The problem with supplements, herbs, and vitamins

0:00, 7 декабря 2019
Без рубрики 'The problem with supplements, herbs, and vitamins
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About Dr Kenny

Dr. Antoinette Kenny, Director of HeartScan Ltd.
MB BCh BAO MD FRCP FRCPI

Dr. Antoinette Kenny is a full time Consultant Cardiologist and Specialist in Echocardiography (ultrasound heart scans) at the Regional Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne.  She is also an expert in cardiac screening for individuals involved in sport.

Dr. Kenny qualified in medicine in Dublin in 1983 and trained in clinical cardiology at St. James’s Hospital Dublin and Papworth Hospital Cambridge. She was awarded the Grimshaw-Parkinson  Fellowship from Cambridge University for her research towards an MD thesis in echocardiography at Papworth Hospital. She was made a Fellow of the Royal College of Physicians, London, in 1998 and of the Royal College of Physicians, Ireland, in 1999.

Following her clinical cardiology training and MD thesis she was appointed Fellow in Echocardiography at the Oregon Health Sciences University, Portland, Oregon, USA.  There she undertook training in advanced echocardiography, including three-dimensional echo techniques, with Professor David Sahn the internationally renowned specialist in echocardiography. In 1993, at the relatively young age of 33, she was appointed Consultant Cardiologist and Clinical Head of Echocardiography at The Regional Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne.  At that time only 19 (

Echo experience:
As Clinical Head of Echocardiography at Freeman Hospital for over 20 years, Dr. Kenny has gained a vast experience in assessing patients with heart failure, valve disorders and inherited cardiomyopathies.  Her expertise includes evaluation and selection of patients for advanced valve replacement techniques such as TAVI (transcutaneous aortic valve implantation) and minimally invasive surgery.  She is a member of the Specialist Heart Valve Team at Freeman Hospital providing specialist echocardiographic expertise for the selection of patients for valve surgery.

Sports Cardiology experience:
Dr. Kenny is also a cardiology adviser to the Football Association (FA) and a member of the FA cardiology consensus panel producing guidelines for cardiac screening.  She has performed cardiac screening for the Football Association since this programme was introduced for young footballers in 1996.

Dr Kenny has also been involved with investigation and heart screening in premiership football players for the last decade and provides heart screening for Newcastle United FC, Sunderland AFC and Middlesbrough FC, including their first team players. Dr. Kenny has particular expertise in distinguishing between the normal changes produced by athletic training (athlete’s heart) that could be misinterpreted as abnormalities and abnormal cardiac conditions that can pose a serious health risk.

Achievements:
Dr Kenny holds full accreditation with the British Society of Echocardiography, the national benchmark of quality in performing and interpreting Echo scans.  As an elected council member of the British Society of Echocardiography she has been involved with standards and quality in delivery of national Echo services.  She also held the post of Chairman of the Scientific and Research Committee of the British Society of Echocardiography with responsibility for organisation of the annual meeting and educational sessions.

She is co-author of a well received textbook of echocardiography which has been translated into other languages. Dr. Kenny is also a leader in education in echocardiography, co-directing a national Echo course and invited to lecture at both national and international Echo conferences.

Dr. Kenny has developed and led research studies in advanced applications of echocardiography over the last two decades and has published widely in peer reviews journals.

Review and Wrap Up

First of all this was not a very scientific experiment. By changing my meds I was able to get my BP down but I failed to collect all the data that the SC asked for. The reasons for this were 1) I returned the Omron wrist cuff early, 2) I kept forgetting to take my BP in the evening (it was a little crazy at my house over the holidays), and 3) the LifeSource died.  But I had used both instruments long enough to form an opinion:

Omron

I had high hopes for the Omron wrist cuff – it was new, and it was small with none of the awkwardness of the more traditional brachial style cuff. But I quickly started finding flaws:

  1. A wrist cuff has to be carefully positioned to get accurate measurements. While Omron says that the edge of the strap should be 1/2” away from the bottom of your palm, I had better luck just centering the strap over the vein where your radial pulse is measured. And besides, exactly where is the bottom of my palm? I could see where that would confuse some people.
  2. I found that manipulating the strap on the wrist cuff with one hand to be a little more difficult than the brachial cuff. Now maybe if I had kept it longer I would have become more adept but right away I felt that this could also lead to some positioning errors.
  3. To make accurate measurements with the Omron requires that you elevate your wrist to the same height as your heart. You can do this one of two ways: 1) physically hold up your wrist for the duration of the measurement or 2) prop it up with a pillow. This step is not required with an arm cuff because once applied it’s already positioned at roughly the same height as your heart. 
  4. Home blood pressure monitors have small air pumps in them to pressurize the cuff – that’s the buzzing sound you hear when you press the Start button. Since the enclosure for the Omron monitor is smaller than the LifeSource device, it has to use a smaller air pump. And a smaller air pump needs more time to pressurize the cuff. So you have to sit there and hold up your wrist while waiting for the cuff to pressurize – I found this a little tiring.
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On the plus side the Omron did come with a small plastic case and didn’t take up too much space. And it had Bluetooth which allowed me to save my measurements on my phone using their app.  

LifeSource

The LifeSource was a boring old fashioned BP Meter that got the job done – until it died. My only complaint about these devices is that they’re awkward to store. There’s the cuff, the base, and the rubber tube connecting the two. Combined these things always get tangled up with other stuff.

Conclusions 

The old fashioned arm cuff is the way to go based on my experience. Yes, they’re awkward but they are solid and less prone to error. Because of this, I replaced the LifeSource with an Omron arm cuff monitor. And for storage I also bought a small enclosure for it.  And as for my BP, I was able to get it down in time for my doctor’s appointment.

When Wally is not creating laboratory mishaps or providing life coach consulting he dabbles in electrical engineering, tells mysteriously hilarious jokes,  and runs a website called Pi-Plates.com.

We met our freshman year at Oklahoma University and Jerry claims my first words to him were “Are you ready for the country?”

Skeptically Yours,

-ACP

Экспериментальная кардиология

Экспериментальная кардиология, используя физиол., патофизиол., биохим, методы и морфол, исследования, изучает на животных состояние сердечно-сосудистой системы в норме и при воздействии различных факторов окружающей среды. Одной из основных задач является моделирование патол, состояний, разработка методов их диагностики, предупреждения и лечения. Решающую роль в развитии экспериментальной К. играет совершенствование методов исследования, отражающее успехи науки и техники. От первых грубых описательных методов, позволяющих вскрыть лишь некоторые общие закономерности, экспериментальная К. перешла к изучению функции и состояния сердечно-сосудистой системы в хрон, опыте с помощью вживленных электродов, к изучению гемодинамики и работы сердца с использованием радиоактивных веществ; к исследованию микроциркуляции на основе данных новейших оптических приборов и т. д. Стало возможным воспроизведение различных сердечно-сосудистых заболеваний в условиях, приближенных к реальным. Так, напр., большое значение для уточнения роли ц. н. с. в возникновении гипертонической болезни (см.) имели работы, показавшие закономерность повышения артериального давления у обезьян и других экспериментальных животных при непосредственном раздражении различных отделов ц. н. с. Определенное место в моделировании сердечно-сосудистых заболеваний занимают исследования коронарного кровообращения с воспроизведением некрозов миокарда. От экспериментов, в которых некрозы миокарда получали путем перевязки венечных артерий сердца, исследователи перешли к изучению моделей, позволяющих воспроизвести патол, механизмы инфаркта миокарда у человека. Среди них модель электролитно-стероидных кардиопатий Г. Селье, некрозы миокарда с тромбозом венечных сосудов, вызванные у крыс и обезьян специальной диетой, включающей большое количество холестерина, или введением животным с экспериментальным липоидозом венечных сосудов сосудосуживающих средств и коагулянтов. Обобщая результаты экспериментального моделирования некрозов миокарда, А. Л. Мясников с сотр. выделил в зависимости от механизмов возникновения так наз. коронарогенные, связанные с нарушением коронарного кровообращения некрозы миокарда, и некоронарогенные, возникновение которых связано с нарушением метаболизма в миокарде (см. Инфаркт миокарда).

Большое место в экспериментальных исследованиях занимают работы по изучению пороков сердца и механизмов развития гипертрофии миокарда, позволившие разработать методы хирургического лечения и обосновавшие некоторые подходы к лечению сердечной недостаточности.

Предметом изучения экспериментальной К. являются вопросы регуляции сосудистого тонуса и артериального давления, в частности значение барорецепторов и рефлексогенных зон сердца, вопросы изучения сократительной функции миокарда, вопросы воспроизведения различных форм нарушений ритма и механизмов развития атеросклероза.

Результаты исследований позволили обосновать ряд методов диагностики, предупреждения и лечения сердечно-сосудистых заболеваний. Это методы электрокардиографической диагностики инфаркта миокарда, изучение которых было начато Смитом (F. М. !Smith, 1918) и продолжено Дж. Паркинсоном, Уилсоном (F. N. Wilson), Я. Г. Эттингером, И. А. Черногоровым и др.; методы биохим, диагностики инфаркта миокарда; методы предупреждения атеросклероза; методы борьбы с кардиогенным шоком; лечение нарушений ритма; использование фибринолитических ферментов и антикоагулянтов; методы хирургического лечения пороков сердца, аневризмы сердца, коронарной недостаточности и т. д.

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Особое значение в экспериментальной К. имеют фармакол, исследования, направленные на изучение механизмов и точек приложения сосудорасширяющего действия ряда средств, механизмов гипотензивного действия различных препаратов, включая центральные механизмы регуляции сосудистого тонуса, состояние ганглиев, гемодинамические показатели, изменение содержания гормонов, регулирующих сосудистый тонус, и т. д. Эти исследования оказали большое влияние на изучение препаратов, воздействующих на метаболизм миокарда и его сократительную способность.

The Beginning

I had a semiannual physical coming up and I realized I better follow my doctor’s advice from my last visit and measure my BP first thing in the morning – before the coffee. Now, I have an old blood pressure cuff that I bought at a garage sale about 20 years ago and it still worked. But I started wondering how accurate it was given its age. So I went shopping on Amazon and decided to buy the same wrist cuff that they use at the demented dentist office. The morning after it came, I measured my BP and… well it wasn’t very good. So, I called my good friend The Skeptical Cardiologist and asked for his advice. And he graciously agreed to help – for a price. We made a deal: he would guide me on my journey to a lower BP. In exchange I would collect some data and provide an opinion on the different cuffs.

In other words: I volunteered to be the SC’s Lab Rat. At first I was proud that he was considering me to provide invaluable data. But, as time went on, I started thinking this might have been his revenge for a laboratory mishap that I caused when we were undergrads. Anyway, on to the experiment!

What Happens to a Plant-Derived Substance That Proves Safe and Effective for a Medical Condition?

It moves from the unregulated, over the counter, internet-marketed realm into the realm of being regulated by the FDA and prescribed by doctors.

I discuss this in a post using the transition of digitalis obtained from the foxglove plant to the cardiac pharmaceutical digoxin.

Steven Novella (Science-Based Medicine) has written eloquently about the “plant vs pharmaceutical false dichotomy” here :

“First and foremost, herbs and plants that are used for medicinal purposes are drugs – they are as much drugs as any manufactured pharmaceutical. A drug is any chemical or combination of chemicals that has biological activity within the body above and beyond their purely nutritional value. Herbs have little to no nutritional value, but they do contain various chemicals, some with biological activity. Herbs are drugs. The distinction between herbs and pharmaceuticals is therefore a false dichotomy.”

Other articles in this area:

  1. Courtesy of Cliff Weathers  a former senior editor at AlterNet who served as a deputy editor at Consumer Reports (Twitter @cliffweathers.) Here are the The four biggest quacks plaguing America and their false claims about  science.

2.  Snake Oil Du Jour: Turmeric

3.  Homeopathy Is Pure Bunkum

The #1 Red Flag Of Quackery Is The Constant Promotion Of Useless Supplements.

Such supplements typically:

-Consist of “natural” ingredients

-Are a proprietary blend of ingredients or a uniquely prepared single ingredient, and are only available through the quack.

-Have thousands of individuals who have had dramatic improvement on the supplement and enthusiastically record their testimonial to its power

-Have no scientific support of efficacy or safety for any illness or medical problem

-Despite the lack of scientific data, the quack is able to list a series of seemingly valid supportive “studies”

-Aren’t checked by the FDA

-Apparently cure everything from heart disease to lassitude

In my post I cite Dr. Gundry’s Vital Reds as a typical example

‘No evidence’ having high levels of bad cholesterol causes heart disease, claim 17 physicians as they call on doctors to ‘abandon’ statins

The Daily Mail article says at one point

Is this really a “new study” that contradicts the great body of evidence showing that statin treatment is safe and effective in preventing heart attacks and stroke in those at high risk for cardiovascular events?

In reality, this is an opinion piece published in a questionable journal* without any new research, and it is the opinion of a collection of well-known (approaching notorious) statin denialists, members of a cult-like organization called The International Network of Cholesterol Skeptics.(THINCS).

Larry Husten, who writes highly informed cardiac journalism at Cardiobrief, gives a good summary of their methods in this description of the authors of an editorial attacking the results of the JUPITER trial:

The lead and corresponding author, Uffe Ravnskov is the founder of THINCS and author of The Cholesterol Myths – Exposing the Fallacy that Saturated Fat and Cholesterol Cause Heart Disease (2000), which is considered the bible of cholesterol contrarianism.

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Ravnskov’s book has been severely criticized in Bob Carroll’s The Skeptic’s Dictionary, which outlines the distortions and deceptive techniques found in the cholesterol skeptics’ arguments.

Harriet Hall wrote an excellent analysis of THINCS 10 years ago at Science-Based Medicine and her concluding sentences are still highly relevant:

Indeed, if they were able to convince a highly intelligent patient like Geo, with a science background who also had easy access to the advice of a forward thinking cardiologist to stop taking his statins, who knows how many thousands have been convinced to stop their medications.

So my best advice for Geo and all of you taking statins is the following:

  1. Make sure you really need to be on the drug after engaging in shared-decision making with your physician and learning all you can about your personal risk of cardiovascular disease, the benefits of statins for you, and the potential side effects.
  2. Once you’ve made a decision based on good information and physician recommendation, try to ignore the latest headlines or internet stories that imply some new and striking information that impacts your health-most of these are unimportant.

The evidence for the benefit of statins is based on a deep body of scientific work, which will not be changed by any one new study. There is a very strong consensus amongst scientists who are actively working in the field of atherosclerosis, and amongst physicians who are actively caring for patients, that statins are very beneficial and safe. This consensus is similar to the consensus about the value of vaccines.

Science moves incrementally, and new studies inform those with open minds. The studies in this area that have been most significant in the last few years have actually strengthened the concept that drugs which lower LDL-C without causing other issues lower cardiovascular risk (see here on PCSK9 inhibitors and here on ezetimibe.)

Incrementally Yours,

-ACP

N.B. *The Expert Review of Clinical Pharmacology”is an open access journal, many of which are predatory. Article are solicited and the authors pay to have their work published. For the article in question, the Western Vascular Institute payed the fee. It’s not clear that there is any peer-review process involved.

Some authors have suggested predatory journals are “the biggest threat to science since the inquisition”and I am very worried about the explosive growth in these very weak journals which exist solely to make money.

I realize that writing this piece will engender the wrath of many so before you leave comments impugning my integrity let me reiterate that I receive absolutely nothing from BIG PHARMA. In fact, by writing appropriate prescriptions for statin drugs I reduce my income as my compliant patients avoid hospital and office visits and all kinds of procedures for heart attacks and strokes!

WebMD: Purveyor of Bad Health Information And Snake Oil

Even media found in your doctor’s waiting room should be viewed with suspicion.

For example, in this post I examined what is in an issue of  WebMD, The magazine turns out to be a useless and potentially harmful combination of:

  • Direct To Consumer  ads promoting expensive, marginally beneficial medications
  • Snake oil products with no benefit and potential risk
  • Celebrity fluff pieces with no useful medical information
  • Brief, often inaccurate blurbs on diet, exercise, weight loss.

Web MD, although free, should not be in doctor’s waiting rooms.

Given this production from WebMD I would also advise patients to avoid the WEbMD website as it cannot be considered  a trusted source of medical information and, like the print format, primarily exists as  an advertising vehicle.

The Data

I’m a lousy scientist. I started off with good intentions but pretty soon, I started forgetting the evening measurements. And then, when I saw that there wasn’t too much deviation between the measurements on my left and right arms, I only made left arm measurements.

Here are the first two days of data:

January 1st:

The BP measured on my right side was lower in the morning and higher with the wrist cuff in the evening.

January 2nd:

On the 2nd day, left and right were more consistent but the wrist cuff was higher in the evening. About this time, I was already getting annoyed with the wrist cuff and decided to return it. My reasons for this are detailed below. 

I continued to measure my BP in the mornings using just the LifeSource cuff:

Other than the data from 1/5/20, there appears to be reasonably good correlation between the left and right arms.

Note the 12 day gap between the last two data sets. That’s because:

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