Tuesday, July 19, 2011

It’s Natural! Does natural make it good for you?


Many people feel that if something is “natural” it’s got to be somehow safe or just better for you. Another way of putting this: if it’s in nature, it’s just wholesome and better for you.

Better than what you ask?

Well, I guess better than a “man or woman made” chemical. Better than a synthetic.
So if it’s found in nature it’s probably okay?  Do you believe this?

Here are a few things that can make you sick or kill you:

All are natural by which I mean they are found in nature, not caused or made by man or woman.
·      Parts of hundreds of plants including the mayapple, deadly nightshade, foxglove,   Dutchman’s pipes , oleander, yew, laurel, mistletoe
·      Amanita mushrooms
·      Many types of viruses and bacteria
·      Parasitic infections (including malaria) caused by protozoans or helminths.

My point is that natural tells you nothing about safety.

Some herbal supplements from plants have been outlawed by the FDA because they have been shown to cause kidney failure or serious liver damage or miscarriages.

But you cannot rely upon the FDA for any assurance of safety of supplements.
The FDA does not regulate supplements like they do prescription drugs.

Sometimes I hear from patients that the drug companies just want to sell drugs to make a lot of money.

Well, I have news for all those pill poppers: all companies including those selling vitamins and “natural” supplements want to sell their product and make a lot of money too.

The supplement industry is huge. Americans spend at least $4 billion yearly on just vitamins and perhaps another $30 billion on other supplements. This is big business! These companies try to promote their products by claiming that they are natural. And lots of people fall for this.

Most people have never taken a course in chemistry. They don't understand that these supplements are chemicals just like prescription drugs are chemicals.

Chemicals might be good or bad for your body. It depends.

After all, your body is composed of complicated chemicals in careful balance, always changing. Chemicals are the building blocks that make up not only our bodies but also the world around us.

I’m a board certified endocrinologist. I specialize in the chemicals in our body called hormones. 
I am also a board certified Physician Nutrition Specialist.
(I also majored in chemistry in college).

Often uninformed people are fine with taking handfuls of supplements, but they are not willing to consider taking a prescription drug.

But some prescription drugs actually are the same as a chemical first found in nature.

Like lovastatin (Mevacor) as discussed in my post on red yeast rice.

Many drugs to treat cancer called alkaloids are taken from plants.

Exenatide (Byetta) to treat diabetes was first found in gila monster saliva.
Now it’s made in the laboratory. The gila monsters appreciate that!

Prescription drugs are carefully tested, well studied and proven to provide benefit. 
And prescription drugs are regulated by the FDA.

The FDA is sure strict these days.

The FDA does not approve many new chemical entities these days. So that means not too many new drugs are available for use.

Every possible new drug has to be rigorously tested before the FDA approves it. There has to be proof of benefit and studies on safety.

I know this directly and personally. As a Certified Physician Investigator, I have supervised many clinical trials since the 1990’s.

And remember you just can’t be sure of what you are getting in those supplements. They don't go through any testing like prescription drugs.

Now don’t misunderstand me. I am not opposed to all herb, vitamin, mineral and nutritional supplements. I take a few myself.

I just believe we should be informed.

We need to carefully evaluate the scientific evidence for possible harm versus benefit for each supplement.

And cost has to be factored in. All those supplements can cost alot!

I ask: Is it worth it? Does it cause more harm than good?
I often save patients a lot of money when they bring in their pills for my review.

Do you know why you take the pills you do? 

Are there any supplements in particular you are curious about?

Let me know. Be well.

Here are a couple of useful websites on dietary supplements:


This one requires a fee and is intended more for health professionals:



Thursday, July 14, 2011

Should I take a krill oil supplement?

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Recently patients  have asked me about krill oil.

Krill is a crustacean, a little like a small shrimp. It contains the omega 3 fatty acids DHA and EPA.

So should you take a krill oil supplement?

Don’t waste your money! Don't fall for the marketing nonsense. If you know some chemistry you will not be duped. These supplements are very expensive when you look at cost per gram of omega-3 fatty acid.

How many of you had a chemistry course in high school or college? If you have not had a chemistry course or had a bad teacher or forgot what you learned in your chemistry course, you will likely be tricked.

If you want marine derived omega-3 fatty acids then get the lowest cost, most concentrated preparation. See my previous posting to learn more.

The animal sources of those essential fatty acids, EPA and DHA, have not been shown to be important. Your body cannot tell from which fish or crustacean the EPA and DHA came from.

There is no proven benefit from the krill outside of its content of EPA and DHA.

Saturday, July 9, 2011

How Do I Control My Blood Sugar Without Going Too Low?


I recently was at a picnic when someone shared her story with me of how she had tried to lose weight while taking her medications for her Type 2 Diabetes. She was getting nowhere. 

She would get shaky and sweaty and weak when she tried to eat less. So she just stopped trying. Has this happened to you?

This person was experiencing hypoglycemia, and, sadly,  getting no help from her doctor.

If you have diabetes you should be working to get your blood sugar (glucose) under good control and trying to keep it there. But you don’t want your sugar to go too low.

So how do you get control and not go too low?

First some background:

Good control of your glucose is very important to prevent problems called complications. These complications are often serious.

Blindness, kidney failure and severe nerve damage are some possible complications of diabetes.

But a major challenge in controlling blood glucose is not going too low. “Too low blood glucose” is called hypoglycemia. Usually too low is below 70 mg/dl.

Your brain needs glucose to work so our body has built in protective steps it takes to keep the glucose from going too low. Normally, adrenaline (epinephrine) is produced when the sugar goes below 70 and other hormones are also produced to keep the glucose up.

Adrenaline helps keep up the glucose but it also causes a fast heart beat and shakiness. And, usually, people feel sweaty, weak and hungry when their sugar is below about 70.

No one likes the feeling of getting hypoglycemic. Some people with diabetes are so worried about going too low that they keep their sugar high all the time. Not good: that means a much higher chance of complications.

Now not everyone feels those symptoms of hypoglycemia even when their glucose is well below 70. In any case, it still is not good to be getting hypoglycemic if you have diabetes.

Remember your brain needs a certain amount of glucose to function normally. If your sugar goes too low, you may not think clearly or see well. You can even pass out (lose consciousness). You don’t want to wake up surrounded by paramedics.

So a key step to prevent hypoglycemia is to be on the best medication or combination of medications to control the blood glucose. The lower your chances of hypoglycemia, the better, as long as your sugar is controlled.

And, in general, the less you have to worry about going too low the better. 
We have enough to worry about in day to day living!

So what medications for Type 2 Diabetes do not tend to cause hypoglycemia?
The generic names are listed below with the brand name in parentheses. 

Metformin
Pioglitazone (Actos)
Bromocryptine quick release (Cycloset)
Colesevelam (WelChol)
Sitagliptin (Januvia)
Saxagliptin (Onglyza)
Linagliptin (Tradjenta)
Liraglutide (Victoza)
Exenatide (Byetta)



On the other hand medications that do tend to cause low blood sugar are:
Glimepiride
Glyburide
Glipizide
Nateglinide (Starlix)
Repaglinide (Prandin)

All of these in italics above can cause hypoglycemia, sometimes severe.

Glyburide is the worst of these. Unfortunately, it is still used a lot by many doctors around the world.

I discuss  insulin in another blog; of course, insulin can cause hypoglycemia but some insulins are much better choices than others because they are less likely to cause hypoglycemia.

Those drugs that can cause hypoglycemia all need to be used with caution and at the lowest dose needed. I like to avoid those drugs whenever possible. Their main benefit is that many are cheap.

So back to my friend at the picnic: she was taking glipizide.  If she were not on glipizide she would not have had problems with hypoglycemia while she tried to lose weight.

If you have had  hypoglycemia on medications for diabetes, you might consider a switch to one of the drugs on the other list. Some actually help with weight loss. 

Talk to your doctor or see us to learn what would be best for you.




Monday, July 4, 2011

What's Good About Cooking Light?

The most recent issue of Cooking Light contains a neat article describing common nutrition misconceptions.

Do steel-cut oats offer more nutritional value than instant oats?

Are brown eggs worth the extra cost over white eggs?

Check out that article.

I subscribe to Cooking Light both for our office and my home. I have for over 10 years.

I recommend the magazine and the website for healthy recipes and much more.

I especially like their "Quick and Easy" recipes that take less time and effort.
But most important the results are delicious! And calorie content per serving is provided.

I have found that (most of the time) Cooking Light offers sound well written advice on nutrition, exercise and more.

And their statements are usually based on solid scientific evidence.

For that we can thank the physicians and registered dietitians who work to produce Cooking Light.

Your Diabetes Endocrine Nutrition Group

Saturday, July 2, 2011

E Prescribing Errors. Are You Surprised?

Has your doctor sent your prescription "electronically" by computer? A recent analysis of almost 4000 prescriptions showed that error rates with these "e prescriptions" occur just as frequently as with handwritten prescriptions.

These prescription errors are not the same as a pharmacy dispensing error in which the prescription was fine but the pharmacy messed up.

About 11 percent of  e prescriptions contained an error. 4 percent of e prescriptions had an error that could have had led to a serious problem.

I think the main lesson here is that in order to reduce errors, regardless of technology, the prescriber and the pharmacist, both need to be careful and diligent. And they ought to freely communicate with each other if there are questions or uncertainties.

And you as the patient should examine the medicine dispensed and check with the pharmacy or your doctor if things seem suspicious or you are otherwise concerned.

Despite this evidence, the feds are doling out financial rewards for doctors who e prescribe and soon will exact penalties for those who fail to e prescribe.

Have you had an error on one of your prescriptions that you thought was serious?
Have you had a pharmacy dispense the wrong medicine?

Reference:
Nanji KC, et al "Errors associated with outpatient computerized prescribing systems" J Am Med Inform Assoc 2011; DOI:
10.1136/amiajnl-2011-000205.


Your Diabetes Endocrine Nutrition Group