Where Do We Live?

By Jacob Schor, ND, FABNO

Photo by Liralen Li via Flickr, used under the Creative Commons License.

There’s a Hebrew expression that roughly translates as "Where do you live?" It’s not meant to ask the location of a person’s residence. Instead it expresses shock, dismay, or disbelief in the ideas held by the person being addressed. By implication, "Do you live on Mars?"

During the winter, I go skiing with my friend Jim every Wednesday. We have done this for almost two decades, from opening day in November to closing day in May. Given the many shared months of our lives spent shivering together, I guess it was fitting that when Jim came back from a business trip to Dublin last winter, he brought me a gift: a handmade wool sweater.

This beautiful sweater came with a brochure affixed to it with one of those plastic fasteners, which needs to be snipped off lest you leave a hole in the garment. The brochure informed me that because the sweater was made of Merino wool, it would be comfortable year round, winter, spring, summer and fall. It is a beautiful sweater and nice to wear outdoors with my vest when the temperature is in the twenties. It’s even wearable indoors when I’m writing, the heat is off and the temperature is below sixty. I’ve tried unsuccessfully to wear it a few times this spring. I joke about wearing it in the summer. We live in Colorado. It’s too hot here to even touch wool during the spring and summer. Though it makes for a good joke, "Oh, the temperature has dropped to 85. Shall I wear my sweater?"

I mention this sweater because I use it as an analogy. That information on that sweater tag teaches us two things. The first is obvious: you can’t believe everything you read. That certainly applies to a good many ‘miracle cancer cures’ my patients read about on the Internet and then expect me to believe in. I tell them about the sweater.

The second sweater lesson is less obvious. The statement that the sweater is wearable year round isn’t false. It’s probably true if you live in Ireland. The truth is relative. In the case of my sweater, to where you live.

My ruminations on the relativity of truth are triggered by Nathan Seppa’s article in last week’s Science News titled "The Sunshine Vitamin."ⁱ

Nathan Seppa and before him Janet Raloff have in their earlier Science News articles closely followed and reported on the growing vitamin D research over the last ten years. This article on the surface purports to cover both sides of the debate triggered by last year’s Institute of Medicine’s report on vitamin D.

Last November, an Institute of Medicine (IoM) panel of scientists announced new vitamin D recommendations. They recommended daily intakes of 200 to 600 IUs per day. For most of us who follow the growing data on vitamin D, and routinely prescribe doses ten times this high, these suggestions seemed absurd.

Seppa points out the argument on which most vitamin D proponents fall back: that "… these amounts still fall short of prehistoric people’s intakes by a Stone Age mile." Living outdoors with little clothing, these people manufactured thousands of international units, or IU, every day, perhaps getting three to five times as much as most people get now.

Seppa then goes on and writes a comprehensive review of the benefits associated with vitamin D. He reviews the many research studies that form the basis of our thinking that vitamin D can produce anti-viral, anti-cancer, anti-allergy (including asthma, allergies etc), anti-autoimmune (including DM, and especially MS), anti-neurodegnerative (Parkinson’s disease, Alzheimer’s disease), anti-hypertensive and anti-cardiovascular disease effects.

Seppa contrasts the IoM’s recommendations with those published this month by the Endocrine Society in the Journal of Clinical Endocrinology & Metabolism.ⁱⁱ "The society, the world’s oldest and largest group devoted to hormone research, called for vitamin D intake levels two to three times higher than the IOM’s recommendations."

The question in my mind isn’t which of these opinions to follow. For naturopathic physicians, this is a no brainer. The majority of us will follow the guidelines and thinking of the Endocrine Society over those of the IoM. The question is why varying groups of intelligent and well-meaning scholars see the world so differently.

I think our views are tainted by the day-to-day needs of clinical practice and the demands it places on us to make pragmatic decisions based on often incomplete data, while those of the IoM panel are made in the academic luxury of being able to stall until more data is available.

Seppa quotes Patsy Brannon, a molecular nutritionist at Cornell University and a member of the IoM panel, who expressed the need for more randomized to settle the question:

"We looked extensively at those areas," Brannon says. In non-bone research, she says, "We found very limited randomized controlled trials, and evidence for cause and effect was not present."

At this point, there is slim if any indication that vitamin D supplementation will be hurtful and ample suggestion that it will provide vast benefits. But that’s our point of view.

This brings to mind another recent article, this one in last Sunday’s New York Times by Siddartha Mukherjee, the author of 2010 book The Emperor of All Maladies: A Biography of Cancer, which won the Pulitzer Prize for General Nonfiction. In his Times article, he reviews the evidence behind the current fear that cell phones will cause brain cancer and compares it with the evidence that links formaldehyde exposure to leukemia and smoking with lung cancer.

Mukherjee points out that the link between formaldehyde and cancer was known in the 1970s. It wasn’t until recently that the National Toxicology Program actually announced the connection. He blames industry lobbyists, particularly plywood manufacturers, for delaying this official stance.

Mukherjee reminds us that "The human trials that established that tobacco smoke is a carcinogen were initially performed in the mid-1950s (some even earlier). The tobacco industry mounted an aggressive campaign to discredit the data, and continued marketing tobacco to the public. The landmark Surgeon General’s Report on smoking and cancer was released in 1964. And it took yet another decade of innovative strategies, including powerful anti-tobacco advertisements and tort cases against tobacco companies, to alter the trajectory of smoking behavior in America."ⁱⁱⁱ

It can take a long time for knowledge to move from research publications to changes in public awareness and behavior. Let’s not even attempt to explain the recent trend toward increased smoking in young people in certain parts of the country.

Seppa sums up the arguments against the IoM’s desire for better evidence of vitamin D effect, and their desire for more randomized controlled trials by quoting Cedric Garland of the University of California, San Diego:

Besides, randomized controlled trials have never been the sole arbiter of medical thinking or policy, Garland says: "If they were, we would all still be smoking cigarettes and no one would be wearing seat belts."

We may never have randomized controlled trials on smoking because at this point it would be unethical to assign people to a ‘smoking arm’ of a trial. The weight of the evidence in support of vitamin D may soon bring us to a similar situation. How can we ethically tell people in a control group to not take vitamin D?

When it comes to wearing Merino wool sweaters in the summer, I don’t live in Ireland. What’s true in Ireland is not true in Denver.

We have to accept that the members of the IoM committee do not live in the same world we do. When it comes to encouraging higher intake of vitamin D, I want to think that we live in the real world, where our desire to improve patient health comes first in our list of priorities.

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ⁱNathan Seppa. The power of D: Sunshine vitamin’s potential health benefits stir up, split scientists. Science News / July 16th, 2011; Vol.180 #2 http://www.sciencenews.org/view/feature/id/332009/title/The_power_of_D_


ⁱⁱHolick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM. Evaluation, treatment, and prevention of vitamin d deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2011 Jul;96(7):1911-30. PMID: 21646368


ⁱⁱⁱMukherjee S. Times Patrolling Cancer’s Borderlines. New York Times. July 12, 2011. http://www.nytimes.com/2011/07/17/opinion/sunday/17Mukherjee.html

Environmental Chemicals Affect Health

By Sara Thyr, ND

Photo by stevedepolo via Flickr, used under the Creative Commons License.

Recent information released by the Endocrine Society showed a link between bisphenal-A (BPA) and polycystic ovarian syndrome (PCOS), with the authors noting that women with PCOS seem to have more vulnerability to exposure to BPA. (HealthDay, Jan 18, 2011)

BPA is commonly found in plastics, and particularly noticed at high levels in canned foods and infant formulas. It appears to be toxic at even low doses, falling into a class of chemicals called hormone disruptors (and also endocrine disruptors). Animal research has shown that BPA causes breast tissue and prostate cells to be more sensitive to hormones and carcinogens, as well as permanent changes to the genital tract. (Environmental Working Group review of research).

This is not the first time that chemicals in our environment have been shown to negatively affect health. The Endocrine Society, a medical group, released information two years ago indicating that BPA, phthalates, and pesticides had a significant negative effect on human health. And many persist in the environment, even after they are no longer used or banned by the government.

Phthalates (or DBP for dibutyl phthalate) are found in cosmetics, beauty aids and pharmaceuticals. They are also not always easily identified on labels, and many cosmetics don’t even have an outer label where consumers can read ingredients before purchasing. A wide range of products may contain DBP – such as antiperspirants, shampoo and conditioners, body lotion, and even gum and candy.

Phthalates are added to products to make them more flexible, such as nail polish and mascara. In lotions they are added to make the skin feel more smooth after application, or enhance the penetration of a cream. The price of using these plasticizers is disruption of hormones and the endocrine system. Allergic reactions are also common, even ones as serious as anaphylaxis. They have been long implicated in cases of male infertility and reproductive health problems.

How do we avoid these products?

If you have any activism in you, joining advocacy groups that bring awareness to the use of these chemicals may be worth your while. The Environmental Working Group is one that utilitizes scientific studies and other in-depth information about all of the toxic chemicals that they study.

Appreciate that everything that you rub on your skin, inhale, chew on, suck on, drink and, of course, eat, is absorbed by your cells and, if it is toxic to them, will have a negative effect on your health. Don’t just assume that because something is available in the U.S. that it must be safe. This industry is largely unregulated.

Avoid using products that contain BPA and DBP if at all possible. Don’t using plastic water bottles – this does good for both your health and your planet. Cutting down on the tons of plastics that are thrown into our landfills will help protect our planet and reduce our dependency on oil.

Avoid perfumes and most air fresheners – especially the ones that you stick into an outlet in your home. Avoid body lotions that contain perfumes or DBP. Become an avid label reader. If you cannot pronounce the words on product packaging and there is a very long, small print list of ingredients, think twice. Skin Free products are free of all toxic chemicals. The Environmental Working Group has a website called the Cosmetics Database where you can look up the personal care products that you use and find out what is in them and what their potential toxic effect is. You can also search in such a way that they will recommend manufacturers whose products are clean.

Buy organic food, avoid canned food and canned sodas, and encourage young mothers to breast feed rather than use formula.

Most naturopathic doctors can put you on a good detox program if you are concerned about toxins in your system. There are even lab tests that will tell you what you are harboring and possibly help you figure out how to avoid them.