"Homines quod volunt credunt."
Julius Caesar
The following debate took place in the comments section of
a post in nicoletta's weblog between c3rs3i, nicoletta and I - and I'm going to just post the whole thing here because I am on holiday and am far too lazy to write a real piece. Besides, I can't seem to post any new replies to the discussion for some reason so I'm going to just write my responses here. Anyone who is taking any kind of supplement or herb for health should find it a riveting read.
In the body of the post, the author expressed the following:
"I don't get why I'm such a tired person all the time. People my age are able to stay awake for hours at a time, pumping caffeine into their blood vessels, which seems adequate in sustaining two or three all-nighters in a row. I sleep soundly despite any dosage of coffee, tea or chocolate."
The rest is colour-coded for your easy reading pleasure. c3rs3i is byzantine some fluffy shade of purple, nicoletta is green and I am black because I'm cool like that.
***
c3rs3i: Might you be (slightly) depressed?
Or have you not had some sun in a while?
Either one can royally mess up your circadian rhythm.
Or could you be using sleep as an excuse to procrastinate? (I did).
My prescription is exercise, multivitamins (preferably gender specific ones), sun and laughter =)
nicoletta: Hmmm....let's start crossing things out. I certainly get enough sun - too much in fact (dangerous UV levels here in the southern hemisphere summer!!) since the weather here is gorgeous and I've been outdoors a lot. My mood seems to be alright - cheerfuller than the norm for me, thanks to the sunshine as well as the inordinate amount of sleep I get in. And, if I want to prorastinate, I'm usually very deliberate about it, and I'll be doing a whole lot of other things besides sleeping. Like reading, watching TV, listening to music for countless hours etc.
I'm on multivites as well. Nahh, I think I've somehow just sunk into a very relaxing lifestyle, which feels great but unfortunately needs to be done away with in the name of academic striving
k0k s3n w4i: Bah, multivitamins. Unless you're pregnant or living in Sub-Saharan Africa, there's really no reason why anyone needs to waste money on them. They are wasted on a system overloaded with micronutrients anyway. The supplements-for-healthy-life industry is really quite a scam. Excess of certain vitamins like A and D is worse than useless - they are harmful.
c3rs3i: You assume that non-conceiving people who have the means of sourcing nutrients naturally do the advantage of their circumstances justice.
And too much water/oxygen/anything kills too.
k0k s3n w4i: Precisely my point - too much of anything is bad for you, and speaking of assumptions, you're assuming that our host is not adequately nourished and that multivitamins will help with her fatigue. On what scientific basis are you recommending them?
It's damnably hard to be deficient of any nutrients in this day and age. You'd seriously have to go faaar out of your way to deprive yourself of any one. It's one of the great success stories of public health policies.
Besides, oxygen is free and water is almost so. Multivitamins, on the other hand, aren't. Most of the supplement industry at large is a scam. Just for an idea of how unscrupulous they are, take the popular cold/flu cure and prophylactic remedy, Echinacea, for example. even after they have been proven time and time again to be useless, the drug companies kept pushing them out because people kept buying them. Take a look at glucosamine which people take for osteoarthritis; studies have shown that it's useless as well but did the drug company go: "aight, this stuff doesn't do anything so we'll stop making them"? No, it's all for profit and because any substance carrying the label of a "supplement" is so laxly regulated, we really do have literally hundreds of tonnes of utterly useless crap on pharmacy shelves. It's a business that's worth billions and billions of dollars every year.
My mom's taking Vitamin C to prevent upper respiratory tract infections, which surprise, surprise, is also completely ineffectual for that purpose. I showed her the evidence and the studies, but that didn't change her mind either.
If nicoletta was taking supplements for some specific health problem under medical advisement, I'd understand but consuming them for general wellbeing is a waste of good money that can be better served for other purposes.
References:
nicoletta: Nope, no specific health problem and no medical advice on supplements either. But I do live with my parents, and the parental prescription for my frequent bouts of illness and chronic cough especially in the winter, is cod liver oil pills! Delicious. I take other multivites irregularly, and all of them are just the leftovers from my pregnancy. I was warned expressly against taking Vitamin A, though - something about its potential in causing birth defects in developing fetuses.
c3rs3i:
KSW
I drew lines from fatigue and hit a couple of things for which I made remedial suggestions. Upon further revelations, they will clearly not help with her sleep issues because the underlying assumptions with regards the causes I made to start off have all been negated.
But if it were the case that she doesn't follow a somewhat balanced diet, I would stick by my recommendations of multivitamins. And I would base this recommendation on my personal experience whereby I used to feel constantly fatigued despite a lot of sleep and felt a marked improvement after. Perhaps it was a placebo effect, but if all the money I have paid has just gone to tricking my mind into behaving better, then I still think it's money well spent because I wouldn't have otherwise come out of it.
Scientific research collated based on a sample set of 1:
Am I highly deficient (without)?
- Doubt it.
Do I think I could/should provide my body with more nutrients besides what it gets from the lettuce in my sandwiches?
- Yes.
Why don't I eat a salad instead?
- I don't like to eat what I don't like to eat but I have put all my salad money in a piggie bank and exchanged it for multivitamins instead!
Doesn't anyone cook for me?
No.
Can't I cook a nice balanced meal for myself?
Certainly, but I'm just a TAD busy at the mo.
If I eat well occasionally, I should be fine without multivits in the periods that I don't?
I don't doubt.
However, I am at work 8 hours a day and 6 hours in the library after and well... there's only so much you can expect from lettuce to keep you a lean-mean working-studying machine.
Oh, and I hate coffee. So if I can bring myself to drink that vile crap just so I can be a more productive human being, you will understand that I will smack you if you try to take away my multivitamins again.
Any word on the ginko biloba I'm also taking? =p
Yes, I see and agree what you mean about how a lot of people get scammed into buying something they don't need but I hope the above shows you that there are some benefits they possess for the non-pregnant, non-starving.
And Glucosamine info was particularly useful, thanks - I'll pass it on to someone who has probably already stopped taking it despite doctor's orders. X\
N
Cod liver oil pills delicious?? I hope you did mean pills (which I have no knowledge of) and not capsules cos I don't remember them being pleasant! The orange cod liver oil mix was yumz but seeing as I read the label and wasn't particularly impressed, KSW will probably tell you it's the scam of the seven seas. =p
nicoletta: sorry, yes, I did mean capsules, and I was being sarcastic =) I hate all cod liver oils, and I've experienced them in four forms (the orange gloop, the white, milky, extremely fishy gloop that makes me gag after each spoonful, the capsules, and the actual cod liver oil i.e. the really, excessively fishy, rancid oil) and I must say the capsules taste the best, because they have the least taste of all.
Always nice to have some professional medical opinions on this humble blog =)
k0k s3n w4i: Let me rephrase. When I asked you on what scientific basis are you recommending multivitamins, I meant "Do you know of any well-controlled, double-blinded studies which show that multivitamins actually help with fatigue/tiredness/oversleeping?"
And unfortunately, you haven't convinced me of anything. What you offered is your experience, an anecdote - and as statisticians like to say: "The plural of anecdote is not data." One only needs to read about placebo controlled trials to know that anyone can tell a good story of how treatment x, y or z helps even when they aren't actually getting any. Human cognition is a very poor arbiter of good science - which is why we have the scientific method to really tell us what's what.
And since you asked about Ginkgo biloba, check out this article on science-based medicine on it. I'll spare you the suspense - the title is
"Ginkgo biloba - No Effect"
From your description of your diet, I find some cause for concern, and it's not because I think you might be depriving yourself of micronutrients (you really need very, very little of those). You actually don't sound like you're getting enough macros, and no amount of supplements in the world is going to help with that. I'm certain that you do occasionally shop for bread and a head of lettuce for your rabbit sandwiches - so it isn't going to take a lot of extra time for you to also throw some cheese, chicken rolls or ham slices, tofu or a couple of apples into your basket while you're at it. It certainly isn't going to take more time than it requires to go to a pharmacy to refill your multivites. Just a friendly advice. You can totally bin it if you don't like the sound of it ;)
As for doctors prescribing glucosamine - well, med schools certainly don't prepare practitioners to think critically. And more often than not, most just don't bother if they think whatever new-agey crap their patients are into couldn't hurt. I defer to the
Science-Based Medicine website for easy-to-read skinnies on edgy, kooky treatments and supplements. They trawl the journals so I don't have to. I highly recommend that you bookmark it as well :)
P.S. As it happens, I really have no opinion on cod liver oil and their derivatives - but I'll say this much. I have yet to read any convincing papers saying that the stuff helps to prevent infections or boost the immune system in any way.
c3rs3i: And hey.. the Gbloba study was for people aged 72 to 96 and they were testing for effects against Alzheimers or other forms of dementia.
This study is irrelevant and ineffectual for proving that it does not enhance cognitive abilities in those of other ages.
Aged 72 to 96!!! Imma whack you with my walking stick.
k0k s3n w4i: There is scant research done on Ginkgo for the more sprightly segment of humanity, but the research does show no positive effects on the population which we would expect the most dramatic improvements from. Neither was it efficacious in preventing cognitive deterioration in those who are most at risk for such impairments. On disciplines I have no expertise in, I listen to the actual experts. And in this case, the resident expert, an academic neurologist, did weigh in on the plausibility of the mechanism by which Ginkgo purportedly act through (thin) and the weight of the evidence thus far - which isn't heavy. I ask you in turn: On what objective evidence or proof are you claiming that G. biloba improves your cognitive functions? Should we just pop every root, berry and leaf which was claimed to be good for something into our mouths just because no studies have been done yet to disprove those claims for our specific biology? And after studies on G. biloba is performed on twenty-somethings, are you going to complain next that they weren't performed on Asians? I daresay you were engaging in special pleading or
ad hoc reasoning there, pardner. The crux of the issue is this - at present, there's no good, reliable scientific reason to suppose that Ginkgo helps your brain work better.
c3rs3i: Man, your life must be quite tiring/some, always having to verify that something works/exists through some scientific study before allowing yourself to believe that it really does. Look at you, turning your nose up at the power of the anecdote when generations ago or even just before the internet went massmarket, that is all people had to go by (nevermind that they got as many things wrong as they did right).
But despite the toxicity of your cynicism, I still appreciate your sharing of what you know, your perspective and concern.
And besides.. we heard yay first.
Anyway, statistics is one of the toys I play with for a living so I have an added dimension of skepticism in that I know you can get data to pretty much say anything you like, double sided, blind controlled or whatever.
No, my sandwiches come straight from the sandwich shop and my fave's bacon and chicken deep fill - So do I have your approval to hold off buying macronutrient supplements for the time being? =D
But yes, I think I will visit a grocery shop for the first time in a month, ignore all the studies negating the benefits of bananas and pop a bunch in my basket.
k0k s3n w4i: Actually no - I just have a healthy respect for reality and mislike being taken for a ride by people out to make a buck. And you assumed that I obsessively look up every aspect of my life; which I don't. It's just that the nature of my profession requires me to keep abreast of the current scientific understanding on all things health related. If a patient asks me if Ginkgo biloba makes them smarter, I'd have to be able to tell them what science does
know at the moment. And that answer is
"There is no evidence for it." It's an answer that may sound ambivalent, but it's about the closest science will ever get to negating any claim. We are quite unlike the new age health gurus who will often tell you
in no uncertain terms that their magic potion, pill or tincture will boost your IQ, cure the common cold and vacuum your house. Call it
"toxic cynicism" if you like, but I prefer the term
"scepticism" which I assure you, is not synonymous with the former. I was unaware that you consider caring about the truth to be such a negative quality for anyone to have.
And before there was the internet, there was the scientific method - a mighty useful tool which had been formalised by our species to offset our limitations in understanding the world. There were universities, academicians and journals. The net merely expedited our access to these resources, and I consider it criminal to not take full advantage of it.
In the medical field, we rarely rely on any one study for our practice. What we would (or should) consider in formulating health advice is usually based on a long-term look at the pattern of research (and if we can get it, a systematic review by an authoritive journal like the NEJM, JAMA or BMJ which is the closest thing to a last word on any healthcare subject).
On to the CRN report you just posted: it merely confirmed what I've been saying. Supplements are only useful in those who are pregnant, at-risk or deficient. We routinely prescribe pre-conceptional folic acid to women to prevent neural tube defects; that's true. Calcium and Vitamin D helps stave off osteoporosis in the elderly (strange that you're okay with the age-group here - cherry-picking much?); no one's denying that. No word on your miraculous brain herb, though. The rest is some iffy projections and over-optimistic claims. If you are aware, you'd also know that the anti-oxidant craze had been undergoing heavy scientific fire in recent years as well. However, the part of the report which interested me the most is this little tidbit at the bottom:
"The Council for Responsible Nutrition (CRN), founded in 1973, is a Washington, D.C.-based trade association representing ingredient suppliers and manufacturers in the dietary supplement industry."
I'd get my information from a source with a little less conflict of interest if I'm you. If you're interested, the CRN is mentioned in quite an unflattering light in
this piece here. And macronutrient supplements? I usually call them
"food".
Unsupplemented,
k0k s3n w4i