Is There Hope for Alzheimer’s

August 26, 2014 by Dr. Steve Chaney

Preventing Cognitive Decline As We Age

Author: Dr. Stephen Chaney

As we age nothing is more terrifying than the word Alzheimer’s. For most of us the ultimate irony would be to spend a lifetime taking good care of our body, only to lose our mind. From time to time there are encouraging reports about the potential of low fat diets, diets rich in fruits and vegetables, B vitamins, omega-3 fatty acids, various herbs, and other natural approaches that might slow cognitive decline as we age.

Inevitably, it seems, those hopes are dashed by subsequent meta-analyses supposedly showing that each of those approaches is worthless. That wouldn’t be so bad if there were effective medications to slow cognitive decline and prevent Alzheimer’s, but there aren’t. The Alzheimer’s drugs on the market today simply have not been shown to be effective.

But, what if all of these studies were missing the mark by focusing on individual interventions? Perhaps we should be focusing a holistic approach instead.

The Power of Holistic Approaches

One of the examples of the power of a holistic approach that I love to use, because it really made an impression on me as a young scientist, occurred at an International Cancer Symposium I attended more than 30 years ago.

I attended a session in which an internally renowned expert was giving his talk on colon cancer. He said, “I can show you, unequivocally, that colon cancer risk is significantly decreased by a lifestyle that includes a high-fiber diet, a low-fat diet, adequate calcium, adequate B-vitamins, exercise and weight control. But I can’t show you that any one of them, by themselves, is effective.”

The question that came to me as I heard him speak was: “What’s the message that a responsible scientist or responsible health professional should be giving to their patients or the people that they’re advising?” You’ve heard experts saying: “Don’t worry about the fat” “Don’t worry about calcium.” “Don’t worry about B-vitamins.” “Don’t worry about fiber.” “None of them can be shown to decrease the risk of colon cancer.”

Is that the message that we should be giving people? Or should we really be saying what that doctor said many years ago – a lifestyle that includes all of those things significantly decreases the risk of colon cancer?

What about Alzheimer’s and cognitive decline? Could a holistic approach have an impact here as well?

Is There Hope For Alzheimer’s?

A study performed by Dr. Miia Kivipelto and colleagues at the Karolinska Insitute in Sweden and the National Institute for Health and Welfare in Helsinki, Finland suggests that a holistic approach may, in fact, be able to slow cognitive decline in older people.

Previous studies had suggested that exercise, a good diet, socialization and memory training might slow cognitive decline in the elderly, but, like all other individual interventions, the benefits of these interventions were not reproducible. Dr. Kivipelto and colleagues designed a clinical study that combined all of these interventions into a single holistic approach.

They started with 1,260 healthy adults aged 60-77 from Sweden and Finland and divided them into two groups. One group was enrolled in a holistic program involving exercise, a healthy diet, socialization and memory training. This group was closely monitored for compliance. The other group was just given general health advice – not unlike the advice you might expect to receive from your doctor.

Each group was given a memory test at the beginning of the study and a second memory test two years later. Both groups scored about the same on the first memory test. However, the group enrolled in the holistic program did considerably better on the second memory test than the control group who had just been given general health advice.

One of the lead investigators was quoted as saying: “These findings show that prevention is possible, and it may be good to start early [before the signs of cognitive decline become evident]. With so many negative trials of Alzheimer’s drugs reportedly lately, it’s good that we may have something that everyone can do now to lower their risk [of cognitive decline].”

Limitations of the Study

There are two big caveats for this study.

1) The study was too short to assess the effectiveness of this approach at reducing Alzheimer’s. The investigators plan to continue the study for 7 years. They hope that enough participants will have developed Alzheimer’s by then so they can accurately assess whether this approach is as effective at preventing Alzheimer’s as it is at preventing cognitive decline.

2) This study was recently presented at an Alzheimer’s Association International Conference. It has not yet undergone the rigorous peer review required for publication. Once the study has been published I will give you an update.

The Bottom Line

1) It has been very difficult to prove that individual interventions, whether they are natural or pharmaceutical, are effective at preventing cognitive decline and the onset of Alzheimer’s as we age.

2) However, a recent study suggests that a holistic approach that includes exercise, optimal nutrition, socialization and memory training may be effective at preventing cognitive decline in older adults.

3) Based on previously published individual studies, optimal nutrition probably includes:

A diet low in fat, especially saturated fat and trans fats

A diet with lots of fresh fruits and vegetables

Extra B vitamins, especially with high risk populations

Extra omega-3 fatty acids

4) Although not mentioned in this study, maintaining proper body weight is also an important part of a holistic approach to reducing the risk of cognitive decline. In a previous “Health Tips From the Professor” I shared data showing that obesity alone can cause a 3-fold increase in the risk of developing dementia.

5) The take home message should not be that each of the natural interventions is ineffective at preventing cognitive decline as we age. Rather, the message should be that a holistic approach that combines all of the natural interventions may be effective at preventing cognitive decline.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Nitric Oxide Benefits and Side Effects

August 19, 2014 by Dr. Steve Chaney

Reverse Heart Disease?

Author: Dr. Stephen Chaney

Nitric oxide has had a meteoric rise from obscurity to fame in just a few short years. It’s an amazing story. After all, nitric oxide is a colorless, odorless gas. Who could have known it was destined for greatness? In this article, we will discuss nitric oxide benefits and side effects.

Its rise to fame started in the 1980’s when scientists from several universities discovered that nitric oxide was an important regulator of numerous physiological processes. Just a few years later in 1992 Science magazine named it “Molecule of the Year”, a very prestigious honor. And, in 1998 three of its co-discoverers received the Nobel Prize for their ground-breaking research.

The Benefits of Nitric Oxide

Proven Benefits

Perhaps the most important benefit of nitric oxide is its role in maintaining the health of the endothelial cells that form the inner lining of our blood vessels. Nitric oxide reduces:

Platelet aggregation

Damage & inflammation of the endothelial cells

Oxidation of LDL cholesterol

Growth of smooth muscle cells.

This is important because these are the very physiological processes that, if left unchecked, can lead to atherosclerosis and disease of the cardiovascular system (Davignon and Ganz, Circulation, 109: 1127-1132, 2004; Tousoulis et al, Current Vascular Pharmacology, 10: 4-18, 2012).

However, the effect of nitric oxide that has gotten the most attention is its ability to relax the smooth muscle cells that surround our blood vessels. That leads to increased blood flow, which in turn decreases blood pressure, relieves angina, and even prevents erectile dysfunction (Davignon and Ganz, Circulation, 109: 1127-1132, 2004; Tousoulis et al, Current Vascular Pharmacology, 10: 4-18, 2012).

Possible Benefits

Many people with atherosclerosis, diabetes and hypertension (high blood pressure) have low nitric oxide levels. It’s not known whether this is a cause or a result of these diseases, but low nitric oxide levels certainly could contribute to the progression and health consequences of all three diseases. We already know that increasing nitric oxide levels can reduce high blood pressure. It is not yet known whether increasing nitric oxide levels could reduce or reverse heart disease and the effects of diabetes, but this is an area of active research.

Nitric oxide is a neurotransmitter and is thought to play a critical role in memory and learning. It also plays a critical role in immune function. In addition, it enhances the metabolic activity of mitochondria, which could enhance cellular metabolism. The physiological significance of these observations is unknown, but this is another area of active research

Finally, because nitric oxide stimulates blood flow, which should increase oxygen and nutrient delivery to active muscle, it has been suggested that nitric oxide supplements would improve sports performance. The results of clinical studies to test this hypothesis have been mixed. The latest research suggests that nitric oxide supplements may enhance performance in untrained or moderately trained subjects, but not in highly trained subjects (Bescoe et al, Sports Medicine, 42: 99-117, 2012). At last, a sports supplement for the common man!

Drugs That Affect Nitric Oxide Levels

Because nitric oxide has such powerful physiological effects, the pharmaceutical industry has been busy creating drugs that either increase nitric oxide levels or increase the biological effectiveness of nitric oxide. For example, these include drugs to treat angina, hypertension, pulmonary hypertension and erectile dysfunction.

These drugs are generally effective, but have some drawbacks, namely:

They have numerous side effects. For example, just listen to the Viagra or Cialis ads on TV.

Some of them lose their biological effectiveness over time, especially the angina medications.

Natural Approaches for Increasing Nitric Oxide Levels

There are two natural pathways for generating nitric oxide in the body.

1) The first pathway is an enzymatic process that oxidizes a nitrogen atom in the amino acid arginine to nitric oxide.

2) The second pathway is a non-enzymatic process in which naturally occurring nitrates and nitrites are reduced to nitric oxide either by bacteria in the mouth and intestine, or by naturally occurring antioxidants.

Arginine is found in proteins. The best protein sources of arginine are red meat, soy, crustaceans (crab, shrimp & lobster), nuts, spinach and lentils. In addition, you can find arginine supplements and arginine-enriched protein supplements.

The best natural sources of nitrates and nitrites are vegetables, especially spinach, beet root and arugula followed by green leafy vegetable and root vegetables in general. Vegetables provide about 80% of the nitrates and nitrites in the American diet.

Nitrates and nitrites do not appear to have the side effects of the nitic oxide producing drugs. This is probably because their effects on raising nitric oxide levels are slower and more modest, and they do not accumulate in the body.

Interestingly, conventionally grown vegetables are higher in nitrates than organically grown vegetables because of the use of inorganic, nitrate-containing fertilizers. However, that doesn’t mean that I recommend conventionally grown produce over organic produce. In last week’s “Health Tips From the Professor”, I reported that conventionally grown produce is 4-fold higher in pesticides.

Red meat and processed meats are also a minor source of nitrates and nitrites in the American diet because nitrates and nitrites are used as preservatives and coloring agents in those meats.

Are Nitrates and Nitrites Beneficial?

Until recently most of the focus has been on arginine as a natural source of nitric oxide. However, there are several lines of evidence suggesting that dietary sources of nitrates and nitrates can also provide the health benefits expected from nitric oxide.

For example, it has long been known that the DASH (Dietary Approaches to Stop Hypertension) diet is as effective as medications for lowering moderately elevated blood pressure. The DASH diet recommends 4-5 servings of vegetables per day, and recent studies have suggested that the nitrates found in those vegetables may play an important role in the blood pressure lowering effect of the DASH diet (Hord et al, American Journal of Clinical Nutrition, 90: 1-10, 2009; Lin et al, Journal of Nutrition and Metabolism, p 472396, 2012).

In addition, a recent meta-analysis of 16 clinical trials concluded that inorganic nitrate and beet root juice supplements lower blood pressure by modest amounts in healthy individuals (Siervo et al, Journal of Nutrition, 143: 818-826, 2013).

Are Nitrates and Nitrites Harmful?

There are two potential concerns around increasing dietary nitrate and nitrite intake.

1) The one you may have heard the most about is the concern that dietary nitrates and nitrites might increase cancer risk. That turns out to be mainly associated with the nitrates and nitrites added to meats because, in the intestine, nitrites can combine with amino acids to form cancer causing nitrosamines.

That does not appear to be a problem with vegetables because vitamin C and other naturally occurring antioxidants in the vegetables prevent nitrosamine formation. There is no cancer risk in consuming more vegetables.

2) The other concern is potential drug-nutrient interactions, especially drugs which also increase nitric oxide levels such as drugs for angina, hypertension, pulmonary hypertension and erectile dysfunction. This is because the combination of nitric oxide from nitrates in the diet and from the drugs has the potential to cause dangerously low blood pressure.

As a general precaution, if you are taking any medications I suggest consulting your doctor or pharmacist before increasing your dietary intake of nitrates and nitrites.

The Bottom Line

1) Nitric oxide plays an important role in keeping the endothelial lining of your blood vessels healthy, which is thought to reduce the risk of atherosclerosis.

2) Nitric oxide also relaxes the smooth muscle cells that surround our blood vessels. That increases blood flow and decreases blood pressure. The increased blood flow also decreases angina and erectile dysfunction.

3) Nitric oxide also may increase blood flow to active muscle cells. This has been reported to increase exercise efficiency and sports performance. This effect of nitric oxide appears to primarily affect untrained and moderately trained athletes, not highly trained athletes.

4) It has been suggested that nitric oxide may be useful for memory and learning, immune function, mitochondrial function and may reduce the risk of diabetes and heart disease. Research is currently going on to evaluate these hypotheses.

5) There are two natural sources of nitric oxide:

The amino acid arginine from proteins and supplements

Nitrates and nitrites from vegetables such as spinach, beet root and arugula and from supplements.

6) Foods (primarily vegetables) and supplements providing dietary nitrates have been shown to modestly lower blood pressure in healthy individuals. They are likely to provide the other benefits associated with nitric oxide as well, without the side effects associated with nitric oxide enhancing medications.

7) Nitrates and nitrites from vegetables are unlikely to increase cancer risk because vitamin C and other antioxidants from the vegetables prevent the conversion of nitrates and nitrites to nitrosamines.

8) If you are taking any medications, especially medications for angina, high blood pressure or erectile dysfunction, consult with your doctor or pharmacist before increasing your dietary nitrate intake.

9) High blood pressure is a silent killer. You should never substitute dietary nitrates for blood pressure medication. Always consult with your physician first. They may be willing to work with you to lower the amount of medication if appropriate. Finally, even if you don’t have high blood pressure, you should monitor your blood pressure on a regular basis. High blood pressure can sneak up on you without you realizing it.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Are Organic Foods Healthier?

August 12, 2014 by Dr. Steve Chaney

Organic Fruits & Vegetables

Author: Dr. Stephen Chaney

Are organic foods healthier for us than conventionally grown foods, specifically fruits and vegetables? The controversy about the benefits of organically raised produce continues. In fact, about the only thing that all sides agree on is that:

Organic foods have lower pesticide and herbicide residues and cause less environmental pollution.
Organic foods generally cost more.

But that is where all agreement ends.

Some experts argue that the pesticide levels on conventionally grown fruits and vegetables are within safe levels and that any risk from the pesticides is outweighed by the health benefits of the fruits and vegetables themselves.
Some studies have suggested that organic foods, fruits and vegetables, are healthier because they have higher antioxidant levels, while other studies have reported no nutritional differences between organic and conventionally grown fruits and vegetables.

Benefits of Organic Food?

The present study (Baranski et al, British Journal of Nutrition, doi: 10.1017/S0007114514001366) tried to overcome the shortcomings of many of the previously published reports.

To begin with this study was a meta-analysis that combined the results from 343 of the best designed previous studies to increase the statistical power of the analysis. In addition, the investigators utilized a type of statistical analysis that was superior to previously published studies. In short, it was a very good study. It does show some benefits of organic food.

The results were fairly clear cut:

Pesticide residues were four-fold lower in the organically raised produce than the conventionally raised produce. This result has been consistently seen in all of the previously published studies, and is probably the #1 reason that people choose organic produce. It is also one of the most agreed upon benefits of organic food.

Polyphenol antioxidant levels were significantly higher in the organically raised produce. The percent increase ranged from 19% to 69% depending on the polyphenolic compound tested. This increase has not been seen in all previously published studies, but would represent a side benefit if true.

Levels of the toxic metal cadmium were significantly less in the organically grown fruits and vegetables. The authors speculated that the cadmium found in conventionally grown produce came from the inorganic fertilizers that were used.

Should You Choose Organic Supplements?

If organic foods are better for you than conventionally grown foods, does that mean that you should also choose organic supplements? While that idea sounds logical, the reality is actually more complex.

While organic foods clearly have less pesticides and toxic metals than conventionally grown foods, the level of those contaminants is not zero – even in foods with organic certification. The problem is that our environment is so polluted that no farm is contaminant free. A farmer can use the best organic practices, but if their groundwater is contaminated or pesticides from neighboring farms blow on to their farm, some of those toxic residues will end up in their “organic” crops.

So with supplements, “Organic” certification is not an absolute guarantee of purity. Instead you should insist on getting your supplements from a company with a very rigorous quality control program and a policy of rejecting any raw materials that contain contaminants of any kind.

The Bottom Line

1) The latest study shows that pesticide residues are four-fold lower in the organically raised produce than the conventionally raised produce. This result has been consistently seen in all of the previously published studies, and is probably the #1 reason that people choose organic fruits and vegetables.

2) Polyphenol antioxidant levels were significantly higher in the organically raised produce. The percent increase ranged from 19% to 69% depending on the polyphenolic compound tested. This increase has not been seen in all previously published studies, but would represent a side benefit if true.

3) While one of the benefits of organic foods is they are less likely to be contaminated than conventionally grown foods, an organic certification is not a sufficient proof of purity when you are choosing supplements.You should insist on getting your supplements from a company with a very rigorous quality control program and a policy of rejecting any raw materials that contain contaminants of any kind.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

VTE

August 5, 2014 by Dr. Steve Chaney

Benefits of Omega-3

Author: Dr. Stephen Chaney

When a blood clot ends up in your lungs, it can be deadly. But that blood clot didn’t start out in your lungs. It initially formed in your veins where it is referred to as a thrombus. Then it broke off and migrated to your lungs – a process called venous thromboembolism or VTE. Venous thromboembolism is the third most common form of cardiovascular disease, killing around 100,000 Americans each year.

What if something as simple as adding more omega-3 fatty acids to your diet could dramatically decrease your risk of VTE? That’s exactly what a recent study (Hansen-Krone et al, J. Nutr., 144: 861-867, 2014) has suggested. It claims that one of the benefits of omega-3 in your diet may be to help prevent venous thromboembolism.

What Is Venous Thromboembolism or VTE?

As described above, venous thromboembolism starts when a blood clot (also called a thrombis) forms in a vein. About 2/3 of the time, the blood clot forms in the deep veins in the leg (called deep vein thrombosis or DVT) and stays there before eventually dissolving. The symptoms of deep vein thrombosis or DVT are generally leg pain and swelling.

About 1/3 of the time, the clot breaks loose and travels to the lung where it blocks blood flow to a portion of the lung (a process called pulmonary embolism). The symptoms of pulmonary embolism are severe shortness of breath, chest pain when breathing or coughing, and death! While the first two symptoms are pretty frightening, it’s the last symptom (death) that we’d really like to avoid.

Why Might Omega-3s Prevent Venous Thromboembolism or VTE?

One of the benefits of Omega-3s is they have been shown to reduce inflammation and platelet aggregation, two of the most important risk factors for venous thromboembolism. So it is logical to think that omega-3s might help reduce the risk. However, good scientists don’t rely on logic alone. They test their hypotheses by doing clinical studies.

Unfortunately, the results of previous clinical studies have been mixed. One study showed a protective effect of omega-3s, but two other studies found no correlation between omega-3 fatty acid intake and VTE. However, these studies had some significant limitations:

They were all performed with populations in the United States where fish consumption is relatively low and many of the fish have low omega-3 content. As a consequence omega-3 fatty acid intake was low and there wasn’t much of a range in intake.

Some of the studies did not ask about the use of omega-3 supplements. In a country where 37% of the population takes fish oil supplements, that is a huge omission.

They did not measure omega-3 fatty acid levels in the blood to verify that their dietary surveys were accurate.

Do Omega-3s Prevent Venous Blood Clots or DVT?

The current study (Hansen-Krone et al, J. Nutr., 144: 861-867, 2014) followed 23,631 people aged 25-97 from Tromso, Norway for 16 years.

The participants filled out a comprehensive dietary survey at the time of enrollment where they indicated the number of times per week they ate fish and how often they used fish oil supplements.

The scientists in charge of the study verified the estimated omega-3 intake from the dietary analysis in a subgroup of the population by measuring omega-3 fatty acid levels in their blood.

Finally, they utilized Norway’s excellent health records to determine how many of the people in their trial experienced a venous thromboembolism – either fatal or non-fatal.

The results were pretty impressive:

Blood level measurements of omega-3 fatty acids verified the omega-3 intake estimates from the dietary survey. There was a direct correlation between estimated intake and blood levels of the omega-3 fatty acids.

Those participants who ate fish most often (≥3 times/week) were 22% less likely to experience a VTE than those who ate fish least often (1-2 times/week). That difference was borderline significant.

Those participants who ate fish most often and took fish oil supplements were 48% less likely to experience a venous thromboembolism than those who ate fish least often and took no fish oil supplements. That difference was highly significant.

Strengths & Weaknesses of the Study

Since not all of the previous clinical studies have reached the same conclusion, it is important to look at the strengths and weaknesses of the study compared to the previous studies.

Strengths of the Study:

Tromso is located on the northeast coast of Norway, so fish consumption is high and most of the local fish are excellent sources of omega-3 fatty acids. Consequently, omega-3 intake was relatively high, which significantly increases the chance of seeing an effect if one exists. Fish consumption in the US is generally lower and not all of the fish consumed are good sources of omega-3s.

The study also took into account the use of omega-3 supplements. Some of the US studies did not.

The estimates of omega-3 intake from the dietary survey were verified by blood analysis of omega-3 fatty acids.

Weaknesses of the Study:

The amount of omega-3 fatty acids in the supplements was not recorded, so it is unclear what level of omega-3 fatty acid intake was required to see a significant decrease in VTE risk. This will make it difficult for future investigators to repeat the study.

They did not measure other nutrients that might affect the venous thromboembolism risk.

The Bottom Line

1) VTE is a serious condition with a high rate of mortality.

2) A recent study suggests that a combination of high fish consumption and fish oil supplement use may significantly decrease the risk of venous thromboembolism.

3) It is interesting to note that even three servings/week of omega-3 rich fish was not enough to cause a significant decrease in venous thromboembolism risk. It required additional omega-3s from fish oil supplements before the decreased risk was significant.

4) Not all previous studies have come to the same conclusion. So while the most recent study had several improvements in design compared to previous studies, the case can’t be considered closed. More studies are clearly needed.

5) This study suggests that omega-3 fatty acids may help prevent VTE from occurring. You should not consider them to be a treatment for the condition. If you are experiencing symptoms of venous thromboembolism (leg pain and swelling for deep vein thrombosis (DVT) or shortness of breath and pain when breathing for pulmonary embolism), don’t reach for your fish oil capsules. Call your doctor right away.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Risk Factors of Prostate Cancer

July 29, 2014 by Dr. Steve Chaney

Vitamin D Deficiency?

Author: Dr. Stephen Chaney

Is vitamin D deficiency one of the risk factors of prostate cancer? What if something as simple as maintaining optimal vitamin D status could decrease your risk of prostate cancer? There is a lot of indirect evidence suggesting that vitamin D deficiency might affect your risk of developing prostate cancer. For example:

Prostate cancer incidence and vitamin D deficiency parallel each other. Both are highest in northern latitudes, in African American men, and in older men.
Prostate cancer mortality rates are highest for patients diagnosed in the winter and at Northern latitudes.

However, clinical studies looking at the correlation between 25-hydroxy vitamin D (the biologically active form of vitamin D in the blood) and prostate cancer incidence have been inconsistent. Because of this there has been considerable controversy in the scientific community as to whether or not there was any correlation between vitamin D deficiency and prostate cancer.

Vitamin D Deficiency and Cancer

That’s what makes the recent headlines suggesting that vitamin D is associated with decreased risk of aggressive prostate cancer so interesting. Does this study show low vitamin D to be one of the risk factors of prostate cancer? Have the conflicting data on vitamin D deficiency and prostate cancer finally been resolved or is this just another case of dueling headlines? Let’s start by looking at the study itself.

This study (Murphy et al, Clinical Cancer Research, 20: 2289-2299, 2014) enrolled 667 men, aged 40-79 (average age = 62), from five urology clinics in Chicago over a four year period. These were all men who were undergoing their first prostate biopsy because of elevated serum PSA levels or an abnormal DRE (that’s doctor talk for digital rectal exam – the least favorite part of every guy’s physical exam). The clinics also drew blood and measured each patient’s 25-hydroxy vitamin D level at the time of the prostate biopsy.

This study had a number of important strengths:

It was conducted at a northern latitude. Because of that 41.2% of the men in this study were vitamin D deficient (<20 ng/ml) and 15.7% were severely vitamin D deficient (<12 ng/ml). That’s important because you need a significant percentage of patients with vitamin D deficiency to have any chance of seeing an effect of vitamin D status on prostate cancer risk.

The study had equal numbers of African American and European American men. That’s important because African American men have significantly lower 25-hydroxy vitamin D status and significantly higher risk of prostate cancer than European American men.

All of the men enrolled in the study had elevated PSA levels or abnormal DREs. That’s important because it meant that all of the men enrolled in the study were at high risk of having prostate cancer. That made the correlation between vitamin D status and prostate cancer easier to detect.

This was the first study to correlate 25-hydroxyvitamin D levels with prostate biopsies at the time of biopsy. That’s important because it allowed the investigators to distinguish between aggressive tumors (which require immediate treatment and have a higher probability of mortality) and slow growing tumors (which may simply need to be monitored).

The results were pretty dramatic:

In African American men vitamin D deficiency (<20 ng/ml) was associated with an increased risk of prostate cancer diagnosis at time of biopsy.

In both European American and African American men severe vitamin D deficiency (<12 ng/ml) was associated with increased risk of aggressive prostate cancer diagnosis at time of biopsy.

The authors concluded: “Our work supports the hypothesis that 25-hydroxy vitamin D is a potential biomarker that plays a clinically significant role in prostate cancer, and it may be a useful modifiable risk factor in the disease”.

That’s “science speak” for “adequate vitamin D status may help prevent prostate cancer” or “low vitamin D may indeed be one of the risk factors of prostate cancer.”

Why Have Some Studies Failed To Find A Correlation Between Vitamin D Deficiency and Prostate Cancer?

The authors of the current study had an interesting hypothesis for why some previous studies have not seen an association between vitamin D status and prostate cancer risk. When you compare all of the previous studies, the strongest correlations between vitamin D deficiency and prostate cancer were the studies conducted at northern latitudes, in African American men, or focusing on aggressive prostate cancer as an end point.

That offers a few clues as to why other studies may have failed to find a link between vitamin D status and prostate cancer risk. For example:

The clue that the correlation between vitamin D deficiency and prostate cancer risk was strongest at northern latitudes and with African American men suggests that you need to have a significant percentage of subjects with deficient or very deficient levels of 25-hydroxy vitamin D before you can see a correlation. Other studies may have failed to show a correlation simply because most of the men in the study had normal vitamin D status.

The clue that the correlation is strongest for aggressive prostate cancer is more subtle. The authors hypothesized that prostate cancer develops over a lifetime. If that is the case, measuring vitamin D deficiency at the time of diagnosis may not represent the lifetime vitamin D status. The vitamin D status could have decreased because the men were older or had become overweight, or the vitamin D status could have changed simply because they moved from one geographical location to another.

In contrast, the progression from benign to aggressive prostate cancer is generally short term, so it would be affected by the most recent vitamin D status. If that is the case, then the vitamin D status measured at the time of diagnosis may more accurately reflect the vitamin D deficiency that affected the aggressiveness of the cancer.

The Bottom Line

1) The latest study suggests that vitamin D deficiency (<20 ng/ml serum 25-hydroxy vitamin D) may significantly increase the risk of prostate cancer. The correlation between low vitamin D status and prostate cancer risk is strongest for African American men.

2) The study also suggests that severe vitamin D deficiency (<12 ng/ml serum 25-hydroxyvitamin D) may significantly increase the risk of aggressive prostate cancer in both African American and European American men.

3) This is a very well done study, and it is consistent with many, but not all, of the previous studies. Clearly more research needs to be done. Future research should be focused on high risk subjects and subjects with low vitamin D status so that the correlation between vitamin D status and prostate cancer risk can be adequately tested.

4) This is another example of why I recommend that you have your serum 25-hydroxy vitamin D level measured on a regular basis and that you aim to keep it in the normal range (20-80 ng/ml). Some experts believe that 30-80 ng/ml is optimal.

5) If you are African American, overweight, live in northern latitudes or it is winter, you may need supplemental vitamin D3. 1,000 – 4,000 IU/day of vitamin D3 is generally considered to be safe. If higher amounts are needed to normalize your 25-hydroxy vitamin D levels I recommend that you consult your physician for the appropriate dose.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Are MultiVitamins a Waste of Money?

July 22, 2014 by Dr. Steve Chaney

The Multivitamin Controversy You Never Heard About

Author: Dr. Stephen Chaney

Are multivitamins a waste of money? You probably saw the recent headlines telling you that “the experts” have concluded that multivitamins are a waste of money. The article (Gualler et al., Annals of Internal Medicine, 159: 850-851, 2013) that generated all of the headlines was an editorial, which means it was an opinion piece, not a scientific study. It represented the opinion of five very prominent doctors, but it was, at the end of the day, just their opinion.

At the time I pointed out fallacies of their arguments in a “Health Tips From the Professor” article (MultiVitamins-Waste Money?). But, what do I know? I have only published 114 papers in peer reviewed journals and two book chapters on nutrition.

It turns out that I’m not the only expert who feels this way. Five very prominent experts recently published rebuttals concluding that the authors of the original editorial ignored “decades of nutrition research and diet monitoring of the U.S. population to reach this misleading conclusion” (Frei et al, Annals of Internal Medicine, 160: 807-809, 2014).

Who Are These Experts?

Before I share what these experts said, I should probably share their qualifications:

Balz Frei, PhD

Distinguished Professor of Biochemistry & Biophysics & Director of the Linus Pauling Institute, Oregon State University
203 publications

Bruce N. Ames, PhD

Director of the Nutrition & Metabolism Center, Children’s Hospital Oakland Research Institute
540 publications

Jeffrey B. Blumberg, PhD

Professor, Freidman School of Nutrition Science and Policy and Director of the Antioxidants Research Laboratory at the Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University
>300 publications

Walter C. Willet, MD, DrPH

Chair of the Department of Nutrition, Harvard School of Public Health
1,422 publications

Thomas R. Friberg, MD, MS

Professor of Ophthamology and Director of the Medical & Surgical Retinal Division of the University of Pittsburg School of Medicine
Principle investigator for the AREDS and AREDS II clinical studies.
134 publications

As you can see, these are not just your run of the mill scientists. They are the top experts in the field.

Are You Wasting Your Money On Multivitamins?

Are multivitamins a waste of money? What did these experts say?

They started by pointing out that few people in the United States follow the USDA dietary guidelines, and “consequently, most people in the United States even in cities like Raleigh, Durham, and Chapel Hill are not well nourished”. Specifically:

93% of U.S. adults don’t get enough vitamins D & E from their diet.
71% of U.S. adults don’t get enough vitamin K from their diet.
61% of U.S. adults don’t get enough magnesium from their diet.
50% of U.S. adults don’t get enough calcium and vitamin A from their diet.

They also pointed out that adequate intake of micronutrients is essential for normal body function and to support good health. Specifically:

Vitamins A, D, iron and zinc are required for normal immune function
Folic acid is required for neurological development. For example, “A multivitamin supplying folic acid dramatically decreases the risk of neural tube defects and is recommended for women of childbearing age.”
The AREDS and AREDS II studies have established the value of supplementation in preventing vision loss due to age-related macular degeneration.

They pointed out that largest (15,000 male physicians) and longest (13 years) randomized, placebo controlled trial of a multivitamin (the Physician’s Health Study II) showed a:

8% reduction in cancer incidence and a 12% reduction in cancer deaths
9% reduction in cataract formation

Finally, they pointed out that the claims that supplement use might actually increase mortality were overemphasized. Specifically:

The claims that high dose vitamin E increase mortality have been refuted by subsequent studies. I have discussed that in detail in my eBook, “The Myths of the Naysayers” (available for free to all subscribers of “Health Tips From the Professor”).
Only 1.1% of the U.S. population consumes more than the recommended upper limit for vitamin A (10,000 IU/day).
The only warning that actually holds up is that smokers should avoid high dose beta-carotene.
More importantly, all of those concerns involved high dose individual supplements. There is no evidence for any risk from taking a daily multivitamin.

In summary, the experts concluded: “Taking a daily multivitamin and mineral supplement not only helps fill known nutritional gaps in the diet of most persons in the United States (thereby ensuring normal body function and supporting good health), but may have the added benefit of helping to reduce the risk for chronic disease.”

The Bottom Line

1) Are multivitamins are a waste of money? No. That was simply the opinion of one group of experts. Other experts have come to the exact opposite conclusion.

2) Of course, it was only the negative opinion that made the headlines. Somehow the opinion that multivitamins are valuable for most Americans never got the attention of the press.

3) According to the experts mentioned in this article, multivitamins play an important role in filling well documented nutrition gaps in the U.S. population, assuring normal body function and helping preserve good health. There is evidence that they may have a modest role in reducing the risk for chronic diseases, and there is no evidence that multivitamin supplements increase the risk of mortality.

4) Of course, you shouldn’t expect miracles from your multivitamin. It’s not going to help you leap tall buildings in a single bound. Your multivitamin should just be one small part of your holistic health program of diet, exercise, weight control and supplementation.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Do Calcium Supplements Increase Heart Attack Risk?

July 15, 2014 by Dr. Steve Chaney

Calcium Confusion

Author: Dr. Stephen Chaney

Should you avoid calcium supplements? Do calcium supplements increase heart disease risk? If you’ve been reading some of the recent headlines in magazines, newspapers and current health articles, that’s exactly what you might think.

And, after years of telling us that calcium supplements may be important for bone health, even some doctors are now recommending that their patients avoid calcium supplements. So what’s the truth? What should you believe?

Can Gut Bacteria Make You Fat?

July 14, 2014July 8, 2014 by Dr. Steve Chaney

Gut Bacteria, Diet and Obesity

Author: Dr. Stephen Chaney

Can gut bacteria make you fat? It has been known for some time that the types of bacteria found in the intestines of obese people are different than those found in the intestines of lean individuals. But no one really knew the significance, if any, of that observation. Did obesity favor certain types of intestinal bacteria, or did certain types of intestinal bacteria favor obesity?

Obese individuals are often insulin resistant, and insulin resistance can cause higher sugar levels in the blood, urine and intestine. So it was easy to assume that obesity simply favored the growth of different types of bacteria in the intestine. However, recent studies have suggested that certain types of bacteria in our intestines may actually cause obesity.

Can Gut Bacteria Make You Fat?

For example, one study (Vijay-Kumar et al, Science, 328: 228-231, 2010) compared a strain of mice that are genetically predisposed to obesity with wild type (genetically lean) mice. They first looked at the intestinal bacteria. It turned out that the obese mice and lean mice had the same differences in intestinal bacteria that obese and lean humans have. And just like obese humans the obese mice ate more, displayed insulin resistance, and had elevated levels of triglycerides, cholesterol and blood sugar (They were pre-diabetic).

The investigators then decided to test the hypothesis that the particular bacterial strains found in the intestines of genetically obese mice might be causing their insulin resistance and obesity.

In the first experiment they killed off the intestinal bacteria in the genetically obese mice by putting high dose antibiotics in their food. Depleting the intestinal bacteria created some health problems for the mice, but it completely prevented the insulin resistance, overeating and obesity normally observed with this strain of mice.

In the second experiment they sterilized the intestines of the genetically lean mice and then colonized their intestines with intestinal bacteria from the genetically obese mice. When they did this, the genetically lean mice developed many of the characteristics of the genetically obese mice including insulin resistance, overeating, obesity and hyperglycemia.

In short, when their guts became colonized with bacteria from obese mice, the genetically lean mice became overweight and developed diabetes. Based on these experiments and other studies the scientists hypothesized that the wrong kinds of intestinal bacteria can make a significant contribution to insulin resistance, which in turn can lead to overeating and obesity. In short, they concluded that bad gut bacteria may make you fat.

The Battle of The Bacteria

In a second study (Walker et al, Science, 341: 1079-1089, 2013) the intestines of germ free mice were colonized with gut bacteria from lean and obese humans. The results were essentially the same as in the first study. That is, the mice who received gut bacteria from lean humans stayed lean and those who received gut bacteria from obese humans became obese.

But then the investigators asked two really interesting questions:

1) If you mixed the two types of bacteria, which one would win “the battle of the bacteria”?

For this experiment they took mice that had received gut bacteria from lean humans and mice that had received gut bacteria from obese humans and put them in the same cage. It turns out that since mice eat each other’s poop, they pick up each other’s intestinal bacteria. (No, I am not suggesting that you…)

The results of this experiment were (envelop please): The “lean” bacteria won out. They became the predominant bacteria in the intestines of all of the mice in the cage. Furthermore, none of the mice became obese – even the ones that had originally been inoculated with gut bacteria from obese humans.

2) Are the types of bacteria in the intestine influenced by diet?

In the previous experiment the mice were eating standard mouse chow – which is pretty healthy if you are a mouse. So the investigators decided to ask what would happen if they ate foods that were similar to really good and really bad human diets. They devised two types of diets for the mice – one that was high in fresh fruits & vegetable and low in fat (the good diet) and one that was high in fat and low in fresh fruits and vegetables (the bad diet).

On the good diet, the results were the same as in the previous experiment. On the bad diet the “lean” bacteria never grew in the intestines of the mice inoculated with bacteria from obese humans and those mice went on to become obese.

This study confirmed that the wrong kind of gut bacteria can cause obesity, but it also showed that diet can influence the type of bacteria that can grow in the intestine – something I talked about in an earlier issue of “Health Tips From the Professor” Our Gut Bacteria Are What We Eat.

The Bottom Line

1) Does this mean that you should rush out and buy some probiotics (good bacteria) as part of your weight loss strategy? The simple answer is no. That would be premature. These studies were performed in mice. Although similar results have been reported in humans (for example, Jumpertz et al, Am. J. Clin. Nutr., 94: 58-65, 2011), those studies are very preliminary at present. In addition, genetics and diet obviously played a role in the results. In short, we are a long way from knowing to what extent intestinal bacteria might contribute to obesity in humans.

2) However, there are many very good reasons to make sure that you supply friendly bacteria to your intestinal track on a regular basis. For example, we know that bad bacteria in your intestine can compromise your immune system, convert foods that you eat to cancer causing chemicals, and cause chronic inflammation – which contributes to a number of major diseases. Can gut bacteria make you fat? We can’t yet say whether good bugs will help keep you slim, but we do know that they can help keep you healthy.

3) Finally, while we can’t yet say whether probiotic supplements can help you lose weight, it is becoming increasing clear that healthy diets (low fat, high fiber diets with lots of fresh fruits and vegetables) support the type of intestinal bacteria that can make you slim. This is yet one more reason why a healthy diet is so important if you want to stay slim and healthy.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Does Grilled Meat Increase Prostate Cancer Risk?

July 5, 2014July 1, 2014 by Dr. Steve Chaney

Author: Dr. Stephen Chaney

Want Cancer With That Burger?

Its summer and you have most likely already visited a backyard bbq. One question that you probably won’t hear from your host or hostess is “Would you like some cancer with that burger?” But, perhaps that is exactly the question that they should be asking.

You probably already knew that red meat consumption may increase your risk of cancer. But, did you know that grilling that red meat may increase your risk of cancer even more?

You probably didn’t really want to know that when fat from the meat hits the hot coals, carcinogens form that are deposited on the meat.

You probably also didn’t want to know that when you cook meat to high temperatures the amino acids in the meat combine to form cancer causing substances.

And you really didn’t want to know that a recent study showed that people who consume well-done red meat were 60% more likely to develop advanced pancreatic cancer.

Does Grilled Meat Increase Prostate Cancer Risk?

This study compared 531 people ages 40-79 who had recently been diagnosed with advanced prostate cancer with 527 matched controls. Both groups were asked about their dietary intake of meats, usual meat cooking methods and doneness of the meat.

The results were quite striking:

Increased consumption of hamburgers was associated with a 79% increased risk of advanced prostate cancer.

Increased consumption of processed meat was associated with a 57% increased risk of advanced prostate cancer.

Grilled red meat was associated with a 63% increased risk of advanced prostate cancer.

Well done red meat was associated with a 52% increased risk of advanced prostate cancer.

However, those percentages are a little bit difficult to compare, because “increased consumption” was defined relative to what the usual consumption or cooking practice was. So put another way, weekly consumption of…

3 or more servings of red meat or…

1.5 or more servings of processed meat or…

1 or more servings of grilled or well done red meat…

…were associated with a 50% increased risk of advanced prostate cancer.

In contrast, consumption of white meat was not associated with increased cancer risk, no matter what the cooking method was used.

Is It Possible To Enjoy Your Cookouts Without Increasing Cancer Risk?

Our local newspaper recently carried some tips by Dr. Denise Snyder from the Duke University School of Nursing in Durham, NC on how you could reduce the risk of giving your guests cancer the next time you are the chef at your backyard bbq.

Here are her suggestions:

Grill fruits and vegetables instead of meat. That was her idea, not mine. My editorial comment would be that grilling white meat (fish or chicken) is also OK.

Use the lowest temperature that will cook your food thoroughly and keep the grill rack as high as possible.

Use a meat thermometer so that you can make sure that as soon as the meat is thoroughly cooked you remove it from the grill. We usually overcook the meat to make sure that it is done.

Shorten your grill time by microwaving the meat first, using thinner leaner cuts of meat or cutting up the meat and making kabobs.

Trim as much fat from the meat as possible before you cook it.

Line your grill rack with aluminum foil poked with holes. This allows the fat to drip down but minimizes the exposure of the meat to the carcinogens formed when the fat hits the coals.

Marinate your meats before grilling. That has been shown to reduce the formation of cancer causing chemicals.

And, of course, avoid processed meats like hot dogs and sausage completely because they have been shown to increase the risk of cancer and diabetes (British Journal of Cancer, 106: 603-607, 2012; American Journal of Clinical Nutrition, doi: 10.3945/ajcn.111.018978, 2011) no matter how they are cooked.

So here’s to a healthier backyard bbq. Bon appétit!

The Bottom Line

1) You already knew that red meat and processed meats may increase your risk of cancer, but how you cook your red meat also matters. Grilling your meat and/or cooking it until it is well done appear to significantly increase your risk of developing advanced prostate cancer.

2) In contrast, consumption of white meat was not associated with increased cancer risk, no matter what the cooking method was used.

3) I’ve included several tips on how you can reduce the cancer risk associated with grilling red meats in the article above so you can enjoy both your cookouts and your health.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Do Diet Sodas Make You Fat?

June 24, 2014 by Dr. Steve Chaney

Should You Kick the Diet Soda Habit?

Author: Dr. Stephen Chaney

We are consuming ever increasing amounts of diet sodas to combat the obesity epidemic. In 1960 14% of the U.S. population was obese and 3.3% of us consumed diet sodas. By 2010 41% of the U.S. population was obese and 20% of us were consuming diet sodas. It’s pretty clear that diet sodas aren’t helping us solve the obesity epidemic, but are they actually part of the problem?

You’ve probably seen the headlines questioning whether diet sodas actually help you lose weight. In fact many of the headlines imply the diet sodas will cause you to gain weight. Two of the more sensational headlines I came across said “Think diet sodas help you lose weight? Not so, Purdue study finds”, and “Can diet sodas actually cause more weight gain than regular sodas?”

Let me start with the first headline. The Purdue publication referred to in the headline (Swithers, Trends in Endocrin. & Metab., 24: 431-441) wasn’t really a study, it was an opinion piece. That simply means that it was a review where the references were selected on the basis of the author’s opinion. That’s OK if you clearly label it as an opinion piece, which Dr. Swithers did.

Now for the second headline: There is no good evidence that diet sodas will cause you to gain more weight than regular sodas. However, a number of published studies suggest that consumption of diet sodas is associated with weight gain – sometimes just as much weight gain as consumption of the sugar sweetened sodas they replace.

Do Diet Sodas Make You Fat?

The evidence that Dr. Swithers (Trends in Endocrin. & Metab., 24: 431-441) cited was pretty impressive.

For example, the San Antonio Heart Study recorded consumption of diet sodas and regular sugar sweetened sodas in 3,862 adults (average age 44) and measured the increase in BMI (a measure of obesity) over the next 7-8 years. That study found:

Individuals consuming >21 diet sodas/week were almost 2-fold more likely to become overweight or obese than individuals consuming no sodas.

There was a clear dose response effect, with a 41% increased risk of becoming overweight or obese for each can or bottle of diet soda consumed/day.

The increase in weight associated with diet soda consumption was just as great for those who were at normal weight at the beginning of the study as it was for those who were obese at the beginning of the study.

In this study the increase in weight associated with soda consumption was greater for diet sodas than it was for regular sodas.

Another major study (Circulation, 116: 480-488, 2007) recorded diet and regular soda consumption in 6039 participants in the Framingham Heart Study (average age 53) and measured the increase in obesity (along with other parameters associated with metabolic syndrome or pre-diabetes) over the next 4 years. This study found:

Individuals consuming one or more sodas/day had a 48% increased risk of becoming obese compared to people with infrequent soda consumption.

In this study the weight increase associated with soda consumption was virtually the same for diet sodas and regular sodas.

Are These Studies True?

These, and similar studies have been criticized because they are looking at associations, which do not prove cause-and-effect. For example, it’s not always clear whether the people in those studies gained weight because they were consuming diet sodas or consumed diet sodas because they were overweight.

That argument is less persuasive for the San Antonio Heart Study, because the weight gain associated with diet soda consumption was also seen with people who were at normal weight at the beginning of the study. Still there is a need for good double blind, placebo controlled intervention studies.

There have been very few intervention studies in which one group of subjects were told to drink only diet sodas and the other group only regular sodas. Unfortunately, in those studies the total caloric intake of the diet soda group was also restricted. So while the diet soda group did lose weight, it’s not clear whether that weight loss was due to the diet sodas or the overall caloric restriction of the diet.

You may have also seen the recent headlines from a study showing that people consuming diet sodas gained no more weight than people consuming water (Obesity, 22: 1415-1421, 2014). But once again, both groups were given detailed instructions on how to restrict total calories. Almost any diet will work if you have a dietitian looking over your shoulder and telling you how to restrict calories.

So what is the average consumer to think? On the one hand, dietitians and health professionals are telling you to drink diet sodas if you want to lose weight. On the other hand, you keep seeing these headlines saying the diet sodas may not help you lose weight or may even cause you to gain weight.

Of all the recent blogs and online articles on the topic, the only one I actually recommend reading is from WebMD (http://www.webmd.com/diet/features/diet-sodas-and-weight-gain-not-so-fast).

WebMD often adheres to the AMA line, but I found this to be a very balanced analysis of the science behind the question of whether diet sodas help or hinder weight loss.

How Could Diet Sodas Possibly Cause Weight Gain?

The million dollar question is: How could diet sodas possibly cause weight gain? After all, they contain no calories. I think the most useful perspective from the Web MD article is that it’s probably not the diet sodas themselves that cause weight gain. It’s what we eat with the diet sodas that cause the weight gain. Here are a couple of quotes I found particularly enlightening.

Dr. Barry Popkin, a colleague from the University of North Carolina, calls it the “Big Mac and Diet Coke” mentality. He says: “Especially in America, we have a lot of people who eat high-fat, high-sugar diets, but also drink diet sodas.”

Why is that? Dr. David Katz from Yale University has research suggesting that artificial sweeteners may condition people to want to eat more sweet foods. He says: “Our taste buds don’t really differentiate between sweet in sugar and sweet from, say, aspartame. The evidence that this sweet taste is addictive is pretty clear. What I have seen in my patients is that those who drink diet soda are more vulnerable to processed foods with added sugars.”

There is some independent evidence to back up that hypothesis. For example, one recent study showed that rats given artificially sweetened yoghurt with their rat chow ate more rat chow and gained more weight than rats fed sugar-sweetened yoghurt with their rat chow (Behavioral Neuroscience, 122: 161-173, 2008). Another study in humans showed that consumption of artificial sweeteners activates a portion of the brain associated with cravings for sweets (Physiology & Behavior, 107: 560-567, 2012).

However, this viewpoint is controversial. Some experts think that the association between diet sodas and weight gain is psychological rather than physiological. Simply put, when people consume diet drinks they feel that they can splurge elsewhere.

The Bottom Line

Once again there is no magic bullet. There is no good evidence that diet sodas will help you lose weight unless you carefully control the calories in everything else you eat. And, diet sodas may just cause you to gain weight because they make you crave the very foods that are worst for your waistline.

In addition, there may be other good reasons not to consume diet sodas. For example, recent studies have shown that consumption of diet sodas may be linked to increased risk of metabolic syndrome or pre-diabetes (Circulation, 116: 480-488, 2007) and heart disease (see Does Sugar Cause Heart Disease? and Can Soft Drinks Cause Heart Disease?

My recommendations are to drink water, herbal teas, unsweetened tea & coffee or unsweetened mineral water or seltzer – perhaps with a splash of fruit juice.

Finally, there is no substitute for a healthy, calorie controlled diet; exercise; and lifestyle change if you want to lose weight and keep it off.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.