To you health!

David

In my book The End of Illness, I make a strong case against them. And for good reason: all of the data thus far has pointed to the potential hazards of taking a daily multivitamin and loading up on supplements, especially those that deliver mega-doses. So you can imagine the response I got today when I learned of this new study published in none other than the Journal of the American Medical Association that seemingly contradicted not only my perspective but the results of countless other respectful studies performed under the rigors of the scientific method (double-blind, placebo-controlled studies).

The gist of this latest study is this, as summarized by CNN: Scientists at Brigham and Women’s Hospital and Harvard Medical School recruited nearly 14,641 male physicians, 50 years or older, and followed them for more than a decade. Half took the daily multivitamin Centrum Silver; the others took a placebo.

Men in the vitamin group had a modest 8 percent reduction in cancer cases compared to the others.

I can hear the resounding Wow! BUT… please read on.

For the lay reader of the summary splashed all over the Internet today like a momentous discovery for medicine, it’s easy to take this study at face value as a logical reason to start taking a multivitamin. Before you pull out your wallet, let me point out a few things that I notice in studies like this, and which has everything to do with a critical reminder I love to give: scrutinize data before accepting it as dogma. In other words, read between the lines:

• For starters, the study showed only a moderately reduced risk of cancer (8 percent relative risk reduction, or about 1 percent absolute risk reduction) in men at least 50 years old. A small statistical reduction, indeed, and it cannot say anything about any other groups of people, including women.

•  The people who showed signs of this reduced risk in total cancer had a history of cancer. Perhaps if you are cancer-free, there’s no reason to take vitamins; if you have a history of cancer and you’re a man over 50, perhaps it’s a conversation to have with your oncologist.

•  The study showed no significant difference in cancer mortality (i.e., the risk of dying from cancer), but when you consider other studies in this realm, the trend is in the direction of increased mortality with vitamins. Put another way, your risk of dying is greater if you take vitamins. (For a comprehensive review of the evidence suggesting potential harm from vitamin use, see chapter 7 of my book.)

• The participants in the study were willing to forgo the use of multivitamins or individual supplements containing more than 100 percent of the RDA for vitamin E, C, beta carotene, or vitamin A. So their intake of supplements was (partially) controlled. What’s more, those taking the vitamins were given a normal dose of Centrum Silver. This study cannot say anything about mega-doses, which reflect a lot of people’s habit today when it comes to vitamins.

• A large majority of the participants in the study had been part of an earlier study looking at the link between taking a daily baby aspirin and cardiovascular disease. We know now that aspirin is a strong anti-inflammatory with anti-cancer effects. How could the researchers have factored out such effects from the aspirin in reducing the risk for cancer?

Bottom line: We need more studies performed. I’m all for changing my position when there’s enough data to make the case. We must put this study in a meta-analysis context with previous studies and ask ourselves, What does the big picture look like? One study doesn’t resolve the big picture. It’s unfair and misleading for the media to report on this study with a blanket headline like “Multivitamin Cuts Cancer Risk, Large Study Finds” (the Wall Street Journal’s version). Such grossly generalized statements prey upon the lay public’s inexperience with digesting scientific data, purported results, and implications and applications to each person’s own individual life.

When you read a headline like this, it’s natural to gravitate toward an overly-simplistic conclusion: vitamins prevent cancer—in everyone. Period. But if I came to you and said I just did a study demonstrating that low-dose multivitamins reduce one case of cancer in 100 people—and only in men over 50 who previously had cancer—how would that change your opinion?

Of all the health ideas I’ve given over this past year, the anti-vitamin one seems to ruffle the most feathers, especially among opponents of my view. I still don’t know why some see me as “controversial” when I back my claims with sound science. I should add that when other doctors were interviewed about this particular study (doctors who, like me, were not a part of the study), they shared similar reactions reported in the media:

“It will be difficult to make generalizations to the broad public from this one study…” said Dr. Ernest Hawk, vice president and division head for the Division of Cancer Prevention & Population Sciences at MD Anderson Center in Houston, Texas. He then went on to say that reducing cancer risk may not necessarily be garnered from a pill but rather by living healthy: eating right, getting plenty of exercise and not smoking.

Amen to that!

In 2010, non-communicable diseases (NCDs) overtook infectious disease as the leading killer worldwide. These include illnesses like diabetes, heart disease, stroke, the ravages of malnutrition, and cancer. A recent study by the World Economic Forum and Harvard University has estimated that NCDs will cost the world economy approximately $47 trillion over the next 20 years, representing 75 percent of global GDP and surpassing the cost of the global financial crisis. These numbers are so overwhelming that they can even stun a cancer doctor like me who is used to breathtaking statistics and gloomy reports.

On a positive note, the World Health Organization has estimated that a basic package of cost effective strategies to prevent and treat NCDs would cost $11.4 billion a year in developing countries. Not too terrible in comparison to those other numbers, but here’s the real hitch: the food shortage is getting worse—not better. Food security is a critical issue in the expanding world population, one that threatens to further affect the world economy unless addressed.

Last month, Shimon Peres, president of Israel, spoke at the World Economic Forum about how the invention of the mirror changed society. For the first time people cared what their appearance looked like, and social interactions naturally shifted. Peres’s presentation was fascinating, for I’d never thought about what it must have been like to suddenly “see” yourself from this totally new perspective—the same one that the world also saw.

Today, we take mirrors for granted. But there’s a new kind of mirror under development that I hope we all get to benefit from, and which reflects a giant leap from the traditional mirrors created thousands of years ago. This next generation of mirrors is the one that will allow each of us to look inside ourselves thanks to genetics—and it will redefine not only what it means to “see” yourself, but also how we solve the world’s hunger and illnesses.

Thanks to high-tech innovation over the past couple of decades, genetics has moved from being primitive and expensive to being a sophisticated, accessible, and cost effective tool that will no doubt help usher in a new era of health. We cannot shy away from technology in the war on NCDs and the rising issue of food security; we must embrace it. The world must also begin to adopt certain standards and safeguards for the new technologies. Collaboration is required among service providers, regulators, policy-makers, and the public to enable this to happen.

My hope is that genetics and other new technologies will allow us to reach a point where we can make meaningful advances in the “war” against all illnesses, and ensure sustainable food security. It will ultimately allow us to look at ourselves in the mirror and be proud that we’ve change the course of history—again—and paved a more vibrant path for future generations.

This coming Sunday, more than 100 million people are going to tune into the Super Bowl as the New York Giants take on the New England Patriots in Indianapolis. They will be watching more than just an American tradition at play—they will be witnessing one of the deadliest sports in history whose record of premature deaths demonstrates in sobering reality the silent killer in all of us: inflammation. Consider the following:

• Heavy (overweight) NFL players are twice as likely to die before the age of fifty.
• Twenty-eight percent of all pro football players born in the last century who qualified as obese died before their fiftieth birthday, compared with 13 percent who were less overweight.
• One of every sixty-nine players born since 1955 is now dead. Twenty-two percent of those players died of heart diseases; 19 percent died from homicides or suicides.
• The average weight in the NFL has grown by 10 percent since 1985 to a current average of 248 pounds. The heaviest position, offensive tackle, went from 281 pounds two decades ago to 318 pounds.
• In 2011, scientists at Loyola University Chicago’s Stritch School of Medicine found that 35 percent of 513 retired NFL players scored poorly enough on a test for Alzheimer’s symptoms to indicate dementia.

I’ve never been a football player, and I’ve never seriously participated in a contact sport. But I know that lots of others do, if just in an amateur setting. There are lots of lessons to be learned here whether you’re an athlete and sports fan or not. Last week, Dr. Sanjay Gupta’s hour-long special “Big Hits, Broken Dreams” revealed the sad consequences to many concussions suffered by NFL players. This side of the football story is just getting started.

Without a doubt, we can point fingers at excess weight and, as a result, premature heart disease as a potent killer among football players. Body size is well documented to be inversely related to longevity. Although it would seem logical to say that a football player’s high level of exercise could protect him from cardiovascular risks associated with large size, this just doesn’t prove to be the case.

The pros of physical activity cannot cancel or supersede the cons of excess weight. Several studies have confirmed this, for large athletes are not in peak physical condition—their time spent exercising heavily does not outweigh the negative health effects of their large size. This research has shot down the concept that you can be both fat and fit. Excess weight is thought to be so damaging because of the hidden march of inflammation behind the scenes.

Whether we’re considering the detrimental effects of excessive body weight or routine hits from other players, the common denominator here is inflammation—a normal part of our bodies’ natural defense mechanism against invaders and injury, but too much inflammation can be harmful.

When inflammation runs rampant or goes awry, it can disrupt the immune system and lead to chronic problems and/or disease. In all of the symptoms that football players exhibit as a consequence of their profession, the one that surely keeps on going is inflammation, which for many of them sets in motion a sequence of biological events that can lead to a heart attack. Long after a football player has hung up his helmet, his body is trying to heal itself, and that pathway back to health likely entails some inflammation. Last year, NFL Hall of Famer Lee Roy Selmon died two days after being hospitalized for a stroke. He was fifty-six.

Though Selmon was far from the image of an obese man who looked dangerously close to having a sudden cardiac event, the inflammation he’d endured years ago on the field had other consequences for him. Would he have died had he not been a football player? We’ll never know, but the facts of his profession’s history share a similar, grim theme.

In addition to the increased risk for heart attack and stroke among those who suffer chronic inflammation, people can also up their risk for all of our most troubling degenerative diseases today, including Alzheimer’s disease, cancer, autoimmune diseases, diabetes, and accelerated aging. Once you understand that blocking unnecessary inflammation as much as you can is key, the next question becomes how—how do you know where and why it’s happening and attempt to control it?

Most of us are not football players, and we’re probably not living like nuns, who live longer than those in any other job, lasting an average of eighty-six years. We’re hard at work in other settings and wearing different uniforms. But inflammation comes into our lives in a way pretty regularly that typically has nothing to do with our jobs.

It strikes when we subject our bodies to irregular routines, eat off schedule, and don’t get enough sleep. It also strikes when we get sick.

Battling a cold or flu entails a bout with inflammation as our bodies fight to rid us of the infection and return to “normal.” I’m a big believer in flu vaccines. If not to prevent the flu, then to at least prevent marked increases of inflammation that can come back to haunt us later in life when we grow ever more vulnerable to diseases rooted in inflammation.

In addition to keeping a regular schedule on a daily basis, I’m also a big proponent of simply wearing good shoes. If the goal is to reduce your overall inflammation and take the load off your joints and lower back to further reduce this inflammation, then I know of no better, easier way to do this than to simply wear a good pair of shoes daily. I love my Nikes and Pumas, and for dress shoes I find inserts that make the cushion all the more supportive and comfortable. This isn’t the most difficult lifestyle change to make, and a good pair of shoes will go a long way to protect you.

And if you need one more reason to wear comfy athletic shoes every day, then consider how much easier it will be for you to make exercise a part of your daily life, which is another excellent way to reduce your levels of inflammation. Just be sure to stay off the football field. Leave that to the pros. And enjoy this Sunday’s game from a comfortable place like I will. Perhaps having a different perspective on the game now will inspire you to invent a better way to protect these gladiators with inflammation-proof suits…so they may be back to play in many more Super Bowls.

So I’ve got an idea. I’m going to make a suggestion that’s pretty simple, doable, and small. Yes, even you can take this itty-bitty step. It’s something that will make your life much better and can actually help you to achieve the bigger, more ambitious goals but which won’t cause a lot of heartache, effort, and self-sacrifice. What exactly am I referring to? The relatively painless act of keeping a regular schedule. That’s right: just try to maintain a predictable schedule on a daily basis. This entails the following:

• Going to bed and waking up at the same time every day, weekends included.
• Eating at roughly the same times throughout the day, snacks included.
• Taking any prescribed medications at the same time every day.
• Exercising (if you do) at roughly the same time every day.

How can this be so unbelievably powerful? The body loves predictability. One of the best ways of reducing stress on the body and keeping its preferred, balanced state of being—homeostasis—is to maintain a consistent routine every single day, especially with regard to the body’s natural rhythms as dictated by sleep-wake cycles, eating patterns, medication use, and physical activity. You’ll feel the difference in more energy, an enhanced sense of wellbeing, and my bet is you’ll effortlessly find the motivation to attack all those other goals on your list. As a doctor, of course I’d love for you to change your habits for the better and reduce your risks for illness. We all know the benefits of exercise and the bane of smoking. We all know that eating fast food won’t fix the fat around our waistlines. But I’m also a realist, which is why I suggest you work your way to a new you just by making a single initial goal of keeping a regular schedule. Simple as that. Watch—and feel—what happens.

Tell me how it goes. . .