Doctor's views on supplements

I think it is really interesting that the majority of doctors will say that supplements are a waste of money. They really believe what they are saying. Many of the people who are really promoting supplements are selling them. They also really seem to believe in their product. It would be wonderful to know where the truth lies.

I believe supplements probably do help some people for some conditions but there is probably also a lot of placebo effect out there. Supplements do not seem to help my husband's a fib but he continues to take them in hopes that if he takes enough or the right combination that they will help.

My husband and I spend hundreds of dollars on supplements. We seldom use prescription drugs. I sometimes wonder if we are misguided.

Debbie

I think supplements have helped me. But I am also nervous that there is no regulation over them, and it's hard to know which companies you can trust and which have filled a pill with garbage.

Debbie,

1) Do not discount the benefits of the placebo effect (PE). It can help motivate people for treatment, and it has effects on the brain itself that may add to the biochemical effects of the medication or other treatment.

Some questions:

How much should doctors encourage patients' expectations that a treatment will help them as opposed to being strictly honest (-- about the probability of success based on experiments where hope for cure played little of no role)?

Does the PE play a more powerful role with some symptoms -- such as physical or emotional pain? Could the PE affect AF by reducing anxiety?

The PE can have some odd effects -- for example, for some, it can turn unpleasant side effects into evidence that the medication is working

The PE may have some limitations -- for example, it may be less durable than the effect caused by a medication -- perhaps because a person's positive expectation is easily disappointed.

Should a patient worry about the PE? In some cases it may be that, although the patient feels better (from the PE), the lack of a chemical effect may be allowing harmful processes to proceed. I am thinking of various cancer treatments, such as laetrile.

Could some AFers expectations of help from supplements encourage them to overlook episodes of low intensity (non-symptomatic, bordering on "silent") AF?

So what is the AFer to do?

IMO, the AFer should accept any positive effects he gets from supplements. I would say the danger described above is less likely to occur now with people aware of unnoticed AF and more likely to do a weeks' monitoring as opposed to a day.

The AFer who experiences a positive PE should be aware of the possibility that his positive placebo reaction may not transfer to others who do not share his placebo potential.

From the other perspective, we should realize that results reported testimonials may not apply to us.

Could accepting a PE have other negative consequences? What do you think?

Following the suggestions that come next can also *help* shake out the substances whose effects are placebo processes. (So can blood tests, which may help to pin down the first phase of a substance's effect.)

2) Some of the problem of evaluating supplements in the individual case could be handled by using principles of singe-case experimentation. A couple of things to consider doing: keeping a journal; adding or changing one substance at a time; and (this is a difficult one...) stopping taking a substance that has worked to see if its absence provokes a return of symptoms ("reversal phase").

For more on this subject, see:

[en.wikipedia.org]

[www.af-ideas.com]

-- Dick

Debbie - As you know, I am a strong proponent of nutritional supplements as an adjunct to healthy lifestyle practices...on a continual basis; not just occasionally.

Supplements don't do any good if a person doesn't eat clean, whole food regularly and eliminate junk food/added chemicals and really take responsibility for what goes into their body…and what doesn’t. The body was designed to work on nutrients. Doctors seem to either have forgotten that basic biochemical fact, or they are now young enough that they were never taught that in the first place, which seems to be the norm over the last 30 or so years. They seem to be taught that drugs and surgery are the only treatment options. There isn’t much money in supplements; cure a patient with nutrients and you lose a regular customer.

It’s both disappointing and frustrating to read comments posted by patients who are told by cardiologists or EPs that supplements don’t work. That really scares me because it’s a fact that the majority of people are deficient in magnesium. Just one important example.... We know that afibbers are almost always deficient in magnesium.... just a basic nutrient required for …well, you know the story…over 300 enzymatic reactions in the body…some of which are heart-related; specifically afib related. Basic science.

In all my years of seeing cardiologists and EPs…not one ever was concerned with my magnesium status…potassium or sodium as an example. No one every wondered if my low level of vitamin D had any influence on my afib. Turns out, the vitamin D expert, John Cannell MD reports on a woman with sick sinus syndrome that disappeared after optimizing vitamin D and another case where the person had trigeminy resolve after vitamin D supplementing. Imagine that! Had I optimized my vitamin D levels in time, might I have avoided ablation? Maybe…I’ll never know because no one checked. But it makes sense. I live in NE Ohio… not much sun for about six months. Hmmmm. Why isn’t it routine to check every afibber’s vitamin D level, and so on…you get the idea.

I have corrected numerous 'ailments' with nutritional supplements whereas Rx drugs initially tried did nothing but flatten my wallet and cause side effects. Even after ablation, when I began having breakthrough events, I could have gone back on drugs but chose, instead, to follow what we have learned here...that the balance of nutrients required for cellular energy production ...in this case-- heart cells... is all-important to stabilize NSR. Erling says… to remain in NSR, I have to keep my voltage up and this depends on these key electrolytes in proper balance and ratio. I am tested periodically for the basic nutrient levels and am comfortable with that approach rather than opting for drugs or another procedure. It's helpful to have the support and guidance of a physician that understands the need for sound nutrition as a basis for health. I own my problem. But I've done a huge amount of reading and research and I am fortunate to have access to a doctor who uses nutrition as a basis for wellness in her practice.

Further, there are just mountains of scientific evidence supporting the therapeutic value of nutritional supplements. You can do a Pub Med search on just about any nutrient and confirm that. It’s just that there is no money going into the coffers of Big Pharma so information that the public needs to know is continually suppressed for fear that someone might think for themselves and opt to use nutrition to get well versus taking a drug hat doesn’t get to the core problem; just masks the symptoms. Worse, doctors seem to be clueless on nutrition unless they become specialists or take the functional medicine certification courses. We aren’t being served well at all when it comes to chronic illness care. Acute trauma care is outstanding and if I have an accident, I’m going to rely on that expertise, but when it comes to maintaining the basic biochemistry, I’ll rely on my own due diligence and supplements.

As far as placebo effect… I seriously doubt that …maybe in a few minor instances.

A few of my many experiences:
For years I doctored with Rosacea… some red splotches on my otherwise clear skin. Annoying.
Saw dermatologist every 2 months for 2 years. $$ Tried tetracycline and a variety of topicals that did nothing.
Changed specialists. He said everything the first Derm instructed was wrong… more try this; try that. In another year - nothing changed.
I attended one of my first health fairs, asked a number of “vitamin” people giving talks and exhibits about my Rosacea. Same collective answer. Lack of stomach acid. Try betaine hydrochloride. I did. Shazam!…No more Rosacea. Inexpensive, effective, and definitely not placebo effect.

Developed a swelling under my jawbone…an enlarged submandibular gland. I consulted with my own dentist and two oral surgeons and a maxillofacial specialist. The treatment was surgically remove the gland. By then, I had lost enough body parts from misdiagnosis that I wasn’t willing to sacrifice another so coincidentally, I became a patient of a new holistic MD just setting up shop in my area. He referred me to a chiropractor who had experience treating these enlargements. I was given potassium iodide drops. Within a month, the swelling subsided and never returned. This was not PE.

When I first began my AF journey, I was often unable to see the patients in my schedule. That caused a great deal of stress for me and I made the decision to retire early (unhappy and more stress). The first thing I did was consult about a very sore, splotchy tongue along with an open lesion on the underside. Both dentists in my office said to see an oral surgeon. I saw several oral surgeons and had biopsies; I consulted with a periodontist, and then I learned of a dermatologist who had an interest in diseases of the oral mucosa. Based on the biopsy, I had Oral Lichen Planus—cyclical and caused by stress. I was given systemic and topical drugs; nothing worked. The appearance and severity waxed and waned for several years. Since my holistic MD had moved, all I had was my Primary Care who was no help… until I began with my current Functional Medicine MD. She tested. I was found to be very low in all of the critical B vitamins… I took supplements, IM injections and in a few months, the lesions had resolved; the redness and pain…all gone… that was over 10 years ago. Not returned. The B vitamin regimen was the answer; Results not PE.

There are more ‘war’ stories but you get the idea. Nutritional deficiencies do occur and supplements are the answer.

Based on all the success stories in CR #61, it is difficult to ignore the potential to cure afib nutritionally…and we are learning more every day about how to do this. See the current conference room now in session. Erling’s Theory for the potassium/sodium ratio in atrial fibrillation is brilliant and a must-read as it drives home the point about the key nutrients we need to maintain voltage and, therefore, NSR.

Jackie

Debbie

Not all doctors are so narrow minded. My EP in London never says that supplements don't work, and never tells me that I shouldn't bother taking them. He records in my notes what I am taking and the effects I say they have.

His comment is always that since there are no clinical trials then there is no evidence about whether they work or not.

Gill

my medical doctor practiced for years in mainstream medicine - then he was confronted with his daughter having an illness which mainstream medicine could not resolve, and he turned to alternative medicines where he found the answer for his daughter. Then he began to study in earnest various alternative approaches. Whle studying, his father-in-law was diagnosed with stage four bladder cancer and the doctors had no further treatments to offer. My doctor advised his father-in-law to take a cancer supplement (Poly MVA) which he had learned about, and the result is that many years later his father-in-law is still alive and well. So my doctor decided to change his practice - he straddles the line between mainstream and alternative as appropriate, and folks come from around the country to see him. Like any other kind of medical treatment, alternative approaches such as supplements must be handled wisely - there are a lot of quacks out there as well as people whose main goal is to make money. Not every alternative practitioner is wise and experienced. You have to be smart about it. It is also true that not all people who are the recipients of alternative medical treatments such as supplements practice healthy lifestyle habits or take supplements appropriately, in which case there is probably little that will help them.

Jackie and Hans and the other fine folks on this website have most definitely helped me with their recommendations about supplements, and I know they have helped many others with the information they provide. I feel very fortunate to have found them.

Food supplements for thought:

Safety of Dietary Supplements: [www.laleva.cc]

Statistical comparison of frequent causes of death (USA): [www.laleva.cc]

In all fairness, we can't paint all doctors with the same brush.

When I was initially diagnosed, I was low in (serum) magnesium, and the docs in the ER gave me an IV solution of mag. The cardio I was referred to immediately, prescribed magnesium (yes, rx'ed mag; it was in the Navy formulary). Last summer, when I was found to be low in vit.D, he advised me to take at least 1000mg/day (it wasn't in the Navy formulary). Not all docs are complete ignoramuses. However, he still seems to be confused about the terms "vagal" and "adrenergic". Fortunately, I'm pretty sure I know the difference. ;-)

lisa,

p.s. I love how they call Malpractice: "Preventable Medical Misadventure"



lisa
__________________________

So much of medicine is looking solely down the wrong end of the gun barrel, and that is really a pity for all of us---Shannon

Debbie,

placebo effect from a recent BBC report...

A patient's belief that a drug will not work can become a self fulfilling prophecy, according to researchers.
They showed the benefits of painkillers could be boosted or completely wiped out by manipulating expectations.
The study, published in Science Translational Medicine, also identifies the regions of the brain which are affected.
Experts said this could have important consequences for patient care and for testing new drugs.
Heat was applied to the legs of 22 patients, who were asked to report the level of pain on a scale of one to 100. They were also attached to an intravenous drip so drugs could be administered secretly.
The initial average pain rating was 66. Patients were then given a potent painkiller, remifentanil, without their knowledge and the pain score went down to 55.
They were then told they were being given a painkiller and the score went down to 39.
Then, without changing the dose, the patients were then told the painkiller had been withdrawn and to expect pain, and the score went up to 64.
So even though the patients were being given remifentanil, they were reporting the same level of pain as when they were getting no drugs at all.
Professor Irene Tracey, from Oxford University, told the BBC: "It's phenomenal, it's really cool. It's one of the best analgesics we have and the brain's influence can either vastly increase its effect, or completely remove it."
The study was conducted on healthy people who were subjected to pain for a short period of time. She said people with chronic conditions who had unsuccessfully tried many drugs for many years would have built up a much greater negative experience, which could impact on their future healthcare.
Professor Tracey said: "Doctors need more time for consultation and to investigate the cognitive side of illness, the focus is on physiology not the mind, which can be a real roadblock to treatment."
Brain scans during the experiment also showed which regions of the brain were affected.
The expectation of positive treatment was associated with activity in the cingulo-frontal and subcortical brain areas while the negative expectation led to increased activity in the hippocampus and the medial frontal cortex.
Researchers also say the study raises concerns about clinical trials used to determine the effectiveness of drugs.
George Lewith, professor of health research at the University of Southampton, said: "It's another piece of evidence that we get what we expect in life.
"It completely blows cold randomised clinical trials, which don't take into account expectation."

Barry G.

Just as a matter of interest I have only ever had one comment on my list of supplements being taken and supplements being proposed to take that I supply each and every one of my MD's at every visit and request that they look at.

The only response that I have EVER received is to hold off on the vitamin K as it will play around with my INR from the Warfarin.

Asides from that all of the MD's and specialists seem quite okay with my supplements. My cardio is a proponent of supplements and has actually given talks on the subject.

I have no idea if they are working or not but have only been taking them since December. I can say for sure that I think the Vitamin C is doing something. Everyone on the house has had colds, flu, coughs, etc. EXCEPT for me. Vitamin C megadoses? Dunno.

Erling,

I agree that supplements are generally safe when used appropriately and I personally find them helpful for my afib.
However, I think that, if nothing else, common sense would dicatate they could be dangerous if used in extreme doses or in contraindicated medical conditions.

The fact that no one is funding large studies studies to prove efficacy is somewhat of a double edged sword because then we don't see the safety data either. It is naive to assume that any substance that can have a profound measurable effect on your body could be OK at any and all doses. Take magnesium for example, as many of us are aware it will cause loose stool and dehydration if taken orally in amounts more than the GI tract can absorb. Right there I can see potential morbidity or even mortality and would this get reported as "supplement related"? Possibly not.

The pharmacy I work at is currently involved in a study with several universites across Canada looking into supplement related adverse effects and supplement / medication interactions. Even from my position as just one reporting location, it is interesting to see how many people have discontinued or changed dosage on various supplement treatments due to side effects (or perceived side effects).

Don't get me wrong I'm 100% pro-supplement but I don't trust data like the link you provided since these types of issues tend to be under reported. I think often we are on our own with regards to both safety and efficacy and we need to be cautious about everything we put into our bodies, always asking the right questions first.

This is why I find this board such a valuable resource.

My 2 cents anyway, for what it's worth.

Monty

Once more, a repetition for emphasis.

"I think often we are on our own with regards to both safety and efficacy and we need to be cautious about everything we put into our bodies, always asking the right questions first.

This is why I find this board such a valuable resource."

Thank you for stating all this so well, Monty.
PeggyM

Montos,

Well said and thanks. The reason for the links and graphs was to encourage thinking about risks in general. All in all, it's obviously much, much safer to be stupid and trusting about supplements than to swallow blindly the potions and pills from a doctor.

Erling