supplements Archives - Health Tips From The Professor

Update On The “Truth About Vaccines”

March 9, 2021 by Dr. Steve Chaney

The Four Biggest Unanswered Questions

Author: Dr. Stephen Chaney

As someone who is not normally a proponent of vaccinations, I have done my best to provide a scientifically accurate evaluation of the vaccines for COVID-19. My purpose has not been to change people’s minds.

If you have already decided to get vaccinated, I applaud you.

If you have decided not to get vaccinated, I respect your opinion.

I have written my articles for those of you who recognize the dangers of COVID-19, want to get vaccinated, but are hesitant because of all the negative chatter about the vaccines you have seen on the internet.

I believe every vaccine should be evaluated on the basis of its risks and benefits.

The benefits are clear. COVID-19 is a deadly disease. It is hard to believe that anyone could look at what has happened in the United States and around the world and not realize COVID-19 is not the common flu. It is the most infectious and deadly disease we have seen in our lifetime. Anything that can help us conquer this deadly disease is tremendously beneficial.

However, every vaccine has risks. The risks are extremely low, but they are not zero. And some past vaccines have had unexpected risks. For that reason, I have evaluated potential risks, including those “risks” you have heard about on the internet, against actual data. I have asked, “Are the risks real?”, “Are they serious?”, and “Do they occur often enough to be of concern?”

The yardstick I use for “Do they occur often enough…?” is the 1 in a million to 1 in 10 million range. The chance of dying in a plane crash is 1 in 10 million. Yet that doesn’t stop us from getting on planes to fly where we want to go.

I think that is an apt analogy. Serious risks from the COVID-19 vaccines are in the 1 in 10 million range. I am willing to take that risk because it will take us to where we want to go – the other side of this pandemic.

I summarized the risks and benefits of the COVID-19 vaccines in a recent “Health Tips From The Professor” article (https://chaneyhealth.com/healthtips/the-truth-about-vaccination/). However, science marches on. That article was written just one month ago, but it is time to update the data and also acknowledge what we still don’t know.

Update On The “Truth About Vaccines”

Last week I recorded a talk on the “The Truth About Vaccines”. Part of my motivation was to provide people with audio and video files that would be easier to share. However, I also used that opportunity to update the information on vaccines. Here are the files. Consider them a gift you can use to spread the word about the vaccines.

Video Link:

https://zoom.us/rec/share/WkDiDdygAnsY4-8YO9HvT55jPOOH73xZ2cTy-cIMDBWSEhOOxgrxliUoH7iAtD5l.hVMILee_-bJg0Xvd

Passcode: FUfZ$3F$

Audio Link:

https://zoom.us/rec/play/vIXHPtXHzg-WV8KQb7JjZws49J0z_LY2yOKA5fWIN93GKvLUw08ViOpOa9QcLlvzEphIKibSvcwhgmoV.07AjXCj2j8Ac1cQy

Passcode: FUfZ$3F$

Note: If you want to share these audio and video files or the “Health Tips From The Professor” article I wrote a month ago, share the link rather than forwarding this email to them.

Similarly, if you would like to share this article with someone, share the link given at the beginning and end of this article rather than forwarding this email to them.

This is because if you forward this email to someone who unsubscribes because they aren’t in favor of vaccinations, it will unsubscribe you from receiving future issues of “Health Tips From the Professor”.

The Four Biggest Unanswered Questions

If you feel like the experts have been “flying by the seat of their pants”, that is because we are. When COVID-19 burst on the scene and spread like wildfire, it was a completely unknown entity. We had no idea what to expect or how effective measures to control it would be.

In fact, much of what we thought we knew was plain wrong. That is why:

We went from “masks are only important for health care workers” to “masks only protect others” to “masks protect us” to “maybe we need double masks”.

That is why a state like California, which has remained mostly locked-down and a state like Florida, which has remained mostly open, have ended up with about the same per capita cases and deaths from COVID-19.

Clearly some mitigation efforts are needed to “flatten the curve” and prevent our hospitals from being overwhelmed. We cannot just let the virus run rampant. But there is no clear agreement among experts as to which mitigation efforts are essential.

So, with perhaps a little humility, let me address the four greatest unanswered questions about COVID-19 and the vaccines. In each case, I will:

Give you the facts as we know them.

Give you my opinion.

Tell you what to watch for and what to do about it.

Here are the questions:

#1: How Long Will Immunity Last? Most headlines you have seen recently are asking this question with regards to the vaccines. But this question is equally important for those of you who have recovered from COVID-19. You also want to know if and how long you are protected from getting infected again.

Studies on this important question have mostly relied on measuring antibodies to COVID-19 in the bloodstream. And the answer appears to be similar for people who have been infected with COVID-19 and people who have been vaccinated, namely:

There are significant individual differences.

- In some people, antibody levels decrease after a few months.

- In other people, antibody levels appear to remain high for at least 6-8 months.

This is why the CDC is considering recommending a booster shot of the vaccine 6-12 months after you have completed your first round of vaccinations. It is also why some are recommending you get vaccinated even if you have recovered from COVID-19. The theory is that you will need to boost your antibody levels again to maintain full immunity from COVID-19.

But is a booster shot really necessary? As I have written previously:

Both the Pfizer and Moderna vaccines create memory cells as well as circulating antibodies.

- Memory cells reside in the bone marrow and retain the blueprint for making more antibody-producing cells if the virus ever reappears. They are responsible for long-term immunity.

- For example, many of you may remember a few years ago, a new variant of the flu virus appeared that hit young people much harder than people over 50. The explanation we were given at the time was that the new variant of the virus was similar to a flu virus that had widely circulated 30 years earlier. We had retained significant immunity to the previous virus, and it protected us from the new virus as well.

Because of memory cells, I am optimistic that we will retain significant immunity to COVID-19 even after circulating antibody levels have disappeared. But we won’t know for sure until we have accumulated enough data to know how well the vaccines protect us from COVID-19 a year or two down the road.

However, the data on patients who have recovered from COVID-19 is encouraging. So far, the reinfection rate seems to be around 1-2% and most of the recurring cases are mild.

So, should you get a booster shot? The risk of the vaccines will not change, so we need to look at the benefit side of the ledger.

If I am right and COVID cases are low 6-12 months from now, the benefit of getting a booster shot would be small. I’d give it a pass.

If I am wrong and COVID comes back with a vengeance, getting a booster shot might be prudent.

#2: Do We Need To Fear The Variants? You have seen the hype, “The new variants are highly contagious, and vaccines may not work against them.” The first claim is correct, but existing evidence suggests that the second claim is overblown.

Tests with antibodies from patients who have recovered from COVID-19 and from patients who have been vaccinated find that these antibodies are 70-90% effective at neutralizing the new variants. To put that into context, 70-90% effectiveness is significantly higher than the average flu vaccine.

New data coming out of England, where one of the variants originated, reports that the reinfection rate for people who have recovered from COVID-19 is around 0.7%, and this has not changed since the British variant strain appeared. [If the antibodies produced from the original COVID infection were not effective against the new variant, we would have expected reinfection rates to increase as the new variant became the predominant version of COVID circulating in the country.]

Of course, these data have not deterred the fearmongers. They are telling you that it is only a matter of time until a variant comes along that is unaffected by vaccines. I consider this unlikely, and here is why.

Vaccines are directed against the spike protein of the virus. That is the same protein the virus uses to bind to our cells. Any mutations severe enough to eliminate antibody binding to the spike protein are also likely to prevent the spike protein from binding to our cells. If the spike protein can’t bind to our cells, the virus can’t enter our cells. Such mutant viruses would be non-infectious. They would die out spontaneously.

Because of that, I am optimistic that the current vaccines will retain significant effectiveness against new variants as they arise.

Once again, the CDC may recommend a booster shot to help protect against the variants. The pharmaceutical companies are also working on vaccines that are specific to the new variants.

Should you get one of these shots? Once again, we won’t know for sure until we see how well the vaccines protect us from the new variants.

If I am right and COVID cases are low 6-12 months from now, the benefit of getting a shot would be small. I’d give it a pass.

If I am wrong and a new variant causes a massive surge in COVID cases and deaths in people who have been vaccinated, getting another shot might be prudent.

#3: Can I Get My Life Back After Vaccination? You have probably heard the CDC recommendations that we can still get COVID-19 and pass it on to others after we have been vaccinated. We should, therefore, continue to wear masks and socially distance ourselves.

I have had many people say to me, “If that’s true, why should I even bother to get vaccinated?” Let me start by covering what we know and don’t know about this question. Then I will put it into perspective for you.

The immune cells in the upper respiratory tract are not in perfect sync with the rest of the immune system. That means that after vaccination we may not get quite the level of protection in our upper respiratory track that we do in the rest of our body.

In the initial studies with rhesus monkeys, the animals were vaccinated and subsequently a high titer of live virus was sprayed directly into their noses. Virus was detected in their nasal passages for about 3 days before it disappeared.

- The animals did not have detectable levels of virus in their bloodstreams. Nor did they develop any disease symptoms.

- However, the brief presence of live virus in their nasal passages led to the suggestion that one might still be able to pass the virus on to others after vaccination.

Small, preliminary studies with a subset of patients enrolled in the vaccine clinical trials suggested that the vaccines might only be around 60% effective at preventing upper respiratory tract infections.

- That means if you are exposed to COVID-19, you might have a 40% chance of developing an upper respiratory tract infection. In most cases you will be asymptomatic, but you could pass the virus on to others.

- The good news is that you are still 95% protected against severe disease, hospitalization, chronic long-term symptoms, and death. This is the answer to the “Why bother?” question.

However, new data out of Israel gives a more optimistic assessment. The latest study reported that the Pfizer vaccine is 89% effective at preventing even asymptomatic disease.

The bottom line is that the data are still coming in. It may be another 6-12 months before we have an accurate estimate of your risk of developing asymptomatic disease and passing the virus on to someone else if you are exposed to COVID-19 after being vaccinated.

So, what do I recommend? I can’t tell you what you should do, but I will tell you what I plan to do.

I still plan to wear a mask and social distance when I am out and about.

I am comfortable meeting with small groups of close friends and family without a mask, especially if they have also been vaccinated.

I am comfortable going back to church because our church follows an excellent social distancing protocol.

I am comfortable traveling to visit our family in California.

Once the number of COVID-19 cases has reached a low level, I will be comfortable resuming all my previous activities, subject, of course, to any state mandates.

News Flash: Yesterday the CDC updated their guidelines for people who are fully vaccinated. They now say that fully vaccinated people can:

Visit with other fully vaccinated people indoors without wearing masks or physically distancing.

Visit with unvaccinated people from a single household who are at low risk for severe COVID-19 disease indoors without wearing masks or physically distancing.

Refrain from quarantining and testing following a known exposure to someone with COVID-19 unless you develop symptoms.

The other CDC guidelines remain in place for now but are likely to change once a larger percentage of the population has been vaccinated.

#4: Why Not Rely On Diet And Supplementation? I have friends who tell me they are not going to get vaccinated. They will rely on diet and supplementation to keep their immune systems strong and protect them from COVID. I respect their choice.

In fact, I have a great deal of sympathy for that choice. When I think of protecting myself from colds and flu, my preference has always been to keep my immune system strong with diet, supplementation, and exercise rather than relying on vaccinations.

However, COVID is different story. It is a far deadlier disease. And even if it doesn’t kill you, it may impact your life for years to come. The long-term health consequences of COVID are perhaps even scarier than the 1% death rate.

Let’s take a realistic look at each of our options to defeat COVID:

In a previous issue of “Health Tips From the Professor” I shared some preliminary clinical studies showing that people with adequate vitamin D status were 60-70% less likely to be infected with COVID, hospitalized with COVID, in the ICU from COVID, and dying from COVID. That is impressive, but it is not 100% protection. And if your vitamin D levels are already adequate, you get no additional benefit from adding extra vitamin D to your diet.

In another issue of “Health Tips From the Professor” I shared a review written by a group of experts on respiratory diseases. They concluded that, in addition to a good diet, supplementation with a multivitamin and extra vitamin C, vitamin D, and omega-3s reduced the risk of dying from respiratory diseases. But they didn’t say it eliminated the risk. It did not guarantee 100% protection.

As for CDC guidelines, wearing a mask gives you somewhere between 30 and 70% protection. Social distancing and handwashing also help, but they don’t offer 100% protection.

Vaccination with the Pfizer and Moderna vaccines gives you at least 60% protection against upper respiratory infections from COVID-19 and 95% protection against severe disease, hospitalization, long term health consequences, and death. It is the single most effective tool we have at our disposal, but it does not give 100% protection. As one of my pessimist friends put it, “95% protection means I have a 1 in 20 chance of getting it.”

COVID-19 is throwing everything it has at us. When faced with a deadly disease and several things I can do that offer partial protection, I choose a holistic approach. I choose to use every tool at my disposal. I choose diet, supplementation, CDC guidelines, and vaccination. Everyone should make their own decision about how best to protect themselves from COVID-19, but my choice is clear. I want to do everything in my power to avoid this disease.

The Bottom Line

In the article above, I have updated my information on vaccines with data from the latest studies, provided you with resources about the vaccines you can share, and have given you updates and perspective on the four biggest unanswered questions about COVID-19 and the vaccines, namely:

How long does immunity last?

Do we need to fear the new variants?

Can I get my life back after vaccination?

Why not rely on diet and supplementation?

For more details, read the article above.

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 Supplements Interfere With Chemotherapy?

February 2, 2021 by Dr. Steve Chaney

Should You Avoid Supplement Use During Chemotherapy?

Since much of my research career was devoted to cancer research, specifically developing new chemotherapeutic drugs for treating cancer, many of you have asked me the question: “Do food supplements interfere with chemotherapy?”

My answer has always been that it is theoretically possible, but that we don’t really know the answer because the necessary studies have not been done.

However, I do know that most cancer drugs are retained in the body for a short period of time. So, my pragmatic advice has always been to avoid supplementation for a day or two before to a day or two after each round of chemotherapy. That is a strategy designed to minimize the possibility that supplementation would interfere with chemotherapy and maximize the possibility that supplementation might aid in recovery between rounds of chemotherapy.

That is why I was interested when I saw the recent headlines claiming certain supplements may interfere with chemotherapy for breast cancer. I wanted to find out if someone had finally done a definitive study on the effect of supplementation on chemotherapy.

So, I have reviewed the study (CB Ambrosone et al, Journal of Clinical Oncology, 38, 804-815, 2020) behind the headlines and will share what I discovered.

How Was The Study Done?

This study was an offshoot of a much larger Phase III clinical trial designed to determine the best schedule for administering three drugs (doxorubicin, cyclophosphamide, and paclitaxel) to patients with high-risk early-stage breast cancer.

The 1,134 patients enrolled in this study were given questionnaires on their use of supplements when they registered for the study to determine supplement use prior to the study. They were also given questionnaires when they completed chemotherapy to determine supplement use during chemotherapy.

The questionnaires documented use of:

Multivitamins

The antioxidants vitamin C, vitamin A, vitamin E, carotenoids, and coenzyme Q10.

Vitamin D.

The B vitamins vitamin B6, vitamin B12, and folic acid.

The minerals iron and calcium.

Omega-3 fatty acids.

Glucosamine, melatonin, and acidophilus.

Recurrence of the breast cancer and death from breast cancer were measured 6 months after chemotherapy ended.

Do Supplements Interfere With Chemotherapy?

The study reported:

The number of patients using individual antioxidant supplements was too low to determine whether individual antioxidants had any effect on treatment outcomes.

When the patients using any antioxidant supplement were pooled into a single group, there was a nonsignificant association between antioxidant supplement use during chemotherapy and an increased risk of breast cancer recurrence and death from breast cancer.

Iron use during chemotherapy was significant associated with an increased risk of breast cancer recurrence.

Vitamin B12 use during chemotherapy was significantly associated with increased risk of breast cancer recurrence and death from breast cancer.

Multivitamin use was not associated with either recurrence or death from breast cancer.

The number of patients using the other supplements was too low to determine whether those supplements had any effect on treatment outcomes.

The authors concluded: “Associations between survival outcomes and use of antioxidant and other dietary supplements are consistent with recommendations for caution among patients when considering the use of supplements, other than a multivitamin, during chemotherapy.”

This is the conclusion that generated the headlines you may have seen.

However, in their discussion the authors conceded that a previous review concluded that, “…insufficient evidence existed with regard to the safety of dietary supplements [during chemotherapy] to make recommendations, and that still may be the case.”

I will discuss the reasons for their disclaimer below. However, I will point out that disclaimers like this never seem to make it into the headlines you read.

What Are The Strengths And Weaknesses Of This Study?

The only strength of this study is that it was performed in the context of an ongoing clinical trial, with surveys conducted before chemotherapy and during chemotherapy to assess supplement use.

However, the study had multiple weaknesses that limit the ability to draw any firm conclusions from the study.

#1: The number of people using supplements in this study was very small. For example:

Only 200 people took any antioxidants during chemotherapy.

Only 137 people took a vitamin B12 supplement during chemotherapy.

Only 109 people took an iron supplement during chemotherapy.

To put this into perspective, if a drug company were submitting a new drug for approval to the FDA, they would be required to submit data from ~50-100-fold more cancer patients to prove that the drug was effective.

With this small number of supplement users, even “statistically significant” observations are questionable.

In contrast, the number of people taking a multivitamin during chemotherapy was 497. Thus, those data were a little stronger than the data for individual supplements.

#2: They did not ask why people were taking supplements. It turns out that the patients who used supplements were older and sicker. They were more likely to be overweight and to have type 2 diabetes.

These are patients who are also more likely to have poor outcomes from chemotherapy. The authors tried to correct for that, but it is virtually impossible to make these corrections when the number of patients taking supplements is so low.

#3: They did not ask about the dose of supplements people were taking.

Multivitamins typically contain RDA levels of antioxidants and vitamin B12, so it would be safe to assume that RDA levels of antioxidants and vitamin B12 are safe during chemotherapy.

Approximately 50% of the women in the study were premenopausal, so it is likely that they were taking a multivitamin with iron. That suggests that RDA levels of iron are safe during chemotherapy for premenopausal women.

In short, the association between supplement use and poorer outcomes from chemotherapy is tenuous. If there is any association, it is likely with high dose individual supplements rather the lower levels of the same nutrients found in a multivitamin.

Is An Effect Of Supplement Use On Chemotherapy Plausible?

As a biochemist, the next question I ask is whether there is a plausible mechanism for an effect of any of these supplements on chemotherapy outcomes.

For two of the drugs in the regimen (paclitaxel and cyclophosphamide), free radical formation may contribute to their effectiveness, but it is not their main mechanism of action. Thus, it is plausible that high dose antioxidant supplements could make these drugs less effective, but the effect should be relatively small.

Tumors require high amounts of iron for proliferation, so it is plausible that excess iron could make tumors more resistant to chemotherapy. However, for premenopausal women, multivitamins with iron did not interfere with the drugs used in this study. Thus, it appears likely that RDA levels of iron, where appropriate, do not interfere with chemotherapy.

The authors said that the reason for the observed effects of vitamin B12 on chemotherapy in their study “remains to be understood”. However, the answer might be found in the dosage of vitamin B12. A previous study reported that doses of vitamin B12 that were greater than 20 times the RDA increased the risk of lung cancer.

If people in this study were taking doses of vitamin B12 in excess of 20 times the RDA, it would provide a plausible explanation for B12 interfering with chemotherapy. If not, there is no known explanation. In any case, I do not recommend taking such high doses of any supplement.

Should You Avoid Supplement Use During Chemotherapy?

Now, let’s get back to the original question: “Should you avoid supplement use during chemotherapy?” If you read the headlines saying, “Supplement Use During Chemotherapy May Be Risky”, you might think that the answer is an unqualified yes. That is also what your doctor is likely to think.

However, when you analyze the study behind the headlines you realize that the evidence supporting the headlines is very weak.

So, that puts us back to where we were before the study was published. Simply put:

It is theoretically possible that supplements interfere with chemotherapy, but we don’t know for sure.

A pragmatic approach is to avoid supplementation for a day or two before to a day or two after each round of chemotherapy. This is a strategy designed to minimize the possibility that supplementation would interfere with chemotherapy and maximize the possibility that supplementation might aid in recovery between rounds of chemotherapy.

Note: This is generic advice. I am not a medical doctor, so it would be unethical for me to provide individualized advice on how to minimize interactions between supplements and chemotherapy. What I recommend is that you ask your doctor whether my generic recommendations make sense for your cancer and your drug regimen.

If this study advanced our knowledge at all, it would be that:

The supplements most likely to interfere with chemotherapy appear to be high dose antioxidants, vitamin B12, and iron supplements.

Multivitamins, even multivitamins with iron when appropriate, are unlikely to interfere with chemotherapy.

The Bottom Line

Recent headlines have warned, “Supplement Use During Chemotherapy May Be Risky”. Is that true?

However, when you analyze the study behind the headlines you realize that the evidence supporting the headlines is very weak.

So, that puts us back to where we were before the study was published. Simply put:

It is theoretically possible that supplements interfere with chemotherapy, but we don’t know for sure.

A pragmatic approach is to avoid supplementation for a day or two before to a day or two after each round of chemotherapy. This is a strategy designed to minimize the possibility that supplementation would interfere with chemotherapy and maximize the possibility that supplementation might aid in recovery between rounds of chemotherapy.

Note: This is generic advice. I am not a medical doctor, so it would be unethical for me to provide individualized advice on how to minimize interactions between supplements and the chemotherapy drugs you are on. What I recommend is that you ask your doctor whether my generic recommendations make sense for your cancer and your drug regimen.

If this study advanced our knowledge at all, it would be that:

The supplements most likely to interfere with chemotherapy appear to be high dose antioxidants, vitamin B12, and iron supplements.

Multivitamins, even multivitamins with iron when appropriate, are unlikely to interfere with chemotherapy.

For more details read the article above.

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 Carnitine Supplements Good For You Or Bad For You?

December 8, 2020 by Dr. Steve Chaney

What Is The Truth About Carnitine And TMAO?

If you are a weightlifter or bodybuilder, chances are you are taking an L-carnitine supplement or a protein shake fortified with L-carnitine. That is because L-carnitine has been promoted for increasing muscle mass and physical performance for so long that most people have come to believe it must be true. Is it true, or is it just another food myth?

If you visit Dr. Strangelove’s website, you may also be told that carnitine supplementation is beneficial for weight loss, migraines, baldness, ADHD and autism, chronic fatigue syndrome, and/or low energy, muscle loss, and cognitive decline in older adults. Are these claims fact or fiction?

On the flip side, recent studies have suggested that the carnitine in red meat might be bad for your heart. Could the same be true for carnitine supplements? Could they also be bad for your heart?

A recent systematic review (AG Sawicka et al, Journal of the International Society of Sports Nutrition, 17: 49, 2020) of L-carnitine supplementation answers these important questions. The authors called their study “The bright and dark sides of L-carnitine supplementation” because they set out to systematically investigate the benefits and potential risks of L-carnitine supplementation.

But before I share the results of this study, I need to give you a little background on L-carnitine. It is time for another Biochemistry 101 segment.

Biochemistry 101: What You Need To Know About Carnitine

Carnitine plays an essential role in human metabolism. It is required for transport of fatty acids into our mitochondria so they can be used to generate energy. Without carnitine we would be unable to utilize most of the fats in our diet as an energy source.

As you might expect, carnitine is essential for any tissues that have mitochondria, but it is particularly important for high energy tissues like skeletal and heart muscle.

For most of us, our liver and kidneys make all the carnitine we need. So, we don’t really need carnitine from food or supplements.

However, we do get significant amounts of carnitine from red meat, much smaller amounts of carnitine from other animal foods, and almost no carnitine from plant foods. Adults consuming diets with red meat and other animal foods get about 60-180 mg of carnitine a day from their diet, whereas vegans only get around 10-12 mg/day.

Uptake of carnitine from the blood into muscle tissues requires insulin. Thus, carnitine uptake into muscle is significantly less on a low-carbohydrate or keto diet than it is on a mixed diet containing carbohydrates.

Finally, our kidneys do an excellent job of regulating blood carnitine levels, with excess carnitine being excreted into the urine. Thus, total body carnitine levels are virtually the same with high-carnitine and low-carnitine diets.

This raises the question: “Are L-carnitine supplements good for you?”

Now, let’s talk about the dark side of carnitine. I have discussed this in a previous issue of “Health Tips From the Professor”. Here is a brief summary:

People who eat a lot of red meat harbor a species of bacteria in their intestine that converts carnitine to trimethylamine (TMA). We don’t know whether this species of gut bacteria is favored by the presence of red meat in the diet or the absence of certain fruits, whole grains, and legumes from the diet of meat eaters.
The TMA is reabsorbed into the bloodstream, and the liver converts TMA to TMAO (trimethylamine N-oxide).
TMAO is associated with an increased risk of heart attack, stroke, and heart failure.

When you think about it, this is a perfect example of double jeopardy. Red meat is high in carnitine, and red meat eaters have gut bacteria that result in carnitine being converted to a compound that may increase the risk of heart disease.

This raises the question: “Are L-carnitine supplements bad for you?”

Let’s look at these two questions. First, I will discuss the recent review. Then I will put the conclusions of that review into perspective by looking at what other health experts say.

Are Carnitine Supplements Good For You Or Bad For You?

Most previous studies of carnitine supplementation have lasted only two or three weeks, which may not be long enough to measure an effect of carnitine supplementation on performance. So, the authors of this review paper selected studies that lasted 11 weeks or more for their review.

The review included 11 studies. They lasted either 12 or 24 weeks. Participants received doses ranging from 1 gm to 4.5 gm of L-carnitine per day. Here are the conclusions of the review:

Participants receiving L-carnitine alone had no increase in muscle carnitine content.

Participants receiving L-carnitine + 80 grams of carbohydrate had around a 10% increase in muscle carnitine content. [To put that into perspective, 80 grams of carbohydrate is roughly equivalent to 2 cups of white rice or two medium potatoes.]

One study compared male vegetarians with male omnivores. The omnivores had no increase in muscle carnitine content, but the vegetarians did. [The study did not analyze the diets of the omnivores and vegetarians, but it is probably safe to assume that the carbohydrate content was higher on the vegetarian diet.]

There was no significant effect of L-carnitine on muscle mass or physical performance. [This is logical, given the minimal effect of L-carnitine supplementation on muscle carnitine levels.

Thus, this review found little evidence that L-carnitine supplementation was good for you. It resulted in little or no increase in muscle carnitine levels or in physical performance.

Two of the 11 studies measured plasma TMAO levels. These studies found that L-carnitine supplementation resulted in a significant increase in plasma TMAO levels.

Thus, this review found some evidence that L-carnitine supplementation might be bad for you.

What Is The Truth About Carnitine And TMAO?

Is carnitine good for you? With respect to this question, the conclusions of this review are similar to the conclusions of other health experts. For example, in their Fact Sheet On Carnitine For Health Professionals the NIH states “Some athletes take carnitine to improve performance. However, twenty years of research finds no consistent evidence that carnitine supplements can improve exercise or physical performance in healthy subjects—at doses ranging from 2–6 grams/day administered for 1 to 28 days. For example, carnitine supplements do not appear to increase the body’s use of oxygen or improve metabolic status when exercising, nor do they necessarily increase the amount of carnitine in muscle.”

The NIH fact sheet goes on to list some diseases causing muscle loss or muscle weakness, for which L-carnitine supplementation is appropriate. However, in these cases, the carnitine supplementation should be recommended by health professionals.

Is carnitine bad for you? The TMAO story is a bit more complicated. As I mentioned above, there is an association between red meat consumption and blood TMAO levels and an association between blood TMAO levels and heart disease.

Is it TMAO that increases the risk of heart disease or is it some other component (saturated fat, for example) of red meat that increases the risk of heart disease? Nobody knows. More research is needed.

There is also a “red herring” that complicates the TMAO story. It turns out that TMAO helps fish survive the high pressures they encounter in the deep ocean. Thus, many fish are high in TMAO, and fish consumption also increases blood TMAO levels.

Are the bad effects of TMAO in fish outweighed by the heart healthy components in fish (omega-3s, for example)? Nobody knows. More research is needed.

To summarize:

There is no reason to take L-carnitine supplements unless directed by your health professional. There is little evidence they will help your physical performance. There is also no good evidence to support the other benefits of L-carnitine you find listed on Dr. Strangelove’s blog or the website of your favorite supplement company.

L-carnitine supplements may be bad for your heart, but much more research will be needed to be sure. [Note: Based on what we know about the role of gut bacteria in TMAO production, vegans could probably take l-carnitine supplements without causing an increase in TMAO levels. However, that is probably a moot point. There is no evidence that L-carnitine is more effective for vegans than it is for omnivores.]

The Bottom Line

On the flip side, recent studies have suggested that the carnitine in red meat might be bad for your heart. Could the same be true for L-carnitine supplements? Could they also be bad for your heart?

A recent review looked at these questions. Here are the conclusions of the review:

Participants receiving L-carnitine alone had no increase in muscle carnitine content.

Participants receiving L-carnitine + 80 grams of carbohydrate had around a 10% increase in muscle carnitine content. [To put that into perspective, 80 grams of carbohydrate is roughly equivalent to 2 cups of white rice or two medium potatoes.]

There was no significant effect of L-carnitine on muscle mass or physical performance. [This is logical, given the minimal effect of L-carnitine supplementation on muscle carnitine levels.

Thus, this review found little evidence that L-carnitine supplementation was beneficial. It resulted in little or no increase in muscle carnitine levels or in physical performance.

This review also found that L-carnitine supplementation resulted in a significant increase in plasma TMAO, a compound that has been associated with an increased risk of heart disease.

Thus, this review found some evidence that L-carnitine supplementation might be bad for you.

The NIH has also issued a fact sheet for health professionals summarizing research on L-carnitine over the past 20 years. The conclusions from their fact sheet can be best summarized as:

There is no reason to take L-carnitine supplements unless directed by your health professional. There is little evidence they will help your physical performance. There is also no good evidence to support the other benefits of L-carnitine you find listed on Dr. Strangelove’s blog or the website of your favorite supplement company.

L-carnitine supplements may be bad for your heart, but much more research will be needed to be sure.

For more details read the article above.

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.

What Supplements Help Mental Health?

January 14, 2020 by Dr. Steve Chaney

Do Omega-3s Reduce Depression?

Author: Dr. Stephen Chaney

We are in the midst of a mental health crisis. According to the latest statistics:

· 19% of adults in the United States have some form of mental illness.

· 16.5% of youth ages 6-17 have some form of mental illness.

· The 5 most commonly diagnosed forms of mental illness are anxiety, depression, post-traumatic stress disorder, bipolar disease, and ADHD.

Even worse, mental illness appears to be increasing at an alarming rate among young people. For example:

· Between 2005 and 2017 depression increased 52% among adolescents.

· Between 2002 and 2017 depression increased 63% in young adults.

· Between 1999 and 2014 suicides have increased 24% in young adults. In the past few years suicides have been increasing by 2% a year in this group.

Much has been written about the cause of this alarming increase in mental illness. The short answer is that we don’t really know. But the most pressing question is what do we do about it?

The medical profession relies on powerful drugs to treat the symptoms of mental illness. These drugs don’t cure the illness. They simply keep the symptoms under control. Plus, if you have ever listened closely to the advertisements for these drugs on TV, you realize that they all have serious side effects that adversely affect your quality of life.

My “favorite” example is drugs for anxiety and depression. You are told that one of the side effects is “suicidal thoughts”. That means that the very drug someone could be prescribed to prevent suicides might actually increase their risk of suicide. Why would anyone take such a drug?

If drugs are so dangerous, what about supplements? Do they provide a safe, natural alternative for reducing the symptoms of mental illness? Some supplement companies claim their products cure mental illness. Are their claims true or are they just trying to empty your wallet?

How is a consumer to know which of these supplement claims are true and which are bogus? Fortunately, an international team of scientists has scoured the literature to find out which supplements have been proven to reduce mental health symptoms.

How Was The Study Done?

This was a massive study (J. Firth et al, World Psychiatry, 18: 308-324, 2019. It was a meta-review of 33 meta-analyses of randomized, placebo-controlled trials with a total of 10,951 subjects. The clinical trials included in this analysis analyzed the effect of 12 nutrients, either alone or in combination with standard drug treatment, on symptoms associated with 10 common mental disorders.

To help you understand the power of this meta-review, let me start by defining the term “meta-analysis”. A meta-analysis combines the data from multiple clinical studies to increase the statistical power of the data. Meta-analyses are considered to be the gold standard of evidence-based evidence.

However, not all meta-analyses are equally strong. They suffer from the “Garbage-In, Garbage-Out” phenomenon. Simply put, they are only as strong as the weakest clinical studies included in their analysis.

That is the strength of this meta-review. It did not simply combine the data from all 33 meta-analyses. It used stringent criteria to evaluate the quality of each meta-analysis and weighted the data appropriately.

What Supplements Help Mental Health?

The strongest evidence was for omega-3 supplements. In the worlds of the authors:

· “Across 13 independent randomized control clinical trials in 1,233 people with major depression, omega-3 supplements reduced depressive symptoms significantly.”

o The average dose of omega-3s in these studies was 1,422 mg/day of EPA.

o The effect was strongest for omega-3 supplements containing more EPA than DHA and for studies lasting longer than 12 weeks.

o There was no evidence of publication bias in these studies. This is a very important consideration. Publication bias means that only studies with a positive effect were published while studies showing no effect were withheld from publication. That makes the effect look much more positive than it really is. The fact there was no evidence of publication bias strengthens this conclusion.

o Omega-3 supplements were more effective when used in combination with antidepressant drugs, but there was some evidence of publication bias in those studies.

· “Across 16 randomized control clinical trials reporting on ADHD symptom domains, significant benefits were observed for both hyperactivity/impulsivity and inattention.”

· Omega-3s had no significant effect on schizophrenia or bipolar disorder other than a mild reduction in depressive symptoms.

There was strong, but not definitive, evidence for folic acid and methylfolate supplements for depression.

· When used in conjunction with antidepressants both folic acid and methylfolate supplements “…were associated with significantly greater reductions in depressive symptoms compared to placebo, although there was large heterogeneity between trials.”

· The largest effects were observed with high dose methylfolate. In the words of the authors: “Two randomized control clinical trials examining a high dose (15 mg/day) of methylfolate administered in combination with antidepressants found moderate-to-large benefits for depressive symptoms.” However, to put this into perspective:

o 15 mg/day is 3,750% of the RDA. This is a pharmacological dose and should only be administered under the care of a physician.

o A smaller dose of 7.5 mg/day is ineffective.

o No comparison was made with folic acid at this dose, so we do not know whether folic acid would be equally effective.

· The authors concluded that there is emerging evidence for positive effects of vitamin D (>1,500 IU/day) for major depressive disorders and N-acetylcysteine (2-3 gm/day) in combination with drugs for mood disorders and schizophrenia. The term “emerging evidence” means there have been several recent studies reporting positive results, but more research is needed.

· The authors did not find evidence supporting the use of other vitamin and mineral supplements (E, C, zinc, magnesium, and inositol) for treating mental health disorders.

· The authors did not find enough high-quality studies to support claims about the effects of prebiotics or probiotics on mental health disorders.

Do Omega-3s Reduce Depression?

The evidence supporting the effectiveness of omega-3s in reducing symptoms of depression is strong. In the words of the authors: “The nutritional intervention with the strongest evidentiary support is omega-3, in particular EPA. Multiple meta-analyses have demonstrated that it has significant effects in people with depression, including high-quality meta-analyses with good confidence in findings…”

However, before you throw away your antidepressants and replace them with an omega-3 supplement, let me put this study into perspective for you.

· Depression can be a serious disease. If you just feel a little blue from time to time, try increasing your omega-3 intake. However, if you have major depression, don’t make changes to your treatment plan without consulting your physician.

· The best results were obtained when omega-3s were used in combination with antidepressants. This should be your starting point.

· Ideally, adding omega-3s to your treatment plan will allow your doctor to reduce or eliminate the drugs you are taking. That would have the benefit of reducing side effects associated with the drugs. However, I would like to re-emphasize this is a decision to take in consultation with your doctor. [My only caveat is if your doctor is unwilling to even consider natural approaches like omega-3 supplementation, it might be time to find a new doctor.]

· Finally, omega-3 supplementation is only one aspect of a holistic approach to good mental health. A healthy diet, exercise, supplementation, and stress reduction techniques all work together to keep your mind in tip-top shape.

The Bottom Line

There are lots of supplements on the market promising to cure depression and other serious mental health issues. Are they effective or are the claims bogus? Fortunately, a recent meta-review of 33 meta-analyses of high-quality clinical trials has answered that question. Here is their conclusion:

· The evidence is strongest for omega-3s and depression.

o The average dose of omega-3s in these studies was 1,422 mg/day of EPA.

o The effect was strongest for omega-3 supplements containing more EPA than DHA and for studies lasting longer than 12 weeks.

· There is fairly strong evidence for folate/folic acid supplements and depression, although there was large heterogeneity between trials.

· There is emerging evidence for vitamin D (>1,500 IU/day) and depression and N-acetylcysteine (2-3 gm/day) for depression and schizophrenia.

· Evidence for other supplements is currently inconclusive.

However, before you throw away your antidepressants and replace them with an omega-3 supplement, let me put this study into perspective for you.

· The best results were obtained when omega-3s were used in combination with antidepressants. That should be your starting point.

For more details, read the article above.

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.