Another dig at complementary medicine

A study published recently in the well-respected journal, the Annals of Internal Medicine was titled

Effects of Nutritional Supplements and Dietary Interventions on Cardiovascular Outcomes: An Umbrella Review and Evidence Map

The conclusion of this trial stated reduced salt intake, omega-3 PUFA use, and folate supplementation could reduce risk for some cardiovascular outcomes in adults. Combined calcium plus vitamin D might increase risk for stroke. The headlines were released stating

Vast majority of dietary supplements don’t improve heart health or put off death, study finds

Photo by Gesina Kunkel on Unsplash

Basically, the theme of the study was that there was no real benefit for the vast majority of supplements and in most cases these supplements have no place in the management of cardiovascular disease. This is yet another large trial which will warm the hearts (so to speak) of the conservatives in medicine who want everyone to believe all that works is a prescription pad or scalpel.

But, when you read the study very carefully there is no mention in the body of the study about the vital aspects which will tell you whether this information has validity. I reviewed the entire article, including the appendix and it was only there that I found the average follow-up for these trials. I have included the table below noting that the authors purely gave average follow-up times that could vary between six months up to the very longest of 10 years. They didn’t specify which of the particular trials they examined fitted into any of the follow-up categories (i.e. short or long term trials), nor did they specify whether the vitamins used were synthetic, naturally sourced, nor the dose, nor whether the vitamins were used alone or in combination. There was also no specification regarding the type of people in whom these supplements were used i.e. primary or secondary prevention. Primary prevention is where a person does not have the disease and you’re trying to prevent it. Secondary prevention is where the person has already suffered an event and you are trying to prevent further events. People in the second category typically have a much greater disease burden and the chance for further events is much higher. If any reader of this study wanted this vital information, then you would have to review each individual trial of the nine systematic reviews and 4 new RCTs selected that encompassed a total of 277 trials, 24 interventions, and 992 129 participants. A total of 105 meta-analyses were generated.

We will hear all the usual claims from conservative clones, supported by the findings from this very large review suggesting there is no evidence for the benefits of supplementation; “if you follow a standard diet, you are obtaining all of the micronutrients necessary without supplementation, and that complementary medicine is useless or in some cases may even cause harm.” There are always the demeaning comments that all vitamins do is give you expensive urine, and that they are recommended by charlatans.

A few years ago, Four Corners (an Australian TV show) presented a segment on US complementary medicine companies which showed very clearly that (most importantly, US) complementary medicines are made to food standard and not pharmaceutical grade. A study of 300 different products demonstrated the vast majority had contaminants and the ingredients written on the bottle were not actually in the tablets or capsules.

Australian supplements, however, are made to pharmaceutical grade and are under strict regulation. There are no contaminants and the ingredients written on the bottle are actually what you get.

Let me give you some examples of the studies ignored by most proponents of orthodox medicine: one of the greatest learning and medical institutions in the world, Harvard University in the United States, has been running, for the last 30 years, the Nurses Health Study and the Male Physicians Trial in around 180,000 people. To use the example of a standard multivitamin, when you examine the randomised controlled trial in the doctors up to 10 years, there was no clinical benefit from taking a multivitamin every day. When the data was analysed at 10 years, however, there was a statistically significant 8% reduction in cataracts and common cancers. You may well say, 8% isn’t that much but we’re talking about something that many conservatives argue has no benefit whatsoever. When you look at the observational study in the women at 15 years, there was a 75% reduction in bowel cancer, a 25% reduction in breast cancer and a 23% reduction in cardiovascular disease. Possibly even more striking, is the twenty-year data in men which showed a 44% reduction in cardiovascular disease, purely by taking a good quality multivitamin on a daily basis. This is better than average dose statin drugs to lower cholesterol!

A recent meta-analysis published in Mayo Clinic proceedings showed an 18% reduction in cardiovascular events in people who consumed high-dose fish oil supplementation or regularly consumed fish over a long period of time, but no benefit up to 5 years which is typically the maximum time period for most of the trials in this meta-analysis. The GISSI trial in Italy performed, in a uniform group of patients with acute myocardial infarction given 1 gm a day Omega3 fatty acids in supplement form for 12 months had a 28% reduction in overall death and a 47% reduction in sudden cardiac death. Again, hardly no evidence for benefit…?

Over the last ten years, I have been involved in research on the natural juice from bergamot fruit grown on the southern ionic coast of Italy. We have published a number of trials in well-respected medical journals showing clear reductions in cholesterol, blood sugar, improvements in liver function and profound benefits when combined with statin therapy. There are a number of ongoing trials which will be published over the next few years showing even greater benefit for the regular supplementation with Bergamot polyphenolic fraction.

I should also mention the supplement Ubiquinol, the active component of CoenzymeQ10. Ubiquinol has been shown to reduce statin induced muscle pain along with improved cardiac function, not to mention general improvements in stress levels, sports performance and general energy levels.

One of the “new kids on the block” is vitamin K2, which has some very promising data around arterial decalcification, improved arterial flexibility and improvement in bone strength. Prof Matthew Budoff from UCLA Harbor Medical School has performed evidence-based studies clearly showing Kyolic aged garlic extract reverses atherosclerotic cardiovascular disease over a 12 month period in patients with proven disease, utilising CT coronary angiography.

Many conservative researchers, not working in the field of Complementary Medicine research, do not appear to know the difference between synthetic and natural vitamin E. Synthetic vitamin E has been shown in a number of trials to be of no benefit, and in some cases, possibly even harmful. Vitamin E does not work well without Vitamin C and the only two trials in the history of evidence-based medicine where natural vitamin E was combined with vitamin C both showed an average 25% reduction in the progression of coronary and carotid atherosclerosis. These two trials, IVUS & ASAP have been largely ignored by orthodox medicine.

I have shown above just a few studies from many that show the significant benefit of many aspects of complementary medicine, conveniently ignored by orthodox researchers who promote the benefits of pharmaceutical therapy and medical interventions at the same time weaken and downplay any contribution from complementary medicine.

But, I’m a proud member of the medical profession and feel many of our achievements do go unnoticed and are not recognised by the general public. That doesn’t mean, however, that doctors should be universally proud of the service they provide. Before there is a continued onslaught against our poorer cousins in complementary medicine, shouldn’t we start to try and clean up our own backyard first?

The commonest cause of death and disability across the world is cardiovascular disease. This is closely followed by cancer. The third commonest cause of death and disability in developed countries is Western healthcare, the so-called, true evidence-based medicine. In the US alone, there are an estimated 780,000 deaths on a yearly basis, caused by the intervention of orthodox doctors. This does not include any disability caused by the medical profession. It is estimated that there are over 100,000 deaths a year from the appropriate prescription of pharmaceutical preparations; two thirds of which comes from blood thinners and diabetic treatments. A study was done on coronary angiography in the New York area and an independent body assessed that 65% of angiograms performed were unnecessary. It is estimated that every year in the US there are 20 million unnecessary antibiotic prescriptions written. We hear often of significant side-effects from the long-term use of commonly prescribed pharmaceutical preparation such a statin drugs, peptic ulcer preparations and non-steroidal anti-inflammatory drugs, to name a few.

We also hear of pharmaceutical companies making false claims about the benefits, whilst playing down the potential side effects of drugs. The Medical Journal of Australia in 2012 article published an article by Elshaug et al suggesting 150 potentially ineffective and unsafe services were provided by orthodox doctors. Again, the Medical Journal of Australia in 2015 published an article by Stephen Duckett et al, suggesting there are a number of inappropriate procedures which are typically unnecessary and may cause harm performed by orthodox medicine.

I have said on numerous occasions that I see orthodox medicine like a high-performance motorcar. You get from A to B very quickly but with the potential of crashing and killing yourself if you’re not careful, whereas, complementary medicine in my view is like a bicycle. It will get you from A to B much slower but you also get some exercise along the way. Clearly the rules for the high-performance motor have to be completely different than the rules for the bicycle.

There is no doubt that well designed, randomised controlled clinical trials over a few years should be seen as the gold standard for the evaluation of orthodox therapies. These are vitally important to ensure firstly that strong, synthetic pharmaceutical agents are effective but secondly that they do no harm. As most complementary medicines are closer to food in their safety, it is important researchers who understand complementary medicine scientifically evaluate these therapies but we must realise that to get an answer we need to follow many more people than the sickest of the sick who are typically used for clinical trials of pharmaceutical therapies and also take the much longer time-frame as demonstrated, for example, in the Harvard trials that I mentioned previously. It is my opinion that in the complementary medical trials, all we need is surrogate markers of benefit. To demonstrate mortality & morbidity benefits for complementary medicines would require many thousands of patients studied for 10–20 years & this will just not happen because of the expense & manpower needed.

It is my opinion that complementary medicines keep healthy people healthier and also makes orthodox therapies work so much better. Until a government body foolishly legislates to have complementary medicine on a medical prescription, I believe this still should be an individual choice. Also, it is unbelievably hypocritical for the self-appointed gatekeepers of so-called scientific information (i.e. many academics in the scientific medical world) to criticise a field in which they have little or no understanding about without first attempting to clean up their extremely flawed backyard.