Robert Blum Website

Robert L. Blum, MD, PhD

TRANSCEND DRUGS

I recently reviewed the new health book TRANSCEND by Ray Kurzweil and Terry Grossman. While I recommended the book in an Amazon.com review (low-calorie diet, exercise, and relaxation are good things), a major concern was their one-sided discussion of various nutritional supplements.

How does one know that a drug, vitamin, or nutritional supplement really works?

I showed how the arduous process of evaluating medical evidence works in my essay

- Does Drug X Really Work? If you want to know what an A, B, or C Evidence Grade means, read that essay (or just click Evidence Grade).

For those readers who just want the bottom line I will show the evidence grades

that the Natural Standard has assigned to some of the nutritional supplements mentioned in TRANSCEND. My prior essay discusses the detailed process by which Natural Standard assigns their grades. Here I'm just providing a quick overview of their recommendations for some common indications - largely to provide balance to Ray's and Terry's enthusiastic endorsements.

Unfortunately, Natural Standard’s reviews are not available to the public. However,

if you want to see a careful scientific review of your favorite vitamin or supplement you can look

it up on the website of the National Center for Complementary and Alternative Medicine (NCCAM). This is NCCAM’s A-Z Search Page.

Omega-3 Fatty Acids (Fish Oil, EPA, DHA)

Fish Oil gets an A Evidence Grade for preventing cardiovascular disease

in those that have it and for reducing elevated blood pressure.

Fish intake gets a B grade for preventing cardiovascular disease

in those that don't have it already. (Note: that's fish not fish oil.)

Fish oil gets a C grade for preventing atherosclerosis and strokes and for preventing restenosis after angioplasty.

It gets Cs and Ds for a host of other diseases (arrhythmia, cancer, angina, diabetes).

I personally take EPA/DHA.. The American Heart Association and the FDA both recommend eating fish, especially for those with cardiovascular disease. (Note: Overfishing and other human-induced ecodisasters are a concern of this website. Mercury accumulation is also a health concern when eating predator fish. )

(Flash news item as of January 2010: JAMA reports association of Omega-3 Fatty Acid consumption and preservation of telomere length. You want your chromosomal telomeres to be long. They protect the integrity of DNA replication.)

Vitamin E (tocopherols, tocotrienols)

Vitamin E gets a D Evidence Grade (!!!) for Cancer Prevention,

Heart Disease Prevention, and Stroke Prevention. Recall that a D Grade means fairly good scientific evidence against this use.

Vitamin E gets a C grade (unclear or conflicting evidence) for dozens of indications including atherosclerosis, use as an antioxidant, prostate cancer prevention.

If you take large amounts of vitamin E you need to be aware of recent studies that have shown increased deaths.

TRANSCEND, to their credit, does discuss the studies that caused vitamin E to fall from grace. Ray and Terry feel that the studies were biased and should have administered all the various congeners of vitamin E. Following these studies, Kaiser Hospitals pulled all high dose vitamin E capsules off their shelves. I also threw mine away.

Vitamin D

Vitamin D gets a B grade for Osteoporosis prevention.

I take 400 units per day and also get outside everyday.

Multivitamins

Multivitamins are not listed among either the Natural Standard's

or NCCAM's reviews. I can see why. Which do you include and how much of each?

To me the most impressive aspect of decades of clinical research on vitamins is the failure to show any significant benefit.

I take Centrum Liquid because it has only 100% of RDAs - probably worthless but cheap.

(I'm really wary of large doses of vitamin C - who wants kidney stones?.) Ray and Terry need to

cite the evidence that shows that large doses of vitamins work.

Coenzyme Q10

Coenzyme Q10 gets a B grade for hypertension (yoga gets an A !).

For dozens of other indications, CoQ10 gets only a C: chronic fatigue syndrome,

cancer prevention, heart attack prevention, angina, heart failure, Parkinson's.

This is one supplement I've studied a lot, since I take statin drugs to lower my cholesterol.

I am quite convinced that statins lower your plasma level of CoQ10

and that taking CoQ10 raises it. The real question is whether intramitochondrial

CoQ10 is lowered enough in statin patients to cause symptoms.

I'm not certain but this drug is part of my daily regimen. If I didn’t take statins, I wouldn’t take it.

Grape Seed Extract

Grape Seed Extract gets A grades for edema and for chronic venous insufficiency and B grades for vascular fragility and prevention of diabetic retinopathy.

However, for cancer prevention and as an antioxidant it merits only a C. (I tried to take this capsule a few years ago and had to stop - it felt like a bomb going off in my esophagus.)

Alpha-Lipoic Acid

Alpha-Lipoic Acid rates a B for angina and peripheral vascular disease

but only a C for dementia, depression, exercise performance, fatigue, and memory.

I had high hopes for this drug since I'm generally a fan of UC Berkeley’s Bruce Ames whose research backs it. Ames has studied mitochondrial function for years and founded a company, Juvenon, that sells Alpha-Lipoic Acid in combination with Acetyl-L-carnitine, another drug on the TRANSCEND list. Since I'm always looking for a safe energy or cognitive enhancer, I tried Juvenon. It seemed to work for a few days then I was back to baseline.

This seems to be another drug that works in the lab but doesn't stand up to prolonged clinical scrutiny.

Resveratrol

Resveratrol merits only a C grade for prevention of cardiovascular disease and breast cancer, and as an anti-aging tonic. I do not take this drug, although I'm very interested in research done at Sirtris by David Sinclair of Harvard that showed life extension in a variety of lab animals when given huge doses. Sirtris was acquired by Glaxo for 700 million dollars.

Since then the whole world is watching and drinking red wine. I don't.

SUMMARY

The above Evidence Grades are those assigned by the Natural Standard, whose methodology for reviewing supplements I describe in my accompanying essay:

Does Drug X Really Work? Since their reviews are not publicly available, I recommend the reviews done by the NIH’s NCCAM, whose A-Z Search List is Here.

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