
http://www.sfgate.com/default/article/Dr-Robert-Lustig-crusades-against-sugar-4160268.php.
Dr. Lustig’s lecture on the hazards of sugar on youtube has been (at least
partially) viewed over 3 million times- it can be found at

But does this mean that the Low Fat diets (which tend to be relatively
high in carbs) are dangerous? A recent meta-analysis of 33 studies found
that low-fat diets help people to lose modest amounts of weight and lowers cholesterol and high blood pressure:
http://www.huffingtonpost.com/2012/12/07/low-fat-lose-weight-foods-diet-cholesterol_n_2253725.html
Dr. Dean Ornish found that an extremely low-fat diet, combined with
exercise and stress reduction, can dramatically reverse cardiovascular
disease. Here is Dr. John McDougall’s youtube presentation titled The Diet
Wars: http://www.youtube.com/watch?v=srkd-irmrC0

talking about this clash between low-fat & low-carb diet advocates. Here is an interesting and passionate article in which Dr. McDougall criticizes the “low-carb”
school, particularly the Paleo Diet (more about that later):
http://www.drmcdougall.com/misc/2012nl/jun/paleo2.htm
A very important consideration in this debate is that not all fats and
carbs are created equal. It is now widely understood that there are not
only bad fats (trans fatty acids, large chain saturated fats) but “good
fats” (essential omega 3 and 6 fatty acids). Likewise, there are good
carbs (complex carbohydrates, glyconutrients) and bad carbs (simple
sugars). The carbs found in white flour are very different than the carbs
found in dark leafy greens.
Another useful concept in this debate is that of the glycemic index- how
much a given food raises one’s blood sugar:
http://www.mendosa.com/gilists.htm. Thus, avoiding high glycemic foods is especially wise. However, if you eat a food with a glycemic index of 80
but at the same time have an equal amount of a food with a glycemic index of 10, the average for the meal is 45; it is advised to eat foods with a
glycemic index below 50. Thus, if one eats some simple starches with a
high glycemic index but at the same time has a high protein food with low
glycemic index it will be balanced and our body will not be affected
nearly as badly.
A new concept that looks to be even more valuable than the glycemic index is Carbohydrate Density. A concise discussion of this by Dr. Andrew Weil is at
http://www.huffingtonpost.com/andrew-weil-md/carbohydrates-weight-loss_b_1937312.html
and
http://www.drweil.com/drw/u/ART03415/Using-The-Carbohydrate-Density-Index.html
Bottom line: There is good evidence for health benefits of both a low-carb diet and a low-fat diet. What does not work is the high-carb/high-fat diet that is currently all-too-common. If someone is significantly overweight and/or diabetic a low-carb diet may be wise for weight loss, but one can also lose weight on a plant-based low-fat diet. If one has heart disease a low-fat diet may be the best choice. While a low-carb diet may be useful for weight loss, it may not be best for our overall health due to lack of phytonutrients from fruits and vegetables. Trying to sum this up:

PRINCIPLE #2:
Minimize simple sugars and starches, especially those with high
carbohydrate density/glycemic index.
When you do have these, have them in moderation with or after a balanced meal, never by themselves.
When eating fats emphasize “healthy fats.” Avoid hydrogenated oils/fried
foods and long-chain saturated fats.

WHAT ABOUT THE BLOOD TYPE DIET OR METABOLIC TYPING?
It is likely that some people will do better on low carb while others will
do better on low fat, based on their genetics. One popular subset of
dietary advice involves metabolic typing to help one determine which diet
is best. This concept was introduced by William Kelley DDS, a dentist who
pioneered proteolytic enzyme therapy for cancer. William Wolcott and
Harold Kristal DDS developed these concepts further, dividing people into
metabolic types based on whether their Autonomic Nervous System is
Sympathetic Type, Parasympathetic Type or Balanced and whether they are a Fast Oxidixer, Slow Oxidizer or Mixed Oxidizer, leading to 9 different
metabolic types (see https://www.metabolictypingonline.com/WhatItIs.aspx).
The concept is that each of these types needs an individualized diet and
supplement program. Popular health guru Joseph Mercola DO promotes a
simplified version of metabolic typing
( http://articles.mercola.com/sites/articles/archive/2003/02/26/metabolic-typing-part-three.aspx )
Another concept that has been popular in recent years is the Blood Type
Diet advocated by Peter D’Adamo ND in his book Eat Right For Your Type
(see http://www.dadamo.com/program_welcome2.htm )
Dr. D’Adamo feels that your blood type determines what diet is best for
you. Many practitioners recommend these diets and many people who have tried them feel they help. But what does the science say?
I have always been skeptical of the Blood Type diet- our bodies have
thousands of genes that can affect our metabolism and determine which diet is best for us; to base our entire diet on just one gene (the one that
determines our blood type) seems far too simplistic. Dr. D’Adamo claims
that 71-78% of those who followed his diet for a month or more and
responded to a questionnaire reported benefits. This is impressive, but
many of these people avoided specific foods like gluten and dairy that are
common allergens. Their improvement may have more to do with them avoiding common allergens that have nothing to do with their blood type. There is surprisingly little science to support the Blood Type diet. The best of several critiques I have read was written by a doctor I have tremendous
respect for, Michael Klaper MD:
http://www.earthsave.org/health/bloodtyp.htm
After reading his critique it is hard to put much stock in the Blood Type
diet.
Likewise, there is little science to support the validity of Dr. Wolcott’s
and Mercola’s Metabolic Typing. For a critique by Joel Fuhrman MD see
http://www.diseaseproof.com/archives/diet-myths-the-fallacy-of-the-metabolic-type-questionnaire.html
(and the interesting and passionate discussion that follows below his
article). Another critique is at
http://davekaiser.ca/the-metabolic-typing-diet-book-review/
The metabolic typing advocated by Wolcott does make more sense to me than the blood type diet but I am not aware of any research that validates it, which make it hard to advocate for.
Bottom line: There are significant genetic differences that mean that one
single type of diet is not appropriate for everyone, but we don’t yet have
proven methods to readily determine which diet is best for you.

PRINCIPLE #3: While no single diet is best for everyone, be wary of
schemes that claim to tell you which diet is best for you. Diet needs to
be individualized and is based somewhat on trial and error.

VEGETARIAN/VEGAN DIETS VS. OMNIVOROUS

This is one of the largest divides in the diet debate and the one people
are most passionate about- at least the Vegans and Vegetarians who feel it
is cruel to eat animals and/or animal products. While there are sound
moral, spiritual, environmental and sociopolitical arguments in favor of
vegetarianism, I will focus here on the health aspects of this diet.
A large body of research shows that there are many impressive health
benefits of a vegetarian diet. Vegetarians live longer. Seventh-Day
Adventist men who were vegetarian live 7.28 years longer than average and women live 4.42 years longer. Vegetarians have a 24% lower mortality from heart disease. Vegetarian diets also prevent hypertension, lower blood pressure and decrease risk of stroke. Vegetarians have up to a 40% lower risk of cancer. Vegetarians tend to weigh less than meat-eaters, who have an average Body Mass Index 8.3% higher than vegetarians. Vegetarians also have a lower risk of diabetes.
A nice summary of arguments for and against a Vegetarian diet is at
http://vegetarian.procon.org/
However, there are many who argue that an entirely vegetarian diet is unnatural. Later in this essay I will discuss the invaluable research of Weston Price, who found that the aboriginal diets of the 14 healthiest populations on Earth he investigated all included animal foods.

It is not clear to what degree the proven benefits of a vegetarian diet are due to the inclusion of large amounts of vegetables and fruits versus the absence of meats. The (likely conservative) recommendations of the USDA are that Americans have 5-13 servings of fruit and vegetables a day depending on age/gender/activity level, but the average American eats about 3 servings per day.  Only 7% of the calories consumed by the average American come from fruits and vegetables. Half of all vegetables consumed are potatoes and half of all potatoes consumed are deep-fried as French fries or chips!

Bottom line: there is room for debate as to whether it is wise to include meat/animal-based foods in one’s diet, but whether one is vegetarian or not there is overwhelming evidence that it is beneficial to include large quantities of fruit and vegetables in our diets.

PRINCIPLE #4
A vegetarian diet has many impressive proven health benefits including
lower weight, increased longevity and lower incidence of heart disease,
cancer and diabetes. Even if one is not a vegetarian, it is wise to include a large percentage of plant-based food in one’s diet.

VEGAN VS. VEGETARIAN
While omnivores tend to class vegans and vegetarians together (like I just
did in the previous segment), many vegans feel it is unhealthy to eat
dairy and eggs. One of the biggest proponents of this view is T. Colin
Campbell PhD., a biochemist who wrote the best-selling books The China
Study and Forks Over Knives. The China Study book discusses The
China-Cornell-Oxford Project, a 20 year study that Campbell helped to
direct, though only a small portion of the book directly discusses the
study. An often-repeated quote from the book is “People who ate the most
animal-based foods got the most chronic disease. Even relatively small
intakes of animal-based food were associated with adverse effects. People
who ate the most plant-based foods were the healthiest and tended to avoid chronic disease.” Much of the book is devoted to discussing the hazards of milk, especially the milk protein casein.
The China Study is a very popular book among vegetarians and especially
vegans. Many who have read it, including Bill Clinton, have changed their
diet after reading it. However, it has received a great deal of criticism.
The most detailed and impressive critique I have found is by a writer
named Denise Minger at http://rawfoodsos.com/the-china-study/

Another thorough critique is by Chris Masterjohn, who is pursuing a PhD in
Nutritional Science, at
http://www.cholesterol-and-health.com/China-Study.html
In a nutshell, the critics state that Dr. Campbell’s analysis of the data
of the China Study is incorrect and the data does not actually support a
link between consumption of animal foods and increased risk of heart
disease, cancer, diabetes etc. While some of the research cited by
Campbell may support a link between casein and cancer (but also may not), he ignores the evidence that whey protein from dairy may be highly protective against cancer and unjustifiably generalizes that since casein is hazardous, therefore all animal protein is hazardous. While focusing on the role cow’s milk may play in triggering autoimmune disease and heart disease, he ignores compelling evidence that wheat protein/gluten triggers autoimmune disease and is associated with heart disease even more strongly than dairy. This is one of many examples of Campbell “cherry-picking” data, emphasizing the data that supports his conclusions while ignoring data that negates it. Dr. Campbell did write a response to his critics, but the response largely criticizes the credentials and motives of his critics and does very little to actually address the criticism.  One can literally spend hours reading the information on this, but for a quick taste I
recommend scrolling down towards the end of “The China Study: Fact or
Fallacy?” by Denise Minger at
http://rawfoodsos.com/2010/07/07/the-china-study-fact-or-fallac/ and
reading the section titled “In summary and conclusion…”
Having read much of the point-counterpoint on this (particularly the
shrewd and extremely thorough analysis by Denise Minger) I do not put much stock in “The China Study.”

Dr. Campbell’s fame has spread through being featured it the documentary “Forks Over Knives” along with another hero of proponents of Vegan Diets, Dr. Caldwell B. Esselstyn Jr. MD, a retired surgeon and author of Prevent and Reverse Heart Disease. Dr. Esselstyn advises a radical diet in that it is not only Vegan but fat-free- he believes one should only eat non-fat plant foods- not only no dairy or eggs but no nuts, avocados or oils of any kind, including oils most nutritionists consider healthy, such as olive oil and flax oil. The only grains he allows are 100% whole grains. Dr. Esselstyn has had some very impressive results in reversing heart disease in the few patients who adhered to this diet. However, this does not mean that they would not have had similarly good results if their diets had included nuts, avocados, olive oil or even some fish, eggs or dairy! Again, the most thorough rebuttal to Dr. Esselstyn’s work is my favorite nutrition blogger Denise Minger’s painstakingly detailed critique of “Forks Over Knives” as found here: http://rawfoodsos.com/2011/09/22/forks-over-knives-is-the-science-legit-a-review-and-critique/#more-1487
This is a lengthy yet very well-documented and reasoned critique, made quite readable by the author’s sense of humor. In this debate I tend to side with Ms. Minger; there is too much data that clearly contradicts the conclusions of Dr. Campbell and Dr. Esselstyn to endorse their views. This does not mean that a largely plant-based diet is not healthy; but it does mean that I do not believe that all fats and animal-derived foods are toxic.
Bottom Line(s):
While there is some evidence that a low-fat vegan diet can help to reverse cardiovascular disease, sound science has not yet objectively demonstrated advantages of a vegan diet over a vegetarian diet.
Many people thrive on a vegan diet, yet many do not. As we will see later
in this essay when I explore the ideas of Weston Price, there is good evidence of the health benefits of including at least some animal-derived food in our diets.

GLUTEN-FREE DIET
This has become its own category. 10 years ago very few people avoided
gluten but in recent years this has become positively trendy. Gluten is a
protein that is found in wheat, rye and barley. Oats don’t contain gluten but are often contaminated with gluten so should be avoided unless labeled gluten-free. Gluten-free grains are millet, quiona, amarinth and buckwheat.
Doctors have long known about celiac disease, a hereditary autoimmune
condition that causes allergy to gluten. Celiac disease affects about 0.8%
of Americans, primarily those of Celtic descent. Common symptoms include chronic diarrhea, abdominal pain, gas and bloating, difficulty gaining weight, fatigue, anemia, skin rashes, headaches, infertility and
depression. While celiac disease is more common than it used to be
(research indicates only 0.2% of Americans had it in the 1950’s), it is
still relatively rare. But besides celiac disease, many people suffer from
Gluten Sensitivity that is unrelated to celiac disease, often called
Non-Celiac Gluten Sensitivity. While about 3 million Americans have celiac
disease, it is estimated that about 18 million Americans have Non-Celiac
Gluten Sensitivity, making it far more common. But even those without such sensitivities might have far better health by minimizing wheat consumption.
Symptoms of Gluten Sensitivity are similar to those of celiac disease, but celiac tends to cause more gastrointestinal symptoms (though gluten sensitivity can cause GI symptoms). Non-Celiac Gluten Sensitivity often primarily causes symptoms outside the GI tract such as headache, brain fog, muscle and joint pains, fatigue and numbness (though celiac can cause these too).
Whereas there are blood tests that reliably diagnose celiac disease, there
are no blood tests that reliably diagnose gluten sensitivity. The best way
to determine if one is gluten sensitive is a trial of strictly avoiding
gluten for 2-4 weeks to see how you feel, and then reintroducing it to see if it causes symptoms.
One main difference between Celiac and Non-Celiac Gluten Sensitivity is
that if one has Celiac they will never be able to tolerate Gluten.
Non-Celiac Gluten Sensitivity is a reversible condition that is caused by inflammation of the intestinal lining. With avoidance of gluten and measures to heal the intestines it will disappear over time.
Why has celiac disease and gluten sensitivity become much more common in recent years? The answer is almost certainly related to changes in the wheat plant. While Monsanto is attempting to introduce GMO wheat, the modern wheat we all eat is not officially a GMO product, yet it has been genetically modified by crossing wheat with non-wheat grasses to introduce new genes and by using techniques like exposing wheat seeds and embryos to chemicals and radiation to induce mutations. Modern wheat has a much higher gluten content than the wheat of our grandparent’s time. There have also been significant changes in the chemical makeup and structure of the gluten and gliaden proteins in modern wheat, as well as a chemical called wheat germ agglutinin that may create a variety of health problems. According to William Davis MD, author of the fascinating book Wheat Belly, modern wheat is a powerful appetite stimulant. He feels that modern wheat is highly addicting, with polypeptides from gluten binding to opiate receptors in the brain, and feels that over-consumption of wheat is the main cause of the obesity and diabetes epidemics in the United States. An excellent summary of Wheat Belly can be found at http://thehealingproject.us/2012/09/22/book-summary-wheat-belly-by-william-davis-md/
However, if you’ve read this far you realize there are (at least) 2 sides to every story, so I feel it is only fair to link to this detailed critique of Wheat Belly written by Julie Jones, who is a paid consultant for the wheat industry: http://www.aaccnet.org/publications/plexus/cfw/pastissues/2012/OpenDocuments/CFW-57-4-0177.pdf
I don’t agree with all her critiques but she does make some good points. I would love to see Dr. Davis’s response, but have not found a response by him yet.
A more balanced critique of Wheat Belly is at http://blog.cholesterol-and-health.com/2011/10/wheat-belly-toll-of-hubris-on-human.html
Both of the above critiques are rather lengthy. One that is briefer but points out some significant flaws is http://noglutennoproblem.blogspot.com/2012/03/wheat-belly-busted.html

Many people who try a gluten-free diet do feel noticeably better and thus conclude that they are sensitive to gluten. However, they may only be sensitive to the structurally-altered form of gluten found in the modern wheat plant. Many of these people may tolerate gluten in oats, rye and ancient grains like spelt, teff and kamut. Just as many people once thought that all fat was bad and then learned there are good fats and bad fats, just as many people thought all carbs are bad and have now learned there are good carbs and bad carbs, I think we will learn that, except for the small percentage of people with true celiac disease, that there are good glutens and bad gluten!

While gluten sensitivity has gotten a lot of publicity, other food
sensitivities are also extremely common. Other common foods that create
multiple symptoms include dairy, eggs, corn, soy and almonds. While there are blood tests that will often show evidence of food sensitivities, these tests have significant false positives and false negatives. The ultimate way to check for food sensitivities is to eliminate commonly allergenic foods for a week or more and then reintroduce individually.

PRINCIPLE #5
Sensitivity to gluten and other common foods is surprisingly common.  Modern wheat is a very different plant than the wheat of our ancestors and may be unhealthy even for those without gluten sensitivity. Many people feel much better when avoiding offending foods.

WHY EAT ORGANIC FOOD?

This is one of the most important parts of this series of essays, so I have given it its own section. See https://drrandybaker.com/2013/04/22/organic-food-diet/

Summarizing some of the main principles, while there is no single best diet for everyone, I advise that people eat whole unprocessed foods as much as possible, with an emphasis on organic vegetables as well as organic less-sweet fruits. Include raw foods in your diet. Animal foods that have been raised organically or are wild are reasonable in moderation but not everyone needs meat. Minimize fried foods, sugars and simple starches. Eat slowly, chew your food well and enjoy what you eat. Avoid overeating. If you do have sweets enjoy them in moderation after a well-balanced meal. Pay attention to how you feel after various foods to determine how they agree with you.

I have more controversies and concepts to explore. What about Raw Food Diets? Alkalinizing Diets? The Specific Carbohydrate/GAPS Diet? This and more will be discussed here in the future so stay tuned!

But I do have a couple of great articles about general dietary advice that I endorse as generally wise diets for most people. Dr. Joel Fuhrman’s Nutritarian Diet is an excellent diet. I do disagree with certain aspects- for example, Dr. Fuhrman advises against coconut oil, whereas I believe it is extremely healthy. Also, I think that it is acceptable to have more beef and cheese than he recommends, as long as the source is grass-fed cow and the cheese is raw. But it is one of the better diets I have seen:
http://www.drfuhrman.com/library/what-is-a-nutritarian-diet.aspx

But maybe my favorite article on a healthy diet is Mark Hyman’s Pegan or Paleo-Vegan Diet. His article includes a good discussion of the pros and cons of a wide variety of foods. See
http://drhyman.com/blog/2014/11/07/pegan-paleo-vegan/

In the meantime, this is a genuinely hilarious essay on the dilemmas faced by those striving to eat healthily while treading lightly on our planet:

http://www.nwedible.com/2012/08/tragedy-healthy-eater.html

And if you enjoy this please check out my posts on Vitamins/Supplements for the Prevention of Heart Disease. the Vaccination Debate and how Hemp can Help Save our Environment…

Vitamins REALLY DO Prevent Heart Disease- beware of MISLEADING STUDIES!!!

Perhaps somewhat lost (thank goodness) in the big news of the election and Superstorm Sandy this week was a study published in the November 7, 2012 issue of JAMA titled

Multivitamins in the Prevention of Cardiovascular Disease in Men

The Physicians’ Health Study II Randomized Controlled Trial

(see http://jama.jamanetwork.com/article.aspx?articleid=1389615)

Quoting from the abstract, the study concluded “Among this population of US male physicians, taking a daily multivitamin did not reduce major cardiovascular events, MI, stroke, and CVD mortality after more than a decade of treatment and follow-up.”

Newspapers around the country had headlines like “Multivitamins Don’t Prevent Heart Disease.” In searching this study I found hundreds of articles that all reported this without one single article yet (as of the morning of 11/11/12) questioning these findings. But, as a medical doctor who specializes in Nutritional and Preventive Medicine I know, based on hundreds of other studies, that it has been shown time and time again that a wide variety of vitamins can and do prevent heart disease. Something doesn’t add up, so I decided to take a look at this study. It took quite a bit of searching to discover what the multivitamin used in this study was, as it is buried in the fine print. The multivitamin used was Centrum Silver. This is considered a perfectly adequate multivitamin by those with only cursory knowledge of nutrition, those who believe that the RDA is perfectly adequate, but for doctors who are knowledgeable about nutritional medicine it leaves a great deal to be desired.

Below is a list of the nutrients in the multivitamin used in this study:
Vitamin or Mineral Amount
Vitamin A (IU) 5000*
Vitamin C (mg) 60
Vitamin D (IU) 400
Vitamin E (IU) 45
Vitamin K (μg) 10
Thiamin (mg) 1.5
Riboflavin (mg) 1.7
Niacin (mg) 20
Vitamin B6 (mg) 3
Folic Acid (μg) 400
Vitamin B12 (μg) 25
Biotin (μg) 30
Pantothenic Acid (mg) 10
Calcium (mg) 200
Iron (mg) 4
Phosphorus (mg) 48
Iodine (μg) 150
Magnesium (mg) 100
Zinc (mg) 15
Selenium (μg) 20
Copper (mg) 2
Manganese (mg) 3.5
Chromium (μg) 130
Molybdenum (μg) 160
Chloride (mg) 72.6
Potassium (mg) 80
Boron (μg) 150
Nickel (μg) 5
Vanadium (μg) 10

More detail as to the form of the vitamins/minerals and excipients is here: calcium carbonate, potassium chloride, dibasic calcium phosphate, magnesium oxide, ascorbic acid, microcrystalline cellulose, dl-alpha tocopheryl acetate, pregelatinized cornstarch and modified food starch.

Centrum Silver contains less than 2 percent of the following ingredients: acacia, ascorbyl palmitate, beta-carotene, bht, biotin, boric acid, calcium pantothenate, calcium stearate, cholecalciferol, chromium picolinate, citric acid, cornstarch, crospovidone, cupric sulfate and cyanocobalamin. More ingredients include FD&C blue no. 2 aluminum lake, FD&C red no. 40 aluminum lake and FD&C yellow no. 6 aluminum lake.

Further, Centrum Silver contains folic acid, gelatin, hydrogenated palm oil, hypromellose, lutein, lycopene, manganese sulfate, medium-chain triglycerides, niacinamide, nickelous sulfate, phytonadione, polyethylene glycol, polyvinyl alcohol, potassium iodide and pyridoxine hydrochloride. It also contains riboflavin, silicon dioxide, sodium ascorbate, sodium benzoate, sodium borate, sodium citrate, sodium metavanadate, sodium molybdate, sodium selenate, sorbic acid, sucrose, talc, thiamine mononitrate, titanium dioxide, tocopherols, tribasic calcium phosphate, vitamin A acetate and zinc oxide.
I will now comment on some of the Vitamins and Minerals proven to prevent heart disease and what was given in this study:

One of the best ways to prevent cardiovascular disease is Vitamin C. In his very well-written book Prevent America’s #1 Killer, cardiologist Dr. Thomas Levy (also a lawyer) presents an excellent case that Vitamin C may be the single best way to prevent heart disease. This is because adequate Vitamin C is essential for creating healthy glycoproteins, a substance which plays a key role in the structural integrity of the endothelium (inner lining of our blood vessels). Inflamed/damaged endothelium is the ultimate pathology underlying cardiovascular disease. See http://www.drpasswater.com/levy.htm for a fine interview with Dr. Levy summarizing his research.

The amount of Vitamin C used in the study was 60 mg a day. I believe everyone should take a minimum of 500 mg twice a day to get the benefits of Vitamin C, and many people may need to take 5-10,000 mg a day in divided doses for optimal health. Taking a form of vitamin C known as  lypsospheric C is likely to be much more effective due to enhanced absorption, in which case 1,000 mg/day may be adequate for most. See http://www.livonlabs.com/

The 60 mg of Vitamin C used in this study likely has virtually no benefit in preventing heart disease.

Another key nutrient in preventing cardiovascular disease is Vitamin E. Everyone knows that cholesterol plays a role in heart disease. However, the role is a bit more complex than commonly thought. Cholesterol only causes problems if the wall of the arteries are damaged (via inflammation/oxidative stress in situations where Vitamin C levels are suboptimal) and if LDL cholesterol is oxidized, in which case the LDL will bind to or enter the arterial wall. Vitamin E prevents LDL cholesterol from being oxidized and also protects the arterial wall from oxidative stress.

The study used 45 IU of Vitamin E in the form of dl-alpha tocopherol, a synthetic form of Vit E that has been shown to be toxic in several previous research studies. Unlike synthetic E, which contains the synthetic chemical l-alpha tocopherol, natural E has only d-alpha tocopherol as well as delta, beta and gamma tocopherols. Doses of 400-1200 units of natural E have been proven to be highly effective in preventing heart disease. 45 units of synthetic E may do more harm than good! See http://www.healthy.net/scr/article.aspx?Id=557 for more on the research proving that Vit. E prevents heart disease.
Another key factor in the cause of heart disease is homocysteine, a toxic metabolite of the amino acid methionine. Vitamins B6, B12 and Folate have been shown to significantly lower homocysteine, reducing risk of both heart attack and stroke. The amount of B6 used in this study was a woefully inadequate 3 mg. A much more reasonable dose to reduce homocysteine is 25-50 mg. Many people may benefit even more from pyridoxal-5-phosphate, the activated form of B6. The form of B12 used in this study was 25 mcg of the cyanocobalamin form of B12. B12 is poorly absorbed by many, and cyanocobalamin is the least beneficial of the 3 common forms of B12. At least 1000 mcg of the methycobalamin form is advisable. While the 400 mcg dose of folic acid used is relatively reasonable, about one-third of the population has genetic difficulties converting folic acid to the active form, L-5-methyltetrahydrofolate (5-MTHF). There is also evidence that folic acid, a synthetic chemical, may increase risk of certain cancers including breast, prostate and colon. I thus advise taking at least 800 mcg of 5-MTHF to prevent heart disease and stroke.

For more on homocysteine and heart health see http://www.lef.org/protocols/heart_circulatory/homocysteine_reduction_01.htm

Vitamin D has also been shown to dramatically lower heart disease risk. A recent study done in Denmark involving more than 10,000 people found that those with the lowest levels of vitamin D experienced a 64 percent higher risk of heart attack, 57 percent higher risk of early death, 40 percent higher risk of ischemic heart disease and at least an 81 percent higher risk of death from heart disease. See
http://www.naturalnews.com/037372_vitamin_D_deficiency_cardiovascular_disease_risk.html

The study used the RDA of 400 IU of Vitamin D. However, to achieve optimal levels of  50-100 nanomoles per liter most adults need to take at least 4000-5000 IU/day.

Another key nutrient that helps to prevent heart disease is Vitamin K. Whereas Vitamin D is necessary for us to absorb calcium, vitamin K makes sure that the calcium we absorb winds up in our bones and not in our arteries. Research has shown that Vitamin K both prevents and reverses atherosclerosis. Doses used in these studies are around 1 mg which is 1000 mcg. Doctors in this study were given 10 mcg.

Minerals can also be helpful. Magnesium has many benefits but Centrum Silver has only 100 mg of magnesium oxide, which is poorly absorbed. At least 200 mg of a well-absorbed form like taurate, citrate or glycinate would undoubtedly help more.

Selenium is also a useful antioxidant but the 20 mcg of sodium selenate is not nearly as beneficial as 100 mcg of selenium monomethionine might. 15 mg of zinc is reasonable but the zinc oxide form is, once again, relatively poorly absorbed compared to other forms of zinc.

Centrum silver also contains 4 mg of iron. This is, fortunately, a tiny amount, as iron is a pro-oxidant that is best avoided by all men and post-menopausal women as the evidence suggests that iron actually increases cardiovascular risk!

Added to the inadequacies of the quantities and forms of the nutrients in Centrum Silver, it also contains FD&C blue no. 2 aluminum lake, FD&C red no. 40 aluminum lake and FD&C yellow no. 6 aluminum lake, hydrogenated palm oil, polyethylene glycol, polyvinyl alcohol, sodium benzoate, pregelatinized cornstarch (undoubtedly of GMO origin), sucrose, talc and titanium dioxide, ingredients that I strongly recommend avoiding.

So, with the above in mind, is it fair to conclude that “multivitamins do not prevent heart disease?”  The only thing that can be concluded is that incredibly inadequate/subtherapeutic doses of vitamins in poorly absorbed forms mixed with a variety of toxic excipients do not prevent heart disease. I could have told you that before this study.
But, unfortunately, the message the general public is receiving is that “Vitamins Don’t Prevent Heart Disease!” This is, as demonstrated, TOTALLY WRONG and I am concerned that the blind acceptance/uncritical reporting of studies like this will lead many people who are taking one of the many high quality multivitamins that do have reasonable doses and forms of these nutrients to stop taking them out of the mistaken belief that they have been shown to be ineffective. This would be tragic.

Postscript:

Of interest, another finding of this same study, published separately in the JAMA on 11/14/12 under the title Multivitamins in the Prevention of Cancer in Men (see http://jama.jamanetwork.com/article.aspx?articleid=1380451 ) showed an 8% reduction in cancer risk. The same critiques I have mentioned above apply. This means that a better quality multivitamin, ideally enhanced with about 5000 units of Vitamin D a day, would almost certainly show a MUCH greater degree of cancer prevention. A nice summation of this study is at http://www.nytimes.com/2012/10/18/health/daily-multivitamin-may-reduce-cancer-risk-clinical-trial-finds.html?_r=0

While this post has focused on the research proving that vitamins and minerals can prevent heart disease, there are many other nutrients that also help prevent cardiovascular disease. These include amino acids like Lysine, Proline and Taurine, antioxidant flavonoids like Anthocyanins and Proanthocyanins, healthy sugars like D-Ribose, enzymes like CoQ10 and Omega 3 and 6 Essential Fatty Acids. Herbs like Hawthorne and Turmeric and supplements like Resveratrol are also useful.

As important a role as the right vitamins and minerals can play in reducing heart disease, these will work much better in the context of a comprehensive holistic approach. Chronic infections, especially periodontal disease and chronically infected root canals, contribute to heart disease, as do heavy metals like lead and mercury, so treating those conditions can be quite important. It is obviously crucial to minimize our exposure to tobacco smoke and other avoidable toxins. Minimizing dietary sugars and starches and trans-fatty acids (found in most fried foods) is also important, as is avoiding foods from animals fed GMO’s and loaded with hormones and antibiotics, including dairy and eggs. Grass-fed beef, low-mercury wild seafood, organically-raised poultry, eggs and dairy are fine in moderation, but one should emphasize organic vegetables and fruits, nuts, seeds and beans. Obviously exercise and stress-reduction also play important roles in preventing heart disease. And perhaps the best medicine of all for preventing heart disease is LOVE.
However, even though love may be the most powerful force in our universe, it would take a whole lotta love to counteract the effects of toxic foods and vitamin deficiencies!

If you like this post please check out my other blog posts and the many posts on my Randy Baker MD facebook page: https://www.facebook.com/pages/Randy-Baker-MD/118815558232253 . Also, an extensive collection of articles I have written in recent years can be found at http://www.drrandy.org

Wishing you optimal health!

Randy Baker MD