Heliophobe Madness

My last blog post reviewed a book by Dr. Michael Holick, one of the world’s experts on vitamin D, who recommends sensible sun exposure to experience the benefits of adequate vitamin D.  In that post I touched on the idiotic extremes the dermatology mainstream have adopted to discourage people from spending time in the sun.

It’s worse than I thought.

Not long after posting, I came across a McClatchy column in our local paper pushing the perspective of most dermatologists, a perspective that’s so unbelievable that it almost reaches comedic proportions. (Our local paper requires paid registration, so I’ve linked here to a paper that doesn’t.) The piece serves to show in spades the way dermatologists think (if that’s what you call it), and lets us know why their advice should be taken with a huge grain of salt.

The piece was written by a health writer, but her go-to experts were a couple of academic dermatologists:

We’ve got the skin-care basics from two experts in the field: doctors Nancy Thomas, associate professor at the University of North Carolina’s Department of Dermatology Lineberger Comprehensive Cancer Center, and Kelly Nelson, assistant professor at Duke University Medical Center’s Department of Dermatology.

As I started reading this article I was preparing myself for all the normal admonitions to slather with sunscreen, wear a big hat, avoid sun bathing, etc., but even I – who am used to reading idiocy in the press about things medical – was stunned at the levels of caution recommended by these brain-dead dermatologists.

Both of these doctors agree that everyone needs sun protection, and needs it apparently all the time. If you listened to them, you almost wouldn’t walk by an open window without using sunscreen first.

Even if you’re inside much of the day, you’re exposed walking to your car, into the grocery store or into work.

So, if you go to the mall, don’t forget your sunscreen for that long walk from the  car to the door.  And don’t forget to reapply before you walk back to the car if you happen to stay in there for a couple of hours.

But what about vitamin D?  A lowly SPF 8 reduces vitamin D synthesis by 90 percent, so your sunscreen-slathered walk from the car to the store gains you no vitamin D. Where should you get it?  Well, if you ask the question, the good doctors start finger wagging.

And don’t make the vitamin D argument, which says sun exposure is necessary to absorb the highly important vitamin. Just take a vitamin supplement

Okay.  But Dr. Holick writes

when you are exposed to sunlight, you make not only vitamin D but also at least five and up to ten additional photoproducts that you would never get from dietary sources.

What about these additional photoproducts?  I’m sure nature didn’t endow us with the ability to make them for no reason.  And you can’t get them from supplements, so where do you get them if you don’t get some sun exposure?  The answer is, you don’t.

Plus, vitamin D supplements are just that: supplements.  They supplement the vitamin D you make yourself – they don’t replace it.

If, God forbid, you actually do go out in the sun, the good doctors recommend a sunscreen with a SPF 30 if not higher.  And don’t just smear a little on, they recommend at least two ounces of the stuff (about a shot glass full).  Plus they want you to put it on at least 20 minutes before going outside and re-slather yourself with another shot glass of the stuff every two hours.

Just this week, New York Times health columnist Jane Brody jumps into the rolling river of mainstream dermatologic nonsense and is swept along to her own idiotic conclusions.  Her greatest fear is sun-exposure-driven skin cancer, not just premature aging and skin spots, although she does comment on those.  Using anecdotal information she would decry in others, she brings her own relatives in as examples.

My paternal grandmother, who lived a block from the beach in Brooklyn and swam daily in the years before sunscreens, had what we called “elephant skin” by her 50s.  But my 90-year-old Aunt Gert, who lives nearby and winters in Florida but never went to the beach or sat in the sun, has the skin of a 60-year old.

Well, I guess that settles that.  And I’ve got a great uncle, still going strong at age 87, who drank like a fish and smoked two packs a day for most of his adult like.  According to Jane’s logic, maybe we should adopt Unc’s lifestyle.

The real meat of Jane’s piece is that since the sun makes us feel better and look better (the vast majority of people surveyed say a tan is more aesthetically pleasing than fish-belly white), people are becoming addicted to the sun.  And, as with any addiction, sun addiction is tough to break.

Jane worries that sun addiction leads first to overexposure then to skin cancer.  She quotes the oft-cited statistic that this year will see

3.5 million new cases of superficial but often disfiguring skin cancers, and an estimated 68,720 melanomas

I think she’s overstating the case for these superficial skin cancers being “disfiguring.”  Most are basal cell or squamous cell skin cancers, which are virtually non-malignant and can be removed without leaving much – if any – evidence of their ever having been there. Both MD and I have had basal cell cancers removed from our foreheads in minor office procedures without any evidence they were ever there.

The 68,720 melanomas, which are malignant, are much more attention getting.  But, there is no evidence that excess sun exposure causes melanoma, while there is data showing that chronic sun exposure and vitamin D seem to prevent it.

Just for grins, let’s go along with Jane and assume that melanoma is caused by the sun.  If we go to the latest cancer statistics from the American Cancer Society (ACS), we find that 8,700 people died last year from melanoma.  We know that sun exposure and vitamin D (along with maybe the other 5-10 photoproducts we synthesize from sun exposure) help prevent breast, colon and prostate cancer.  If Jane is correct and we avoid the sun, we run less risk of being one of the 8,700 people who perish from melanoma. But what about the other side of the coin?

According to the same ACS statistics, last year 40,230 people died from breast cancer, 32,050 from prostate cancer and 51,370 from colon cancer. So, on the one hand, we have 8,700 people die of a disease that probably isn’t related to sun exposure while on the other we have 123,650 who died from cancers known to be related to lack of sun exposure.  I don’t know about you, but I’ll go with the sun exposure, “disfiguring” superficial skin cancers be damned.

Plus, we didn’t even mention the devastating disease multiple sclerosis, a disease much more common in those with little sun exposure.  There are between 250,000-350,000 new cases of MS diagnosed each year. I’ll be happy to accept the risk of a few minor cancers to significantly reduce my risk of developing MS.

The danger of too much sun is minimal – the danger of too little sun is enormous.  I know which side I come down on.  The health trade offs remind me of a corny joke I heard when I was a kid that made such an impact on me that I’ve remembered it since.  The joke (or parable) was about economic issues, but it applies to sun exposure as well.

Did you hear the one about the guy who took big steps to save his twenty dollar shoes and ripped his 50 dollar pants?

It’s just another way of saying don’t be penny-wise and pound foolish.  In terms of our current discussion, we could say, Don’t be skin-cancer-wise and colon-breast-prostate-foolish.  Which is exactly what the misguided perspective of most dermatologists would have us be.

Painting: Olive Trees with Yellow Sky and Sun by Van Gogh

Sunshine Superman

“If I had to give you a single secret ingredient that could apply to the prevention — and treatment, in many cases — of heart disease, common cancers, stroke, infectious diseases from influenza to tuberculosis, type 1 and 2 diabetes, dementia, depression, insomnia, muscle weakness, joint pain, fibromyalgia, osteoarthritis, rheumatoid arthritis, osteoporosis, psoriasis, multiple sclerosis, and hypertension, it would be this: vitamin D.”

During the whirlwind that has been my life of late, I managed to make my way through Dr. Michael Holick’s terrific book The Vitamin D Solution from which the above quote comes.  Before I get started on my review, in the interest of full disclosure, I’ve got to tell you that of all the books I’ve reviewed on this blog since its inception, this is the first and only one that I’ve been sent gratis by the publisher.  It was strange how it came about.  I learned of this book long before it was published and had pre-ordered it through Amazon.  A few weeks or so after my pre-order, I received an email from the publisher’s PR agent for this book asking if I would like a pre-publication copy for possible review.  I sure would, said I, and promptly canceled my Amazon order.

I’ve been a fan of Dr. Holick’s for years now, reading every paper he publishes, which is a considerable job given his prolific output.  I’ve corresponded with him a time or two on a few issues and he has always been very generous with his advice.  I consider him THE authority on vitamin D.  So, I was eager to dig into his book.

I wasn’t disappointed.

I figured that somewhere along the way, Dr. Holick had gotten intrigued with vitamin D, had pursued his interest and had become sort of a guru.  But in reading his book, I learned that he is much more than that.  He began studying vitamin D as a graduate student and ended up being the person who actually discovered 1,25 (OH)D, the major circulating form of vitamin D in humans.  This was back in the early 1970s, and he’s been studying vitamin D without letup since.  His book is the most up-to-date source of all the science available about this amazing nutrient.

Dr. Holick sums up the importance of vitamin D to human well being in this single sentence from early in the book:

The sun is as vital to your health and well-being as food, shelter, water and oxygen.

Which seems reasonable since every morsel of energy we consume originates with the sun.  No sun, no plants.  No plants, no animals.  No plants and animals, no us.  As Sir Karl Popper noted, we eat the sun. We evolved in the sunlight, so it makes sense that the sun offers other benefits as well food.

Dr. Holick begins his book with a fascinating comparison of a ten-year-old girl growing up somewhere along the equator to a ten-year-old girl growing up in the United States or Europe.  The former will probably never learn how to use a computer, never go to a mall, never learn to drive a car and will probably end up spending most of her life outside tilling the soil as did her parents and grandparents.  She will probably experience periods in her life of poverty and poor nutrition.  By contrast, her US or European counterpart will always have plenty to eat, will learn to shop, order pizza, operate a computer, Game Boy, Wii, and God only knows what other kinds of electronics.  She will have her doting parents slather sunscreen on her to protect her skin from birth until she’s old enough to do it herself.  She will come of age in a different world, filled with the latest in medical technology.

And she will pay for it with her health.

Her equatorial counterpart will be only half as likely to get cancer in her lifetime.  She will have an 80 percent reduction in risk of developing type I diabetes before the age of 30.  And she will live longer.  If she can avoid trauma or an untreated severe medical condition, the girl growing up in the more primitive but sunny circumstances will have an overall 7 percent greater longevity than her US/European counterpart.  She will have stronger bones, lower blood pressure, fewer cavities in her teeth, a greatly reduced risk for heart disease, type II diabetes, obesity, arthritis and most of the other diseases that will plague her more Westernized sisters.

Why the difference?  According to Dr. Holick, the equatorial girl has vastly more exposure to natural sunlight over her lifetime than does the other.

But, you might ask, why don’t the children in the US and Europe play outside more in the sunshine and reap its many benefits?  A couple of reasons.  Most of the US and Europe are too far north to get enough sun exposure to generate the production of adequate vitamin D during a large part of the year.  And, second, most parents are so fearful of sunburn that they slather their kids with sunscreen if and when they let these children play outside during the part of the year they can make adequate vitamin D.  Since a sunscreen with an SPF of only 8 reduces the synthesis of vitamin D by 95 percent, think of how little vitamin D children with sunscreens of SPF 30 or 45 are making.  Zero.

Why?

Heliophobes.

Readers of this blog know that I refer to people who have an unreasoning fear of fat as lipophobes, fat fearers.  Well, since Helios was the Greek god of the sun, I’ll call those who have an unreasoning fear of the sun heliophobes.

Why do people become heliophobes?  Same reason they become lipophobes: they refuse to think.

Just as lipophobes see a heart attack in every morsel of fat, heliophobes see skin cancer in every ray of sunshine.

To give them their due, the heliophobes have at least a smidgen of data to bolster their point of view.  Unlike the lipophobes, who have no reliable data demonstrating that saturated fat causes heart disease, the heliophobes can point convincingly at the data showing sun exposure causes problems for the skin.

Unquestionably, excess sun exposure causes premature aging of the skin and a couple of types of skin cancer.  Of this there is no doubt.  But, lack of adequate vitamin D appears to be related to an entire host of serious problems including melanoma, the most dangerous and deadly form of skin cancer.  The most common type of skin cancer from overexposure is basal cell carcinoma, which is just about the least malignant of all cancers, and if treated (by removal) results in virtually no mortality.  The same can’t be said for prostate, breast and colon cancers, all cancers thought to be sun (or, more correctly, lack of sun) related.  These cancers are much more prevalent the farther north one goes and almost non-existent at the equator.

The trade off, in my opinion, is well worth it.  Especially when it’s possible to have the best of both worlds and avoid both the premature aging, minor skin cancers AND the breast, prostate and colon cancers (not to mention multiple sclerosis, osteoporosis, and the host of other disorders laid at the doorstep of too little vitamin D) by sensible sun exposure.

Dr. Holick tells you how.  He provides charts and tables telling you how much sun exposure you require for adequate vitamin D synthesis depending upon where you live in the world.  And he describes how you can make up any difference by taking vitamin D supplements.

Why not just take the supplements and forget about the sun?

Vitamin D made in the skin lasts at least twice as long in the blood as vitamin D ingested from the diet.  When you are exposed to sunlight, you make not only vitamin D but also at least five and up to ten additional photoproducts that you would never get from dietary sources or from a supplement.

Old Mother Nature is pretty parsimonious with her creations, and I suspect she wouldn’t have five to ten photoproducts circulating around if they didn’t do something good for us.  Just because we aren’t advanced enough yet to figure out what it is they do, doesn’t mean they don’t do something.  Thus Dr. Holick’s recommendation to hit the sun if at all possible instead of the supplement bottle.

Plus, there are some downsides to indiscriminately throwing back the supplements without monitoring your 25 (OH)D levels.  See here and here, for example.

One of the few criticisms I have of this exceptional book is that Dr. Holick goes way overboard in his obvious worry about the opinion of the heliophobes.  Throughout, he repeatedly warns against overexposure as if getting a little too much sun from a day at the beach could lead to one’s body becoming wrinkled and having skin cancers the size of buboes popping out all over within a week.  But we can’t be too hard on the poor Doc because the water in which he swims professionally has a high SPF indeed.  His colleagues are primarily dermatologists and Dr. Holick works hard not to gain their total opprobrium.  As cardiologist wage their misguided war against fat, dermatologist wage theirs against the sun.  And just as many cardiologists haven’t figured out that fat can be a good thing, dermatologists apparently haven’t learned of the good sunshine can do.  Or if they have learned it, they’ve chosen to ignore it to their patients’ detriment.

The dermatologists are a pretty vocal group and are constantly issuing press releases about the dangers of sun exposure.  So sun phobic are dermatologists that in their minds, the perfect place to vacation would be inside a cave.  I’m not really exaggerating – they are heliophobes of the deepest dye.  And they don’t tolerate dissent.  Ask Dr. Holick.

In 2004 I was forced to give up my position as a professor of dermatology at Boston University Medical Center, a position I had held for nearly ten years.  My stalwart support of sensible sun exposure just didn’t jibe with the views of the chair of the department.

Since this time the scientific literature has exploded with articles about the benefits of vitamin D and the widespread epidemic of vitamin D deficiency.  (I just ran a PubMed search for vitamin D and found 48,552 citations.) I wonder if this silly woman who fired him and was so pompous and cocksure now feels any sense of remorse?  Especially since she still labors in obscurity while Dr. Holick is an academic rock star.

Another point I would take issue with is Dr. Holick’s statement in the book that there is no difference between vitamin D2 and vitamin D3.  He says he’s performed studies looking at these two versions of vitamin D and found both of them to maintain vitamin D levels in the appropriate range.   Since he’s done the studies and seen the data, I don’t have any reason to disagree with him on his findings.  But, there have been a number of anecdotal reports showing that people with problems due to vitamin D deficiency seem to have better symptomatic improvement if they take vitamin D3 (the real vitamin D) than if they take equivalent doses of vitamin D2.

Since these are anecdotal reports, we can’t put absolute faith in them, but I would still recommend vitamin D3 over vitamin D2.  In these situations where one supplement is supposed to perform better than another, usually the one that allegedly performs better, costs more.  So you end up in a risk reward situation: Do I want to pay more to get a better effect or do I want to pay less and hope for adequate results?  In the vit D3 versus vit D2, we don’t have this circumstance.  Both are dirt cheap, and, if anything, vitamin D3 is less expensive.  So if they both create the same blood levels, but one engenders more anecdotally positive reports, why not go with it.  My advice is to buy vitamin D3 and avoid the D2.

One more criticism I have of the book (might as well get ‘em out early) is Dr. Holick’s aligning with the mainstream in criticizing saturated fat.  I’m sure he hasn’t looked at the literature on saturated fat, because if he had, he wouldn’t have written what he did.  But I can’t really hold that totally against him since he is, after all, a mainstream guy (in all but his defense of sunshine), and, as such, would be expected to be marinated in the mainstream biases.

Unfortunately, for a century now, the American diet has been getting higher in fat–especially in the extra-unhealthy saturated fats.  This may partly explain why skin cancer rates have gone up, as well as diabetes and heart disease.  The average American diet is about 16 percent saturated fat, whereas most qualified dieticians [sic] will tell you it should be no more than one third of that.  To make matters worse, there has been a trend toward fad weight-loss programs advocating high fat content (the Atkins diet is probably the best known of these).

Leaving aside whether these diets actually work in the long term to help people keep weight off, diets high in saturated fat may cause a variety of life-threatening health problems and probably contribute to skin cancer, not to mention all other types of cancer.  But you don’t necessarily have to go on a traditional ‘diet’ to achieve the results you’re looking for.  You just need to start moving toward foods lower in saturated fat and try to limit or evict those foods that contain excessive amounts of fat–which is typically found in processed products (which also usually contain lots of salt and sugar) and marbled meats.  There are several excellent eating plans out there that advocate eating this way.

It’s beyond the scope of this book to offer specifics on the perfect diet, but I’ll say that a healthy eating regimen calls for plenty of fresh fruits and vegetables, high-quality proteins (“high-quality” meaning they are low in saturated fat but can be high in healthy monounsaturated fats, as is the case with wild salmon), and whole grains.

Jesus wept.

Fortunately, aside from a few small mentions here and there, this is about the extent of his saturated fat bashing.

For a while now, I have been worried about the long-term effects that will come about from the heliophobes and their constant sunshine bashing. (In fact, MD and I wrote a whole chapter about it in The Protein Power LifePlan back in 2000.)  But after reading The Vitamin D Solution, I’m greatly concerned.  Conscientious parents have no idea of the future damage they may be causing by never letting their children play outside without slathering them with sunscreen.  Today’s children have weaker bones are are much more prone to fracture than children of a few decades ago.  As Dr. Holick reports

Even more alarming is a new epidemic in which bone formation in children appears normal but is actually much softer than is should be.  Girls today break their arms 56 percent more often than did their peers forty years ago.  Boys break their arms 32 percent more often.

I’m sure the girls and boys of forty years ago were much more rough and tumble than the ones of today, yet the kids of today suffer more fractures.

While writing this post I got an email notifying me of a recent study showing that melanoma, a virulently malignant form of skin cancer is occurring with frighteningly high frequency in today’s teens.  These are the adolescents at the leading edge of the great heoliophobe movement, the very ones whose parents, in an effort to protect them, coated these kids liberally with sunscreen every time they walked out of doors.  Did their well-meaning parents set them up for this terrible disease?  Are the chickens coming home to roost?  It’s difficult to say for sure, but, in my opinion, it’s more than likely.  Here’s what happened.

When I was a kid, I played outside all the time.  So did all my friends.  We were outside, especially during the summer, from the time we got up until it was dark.  Since we played outside most all the time, as summer approached and the suns rays became more direct, we had already developed the base of tan from being outside all during the spring when it was difficult to get sunburned.  Our tans protected us from the effects of the sun, blocking both UVA and UVB light.

UVB rays are those that burn the skin and the ones that drive the synthesis of vitamin D.  UVA rays are those that mobilize the melanin (the pigment in the skin) and bring it to the surface.  When enough melanin comes to the surface, our skin gets darker, i.e., we develop a tan.  The tan then protects us from the harmful effects of the sun, allowing us to stay out all day without getting a sunburn and without getting too much UVA, which is important since excess UVA exposure is thought to be the cause of melanoma.

Although many sunscreens available today claim to block both UVB and UVA, when today’s teens were young children, virtually all of the sunscreens on the market then blocked UVB only.  Which is probably the root cause of the increase in melanoma in adolescents today.  Here’s what happens.

People who don’t use sunscreens and who have good sense get out of the sun when they begin to burn.  Avoiding the sun limits the exposure to both UVB, the burning rays, and UVA, the melanoma-stimulating rays.  When people slather on sunscreen that blocks UVB only, they can then stay out in the sun for a long time without burning.  The price they pay for this is that they end up with an extremely large dose of UVA, which doesn’t cause pain but sows the seeds for later melanoma development, a fate that has in the past befallen many a vacationer to the sunny areas of the world.

Many people labor away in offices for 50 weeks of the year then escape for a couple of weeks of fun in the sun.  Since they have limited time, they don’t want to spend it with graduated sun exposure while they develop a tan.  They pile on the sunscreen in copious amounts, hit the beach and stay out all day, stopping only long enough to put on more sunscreen.  During this process, they accumulate the effects of huge exposure to UVA and often pay the price years later by developing melanoma.  Those hardy folk who work outdoors all year long and have constant sun exposure almost never develop melanoma.  Why?  Because they develop a tan that blocks the UVA.  Plus, thanks to their constant sun exposure, they receive the benefit of plenty of vitamin D synthesis, which has been shown to be protective against melanoma.  The poor schmucks on vacation who broil in the sun while basting themselves with sunscreen get way too much UVA and don’t get any vitamin D because sunscreen blocks virtually all of the vitamin D synthesizing rays.  They are the victims of a true double whammy.

And that is what I suspect is driving the increase in melanoma in teens today: their poor misguided parents attempting to do the right thing.  Very sad, indeed.

Along with the increase in melanoma, the huge epidemic of fibromyalgia we are seeing today is in great measure a consequence of vitamin D deficiency.  Without enough vitamin D, bone doesn’t harden as it should.  It grows, but is softer and mushier and less supportive than it should be.  The body continues to make more bone to try to remedy the problem and the bones actually enlarge.  This enlargement presses against the periosteum, the fibrous sheath that surrounds the bone and through which the nerves run.  As the pulpy bony growth presses against the periosteum, it stimulates the nerves in the periosteum and causes the deep bone pain common to sufferers of fibromyalgia.  Doctors who are up to date on their vitamin D knowledge will press the breastbone to try to elicit pain.  And if they do, their patient is probably suffering from a vitamin D deficiency.  If that’s what the blood test shows, then the fibromyalgia can be treated with a course of sunshine and/or vitamin D supplementation.

A couple of weeks ago, I was reading The Vitamin D Solution on a plane, and the guy sitting across the aisle from me was reading Predictably Irrational, which I had read and enjoyed a while back.  I kept looking to see where he was in his book, and he kept glancing at mine.  After we had landed and were taxiing in, he asked me if I had ever known anyone who had responded medically to vitamin D.  He then told me that he had been experiencing severe, debilitating pains in the bones in his chest, back and legs.  He went to his doctor, who checked his vitamin D levels, found them way low, and started my new friend on a course of vitamin D supplements, which, in due course, had gotten rid of his problem.  He was a pretty tan guy, so I asked him about his sun exposure and wondered why he would be vitamin D deficient.  He then told me he was a kidney transplant patient, which explained everything.  As you will learn when you read Dr. Holick’s book, the kidney converts the inactive form of vitamin D circulating in the blood to the active form.  This gentleman’s transplanted kidney obviously wasn’t doing it for him.  Vitamin D supplements did the trick, however, and his pains had vanished.

The subject matter I’ve covered in this post barely scratches the surface of what’s there in Dr. Holick’s new book.  I heartily recommend it to all.

Before I sign off here, though, I want to relate a funny story.  Funny to me at least.  It involves a character who was a running dog of mine back when I was in medical school.  Any of you who read The Protein Power LifePlan already met this guy in another humorous adventure of his I related in the section on iron overload.  He’s the guy who dated the pig lady.

This guy was, in Billy Bob Thornton’s memorable words to Woody Harrelson in the movie Indecent Proposal, a “real poon hound.”  This guy would relentlessly go after anything with a skirt.  And, as often happens with those types, he came down with a bad case of herpes.  As soon as he got his diagnosis he went into a depression for about a week and then began reading everything he could read on herpes.  He discovered that herpes was typically a local infection but that in some patients (mainly immunocompromised ones) herpes could go systemic, which means it could spread through the bloodstream and and create a hellish infection everywhere, often with fatal consequences.  His affliction was never far from his mind, which led to the tale that follows.

In those days Zovirax hadn’t been developed, so the only remedies for this loathsome disorder were OTC products that didn’t really work.  At that time the main OTC med was Stoxil, which my friend purchased by the car-load lot and coated himself (or at least his infected parts) with at the least sign of an outbreak.

One day he came down with some kind of upper respiratory infection and called me to get something for it.  He was prone to these infections, which responded well to minocycline, a tetracycline-derivative drug.  I called him in a course of the drug and forgot about it.

Unbeknownst to me, my friend was planning a day at the lake with his latest inamorata.   Complexion-wise, he was lily white and usually avoided the sun.  A day at the lake was not his typical recreation, so I can be excused from not telling him not to go out in the sun; it would have never occurred to me that he might do so. The sun can be a problem because tetracycline drugs have a propensity to give people who take them a photosensitivity reaction when they get too much exposure.  These photosensitivity reactions cause the skin to swell and become discolored and blistered.

My friend took his meds as prescribed, had a great day at the lake, came home with the girl and hit the sack.  After he had been asleep for a few hours, he woke up needing to relieve himself.  On his walk to the toilet, he passed the bathroom mirror and glanced at the mirror wherein he saw the Elephant Man staring back at him.  His face red, blistered and swollen, eyes just slits.  He had obviously had a bad photosensitivity reaction (obviously that is to those who knew about such things) after his day in the sun while on minocycline.  But he didn’t know this.  He flew into a blind panic because the first thing that sprang to his mind was that his herpes was swarming on him: that he had developed systemic herpes.  He immediately grabbed the Stoxil and practically bathed in it.  Then he put in an emergency call to his dermatologist, whom, I’m sure, found it strange since dermatologists rarely — if ever — get emergency calls.

When he told me about it later in the day, I burst out laughing and have laughed about it any time I thought of it up to this moment.  In fact, I’m having trouble typing these words because I’m still laughing so hard remembering.  Who says doctors are humorless?  My friend even laughed about it later, though admittedly not to the same degree I did.  What I found so funny was not his condition but the fact that he was so obsessed with his herpes that the first thought that jumped to his mind was that his disfigurement was his herpes going wild.  Maybe you just had to be there.

Don’t let my semi-off-topic detour make you forget about picking up a copy of Dr. Holick’s book.  Despite my few minor criticisms, it is an excellent book that provides a wealth of useful information.  Just the Q&A is worth the price of the book because in that section Dr. Holick answers all the questions anyone might think of about vitamin D, including the one I’ve been asked numerous times: If you shower after sunbathing, does it wash away the vitamin D.  The answer is No.  Then he explains why.

There is something for everyone in this book, from studies showing sun bathing works as well (if not better) than medications for lowering blood pressure to discussions of vitamin D and its effects on obesity and leptin secretion.  It doesn’t matter if you’re depressed, have multiple sclerosis, psoriasis, osteoporosis or even PMS, you can learn how vitamin D will help you out. Grab a copy and start reading.

Since the last time I posted (which, admittedly, was a while ago), I’ve flown about 8 billion miles, so I’ve had plenty of time to read while in the air.  Here is a list of the books  on my nightstand right now.

Pandora’s Seed: The Unforeseen Cost of Civilization by Spencer Wells.  I’m about a forth of the way through this book describing the problems we hunting/gathering humans have had in adapting to agriculture.  So far, so good.  A couple of medical missteps already, but nothing major.  But I haven’t gotten to the real meat of the part on disease, so I’ll reserve my judgment until then.

The Upside of Irrationality: The Unexpected Benefits of Defying Logic at Work and at Home by Dan Ariely.  This is the follow up book to Predictably Irrational, which I posted about earlier.  While the first book explained how predictably irrational we humans really are, this second one teaches us how to benefit from it.

Manthropology by Peter McAllister.  A fun book written by an Australian anthropologist discussing what wimps modern men (and women) are compared to their Paleo ancestors.  According to McAllister, today’s elite athletes would have trouble competing with our ancient predecessors in any events requiring speed or strength.  Unfortunately this book won’t be available in a US edition until Oct 2010.  If you want it before then, you can get it on Amazon, but you’ll have to pay through the nose for it like I did. I couldn’t resist the title.

The First Cut, Cut to the Quick, and The Deepest Cut all by Dianne Emley.  The careful reader can probably detect a theme in these books, which are are police procedural mystery novels set in Pasadena, CA.  The protagonist, Nan Vining, is a single mom and has recovered from a near death experience after having been stabbed in the throat while on duty.  These have been my escapist books over the past couple of weeks.  I’m running out of mysteries to read because it seems that I have read everything written by US and UK (and even Australian) authors.  Help!  Any and all suggestions will be appreciated.

36 Arguments for the Existence of God: A Work of Fiction by Rebecca Goldstein.  A literary novel if there ever were one.  Probably not everyone’s cup of tea, but I enjoyed it immensely.  It has so many moving parts that it’s hard to describe.  Read the Amazon review if you’re interested.

The Rational Optimist: How Prosperity Evolves by Matt Ridly .  I was curious to see how Matt Ridly, an excellent science writer, would approach a more soft science than usual.  His thesis is that collective human intelligence will save us from the fates all the Erhlich’s and Malthusians fear await us.

Decoding Reality: The Universe as Quantum Information by Vlatko Vedral. Another book that is no doubt not everyone’s cup of tea, but I’m a physics/quantum mechanics geek so I enjoy this kind of book.  It explores the idea that information is the basic element making up the universe.

Cro-Magnon: How the Ice Age Gave Birth to the First Modern Humans by Brian Fagan.  Dr. Fagan is an Emeritus Professor of Anthropology at the University of California, Santa Barbara and a fellow member of the Santa Barbara Yacht Club. This book, his latest, explores the time that Cro-Magnon man and Neanderthals co-existed in Europe and how the superior intellect of the former allowed them to survive the Ice Age.  Until I read this book, it hadn’t occurred to me that the Cro-Magnons, who were identical to us genetically, roamed Europe for about 30,000 years, a length of time vastly longer than all of recorded history.  And yet it seems we know less about them than we do most of the other primitive beings.

Protexid and Protexid ND and adventures in DR

I’m going to reveal the only medical problem I have (at least that I know of) other than the propensity toward obesity when I eat too many carbs.  I’m going to explain how the direct response business works.  I’m going to talk about the problems direct marketers have in dealing with our servants in Washington. And I’m going to tell you how you can get the best nutritional supplement I’ve ever seen in action absolutely free.  How’s that for a pleiotropic post?

First the medical problem.  I’ll reveal it in true AA fashion.

I am a GERD (gastroesophageal reflux disorder) sufferer.

I don’t get it often, but when I do, it’s a nightmare.   As long as I stick with my own diet, I never ever have a problem.   But sometimes, what with traveling and all, I’ll stray from the straight and narrow for a bit.   The first day or two or even three after I’ve fallen off the wagon, I don’t have symptoms.  But starting about day three or four, it turns brutal.   And like most everyone else, once the let’s-eat-carbs devil is on me, I want to keep on going.   And I pay dearly.   I actually become afraid to go to bed because I know what’s going to happen.   Those of you who are fellow sufferers know what I mean.

I’ve taken to never going far without my team of GERD-preventative products, which, even though OTC, are really the only semi-sort of medicines I ever take.   I always packed the duo shown below: Tums and Pepcid AC.   Both are OTC, although Pepcid used to be prescription.   I hated to take them, but I hated the symptoms of GERD even worse.

GERD regimen1

Now for the direct response business.

A direct response company (DR) is one that sells products direct to consumer through channels other than retail stores.   Companies that sell through catalogs, online, direct mail, infomercials, Google ads, websites, etc are called DR companies.   Anyone who sells this way is said to be in DR sales.   Many companies have physical stores but still have a DR arm that sells through catalogs and online.   The little product section of our website is a DR store.

As I’ve mentioned on this blog, or at least in the comments somewhere, MD and I are part owners of a couple of DR companies that produce and sell unique, patented nutritional products.   I’ve avoided promoting any of those products on this blog because I didn’t want to contaminate it with commercial marketing. I want what I write to be accepted as my opinion based on my years of practice and my reading and understanding of the medical literature, not as an overt or even subtle effort to drive readers to buy products that I may have to sell.  Any time I do post about a product, which I did once with Pentabosol, I am always clear that I am in the business of selling said product, and I expect anyone reading what I have to say about it as coming from someone who stands to gain financially by its sales.

I will never follow the loathsome practice used by a majority of the newsletters out there that recommend products in a seemingly unbiased fashion then offer a link for readers to purchase those products from what appears to be a third party, but which, in reality, is a company owned by the newsletter publisher.  I believe such behavior is beneath contempt.

How does my GERD and my involvement in the DR business all come together in one post?

Because GERD is a problem that afflicts me, I do a fair amount of research on it.   Through this research, I’ve discovered that I’m far from alone in suffering GERD’s debilitating effects.  There are estimated to be anywhere from 25 million to 40 million fellow GERD sufferers in the US alone, numbers that get the attention of the DR marketer in me. (Not to mention the pharmaceutical companies, which is why the commercials for the little purple pill are all over TV.) For several years, I’ve been on the lookout for a natural supplement that works for GERD. If you google GERD or heartburn, you’ll find plenty of nutritional supplements, but based on my experience, none of them really work – at least not for me.  Below is a photo I took of a part of an entire section at Costco devoted to OTC reflux meds.

Costco gerd1

A few years ago I was doing my morning cruise through the medical literature when I came upon a paper by a Brazilian scientist about a natural supplement he had developed and used successfully to treat severe GERD. I read his paper his paper (pdf file) and found a follow-up paper and was intrigued. He had compared his supplement head to head with omeprazole, the generic for the drug Prilosec (and the precursor to Nexium, the little purple pill), and his supplement had won.   Moreover, he had a large number of subjects – almost 300, which is a pretty huge number for trials with natural supplements.  Usually it’s something in the range of 10-20.  He found that within 40 days ALL the subjects on his supplement had achieved complete relief from their GERD symptoms whereas only 67 percent of those on the drug had done so.  As you might imagine, this paper got my attention.

When I looked at the ingredients, it didn’t look to me as if they would particularly work to relieve GERD, but, according to his study, not only did they work, they were shown by endoscopy to actually heal ulcerations.  The follow-up paper (pdf file) had photos of the healing progression.  In doing further research on the product and the ingredients, it looked as if this product worked in a different way than all the others on the market.

Since the beginning, when people first starting treating GERD and acid reflux, they’ve used a variation of the same treatment: reducing the amount of stomach acid.  The theory is that acid from the stomach gets through a loosened lower esophageal sphincter (LES), the muscular ring that holds the bottom of the esophagus closed, and splashes onto the delicate tissues of the esophageal lining, burning them in the process.  Although new theories are emerging as to what really causes GERD, the excess acid reflux theory has held sway for ages.  According to the precepts of this theory, if you can reduce the degree of acidity of the stomach acid or cause the stomach to produce less of it, you can reduce the effects of the acid that makes its way through the LES to the vulnerable esophageal cells.

Antacids, the earliest approach developed, work by neutralizing stomach acid.  The newer drugs such as Prilosec and Nexium work by making the stomach produce less acid.  In both cases, the problem is solved by either getting rid of the acid or neutralizing it.  Which, for the most part, works to reduce or eliminate the symptoms of GERD.  But, and this is a big ‘but,’ maybe isn’t the best way to go.  Stomach acid is there in the stomach for a reason.

It’s the first line of defense against microbe invasion.  If you swallow germs, the acid works to destroy them.  When you breath in germs, they get stuck to the mucus in your respiratory tract, then the little hairs (that haven’t been burned off due to smoking) move this mucus, filled with germs and particulate matter you don’t want in your lungs, upward and dumps it in the back of your throat (you never notice this happening, but it happens 24 hours per day) from where you swallow it.  Those bugs then get killed when they hit the acid in the stomach.

When food reaches the stomach, the stomach acid acts upon it as the first phase of the digestive process.  Protein starts to be broken down in the stomach.  When the acidic stomach contents are released into the first part of the small intestine, their acidity stimulates the release of alkaline juices to neutralize them and do other work in the digestive process.  Whenever stomach acid is gotten rid of or neutralized, the very first step in the digestive process is compromised and there is a domino effect from there on.

Studies are starting to demonstrate that those who take the newer anti-GERD drugs suffer a higher incidence of pneumonias and other infections (which makes sense since the first line of defense is knocked out) and more osteoporosis and hip fractures (which also makes sense since protein digestion and absorption is affected).  As far as I know, antacids haven’t been implicated, but that’s probably because people don’t take them all the time as they do these other drugs.  Most people only take antacids as they need them, so their acid isn’t affected 24 hours per day, day in and day out.

This Brazilian product appeared to work by strengthening the LES so that the acid didn’t get to where it wasn’t supposed to be.  But the acid itself wasn’t effected, so the digestive process could perform unhindered.

I thought this could be a terrific product for DR, so I tracked the researcher down in Brazil.   He told me he had used the supplement on many, many patients besides the ones in the study and that he was shipping it all over Brazil and to people in the US and Canada.  Furthermore, he informed me that he had the worldwide patent rights on the product.   I told him I would love to work an arrangement with him to get the exclusive license to make and sell his product.  I (and my partners) flew him to the US where we put him up for a week and picked his brain on the product.  Satisfied that it was legit and that his patents were in order, we executed a worldwide exclusive licensing agreement with him.

We began to formulate a strategy to sell the product, which we named Protexid.   We decided to start with a radio infomercial because they are much less expensive to produce and can be used to work out the bugs in the presentation before jumping into the much more expensive television infomercial market.   At the same time we were in the planning stages for the radio infomercial we were working to come up with a name for the product (the name he was using in Brazil wouldn’t make any sense to an American consumer), designing the labels and accompanying literature and all the rest of the creative stuff that has to be done to bring a product to market.

Our Brazilian doctor had sent us names of clients he had in the US who had been using his product.  We got in contact with a number of these folks and found them to have been tremendously satisfied and several were willing to be testimonials for us.  Once we had all the parts of the promotion together, MD and I went to a studio and recorded the radio infomercial.  We stayed in the booth for two days making a number of iterations of the program.  Once finished we got the shows transcribed and sent the scripts to the attorney whose job it is to keep us out of trouble with all the government regulatory agencies.   MD and I are old hands at this, so we pretty much know how to do these things on the fly and stay in the clear.  Consequently, we were expecting a few little cuts here and there, but nothing that would substantively alter what we were trying to say.   We’re we ever in for an eye opener.

Here comes the part about our friends in Washington.

When we spoke with the lawyer, we found that our show had been cut to the bone.   GERD is a disease, and if you make disease claims – as in, it relieves the symptoms of GERD – you are making a disease treatment claim, which runs you afoul of the FDA.   The only way you can make a so-called disease claim is to go through the same kind of extensive FDA-approved studies as drugs have to go through.   If you try to make a disease claim without doing this, you get hammered by the FDA.   Then there are all the FTC regs.   About half the time you can’t say one thing because the FDA won’t let you and the other half you can’t something else because the FTC won’t let you.   After our lawyer – who really is reasonable – got through with our show, it turned out that the only claim we could actually make was the following:  Protexid may offer relief from occasional heartburn.   Nothing about GERD, nothing about acid reflux, nothing about the long term problems with untreated GERD, and nothing about how our product stacked up against a prescription drug.   All in all, our program had been totally emasculated.

We had no way to explain how phenomenal Protexid really is without risking serious problems from our government watchdogs.  Which is extremely frustrating when you’ve got a product that works as well as this one and that so many people could benefit from.

And it works extremely well.

As we were fiddling with all the work necessary to get this project moving, I was going about my business doing all the things I normally do including tending to this blog.   Over the first couple of months or so that we had the product I had an episode or two of GERD, but dealt with them with Tums and Pepcid AC as usual.   I didn’t use our own product for a couple of reasons.   First, the samples we had gotten from the Brazilian doc had been made in China and I wasn’t about to take them.  Second, when I got GERD, I got it bad (for some reason, I never have a slight case or a touch of it; I always have the full-blown version), and I wanted to take something I knew worked, not something I had never taken before.  So even when we had our own US manufactured product, I didn’t take it myself.

I’ve had tons of experience with natural supplements, and they all pretty much work the same.   You take them for several weeks or a few months and you build up levels that actually start to work.  Krill oil had been the perfect example.   I took a krill oil/fish oil/curcumin combination to relieve my aches and pains from playing too much golf so I could quit taking all the ibuprofen I was taking.  After about a month and a half I was pretty much ache and pain free.   Now I take only a single krill oil softgel and one curcumin daily to keep myself that way.  But it initially took almost two months for the natural supplement combo I was using to kick in and do its thing.   Which, in my experience, is pretty much the standard course with natural supplements: many work, and work well, but it takes time.

When I have an episode of GERD, I don’t have time to wait.   I want relief now.   I don’t want to lay awake all night in agony and do so for two months while I’m waiting for the natural supplement to kick in.  Thus I never used our own product the couple of times I needed something.

Until one time MD and I went on a several-day-long trip, and I forgot to take my Tums and Pepcid.  A couple of days into the trip, I could tell I was going to get GERD that night. (Most of the time I can tell when it’s going to happen; occasionally it sneaks up on me.)   I was desperate.   I was getting ready to head off to find a drug store and get the stuff I needed, but MD brow beat me into taking a Protexid.  I took one capsule (the standard dose) at bedtime and experienced no GERD.  I wrote it off as a fluke.  But then I tried it again the next night and, again, no symptoms. I tried to test it by eating a bunch of junk that I knew would normally do me in.  One capsule at bedtime and nothing.   This is what the Brazilian doctor had told me, but I simply hadn’t believed him.  Once I saw how well it worked for me, I became almost a religious convert.  I knew a few guys I played golf with who had GERD.  Most took prescription drugs daily for the condition.   I got them to try the product.  In every case, they got complete relief with one capsule at bedtime. I was stunned that it worked so well.

I have had probably 30 people that I now know first hand who have taken this product with success equal to mine.   One guy – a surgeon – ditched drugs he had been taking for years and got total relief.   He feared he was going to have GERD one night, and so took one of his prescription drugs that night in addition to the product.   He didn’t have symptoms and we don’t know if he would have on the product alone or not.   But that’s as close as we’ve come to a treatment failure with his product.

In fact, in all my years of medical practice, I have never seen a natural supplement that works like this one.   It works quickly and it takes only one capsule at bedtime, not the large doses throughout the day that are associated with most natural supplements.   It is the only supplement I’ve ever seen that has truly drug-like effects in terms of speed of action and efficacy.

So we’ve got this great product and we can’t really tell people via paid advertising how it really works.  We ran our emasculated radio infomercial, but, as expected, it didn’t do squat.  The people who purchased the product were happy, but not nearly enough bought it to make continuing to run the show profitable.  We cut our losses and shut down.

We were approached by another company that wanted to promote our product via television infomercial, so we negotiated a sub-licensing agreement with that company.   This outfit went over the moon in making claims about Protexid (in our licensing agreement, of course, we made sure we were exempt from any liability for claims this company made), yet they, too, were unsuccessful in making the promotion a success.  They spent even more money and tried again with even more aggressive claims and got very little return.  They finally gave up and returned the rights back to us.

Why didn’t these shows work?  We knew ours didn’t work because we couldn’t really describe how effective the product really is.  But how about the other show?  The one that took it over the moon in terms of claims?  Why didn’t it sell there? I’ve got my suspicions as to why that I’ll talk about it a bit.

Right now we’re scratching our heads about what to do with this phenomenal product. I put it up on the catalog part of our website, but no one really knows what it is, so we haven’t really sold much Protexid that way.

Which brings me to the point of this meandering post.  We’ve worked on this project for going on three years now and the Protexid we’ve got left is going to expire soon.  It really isn’t going to expire in terms of efficacy, but it’s going to expire based on the dates the manufacturer printed on the bottles.

There are two versions.  The first, pictured to the left, is the original that is the product used in the published study.  It’s in a blue bottle and is called Protexid. (In case you’re wondering, Triparadol is what the name is in Brazil) The other is in an orange bottle and is called Protexid ND.  The Protexid ND has lower doses of a couple of ingredients and seems to work as well as the regular strength product.  I’ve used both – I use whichever I happen to have at hand when I need it – and haven’t seen a difference.  The Brazilian doctor uses the lower dose all the time and in his follow-up paper he used the lower dose, but we made the higher dose so we thought we could use the first paper that compared Protexid to the prescription drug.  Had we used the first published paper to support the claims for the product with the lesser dosage, we would have been hammered.

We have about 80 of so bottles of the blue, full-strength Protexid, but it expires at the end of November.  We have more bottles of the Protexid ND, which expires at the end of December 2009.  I don’t know off hand how many Protexid ND we have, but substantially more than the other.  As I say, as far as I can tell, they both work the same.

NOTE: All the full-strength Protexid is gone.  All that’s available now is the Protexid ND, which, as far as I can tell (from my own experience, anyway) works as well as the full-strength stuff.

Get it free!

Anyone who wants to try this product can get it absolutely free by ordering on our website.  The price should be set at $0.  All you will have to pay is the shipping and handling, which is minimal.  Please, though, no more than two per person.  That’s TWO per person.  It can be one of each or two of one kind, but not two of both kinds.  I want to make sure that everyone who wants to try Protexid gets a chance, and there really is a limited amount left.  No obligations on your part.  You don’t have to sign up for more.  Just grab it and run.  So, if you or someone you know has the problem, give it a try.

NOTE: OUR SHOPPING CART DOESN’T ALLOW US TO LIMIT QUANTITIES OF ANYTHING PURCHASED.  SOME CLEVER PEOPLE HAVE FIGURED OUT THAT THEY CAN ENTER 4, 10, 20 or even, as in one case, 100 INTO THE AMOUNT WINDOW.  DOING THIS AUTOMATICALLY CALCULATES SHIPPING CHARGES ON THE LARGER AMOUNT, WHICH KRISTI HAS TO GO BACK AND CHANGE TO THE AMOUNT FOR TWO BOTTLES, THEN REFUND THE CREDIT CARD FOR THE DIFFERENCE IN SHIPPING.  I’VE INSTRUCTED KRISTI TO HENCEFORTH CANCEL THE ORDER AND REFUND FULL SHIPPING FOR ANYONE WHO ORDERS MORE THAN TWO BOTTLES OF PROTEXID ON THIS FREE OFFER.

I don’t think Protexid will ever be a good infomercial product because due to government regulations it can’t be promoted in a way that explains what its real benefits are.  And without the explanation no one really wants to purchase a product that ‘may offer relief from occasional heartburn.’  And the obvious problem with GERD is that it hurts and that some people actually spit up acid and burn their throats.  These problems can be solved with prescription medicines – or, as in my case, with OTC meds.  But without the explanation as to why these aren’t the best solutions, why would anyone have the impetus to pay for Protexid when prescription drugs that relieve the symptoms can be had for the price of a co-pay.

So we are changing course to look at selling Protexid into the retail market and/or through health practitioner’s offices. I have a friend who is a naturopathic physician who works in an integrative pharmacy, which is one that does compounding and sells a lot of nutritional supplements along with prescription medicines.  She tells me that almost 70 percent of people who come into the pharmacy (who aren’t coming in specifically to get a prescription filled) are looking for something for GI problems, and that most of those are having problems with GERD.  The pharmacy in which she works is in an upscale part of Los Angeles, and she says most of the people coming in have a prescription for Nexium or one of the other similar drugs, but are looking for natural alternatives.  This is the group we need to be marketing Protexid to, but our whole team are skilled only in the DR way of marketing.  None of us have a clue as to how to get a product into a pharmacy.  I’m constantly amazed at the collective wisdom of people who read this blog.  Maybe someone out there is experienced in retail placement or other means of distribution that they could direct me to.  If so, I would love to hear from you.

And if anyone has used this Protexid ( you know who you are) and wants to tell about the experience – good or bad – send it to the comments, and I’ll post for all to read.

Until we get our marketing strategy worked out, we’re probably not going to manufacture any more Protexid, so gets yours free while they last.

One last thing.  I’ve given Kristi, our long suffering assistant who works for slave wages, time off for good behavior, so she is leaving tomorrow for Thanksgiving with relatives.  She may not be able to get some of these orders out until Monday.  Thanks in advance for your patience.

Thiamin and diabetic nephropathy

Changes in diabetic nephropathy

Changes in diabetic nephropathy

I received a short paper from a colleague in Portugal a couple of days ago that demonstrates in just a few pages how science should really work.

The paper from the journal Diabetologia reports on a study done in Pakistan showing that high-dose thiamin (vitamin B1) may be a valuable therapeutic agent in the treatment of diabetic nephropathy.   This small study certainly isn’t the final word, but it does show how medical science should work.

First, the paper starts off in the introductory paragraphs discussing how the idea for high-dose thiamine therapy came about.  Before we get into that, however, let me digress briefly to discuss diabetic nephropathy for those who are unfamiliar with it.

The main job of the kidney is to remove waste products from the blood while keeping the non-waste products, i.e., proteins, sugar, etc. in the blood.  You can think of the kidney as a sieve with tiny holes.  All the waste that needs to be filtered is small enough to fit through the holes while the substances meant to remain unfiltered are large enough to not fit through the holes.  If you were to pour liquid containing both waste and non-waste matter into a long tube with your sieve somewhere in the middle in a place non-visible to you, you could check to see if your sieve were damaged by looking at what comes out at the bottom of the tube.  If you find only waste, then you can be pretty certain that your sieve is functioning.  If, on the other hand, you find material coming out the bottom that should have been caught by the sieve, you can be pretty sure there are holes torn in your sieve.

This in very simplistic terms is what happens in the kidney.  Proteins are large molecules and should never make it through the kidney into the urine.  Protein in the urine in any significant amount tells you the kidney has a problem.  With simple lab tests we can identify microscopic levels of protein in the urine, and anyone having a certain amount is said to have microalbuminuria, which means microscopic levels of albumin (the main protein in blood) in the urine.

In people with diabetes, microalbuminuria means the kidneys are starting to develop nephropathy, or pathology (or disease) of the nephron (the basic unit of the kidney).  To go back to the sieve analogy, they’ve developed bigger holes in their sieve. This condition afflicts about 40 percent of those with diabetes and can (not that it always does, but it can) progress to complete kidney failure, requiring dialysis or kidney transplant.

Diabetic nephropathy is most likely caused by the toxic effects of too much sugar in the blood and is helped, and even reversed, by careful control of blood sugars.  Despite this common knowledge, many unenlightened people continue to treat the condition by limiting dietary protein instead of focusing on the continuing damage caused by elevated blood sugar.  In order to keep caloric intake up, what do people substitute for protein?  You got it.  Carbohydrates.  And since dietary carbohydrates become blood sugar fairly quickly, they end up damaging the kidney more than the protein they are replacing.

Now that you’ve got at least a working notion of what diabetic nephropathy is, let’s look at our paper.

The authors start off with a description of the research on thiamin to date that gives us a nice picture of how the various types of studies all tie together to make real science.

First off, someone noticed that people with diabetes and protein in their urine had low blood levels of thiamine.  This observation prompted researchers to do observational studies of this phenomenon.

In evaluating large numbers of subjects with and without diabetes and protein in their urine, scientists determined that the diabetics typically had lower blood thiamin levels than the non-diabetics.

But, at this step, these studies are simply observational studies and can’t possible prove causation.

The next step in the scientific evolution is to hypothesize that low thiamin levels are somehow involved in the development and/or progression of diabetic nephropathy.  If this hypothesis is valid, then giving thiamin should improve the condition.

Researchers gave thiamin to rodents with diabetes and discovered that increasing blood levels of thiamin reduced or eliminated proteinuria in the animal model.

Here is where the tricky point arrives in the study of drugs – trying them in humans.  As I’ve written many times in these pages, rodents are not just furry little humans.  What often causes no problems for them causes huge problems, including the ultimate problem – death – in humans.  So it is a difficult business to start giving experimental drugs to humans.

In this case, however, it isn’t so bad because thiamin – even in high doses – is non-toxic to humans.  The next step is the randomized, double-blind, placebo-controlled clinical study, which the authors of our paper under discussion performed.

Researchers randomized a group of 40 subjects who had diabetes and microalbunuria into two groups.  Subjects in one group got three 100 mg thiamin capsules per day; subjects in the other group got placebo.  (I couldn’t tell from the paper whether the three capsules were spread out over the day – I would assume they were – or were taken all at once.)  The two groups remained on their supplement regimen for three months followed by a two month washout (a period in which no one either thiamin or placebo).

The results were pretty spectacular.

There was a significant drop in the amount of protein in the urine of subjects taking thiamin as compared to those taking placebo.  Even more exciting was the following:

After [thiamin] therapy for 3 months, regression of microalbuniuria to normal urine albumin had occurred in 35% of the patients.

Over a third of the patients on thiamin had no more evidence of diabetic nephropathy, at least as demonstrated by protein in the urine.  This is a spectacular result, especially for a natural substance with virtually no toxicity.

I appreciate the way the authors of this paper presented their data.  It is much more informative than simply providing the average differences between the study group and the control group.

Take a look at the graphs below.  The upper figure is the overall change in microalbunuria between the groups.  The middle graph is the change in the subjects on placebo; the bottom graph shows the changes in subjects on thiamin.

thiamin-study-results

As you can see, the results of each subject are presented a single line.  You can tell a lot from these kinds of graphs.  For example, you can see that in the thiamin group there was a generalized downward slope to all the lines, which means that all the subjects improved on the regimen, a fact that is most important.  The middle graph, the one showing the results from the placebo is interesting as well.  You can see that the vast majority of subjects had no change while a couple had significant changes.  Why would there be improvement on the placebo?  Who knows?  If I had to guess, I would guess that those subjects taking the placebo who showed the major improvement may have changed their diets on their own.  These were patients at a diabetic clinic who were being treated for their condition, so maybe these subjects were more aggressively treated.  But, it really doesn’t matter because we can see from the flat lines of most of them that there was no change due to the placebo.  This type of graph at least allows us to speculate and to realize why there was a slight drop in the average level of protein in the urine of even those subjects on placebo.

The authors note in their discussion that

this is an encouraging pilot-scale outcome that high-dose thiamin reverses early-stage nephropathy in type 2 diabetes.

They go on – as they should – to recommend larger scale studies to see if their findings hold up.

Based on this study, would I, myself, take thiamin in 300 mg per day doses if I had diabetic nephropathy?  Absolutely.

Although it is only a pilot study, the results are pretty stunning.  But the ‘drug’ is harmless.  So what is the risk?  A few pennies per day for the thiamin?

If this were a study in which, say, statins were used as the agent, I wouldn’t be quite as eager.  I would probably wait until other larger studies had replicated these findings.  Why?  Because statins aren’t harmless.  One can die from them. Or can have miserable generalized muscle aches and weakness.  In other words, there is a lot bigger downside to taking statins than there is to taking thiamin, so I need a much greater level of comfort to make the risk/reward calculation in favor of taking a statin.

The only weakness I can find in this paper is that the authors spent no time discussing the possible mechanism for the benefits of thiamin on diabetic nephropathy.  Perhaps they ran out of time and are saving it for another paper. Alas that is what has happened to me as well.  MD’s group is performing with the symphony today, and I’m being badgered to get ready to leave.  So, I, too shall leave a discussion of the potential mechanism to a future post.

Hat tip to Pedro Bastos for sending me this paper.