Apr
30
2014

Overuse Of Supplements Can Create Health Risks

The Dietary Supplement Health And Education Act of 1994 made it easier for people to acquire supplements and vitamins from health food stores. But since then there has been a proliferation of various products that are sold as supplements and not as drugs. It may give you the impression that all supplements are harmless, but this is not so. There are some supplements like vitamin A where you need to watch that you are not inadvertently overdosing, as toxicity is a problem; calcium supplements are also potentially toxic, if overdone. And amino acid supplements (protein supplements) can lead to an overdose of brain hormones. Here is a sample of some of the supplements that I would want you to watch.

1.Vitamin A toxicity:

Vitamin A is essential for normal night vision, for red blood cell production in the bone marrow and for the immune system. Here is a brief review about its metabolism. But while small amounts are beneficial for the body, high doses are toxic. In the 19th century the Arctic explorer Elisha Kane reported that consumption of polar bear liver caused severe headaches, drowsiness, irritability and vomiting within a few hours of ingesting it.

It is now known to be due to “pseudotumor cerebri”, a condition that mimics a brain tumor, but is caused by an acute overdose of vitamin A contained in liver (Ref. 1).

In the US where people eat enough meat, fish and dairy products, there is no overt vitamin A deficiency. Read this link to avoid overdosing with vitamin A in multiple supplements.

Overuse Of Supplements Can Create Health Risks

Overuse Of Supplements Can Create Health Risks

2. Vitamin C:

Vitamin C is an important antioxidant vitamin and is needed as a co-factor for many metabolic reactions. It is participating in the production of collagen and connective tissues, helps with fatty acid transport and is necessary for the synthesis of neurotransmitters in the brain (Ref.2). The lack of vitamin C is known as scurvy; symptoms include bleeding gums from fragile capillaries, delay in wound healing and impaired bone metabolism. Although in the earlier research it was hoped that vitamin C would prevent colds and cure cancer, more recent reevaluations found that it does not prevent you from getting colds, but it accelerates the recovery from colds by cutting down the recovery time by as much as 25 to 30% and it also does have some cancer protective effects (Ref.2). Higher doses seem to be more beneficial, but 1500 mg per day seems to now be the consensus of a reasonable upper dose limit per day.

What about kidney stones? Several studies in the past have warned about vitamin C being broken down in some people into calcium oxalate kidney stones. Here is a brief review of the literature with regard to kidney stone formation. A study regarding the DASH diet, which is used for people with high blood pressure, showed that the incidence of kidney stones is almost half for both men and women compared to controls on a normal North American diet.

There has been a concern among the medical community that vitamin C as a supplement would increase kidney stones (oxalate stones). However a 2014 study showed that when both vitamin C and vitamin E are taken as supplements, the kidney stone formation goes down.

Many inhabitants of industrialized countries including the population in the US and other countries are magnesium deficient and this can be a major factor for forming calcium oxalate stones. But it has been known for decades that those who develop kidney stones excrete more oxalates in their urine (so-called “oxalate excreters”). Here is a 1996 study that measured this in detail.

If you are taking in a lot of green smoothies from green leaf vegetables (spinach, kale, Swiss chard) that are high in water-soluble vitamins, you may not require any vitamin C supplements. In other words, think about what else you do and eat and add it up, so you do not exceed a total of 1500 mg to 2000 mg of vitamin C per day.

If you are taking in a lot of green smoothies from green leaf vegetables (spinach, kale, Swiss chard) that are high in water-soluble vitamins, you may not require any vitamin C supplements. In other words, think about what else you do and eat and add it up, so you do not exceed a total of 1500 mg of vitamin C per day.

3. Calcium supplements:

Calcium is a key mineral in the body, important not only for healthy bone structure, but also to balance the electrolytes within the blood, in the extra cellular fluid space and within our cells. If calcium is low, the brain is more prone to seizures and the heart can produce dangerously irregular heart beats. We definitely need a balance of calcium! Because calcium is so central to our wellbeing, several factors work together to keep our calcium levels stable: the kidneys, the thyroid, the parathyroid glands, the adrenal glands, the bone as a reservoir of calcium, the gastrointestinal tract for absorption and a good, balanced nutrition. The chapter on “Vitamins and Minerals” of Ref.3 points out that 4000 mg of calcium per day definitely causes toxicity (hypercalcemia and milk-alkali syndrome).

Absorption is dose dependent meaning that only 500mg of calcium carbonate is absorbed at a time. Vitamin D3 deficiency leads to reduced calcium absorption. But with high doses of vitamin D3, which is now often recommended, more calcium is absorbed, so it is important not to take too many calcium supplements. They can also interfere with iron and zinc absorption and when more than 2600 mg of calcium is taken magnesium absorption is inhibited as well. Calcium can interfere with thyroid hormone supplements (take 4 hours apart) and may reduce the effect of calcium channel blockers, drugs used for angina or high blood pressure.  There is a balance between calcium stored in bone (99% of total body calcium) and the circulating portion of 1% of calcium in the blood. The parathyroid hormone and calcitonin are also involved in this balance. Hypercalcemia is the condition when calcium is too high. Common causes are the improper use of diuretics (thiazide diuretics), overuse of calcium carbonate supplementation (often for osteoporosis) and overuse of vitamin D3, which increases the absorption of calcium (Ref.3). See your family doctor for blood tests and advice what to do in your case.

4. High protein diets and protein (amino acid) supplements:

Many protein supplements are available through health food stores and vitamin stores. The advertisers often state that our food would be substandard and these supplements would help “to regain strength”.  Athletes hope to get stronger muscles from amino acid supplements because they are the building block for protein that builds up muscles. Fact is that no supplements are needed when you eat balanced meals containing meat and fish and you exercise regularly. The protein in your food will be broken down into amino acids and your body metabolizes this into your own protein. Here is a website that reviews the subject of supplementation with amino acids.

It is clear from this that this is a rather complex problem. Vegetarians may require these supplements to replace protein for the missing meat intake. But the rest of us have to guard ourselves against overdosing with too much meat, amino acids supplements or protein supplements.

High protein diets (Atkins diet and others) have been glorified as being helpful for weight loss. But the long-term effect of such diets lead to chronic kidney damage in those with diabetes and high blood pressure as evidenced by protein leakage in the urine (called ”microalbuminuria”, Ref.4).

According to this reference the average protein requirement is 0.6 g of protein/kg body weight/day. This text comments that this would be compatible with the World Health Organization (WHO) recommendation for protein intake. For a person weighing 140 lbs. this translates into about 50 grams of protein per day. Here is a website that explains the upper limit of meat intake with the example of an 8-ounce portion of top sirloin steak.

Protein supplements have become very popular, but you need to be careful when you supplement with this that you do not get an overdose of amino acids. Amino acid profiling has been useful for physicians and naturopaths to examine deficiencies in children or adults checking for essential amino acids in the blood.  However, in the industrialized countries such as the US, Canada and others the larger concern is now the overuse of meat in our food (e.g. Atkins-like diets) and protein supplements. The same amino acid screening tests will find several of the ingredients (amino acids) in these protein supplements to be too high. In this case it is imperative to stop the protein supplements to prevent amino acid toxicity.

This study warns that not enough is known how performance-enhancing supplements affect the metabolism of the body. There are discussions that perhaps upper limits for amino acid supplements need to be established:

5. Creatine supplementation:

Other supplements of concern are creatine supplementation in the sports-minded and in athletes who want to build up muscle mass. Creatine is synthesized by the liver form amino acids derived from fish and meat that is broken down into the amino acids arginine, glycine and methionine. So, there is no shortage, but athletes and sports minded people want to push the envelope and take in additional creatine that helps their energy metabolism (ATP production) in the muscles to increase their performance (Ref. 5) Creatine is vital for the brain, the heart, the kidneys and the eyes (retina). It is a buffer for lactic acid during anaerobic exercise. Some of the side effects are muscle cramps, diarrhea, fluid retention and kidney failure when exposed to high heat and dehydration. There are no long-term studies of the use of creatine supplements, yet some athletes are taking them long-term.

Conclusion:

We are tempted by various merchants and infomercials to take in more and more vitamins and supplements including protein and amino acid supplements. But when you eat well-balanced meals, preferably organic food, you already have enough protein, nutrients, calcium, vitamin C and vitamin A contained in food. So you may be inadvertently putting a strain on your kidneys that have to eliminate whatever it is that is too much for your body to take. Your liver may also be quietly working overtime as well. Your brain gets overactive by the surplus of amino acids that are utilized by the brain to make brain hormones. Your system can only take so much; at one point a surplus of supplements will make you sick! So, be vigilant and think about what your regular food intake already provides. Do you really need that supplement or do you already get enough from your food intake? Are you falling for some marketing scheme? Remember, you are the steward of your own health!

References:

1.Shannon: Chapter 69: The Vitamins. Haddad and Winchester’s Clinical Management of Poisoning and Drug Overdose, 4th ed.© 2007 Saunders

2. Mandell: “Water-Soluble Vitamins”. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 7th ed. © 2009 Churchill Livingstone

3. Rakel: Chapter “Disturbances in Calcium and Phosphate” and chapter entitled “Vitamins and Minerals”. Textbook of Family Medicine, 8th ed. © 2011 Saunders

4. “High Dietary Protein Intake” in “Taal: Brenner and Rector’s The Kidney”, 9th ed. © 2011 Saunders

5. DeLee: DeLee and Drez’s Orthopaedic Sports Medicine, 3rd ed. © 2009 Saunders

Last edited April 30, 2014

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Mar
29
2014

Alternative Treatment Of Hyperactivity (ADHD)

Attention Deficit Hyperactivity Disorder (ADHD or ADD, attention deficit disorder) has been in the spotlight on and off over the years. It affects 8% to 10% of school-aged children, and about 2% to 5% of adults who still have this condition.

Typically a parent receives a note from school that they must come to a teacher/parent meeting and it is discussed that the child is disruptive in class, not paying attention, interrupting the teacher inappropriately and forgetting to do their homework. The teacher suggests that this may be a sign of hyperactivity. The school nurse is also of this opinion and they suggest getting a prescription for Ritalin or Adderall (amphetamine type medications), drugs that have been shown in other kids to be fairly effective in treating the symptoms.

Next the child is seen by the doctor who confirms the diagnosis and Ritalin (methylphenidate) is prescribed.

In an attempt to quickly control the situation, the side effects of Ritalin are often not discussed in detail: agitation, insomnia, nervousness, anxiety, nausea, vomiting and loss of appetite, palpitations, dizziness, headaches, an increase in the heart rate, blood pressure elevation, and even psychosis (Ref.1).

It is easy to just write a prescription for Ritalin and hope that all is well. Had the parents heard of all the possible side effects, they may have asked whether there were alternative treatments available.

The causes of hyperactivity (ADHD)

The exact cause of ADHD remains unknown, but there is a clustering of this condition in some families, so there seems to be a clear genetic component (Ref.2). It appears that several genes are involved, namely those associated with serotonin and glutamate transporters, but also those affecting dopamine metabolism. Males are affected with ADHD more often than females (in children 3:1, in adults 1:1).

Alternative Treatment Of Hyperactivity (ADHD)

Alternative Treatment Of Hyperactivity (ADHD)

Some remarks regarding brain development are in order: Dr. Kharrazian describes that the grey matter of the brain develops before the age of 9 and the development of the white matter is completed by the age of 19 (Ref. 3, p.3). In ADHD patients the frontal brain is underdeveloped resulting in an inability to suppress unacceptable behavior, immediate desires and impulses. Prescription drugs may alter the behavior on the surface, but the frontal brain development is still lagging behind. The only thing that can influence this is behavioral/cognitive therapy and extra tutoring while the symptoms are controlled. The window of opportunity is closed by the time the ADHD patient has reached the age of 19. After that a juvenile ADHD turns into a permanent adult ADHD. The cases that had only childhood ADHD and outgrew it were the ones where the frontal lobe abnormalities had corrected themselves before the age of 19.

This review article has noted that there is an association between a Western style diet (sugar and fat rich) and ADHD.

Interestingly both Ref. 1 and 2, which I would categorize as having originated from mainstream conventional medicine circles, deny such an association. But the link also noted that a healthy diet with fiber, folate, and omega-3 fatty acids as well as supplementation with iron and zinc when these minerals are found to be low in the blood, do make a significant difference in ADHD patients towards normalization of their symptoms.

One of the under diagnosed causes of ADHD is gluten sensitivity as Dr. Perlmutter described in his book (Ref. 4, pages 150-158). This can spare the child or teenager the toxic side effects of anxiolytics, antidepressants or antipsychotics that may be inappropriately prescribed by their physicians, and a gluten free diet would allow the brain to recover very quickly in such cases. A food sensitivity history and some simple gluten sensitivity blood screening tests will diagnose this condition or rule it out.

To complicate matters even more, Dr. Amen has mentioned in several books that there are at least 7 different subcategories of ADHD that he has found in ADHD patients when studying thousands of single-photon emission computed tomography brain scans (SPECT brain scans). Dr. Amen mentions that the 7 subcategories of ADHD are the combined type ADD, the primarily inattentive ADD subtype, overfocused ADD, temporal lobe ADD, limbic ADD, ring of fire ADD and trauma induced ADD. Dr. Amen explains that each of these types needs to be treated differently and some of the treatment failures are explained by the fact that the wrong type of ADD was treated (Ref.5).

Treatment of ADHD

In the following I mention 5 steps that are useful for treating ADHD patients.

  1. A first step toward normalization of the metabolic changes in the brain metabolism of the affected child or adult is to adopt a diet that has been linked with low risk for ADHD: avoid food additives, cut out refined sugar, avoid known food allergies like gluten sensitivity and others. You may need to test the patient for food allergies using an elimination diet. Add a good amount of molecularly distilled omega-3 fatty acids (the pure form of omega-3 without mercury, lead or PCBs) as this has shown beneficial effects in ADHD patients.
  2. Involve a behavioral psychologist for behavioral/cognitive therapy treatments. This is particularly effective in the 9 to 19 year old category where the frontal region of the brain is still developing.
  3. Work together with the schoolteacher and get supplemental teaching in areas of academic weakness to reduce the frustrations in the classroom setting.
  4. In adolescent girls who just started their period, a relative lack of progesterone (estrogen dominance) may be a contributory factor. A small dose (20mg to 30 mg) of bioidentical progesterone from day 6 to 16 of the menstrual cycle may help significantly in alleviating the symptoms of ADHD. You may need to consult a naturopathic doctor or anti-aging physician to get a prescription for that.
  5. If all of this helps only marginally, then a smaller amount of Ritalin may be helpful; however, blood tests should be drawn from time to time to monitor for drug toxicity as the rate of absorption and elimination of the drug varies significantly from patient to patient.

It is interesting that studies have shown that a combination of Ritalin or Adderall with alternative treatment methods had a better outcome than either method alone.

Conclusion

It is important to think about the various possible causes of ADHD and not just get caught up in the knee-jerk reflex of treating ADHD with Ritalin (note that this was only step 5 above, if all the other things failed). In co-operation with the school system and using alternative ways at home first (change of diet, possible addition of low dose bioidentical progesterone cream in girls) and additional tutoring in weak school subjects the need for Ritalin may be avoided. If all else fails, the conservative approach is still available, but I suggest that drug monitoring (blood levels that should be done from time to time to avoid toxicity) is important.

More information about ADHD: http://nethealthbook.com/mental-illness-mental-disorders/developmental-disorders/attention-deficithyperactivity-disorder/

References

1. Ferri: Ferri’s Clinical Advisor 2014, 1st ed., © 2013 Mosby.

2. Jacobson: Psychiatric Secrets, 2nd ed., © 2001 Hanley and Belfus

3. Dr. Datis Kharrazian: “Why Isn’t My Brain Working?” © 2013, Elephant Press, Carlsbad, CA 92011

4. David Perlmutter, MD: “Grain Brain. The Surprising Truth About Wheat, Carbs, And Sugar-Your Brain’s Silent Killers.” Little, Brown and Company, New York, 2013.

5. Daniel G. Amen: “Use Your Brain To Change Your Age” © 2012, Harmony Books, An imprint of Crown Publishing.

Last edited Nov. 7, 2014

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