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Get Vitamins from Food, Not Pills

One in three women and one in four men in the United States take vitamin pills regularly. This month, a study that followed 182,099 people in California and Hawaii for an average of 11 years showed that taking multivitamin pills neither decreased nor increased the death rate for all causes or the rates of heart attack or cancer (American Journal of Epidemiology, August, 2011).

A previous review of 67 randomized trials of vitamin pill effects on life and health found that taking vitamin pills may shorten life (Cochrane Database of Systematic Reviews, Issue 1, 2008). The authors found an increased death rate of 16 percent in those taking vitamin A pills, seven percent with beta- carotene, and seven percent with vitamin E. The Women's Health Initiative study followed women for eight years and found that taking multivitamin pills has little or no influence on the risk of common cancers, heart attacks or death rate in postmenopausal women (Archives of Internal Medicine, February, 2009). A review of the world's literature shows that multivitamin use neither increases nor decreases risk for breast cancer (Annals of Pharmacotherapy, published online April 2011).

VITAMIN D FROM SUNLIGHT, NOT PILLS: Vitamin D is the only vitamin that appears consistently in the literature to help prevent heart attacks and cancers, and that benefit is related more to the fact that you can get it from sunlight (Cancer Epidemiology, Biomarkers & Prevention, April 2011). The Swedish Women's Lifestyle and Health cohort study followed women for up to 15 years and found that women who got sunburned twice or more per year during adolescence live longer than those who had been sunburned less than that. Women who went on sunbathing vacations more than once a year lived longer and suffered fewer heart attacks.

VITAMIN B PILLS MAY CAUSE HARM: Every chemical reaction in your body is started by an enzyme. For your body to convert chemical A to chemical B, you need an enzyme to start that reaction. All eight B vitamins are parts of enzymes. When you take large doses of one enzyme, you accumulate end products that must be balanced by also taking large doses of other enzymes. For example, NIACIN LOWERS CHOLESTEROL, BUT RAISES HOMOCYSTEINE: People who take large doses of niacin to lower cholesterol have a marked elevation of homocysteine, a risk factor for heart attacks. Here is how it happens: Proteins are made up of building blocks called amino acids. The B vitamin, Niacin, is part of the enzyme that converts an amino acid, cysteine, into homocysteine.

Three other B vitamins, folic acid (B9), cobalamin (B12), and pyridoxine (B6)} protect you from accumulating too much homocysteine. Folic acid and cobalamin convert homocysteine to cysteine, while pyridoxine converts homocysteine to methionine. Therefore, when you take niacin, you also have to take the other three vitamins to protect you from accumulating homocysteine. Nobody really knows how to balance large doses of vitamins when you take them in pills. I think that it is safer to depend on nature to provide the proper balance of vitamins in foods.

MY RECOMMENDATIONS: I do not believe that taking one vitamin pill a day is harmful. I do believe that taking large doses of vitamins can harm you. I also believe that you do not need to take vitamin pills. Eat a diet rich in fruits, vegetables, whole grains, beans, seeds and nuts. Some people need to take vitamins D or B12, but you should be able to get B12 from fish or chicken, and get your vitamin D from sunlight if possible.

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Dear Dr. Mirkin: Should cortisones (glucocorticoids, steroids) be injected into painful joints?

We do not know. Orthopedists inject cortisone into joints because they know that these injections can provide immediate dramatic relief of pain and swelling in damaged joints whether from trauma or from inflammatory diseases such as rheumatoid arthritis. However, a major side effect of cortisone is loss of calcium and weakening of bones. Therefore many doctors recommend that a person receive only up to three cortisone injections into a joint during a lifetime.

A recent study from MIT shows that cortisone-type injections can prevent long-term damage to injured joints (Arthritis Research & Therapy, September 2011).

Damaged cartilage almost never heals and can eventually lead to osteoarthritis. Bones come together to form joints, and the ends of bones are protected by a thick white gristle called cartilage. When you damage cartilage, the outer surface layer in the joint breaks down and the ability to form a new outer layer is markedly reduced, so broken cartilage does not heal. Your joint produces cytokines (TNF, IL-1, and IL-6) that mobilize your immune system to kill invading germs. These same cytokines also attack the broken cartilage to cause even more damage. Cortisone Injections reduce these cytokines, prevent further joint damage, and restore the synthesis of new cartilage to normal levels.

Professor Alan Grodzinsky from the MIT Center for Biomedical Engineering said, "Our results suggest that short-term glucocorticoid treatment after joint injury may help restore components of cartilage to pre-injury levels and consequently may prevent the long term changes which lead to osteoarthritis."

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Dear Dr. Mirkin: Is carbohydrate loading before competition more effective in increasing endurance than taking carbohydrates during competition?

No! This month a review of eighty-eight randomized crossover studies in which carbohydrate supplements were consumed, with or without protein during exercise, showed conclusively that it increases endurance very significantly, and the longer the event, the greater the benefit (Sports Medicine (Auckland, N.Z), September, 2011).

TAKING CARBOHYDRATES HELPS YOU EXERCISE MORE INTENSELY. The limiting factor in how long you can exercise intensely is the time it takes to bring oxygen into muscles. Since sugar requires less oxygen to power your muscles than fat and protein do, taking extra sugar reduces oxygen needs and allows you to run, ski, skate, swim, and cycle faster.

CARBOHYDRATE LOADING: Sugar is stored in muscles and liver. Several years ago, researchers showed that athletes could increase their sugar stores in muscles by restricting carbohydrates seven to four days before competition, and then eating extra carbohydrate-containing foods for the three days prior to competition. However, all recent research show that conditioned athletes can maximally store sugar in muscles just by reducing their amount of prodigious training for four days and eating a little extra carbohydrate-containing food.

WHY SUGAR DURING COMPETITION IS BETTER: The amount of sugar that can be stored in muscles is limited. If you exercise long enough, you will decrease sugar stores and start to burn more fat, which will increase your need for oxygen and slow you down. When you take sugar during competition, either in drinks or food, you increase the percentage of sugar that your muscles use, decrease your oxygen needs, and go faster longer. During races lasting more than an hour, we take sugared soft drinks, whole grain bars, and sugared apricot paste.

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Recipe of the Week:

Asparagus-Shrimp Salad

You'll find lots of recipes and helpful tips in The Good Food Book - it's FREE

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September 11th, 2011
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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