Monday, January 4, 2010
The Era of Echinacea by Michael Spector
Not long ago, for reasons I still don't understand, I began to feel unfocused and lethargic. Work was no more stressful than it had ever been, and neither was the rest of my life. The bulk of my savings had been sucked into the vortex of the newly recognized black hole called the economy. But whose had not? I try to eat properly, exercise regularly, sleep peacefully, and generally adhere to the standard conventions of fitness. It didn't seem to be working. My doctor found nothing wrong and my blood tests were fine. Still, I felt strange, as if I were lacking in energy - or in something. So I did what millions of Americans do every day. I sought salvation in vitamins.
First, though, I had to figure out what variety of salvation to seek. There are many thousands of pills, potions, powders, gels, elixirs, and other packaged promises of improve vitality for sale just a few blocks from my home. I walked to the closest store, a place called The Health Nuts... Unfortunately the collection of pills was so enormous, the choice so vast, and the information so humbling that while I may not have been depressed when I arrived at The Health Nuts, spending half an hour there did the trick.
I went home and consulted the Internet, which was even more intimidating: there are millions of pages devoted to vitamins and dietary supplements. You could spend your life combing through them and then another life trying them all out. As fortune would have it, however, my eyes were drawn immediately to the Vitamin Adviser, a free recommendation service created by Dr. Andrew Weil, the ubiquitous healer, whose domed head and bearded countenance are so profoundly soothing that with a mere glance at his picture I felt my blood pressure begin to drop.
Andrew Weil seemed like just the man to lead me out of the forest of nutritional darkness into which I had inadvertently wandered. His Vitamin Adviser Web site assured me that, after answering a few brief questions, I would receive "a personalized comprehensive list of supplements based on my lifestyle, diet, medications, and health concerns. In addition, if I so chose, I could order the "premium quality, evidence-based" supplements in the proper doses custom packed in a convenient dispenser box and shipped directly to me each month."
If filled out the form, answering questions about my health and providing a brief medical history of my family. Dr Weil responded, recommending a daily roster of twelve pills, including an antioxidant and multivitamin. Also on my list: milk thistle (for those who drink regularly or have frequent chemical exposure), ashwagandha ( to help the body deal with stress and to enhance energy), cordyceps ( a Chinese fungus to increase aerobic capacity and alleviate fatigue) and eleuthero aka Siberian ginseng ( to treat lethargy, fatigue and low stamina). In addition, there was 1000 milligrams of Vitamin C ( which " may provide additional protection against the oxidative stress of air pollution and acute or chronic illness), saw palmetto mixed with stinging nettle root (to support prostate health), an omega-3 pill, Saint John's-wort, folic acid ( to help protect against heart disease, lung and colon cancer and to slow the loss of memory due to aging) and finally another ayurvedic herb, triphala ( a mixture of three fruits that help tone the muscles in the digestive tract).
The total "customized" package was priced at $1, 836 a year ( plus shipping and tax). I asked myself, what is worth more than our health? If that was how much it would cost to improve mine, then that was how much I was willing to spend. Dr. Weil, who argues that we need to reject the prevailing impersonal approach to medicine, reached out from cyberspace to recommend each of these pills whole-heartedly and specifically, just for me. Before sending off a check, however, I collected some of the information on nutrition and dietary health offered by the National Institutes of Health, the Harvard School of Public Health and the Memorial Sloan-Kettering Cancer Center. [ The Web site of the Mayo Clinic is also a useful resource for such purposes-J.S.]
It turned out that my pills fell essentially into three categories: some, like cordyceps and triphala, seemed to do no harm but have never been shown in any major, placebo-controlled study to do any particular good; others, like Saint-John's wort, may possibly do some good in some cases for some people, but can also easily interfere with a negate the effects of a large number of prescribed medicines, particularly the protease inhibitors taken by many people with AIDS. Most of the pills, however, including the multivitamin and antioxidant, seemed just plain dangerous.
Despite Dr. Weil's assurances that his selections were "evidence-based" not one of those twelve supplements could be seen to hold anything more than theoretical value for me. At best. One study, completed in 2008, of omega-3 fatty acids so beneficial when eaten in fish, found that in pill form they had no discernible impact on levels of cholesterol or any other blood lipids. The study was not large enough to be definitive; other trials are needed (and already underway). But it would be tough to argue with Jeffrey L. Saver, vice chairman of the American Heart Association's Stroke Council, professor of neurology at UCLA, and the director of its department of Stroke and Vascular Neurology, who called the findings "disappointing".
Others agreed. "You know, most of that stuff just comes right out at the other end," former surgeon general C. Everett Koop told me. The ninety-four-year-old Koop is congenitally incapable of ignoring facts or pretending they shouldn't matter. "Selling snake oil has always been one of America's greatest con games. But the more we know about our bodies, the more people seem to buy these pills. That part I never did understand, you would have hoped it would be the other way around. But every day it becomes clearer: we need to eat properly and get exercise. And every day more people seem to ignore the truth."
After following 161,808 women for eight years, a team of researchers from the Women's Health Initiative under the direction of the National Heart, Lung and Blood Institute found no evidence of any benefit from multivitamin use in any of the ten conditions they examined. There were no differences in the rate of breast or colon cancer, heart attack, stroke, bone fractures or blood clots. Vitamins did nothing to lower the death rate. Another major trial recently showed that the risk for developing advanced prostate cancer, and dying from it, was in some cases actually twice as high for people who took multivitamins as it was for those who never took them at all.
In 2007, the Journal of the America Medical Association published results from sixty-eight trials that had been conducted during the previous seventeen years which found that the 180,000 participants received no benefit at all from antioxidant supplements. In fact, vitamin A and vitamin E actually increased the likelihood of death by 5 percent. Vitamin C and selenium supplements had no significant effect on mortality.
Kelly Brown, director of the Rudd Center for Food Policy and Obesity at Yale University has studied the impact of nutrition on human health for years. "Vitamins in food are essential. And that's the way to get them. In food." With a couple of exceptions like folic acid for pregnant women and in some cases vitamin D, for the vast majority of Americans dietary supplements are a complete waste of money. Often, in fact, they are worse. In May 2009, researchers from Germany and the United States reported in the Proceedings of the National Academy of Science that antioxidants like vitamin C and E actually reduce the benefits of exercise. "Antioxidants in general...inhibit otherwise positive effects of exercise, dieting and other interventions."