1. A Lifetime of Quality Care That’s Convenient & Complete Dietary Supplements (Part 3) Robert Grimshaw, MD FACP A Lifetime of Quality Care That’s Convenient & Complete

2. Dietary Supplements (Part 3) Continuing our series on popular supplements, from the American College of Physicians meeting and other sources. Remember, purity and potency are not guaranteed under American law because they’re considered foods. I don’t recommend any supplements without careful thought and consultation; a good way to think of this is “if it has an effect, it will have a side effect.”

3. A Lifetime of Quality Care That’s Convenient & Complete Dietary Supplements (Part 3) Glucosamine is the most popular supplement for osteoarthritis. As readers of these pages are aware, a well-designed Belgian study reported in early 2000 showed slowing of structural damage to the knee. Dose is 1500 mg per day. Side effects are few, but it might worsen blood sugars in diabetics or prediabetics. Several weeks may be required to show an effect.

4. A Lifetime of Quality Care That’s Convenient & Complete Dietary Supplements (Part 3) Chondroitin is frequently used in combination with glucosamine. The number of studies in humans is very small, but there appears to be a modest benefit in osteoarthritis at 4-6 months. Both “nutriceuticals” act in different ways to enhance production of cartilage matrix by the chondrocytes that provide the joint lining. Studies of one agent against the other or against the combination haven’t been done. And it’s hard to make chondroitin: 6/13 products studied flunked quality testing.

5. A Lifetime of Quality Care That’s Convenient & Complete Dietary Supplements (Part 3) DHEA: (dihydroepiandrosterone) is being used to improve sexual function, and also for preserving thinking, improving strength and slowing aging. DHEA is harvested from animal adrenal glands and is in the same group as testosterone. Evidence for erectile function comes from the University of Vienna, with improvement in a 40 patient trial for 6 months. The dose was 50 mg per day. Studies of DHEA in depression, osteoporosis, strength, lupus, and weight loss have shown intriguing trends, but all had small numbers of participants (generally less than 10 in the treatment arms). Side effects include acne, irritability, increased appetite, drop in “good” HDL cholesterol, prostate enlargement and liver toxicity (much as oral testosterone). I could find no long term safety studies.

6. A Lifetime of Quality Care That’s Convenient & Complete Dietary Supplements (Part 3) SAM-e: (S-adenosyl-methionine) - pronounced “Sammy” - is being touted for depression, arthritis and liver disorders. SAM-e is found through-out the body, including the brain and spinal cord. A review of 20 studies (giving it by vein) show improvement in mood and symptom improvement at least as frequent as with older (tricyclic) antidepressants. There’s little data on oral SAM-e. For some liver conditions, it may be superior to placebo; for arthritis, the data is scant. It can cause thirst, salivation, head-ache, nausea, diarrhea and urinary frequency. It changes the metabolism of 3 important neurotransmitters: serotonin, norepinephrine and dopamine. Drug interactions are to be expected, but haven’t been studied. And, it’s very hard again to make it: chemical stability of the oral form has been a problem and on testing some pills had no detectable SAM-e in them.

7. A Lifetime of Quality Care That’s Convenient & Complete Dietary Supplements (Part 3) Selenium: this antioxidant has been suggested for preventing prostate cancer and other cancers, heart disease and sun damage to skin. The evidence on cancer comes from a study at the University of Arizona. Dr. Larry Clark found that patients taking 200 micrograms daily selenium had 63% less prostate cancer, 58% less colorectal cancer and 45% less lung cancer. There were some 1300 patients in the study published in 1996 in the Journal of the American Medical Association. That study is yet to be confirmed by similar one. Other studies have shown that areas of the country with low selenium in the soil (such as the Pacific Northwest and some parts of the East Coast) have higher rates of such cancers. We should point out that a blue ribbon panel of the Institute of Medicine recently set the recommended level at 55 mcg per day, with the upper limit of 400 mcg per day. Those taking too much can have brittle nails and hair loss. Sources of selenium include yeast, whole grains, fish, meats and nuts.

8. A Lifetime of Quality Care That’s Convenient & Complete Dietary Supplements (Part 3) MSM: or methylsulfonylmethane, has been recommended for arthritis, muscle pains, asthma and headaches, as well as emphysema, cataracts, allergies depression and even constipation. It is expensive, and is very similar to an industrial solvent called dimethyl sulfoxide (DMSO). The theory of action of this supplement is that the body uses sulfur (which is in MSM) for cell oxygenation and cartilage and collagen manufacture. There are no long term studies and few if any published scientific studies. It is difficult to imagine anything that would have as many benefits as claimed for this one. Bottom line: unproven.