Lifestyle Changes, Fad Diets and Dietary Supplements: What Works, What’s Worthless and What’s New! Dr. Moyad, MD, MPH

VOLUME: 1, ISSUE 1

The most overrated, overpriced, and overhyped supplement of the year is RESVERATROL! Bottom Line:

Do not spend your money on this

trials in obese men and

supplement until it proves it can actually do something

non-obese

besides make your wallet or purse lighter. Drink red wine

showed

(contains resveratrol from grape skins) or white wine in

supplement is not

moderation to enjoy better benefits right now compared to

really doing anything

resveratrol dietary supplements.

for general health.

that

And—worse

What else do I really need to know? SRT501,

women the

news—

at the time I was

research [...] found in a small clinical trial that resveratrol supplements might block the healthy benefits of exercise!

a resveratrol-like compound, was being developed by

writing this newsletter,

a pharmaceutical company and was estimated to cost

new research from the

only $750 million (sarcasm alert), and was supposed to

Journal of Physiology found

be promising, especially in the area of cancer. It failed

in a small clinical trial that

to show a benefit in a multiple myeloma clinical trial,

resveratrol supplments might block the healthy

and there was a lot of toxicity. Other recent, small clinical

benefits of exercise!

The most overrated and overhyped dietary clinical trial of the year is PREDIMED Mediterranean Diet Study. Bottom Line:

A Mediterranean diet compared to

What else do I need to know?

Researchers

a Mediterranean diet with less olive oil, nuts, and fatty

decided to evaluate the potential impact of a Mediterranean

fish (so called “low-fat” or “control” diet) appeared to

diet in a primary prevention trial of individuals at high risk for

significantly reduce the risk of stroke in those with a high

a first cardiovascular event (for example, a heart attack or

cardiovascular risk, but it did not appear to reduce the risk

stroke). This was a multicenter randomized trial from Spain.

of dying younger from any cause (cancer…) compared to

Individuals actually followed 1 of 3 diets:

the control diet. WHAT?! This is correct! What does this mean? How about a free advertisement for extra virgin olive oil and nuts! Actually, what it really shows is that there are plenty of different diet plans that can work for you. And, what you should know is that if you can

1. the Mediterranean diet with extra-virgin olive oil, 2. the Mediterranean diet with mixed nuts, or 3. a control diet (“low fat”) where participants were encouraged to reduce fat intake and to consume less olive oil, nuts, and fatty fish.

reduce your blood pressure, then you can almost

The primary end point was major cardiovascular events

immediately reduce your risk of having a stroke.

(myocardial infarction, stroke, or death from cardiovascular disease). A total of 7447 individuals were enrolled (57% were

women), and the trial was stopped after the interim analysis

end point in the 2 Mediterranean diet groups compared to the

and after a median follow-up of 4.8 years. Average age of

control group. This was primarily due to a significant reduction

participants was 67 years (range, 55 to 80 years), and average

in the risk of stroke (33% to 46%; P =0.04 and P =0.006). There

waist circumference was 39 to 40 inches (for men and women),

were no significant differences between the Mediterranean

>90% were overweight or obese (about half obese and half

diet groups and the control group in other end points such

overweight), and only 8% had a normal BMI (scary stuff).

as myocardial infarction or death from cardiovascular or any

Approximately 80% of participants had high blood pressure,

cause, but nonsignificant trends favored the Mediterranean

70% had bad cholesterol numbers, and half had diabetes.

diet. Most subgroups studied appeared to benefit, especially

These individuals were NOT HEALTHY!

those with hypertension, dyslipidemia, and/or obesity. A Mediterranean diet with increased consumption of extra-virgin

A significant reduction (28% to 30%) occurred in the primary

olive oil or nuts reduced the risk of major cardiovascular events.

OKAY…Now that was a more partially politically correct version of this study! Let’s take another look at this study. Here is your very basic Mediterranean diet that was used in this study (and below is my sarcastic but accurate commentary that you did not hear much about after so many “experts” were drooling over these results):

Extra-Virgin Olive Oil (≥ 4 tablespoons/day) Note:

Olive oil has 120 calories/tablespoon, which means

participants were getting, in some cases (others were just getting 1 more tablespoon), at least 480 calories/day from olive oil, which makes it impossible to lose weight or waist, and that is one reason why most individuals did not lose weight! Olive oil was provided for free by a local olive oil company to the Mediterranean diet groups but not to the control group. If you provide something for free to people, especially in terms of food, you are more likely to eat it regularly. In many ways, this diet study was a free advertisement for olive oil, and many of the researchers had multiple financial relationships with nutritional or food companies.

Tree nuts and peanuts, but especially walnuts, almonds, and hazelnuts (≥3 servings/week) Note: Why mostly walnuts, almonds, and hazelnuts? It was because they were also provided to the participants at no charge on a regular basis. Hey, free olive oil and nuts on the house for years if you are in the Mediterranean diet group but not for the control group. Wow! This sounds like a wonderful free advertisement for extra-virgin olive oil and nuts!

Fresh Fruits (≥ 3 servings/day) Note: This makes sense for many diet plans. Vegetables (≥ 2 servings/day) Note: This makes sense for most diet plans. Fish (especially fatty fish) and seafood (≥ 3 servings/week) Note:

This

makes

sense

for most diet plans.

Legumes (≥ 3 servings/week) Note: This makes sense for most diet plans. Sofrito (≥2 servings/week) Note: This is a sauce that is made with tomato and onion and often includes garlic and aromatic herbs, and it is simmered slowly with OLIVE OIL! More olive oil? Yes, and the olive oil was, once again, provided for free.

White meat Note: This makes sense for most diet plans, especially when using lean meats. Wine with meals (optional, ≥7 glasses/week) Note: This is not going to help participants lower their weight or waist and, in some cases, it does not allow for blood pressure reduction, but at least this adds some fun to the diet plan!

Stay away from the following as much as possible: Soda drinks, commercial baked goods, sweets, pastries, spread fats, and red and processed meats. Note: This makes sense for most diet plans.

The LOW-FAT group was instructed to eat low-fat dairy

pressure in the Mediterranean diet probably explain why it

products, bread, potatoes, pasta, rice, fruits, veggies, and

worked so well to reduce the risk of stroke. Yet, what you

LEAN FISH (not omega-3–rich fish) and seafood. They

should really walk away with from this study is that a diet

were discouraged from consuming vegetable oils including

with multiple healthy eating patterns is a healthy direction,

olive oil, nuts, fried snacks, fatty fish and seafood canned

but weight reduction is also critical for enormous success.

in oil, red and processed meats, visible fats in meats and

None of the groups lost weight! So, the suggestion,

soups, spread fats, and sofrito.

it appears, is that you can eat all the olive oil and nuts SO, THIS IS NOT A LOW-FAT DIET BUT STILL

you want and you will not gain weight if you are already

A HIGH-FAT PARTIAL MEDITERRANEAN DIET

obese because these foods make you feel satiated. Yet,

that puts individuals at a disadvantage, especially

the control group eating far more carbohydrates (no limits

when trying to lower their blood pressure from

on pasta, bread, potatoes, rice, etc) did not gain weight

these foods.

either. I could argue that the study would have been stopped in just 1 to 2 years, and the researchers would

There

and

now be candidates for the Nobel Prize if one group would

disturbing about this clinical trial. It was interesting in

is

something

simultaneously

interesting

have lost a lot of weight on a diet and dropped their blood

terms of helping to confirm that a Mediterranean diet

pressure, cholesterol, and blood sugar. And, had weight

that encourages more daily olive oil or nuts per day can

loss occurred in the control group, I bet there would have

reduce the cardiovascular risk of individuals at high risk.

been no difference among any of the diets.

Yet, the study was disturbing for many reasons

Look, I love the Mediterranean diet

because participants were SO UNHEALTHY OVERALL in terms of their basic health

more than a football team that beats

[The main measurements, such as weight and Notre Dame, Michigan State, and number of medications being taken. Ohio State in the same year. take-away] is However, I do not like it when a that a diet with The study was also disturbing Mediterranean diet gets credited multiple healthy in the way it was subjectively for working better than a low-fat construed or biased by many or another type of diet when eating patterns is a “experts” and even these this was really just a deceptive healthy direction, but researchers in terms of definitive study to suggest that you weight reduction is proof that the Mediterranean diet need to get more extra-virgin is the best dietary intervention, olive oil and nuts in your diet! also critical for and that other diets such as low-fat Did I just suggest that this was a enormous diets do not work as well. WRONG!! biased dietary study for commercial success. The low-fat comparison group was purposes? NO COMMENT! (Hey, I getting 39% of their calories from fat at the

feel more like a politician every single

beginning of the study, and at the end of the

day.) Here is my advice: eat a Mediterranean

study, it had decreased to only 37%, which is still a high-fat

diet, lose weight and waist (if needed), and lower your

diet (average American diet is 33% FAT)!!!

blood pressure, cholesterol, and blood glucose (again, if needed).

In addition, the Mediterranean diet group received personalized attention and advice throughout the trial and, for the first 3 years, the control group did not. Then the study was changed to also give some personal attention to the control group. So, what has been learned? Getting more extra-virgin olive oil and/or mixed nuts is healthy as long as significant weight gain does not occur, and reductions in blood

Exercise daily and stay away from tobacco, and the Mediterranean diet will provide much better results compared to what occurred in this overhyped study that got the nation’s attention for a few hours!

FISH OIL FLOPS 3 Times (AREDS2, Italian, OPERA)! Bottom Line: 1000 mg of omega-3 (EPA 650 mg

treatment of dry eye syndrome.

+ DHA 650 mg) added nothing to the current eye

If you are perfectly healthy,

formula (eg, Ocuvite, the original by Bausch and Lomb

there is no proof you

with vitamin E, C, zinc, and copper) already shown to

need to take fish oil

reduce the progression of macular degeneration. Fish

right

oil did not reduce the risk of a cardiovascular event

being addressed in an

(heart attack, stroke, etc) in those at high risk for such

ongoing study in the

an event, nor did it reduce the risk of atrial fibrillation

U.S. called “VITAL,”

after surgery when used in really large dosages.

but for now many

now.

This

is

folks do not need fish

What else do I need to know?

oil. Fish oil does not

Fish oil does not appear to reduce the risk of atrial fibrillation better than does a placebo, especially after having surgery.

There is no need to add fish oil to your macular

appear to reduce the

degeneration or eye health supplement right now

risk of atrial fibrillation

because it is not doing anything. The only eye health

better than does a placebo,

supplement that should contain fish oil is one for the

especially after having surgery.

Beta-carotene supplements are bad for smokers (current and former) Bottom Line: Former and current smokers simply

smokers taking beta-

should not take any dietary supplements with beta-

carotene supplements,

carotene in them because it can increase the risk of lung

and both studies

cancer. Food sources of beta-carotene are safe, and it

showed a significantly

is only the supplement that appears to be increasing

increased risk of lung

this cancer risk.

cancer in smokers

both studies showed a significantly increased risk of lung cancer in smokers taking these supplements.

taking these supplements.

What else do I need to know? Two older and

However, now it appears even

very large definitive clinical trials, known as ATBC and

ex-smokers may be at risk for lung cancer if they take

CARET, both tried to show a lower risk of lung cancer in

beta-carotene dietary supplements.

Lutein/zeaxanthin might be good for eyes if you do not get enough from food! Bottom Line:

Adding 10 mg of lutein

and 2 mg of zeaxanthin to your eye health formula if you have macular dengeration might be a good idea. Kale and egg yolks are my favorite large dietary sources of lutein and zeaxanthin. In this clinical trial, researchers also found lutein and zeaxanthin appeared to have no impact on cataract risk.

Kale and egg yolks are my favorite large dietary sources of lutein and zeaxanthin.

What else do I need to know? These 2 compounds are being studied to improve skin health, but for now, it appears they may be able to improve eye health in terms of preventing the progression of macular degeneration when added to a traditional eye health supplement.

Scaring people for what reason? Omega-3 and prostate cancer? Bottom Line: Medicine is like a courtroom where the

of the cholesterol blood test), relieve dry eye, and help with

verdict is decided by the preponderance of evidence. This

joint pain in some individuals. Otherwise, I do not believe

study adds very little to the evidence and simply made

fish oil supplements do much of anything else right now.

exaggerated conclusions based on blood work from a study of vitamin E and selenium. Fish consumption is

What else do I need to know?

associated with a lower risk of cardiovascular disease and

comes out that scares you or goes against the norm of

arguably several cancers including prostate cancer. Fish oil

nutritional thinking, take several weeks to investigate the

supplements can lower abnormally high triglycerides (part

merit of the study before you toss out your supplements

When a study

or add any new supplements based on just one study.

Vitamin C and Kidney Stones…Hurts So Good (John Mellencamp, circa 1982)? Bottom Line: Vitamin C in high doses (≥ 1000 mg/day)

Vitamin C in high doses (≥1000 mg/day) probably increases the risk of a kidney stone.

probably increases the risk of a kidney stone. The result

What else do I need to know?

of this study translates into 1 new kidney stone per 680

This was a group of

high-dose (≥ 1000 mg/day) vitamin C users per year. This

23,355 men who had

is not a small number so if you are worried about kidney

never had a kidney stone.

stone risk with vitamin C, take a lower dosage (≤ 500 mg)

After 12 years, men taking

or switch to a pH neutral or buffered vitamin C (calcium

vitamin C were twice as likely

ascorbate), which, from preliminary results, carries fewer

to develop a stone compared to those who did not use

side effects and may not have the same risk of kidney

this supplement. Although it did not prove cause and

stones compared to plain vitamin C.

effect, there has been enough research on vitamin C over the last 50 years to suggest these results are accurate.

Best Dietary Company/Product of the Year! SO DELICIOUS! Bottom Line:

“So Delicious” dairy-free brand of

What else do I need to know?

chocolate ice cream with coconut milk had only 100

The So Delicious company calls them “coconut milk frozen

calories per serving (half a cup), 10 grams of fiber, and 1

desserts” and the chocolate (no sugar added)-flavored

gram of sugar…and tastes great! Try it! You should like it!

100-calorie-per-half-cup product is arguably the best!

If you do not like it, then just go back to regular chocolate

Peruse their Web site and see what you can find! Yummy!

ice cream.

Best Diet Product of the Year that allows you to you take fewer pills? BARLEAN’S OMEGA SWIRL! Bottom Line: Why even take a fish oil pill anymore, if

(Moyad, circa 2013)! They have a new high-potency

you believe in them, when you can take only 2 teaspoons

“omega swirl” with only 60 calories/tablespoon and 1500

of Barleans Omega Swirl and take in 5 servings/day of fruits and veggies appeared

Niacin=20 mg

Magnesium=100 mg

Nickel=5 µg

to benefit compared to those with a diet that was not as

Vitamin B6=3 mg

Zinc=15 mg

Vanadium=10 µg

adequate. Men with a parental history of cancer did not

Folic Acid=400 µg

Selenium=20 µg

Silicon=2 mg

appear to benefit as much in this study.

*Note: IU=International Units, mg=milligrams, µg=micrograms (also symbolized by “ug” on some supplement containers), UM=University of Michigan (just thought I would throw that in to see if you were still paying attention), PU=symbol or saying for what someone says when a skunk is sleeping under your living room couch (again, just seeing if you are still paying attention).

also follow the results of

this study. Men with and without a personal history of cancer appeared to reduce the risk of being diagnosed with cancer by ≥ 8% when taking a Centrum Silver daily vitamin compared to a placebo. The side effects were similar to those of a placebo. Even men

Older men (70+) appeared to get more benefit in terms of cancer reduction compared to younger men (50+).

cardiovascular health in this study? I am glad I asked myself

So, it passed the Moyad test of being safe for the heart. So, for pennies a day, it is possible to reduce your

this question. A total of 27 men died from a heart attack

risk of being diagnosed with cancer regardless if you are

in the Centrum group and 43 died in the placebo group (P

really healthy and fit or not. I was shocked at how critical

=0.05). When this group was further analyzed, it appeared

some bone-headed alternative and conventional medical

that men with no personal history of cardiovascular disease

“experts” acted when this study was released! Some

had a 44% significant (P =0.56) reduction in the risk of

conventional folks argued the results were not impressive

dying from a heart attack compared to those on placebo

enough, and some alternative experts suggested a different

(22 vs 39 deaths). Men with a history of cardiovascular

multivitamin would have had a better result! What a bunch

disease did not have an increase or a decrease in the risk of

of Monday morning quarterbacks!

However, what was the impact of Centrum Silver on

dying from a heart attack with the multivitamin compared to placebo (5 vs 4 deaths).

Centrum Silver should be applauded and rewarded for being in this study because they risked their entire business

Does this mean Centrum Silver reduces the risk of dying from a heart attack? Not really, because there

by being a part of this research because, had something

were not enough heart attacks in this study to prove

would have been on that same table in the bookstore

cause and effect, but there were enough cardiovascular

where former scandalous best-selling books that hit #1 on

events (stroke, death from heart disease, etc) to show that

the NY Times Best Sellers list are a few years later that

the multivitamin did not increase or decrease the risk of

sell for $0.99. In other words, you couldn’t have given

cardiovascular disease overall.

this supplement away if something went wrong. Kudos to

gone wrong, then the #1 selling multivitamin in the U.S.

Centrum Silver!

Best/Most Awesome References:

• Popat R, Plesner T, Davies F, et al. A phase 2 study of SRT501 (resveratrol) with bortezomib for patients with relapsed and or refractory multiple myeloma. Br J Haematol 2013;160:714-717.; • Poulsen MM, Vestergaard PF, Clasen BF, et al. High-dose resveratrol supplementation in obese men: an investigator-initiated, randomized, placebo-controlled clinic trial of substrate metabolism, insulin severity, and body composition. Diabetes 2013;62:1186-1195.; • Yoshino J, Conte C, Fontana L, et al. Resveratrol supplementation does not improve metabolic function in nonobese women with normal glucose tolerance. Cell Metab 2012;16:658-664.; • Gliemann L, Schmidt JF, Olesen J, et al. Resveratrol blunts the positive effects of exercise training on cardiovascular health in aged men. J Physiol 2013; July 22: epub ahead of print.

• Estruch R, Ros E, Salas-Salvadóo J, et al, for the PREDIMED Study Investigators. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 2013;368:1279-1290.

• Age-Related Eye Disease Study 2 Research Group. Lutein + zeaxanthin and omega-3 fatty acids for age-related macular degeneration; the AgeRelated Eye Disease Study 2 (AREDS2) randomized clinical trial. JAMA 2013;309:2005-2015.; • Risk and Prevention Study Collaborative Group. N-3 fatty acids in patients with multiple cardiovascular risk factors. N Engl J Med 2013;368:1800-1808.; • Mozaffarian D, Marchioli R, Macchia A, et al, for the OPERA Investigators. Fish oil and postoperative atrial fibrillation: the Omega-3 Fatty Acids for Prevention of Post-Operative Atrial Fibrillation (OPERA) randomized trial. JAMA 2012:308:2001-2011.

• Age-Related Eye Disease Study 2 Research Group. Lutein + zeaxanthin and omega-3 fatty acids for age-related macular degeneration; the AgeRelated Eye Disease Study 2 (AREDS2) randomized clinical trial. JAMA 2013;309:2005-2015.

• Age-Related Eye Disease Study 2 Research Group. Lutein + zeaxanthin and omega-3 fatty acids for age-related macular degeneration; the AgeRelated Eye Disease Study 2 (AREDS2) randomized clinical trial. JAMA 2013;309:2005-2015.

• Brasky TM, Darke AK, Song X, et al. Plasma phospholipid fatty acids and prostate cancer risk in the SELECT trial. J Natl Cancer Inst 2013; July 10: epub ahead of print.; • Szymanski KM, Wheeler DC, Mucci LA. Fish consumption and prostate cancer risk: a review and meta-analysis. Am J Clin Nutr 2010;92:1223-1233.

• Thomas LD, Elinder CG, Tiselius HG, Wolk A, Akesson A. Ascorbic acid supplements and kidney stone incidence among men: a prospective study. JAMA Intern Med 2013;173:386-388.

sodeliciousdairyfree.com

www.barleans.com

• Gaziano JM, Sesso HD, Christen WG, et al. Multivitamins in the prevention of cancer in men: the Physicians’ Health Study II randomized controlled trial. JAMA 2012;308:1871-1880.; • Sesso HD, Christen WG, Bubes V, et al. Multivitamins in the prevention of cardiovascular disease in men: the Physicians’ Health Study II randomized controlled trial. JAMA 2012;308:1751-1760.