Thursday, November 22, 2012

Dr. Oz: lycopene lowers cholesterol?

Does lycopene lower cholesterol?

Well, if you believe one of the most well known doctors in the United States, Dr. Oz, you would think that lycopene lowers LDL cholesterol “as much as statins”.
Dr. Oz is often cited by my patients.
Dr. Oz has a TV show, and along with Dr. Roizen, he has a regular newspaper column providing a “tip of the week”.

In their recent column, they advise that we can simply consume a half-cup of tomato sauce daily to lower LDL cholesterol as much as statins.

I say: get real!
Okay even if we were to consume that much tomato sauce (sauce not juice) daily, what is the evidence that lycopene found in such foods as tomatoes, actually lowers LDL cholesterol (the bad cholesterol)?

Quick answer: none. No evidence.

There are absolutely no randomized, placebo controlled clinical studies that demonstrate cholesterol lowering with lycopene.
And there are no studies examining lycopene versus statin.

And the best published study I could find with lycopene showed no effect on LDL cholesterol levels.

And you may ask what is lycopene? 

It is the chemical that gives tomatoes and red bell peppers their red color.
It also has antioxidant properties. And if you have read my previous post on antioxidants you can see through those dubious antioxidant claims.

Okay, but where did Oz and Roizen come up with this idea about lycopene?

I really don't know. I did not call and ask either of them before writing this post.

But I think they probably got excited after seeing a recent publication.
That epidemiologic study found that men who had higher lycopene levels in their blood seemed to have fewer strokes over a 12 year period of time.
This study is interesting but it proves nothing. 

As with all studies of associations, this report does not prove that consuming lots of foods high in lycopene will reduce your risk of stroke. And this study did not evaluate the effect of lycopene on cholesterol. 

Drs. Oz and Roizen often make bold statements based upon this kind of association type study.
These judgments on their part represent uncritical, uninformed thinking.
This type of conclusion misleads.
This type of conclusion is junk science. Other physicians have been very critical of Dr. Oz.

You may ask: do I recommend my patients eat a variety of foods including fruits and vegetables?
Of course I do.
And I also recommend that they not read or watch Dr. Oz.

Sunday, November 11, 2012

Eat more to lose weight?

Should you eat more to lose weight?

This is one of the stupidest recommendations my patients have read or been told.

But many people seem to believe this advice:

      that if you don't eat enough, your body will go into "starvation mode" and you will not lose weight.

Another way of stating this is that below a certain calorie intake, you will stop losing weight.

Let me make this perfectly clear: this is complete nonsense.

There is excellent science on calorie intake and weight loss. See a recent post.

To believe that taking in more calories helps you lose weight is as stupid as:

      if you want to jump higher, put weights on your shoes, that really helps a lot.

Or, if you want to go really fast while driving your car, step on the brake along with the gas pedal.
Weight loss is not easy.

But the laws of physics remain:  you need to take in less calories than you burn up.

And eating fewer calories, always helps weight loss efforts.

New medications like Qsymia can help.

Good luck in your efforts!

Your Diabetes Endocrine Nutrition Group

Wednesday, November 7, 2012

Osteoporosis Drug Risks

Osteoporosis Drug Risks

There has been a lot of recent concern recently about osteoporosis drug risks.
Osteoporosis is a condition of the bones that increases the risk of fractures.

One in 2 women and one in 4 men over the age of 50 will break a bone due to osteoporosis.
About 2 million fractures related to osteoporosis occur each year in the United States.
About 300,000 are hip fractures.
Hip, wrist and vertebral (spine) fractures cause untold suffering and disability.

Guidelines and online calculators  and an app for the iphone are available to guide physicians as to who should be treated with medication. Those persons who have had a so-called fragility fracture are much more likely to have another fracture.

The most commonly used drugs to treat or prevent osteoporosis are called bisphosphonates. The four bisphosphonates used for osteoporosis in the U.S are alendronate, ibandronate, risedronate, and zoledronic acid.
The brand names for these are Fosamax, Boniva, Actonel and Reclast.

Reclast is given once a year intravenously. Boniva is available by mouth given monthly and intravenously once every 3 months . Fosamax and Actonel are given by mouth.

Doctors never want to cause more harm than good with a medication.
Recently, a possible increased risk of unusual fracture of the “thigh bone”, the femur, has been seen. This atypical fracture is thought to be possibly increased in those persons on long-term bisphosphonates.

In this post I will focus on these so called atypical sub-trochanteric fractures. 
Some may be concerned about osteonecrosis of the jaw (abbreviated ONJ)  with bisphosphonates. When bisphosphonates are used for osteoporosis, ONJ appears to be very rare and not clearly caused by the drug at these doses. 
A recent article discusses safety concerns of bisphosphonates.

The American Society of Bone and Mineral Research has provided a detailed report on atypical sub-trochanteric fractures. Of all hip and femur fractures, less than 1% are these atypical sub-trochanteric fractures. These atypical sub-trochanteric fractures appear more likely, perhaps two and half times more likely, in those who have taken bisphosphonates for more than 5 years.

That sounds bad but the risk of such fractures is very low.
Atypical sub-trochanteric fractures occur at a rate of about 3 in 10,000 women over 1 year  who are 65 years or older.
But typical hip fractures overall are 30 times more frequent: 103 in 10,000 women aged 65 or older over 1 year.

And bisphosphonates have repeatedly been proven to reduce fractures in those at increased risk for fracture. 
Bisphosphonates reduce fractures by 30-70% depending on the drug studied and the particular fracture.

So what should be done while we wait to learn more about these atypical sub-trochanteric fractures?

Those who really need treatment should be treated. FRAX can be very useful. But sound judgement and clinical expertise needs to be coupled with FRAX.    I often see patients who probably do not need the medication they are taking for their bones.

We should consider discontinuing treatment in those who are doing well and who are at lower risk after 5 years of oral bisphosphonates or 2-3 years of intravenous bisphosphonates. Recent data suggest that FRAX may be helpful in deciding when to stop treatment with a bisphosphonate.
At this time, there are no studies on how long treatment might be stopped.
Many people, especially those with more severe disease and history of fractures, will do best by continuing treatment.

Keep in mind that we do not have data on  atypical fractures in those treated with Prolia long term.
And Prolia is not a bisphosphonate but it appears to be highly effective.

Discuss matters with your doctor who should be keeping up to date with developments in this area.
And remember no treatment is without risk. 
We should weigh risks versus benefit. 
There may be no clear right or wrong answer here.
And if in doubt, patients and or doctors should get another opinion.
In general, endocrinologists and rheumatologists are the specialists with expertise in osteoporosis.

I hope this helps in thinking about osteoporosis drug risks versus benefits.