Mark’s Daily Apple

Dear Mark: Mulling Multivitamins21

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Choices, choices.

Dear Mark,

I’m new to your blog and am interested in taking better care of my health. I’m changing my diet and want to start a multivitamin. I go to the store though and end up bewildered enough that I don’t end up buying anything. What am I supposed to be looking for?

Not surprisingly, I get a good number of questions about supplements. Since it’s a topic I’m obviously passionate about, I’m always happy to offer advice on what my research and experience have taught me about wise supplementation.

First off, I definitely recommend the kind of product you’re looking for: a core nutrient assurance. As you know, I’m all about a good diet – a great diet, in fact. But a great diet with strategic supplementation can offer optimum health benefits A few fundamental suggestions:

• The divide from one “multivitamin” to another can be, well, cavernous. Unfortunately, there’s a lot of junk out there – incomplete, impure, inconsistent “formulas” (if you can truly call them something as intentional as formulas at all). Select a multivitamin from a trusted source to ensure you’re getting a product that offers purity as well as accurate and consistent dosages of nutrients. Yes, you’d think this would be a given, but it’s not. Many products, when tested by consumer advocacy groups, have been shown to not even contain some of their advertised nutrient ingredients or to contain certain ingredients at toxic levels. Some have even been shown to contain lead, presumably from subpar manufacturing conditions.

• I think a “multivitamin” should be more than a collection of a few vitamins. And most people really do want more than that. For the best benefit, look for a comprehensive daily nutrient supplement that offers the full array and appropriate balances of vitamins, minerals, phytonutrients and beneficial plant extracts. I never recommend supplementing piecemeal: a B-6, a calcium
chew, a vitamin C tablet, etc. Not only is this approach incomplete; you risk lack of absorption or redundancy of nutrients. More about that in a minute.

• For maximum potency, consider the freshness of vitamins. Many people would be surprised to know that store bought vitamins can sit on shelves for months or even years before being purchased. (And that doesn’t include the time they sat in warehouses and in multiple transports!) Liquid vitamin formulas, in particular, lose potency relatively quickly and oxidize easily. I would advise against them.

• Speaking of multivitamin “form,” tablets or caplets can be problematic as well. Because uncoated tablets don’t offer any buffer, they can irritate the stomach. On the other hand, caplets can have such a hard coating that they don’t fully dissolve and can become, as nurses call them, “bedpan bullets.” (There’s an image for your day.) On top of that, vitamins in caplet or capsule form can have unnecessary gums, glue, fillers and binders. The key is to find a formula that balances ease of absorption and natural buffering. Capsules with only essential ingredients are best. And I highly recommend a formula that contains enzymes for optimum absorption.

• The mark of a quality formula is the bioavailability and appropriate balance of its nutrient contents. I could talk forever and a day about this subject, but let me just give a few examples of what I mean. A quality formula contains the more “bioavailable” form of vitamin D, which is D3. Cheaper, lower quality supplements contain D2, which also happens to be the form used to enrich milk. A quality formula contains vitamin B12 as methylcobalamin and not cyanocobalamin. It should contain vitamin B6 as pyridoxal 5’ phosphate, the metabolically active form, and not pyridoxine.

• Likewise, the ability of the body to best absorb most nutrients involves those nutrients’ synergistic relationships, so to speak. Take beta carotene. There are over 500 carotenes, and optimum absorption and utilization occurs when they’re taken together. A hallmark of a quality formula: mixed carotenoids. Other examples include spectrum vitamins like B and E (with alpha, beta, delta and gamma tocopherols). Taking only one form of either doesn’t make any sense and won’t do you much good. You might as well throw your money down the toilet. Look for both mixed tocopherols and tocotrienols, the two main groups in the vitamin E complex.

• Finally, there are the basics. It’s important to expect the best in terms of protection. Make sure the bottle is in a protective sleeve. In most cases, multivitamins are only protected by the bottle cap. Also, look for added layers of protection from air and light to ensure freshness and full potency.

If you’re interested in learning more about the benefits and ideal formulations of particular nutrients, I recommend checking out these non-profit scientific research sites. (And, as always, share your choice with your doctor.)

• PLoS Public Library of Science
• Vitasearch
• PubMed

Thanks to all who have sent questions. Please keep ‘em coming!

nats Flickr Photo (CC)

Further Reading:

The ORAC Gift of Health

Debunking Vitamin Myths

Posted: Dear Mark, Health, How To, Men's Health, Nutrition, Personal Improvement, Supplements, Women's Health

Study Finds Frequent Sleep Disruption Increases Risk of Kidney, Heart Disease11

Something else to lose sleep over…

A study published in the April edition of the American Journal of Physiology - Regulatory, Integrative and Comparative Physiology suggests that frequent disruptions in the sleep cycle (also known as circadian rhythm) can increase the risk of kidney and heart disease. (The study is not yet available online.)

Conducted by researchers from the Peter Munk Cardiac Centre at Toronto General Hospital, the study altered the internal biological clocks of rodent (hamster) models using external regulators (such as reversing light and dark periods) and found that the changes resulted in cardiomyopathy (damage and enlargement of the heart) and scarring of the kidney tubules.

Based on findings from this and several other previous studies, the researchers concluded that renewal of organ tissues likely occurs during sleep, suggesting that sleep disruption prevents this process from happening and results in damage to the organs.

The researchers note that these problems may be particularly acute among flight crews, truck drivers, and “graveyard” or other variable shift workers. In fact, while most studies of these populations have focused on the effects of sleep deprivation and concentration and performance, the latest study may help explain why such workers have higher rates of cardiovascular disease. With that being said, the study’s lead author suggests that such workers consider these findings when scheduling work time,” or at the very least “try to maintain a constant working schedule for one month or more [to allow] the body to readjust its clock to external cues.”

Don’t have an erratic work schedule? Unfortunately that doesn’t mean that you’re immune to sleep disruptions. A new baby (or just one that’s acting possessed as of late!), a stressful work project, or even just a few late nights in a row can throw your sleep schedule into a rut.

But, if there’s one tried and true tip for regulating your sleep pattern, its eschewing those weekend lie ins. Yes, it feels great to sleep ‘till noon, especially if you’ve had a rough week, but setting your alarm for just one hour beyond your usual wake up time will allow you to feel well rested without sending your body in to shock once Monday morning rolls around!

joshunter Flickr Photo (CC)

Further Reading:

Americans Get Too Little Sleep

7 Tips to Get Out of Bed

Posted: Health, Men's Health, Prevention, Women's Health

The Salt/Blood Pressure Debate12

Rain, rain, go away…

In response to last week’s canned soup post, reader Dave offered this comment: “I’d just like to point out that just as many Apple readers believe in literature that debunks the lipid hypothesis, there’s a camp that says there is minimal effect on blood pressure from salt. There are two sides to many stories!”

We couldn’t agree more that nutritional (or general health) debates are rarely so simple as they’re made out to be. As long-time readers have probably noticed, we’ll mention salt recommendations now and then and generally try to keep our recipe suggestions fairly low in salt. We do tend to follow general salt recommendations. Blood pressure issue aside, high salt intake (as we mentioned last week) has been associated with osteoporosis, asthma, kidney disease and stomach cancer.

But what about the salt and blood pressure issue? Does it really hold water (pun intended)? We’d say it has enough bearing to figure into our choices, and for some people, research suggests, it’s crucially significant.

For years, scientists have researched the possibility of a “salt sensitive hypertension” that was the general result of a person’s genetic profile. In other words, salt sensitive peoples’ blood pressure is impacted more than the average person’s. To be precise, their blood pressure rises 10% or more in response to a salty meal.

In 2006, researchers at the University of Virginia Health Center announced that they had traced the “sensitive” salt response to particular gene variations and that they were in the process of completing a genetic test for the salt sensitive profile. Salt sensitivity, researchers say, whether it accompanies chronic high blood pressure, negatively impacts the vascular system in the same way high blood pressure itself does. African-Americans are more likely to be salt-sensitive than people of other races in the U.S. The test, once it becomes readily available, will hopefully be a useful tool for people who want to learn more about steps essential for their individual health.

But as for the rest of us, does salt matter for blood pressure? It’s true that many studies in this area, as in all areas, have their failings. And, it’s true that salt is just one piece (albeit an important one) involved in the process of fluid retention and its link to higher blood pressure.

Yet, there seems to be enough suggestion that salt can have a significant or at least measurable impact on blood pressure. A unique look into the connection was found in a recent study that compared blood pressure in groupings of salt mine workers in India, dividing those who worked directly with the processing of salt and those that worked away from the milling plant and its processing steps. The group that worked directly with the salt and had opportunity for inhalation of salt on a daily basis showed higher blood pressure (average of 4 points higher for the systolic measurement) than the group that didn’t work in the mill. After a group of mill workers used face masks and goggles for just four days, their blood pressure dropped an average of ten points in the systolic measurement.

While the above study examines a mode of salt intake other than ingestion, there is no shortage of studies that measure the effects of reducing dietary salt intake. Follow up research on two study groups from the 1990s help strengthen the argument for lower salt intake as helpful in preventing heart disease. Former subjects that had been part of the intake “intervention” group and were given the low salt diet, 10-15 years later had a “25% reduction in the risk of cardiovascular disease.”

Another study out in 2006 showed significant and positive impact of salt substitute use in Northern rural China, which is known to have especially high rates of hypertension as well as high salt intake. The salt substitute, researchers said, “demonstrated that it could reduce blood pressure to about the same extent as single drug therapy.”

And, ultimately, what does a low salt diet look like? First off, it should mean pretty much no processed food. We definitely support that! Up to ¾ of American’s salt intake comes from processed foods – those curious boxed creations you find in the middle of the grocery store, cured meats, etc. Cut those out, and you’re already in good shape. We certainly don’t begrudge anyone reaching for the salt shaker. We do, but we also don’t rely on it for taste. The more people moderate (yes, moderation is the key here, not elimination) their salt intake, the more likely they are to turn to other sources of flavorings, hopefully healthful ones like herbs and more varied, flavorful ingredients like peppers, onions and other vegetables and fruits. At least, that’s what we’d suggest.

This is one of those fascinating discussions that we love to continue. We’re always on the lookout for research from both sides of the issue. Keep your comments coming!

Further Reading:

10 Ways to Reduce Salt

10 Innovative Uses for Salt

Sugar Shock - Salt: The “Forgotten Killer”

The Migraineur: Salt No Longer Generally Recognized As Safe?

Posted: Diet, Health, Men's Health, Prevention, Women's Health

Dear Mark: Hardgainer18

You wanna be scrawny or brawny?

Dear Mark,

I am 6 feet 2 inches tall. I have been eating and exercising in the “evolutionary” or “primal fitness” way for about 18 months, and I was in good physical condition prior to that. I have been lifting weights for years. I am fit and active with a low percentage body fat. My stomach is flat. You can tell that I have abdominal muscles. But here is my hang up: I can’t seem to pack on any extra muscle. I weigh in at 150 pounds. I am the ultimate hardgainer, as they say in the iron game. I’m not looking to become huge. I have a lanky, Jimmy Stewart kind of frame, and no amount of training will turn me into Arnold. But what the heck does a guy have to do to gain a lousy 5-10 pounds of muscle? — Ed

First off, keep doing what you are doing. You’re building the most important base, namely that of health and strength. Eating and training like you are, your body is able to find and develop its perfect, natural design. Ultimately, if you have low body fat, good strong muscles and lots of energy, the most important ratio is power-to-weight.

Your goal of adding a few more pounds of muscle seems doable with intensive effort. Most hardgainers can add 10-20 pounds of muscle with some work. Beyond that it gets increasingly difficult to gain and/or maintain.

Since I don’t know the specifics of your diet and lifting routine, I’ll offer some general pointers here. In terms of diet, extra protein is critical. I’d recommend at least 1 gram of protein per pound of lean mass per day. If you’re older than 50, check out the Mature Muscle post from last month. In it, we mentioned research suggesting that a high protein post-workout snack was especially important for the more seasoned crowd and that high protein food might be a more effective source for the snack than a protein supplement.

I would also suggest including more healthy fats in your diet. We mentioned in the same post that fish oil, which I always recommend for various reasons, can enhance the conversion process of food protein to muscle protein. That suggestion holds for anyone.

In terms of your workout, you can always see a good trainer to ensure you’ve perfected your form. Otherwise, I don’t see any way around the necessity of lifting harder to get the results you want. I’d specifically recommend “CrossFit” style work for you. That means compound movements using larger muscles, which generates human growth hormone immediately post-workout. Again, a trainer who is experienced in CrossFit can offer tips and help you take things to the next level.

On that same note of human growth hormone, it’s essential to get enough sleep. HGH is secreted during sleep, and building takes place during good old shut eye as well.

Good luck, Ed, and let me know how it goes.

Telstar Logistics Flickr Photo (CC)

Further Reading:

How much protein should I be consuming?

More of My Personalized Advice

Eating Fabulous: Fish and fish oil supplements equally effective sources of omega-3s

The IF Life: Building Muscle 101

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Technorati Tags: muscle, hardgainer, fish oil, HGH, human growth hormone, protein, CrossFit

Posted: Dear Mark, Diet, Fitness, Health, How To, Men's Health, Nutrition, Personal Improvement

Reader Response: Fast Food Indulgence, Dirty Marketing Tricks and Personal Responsibility40

Wendy’s, not to be outdone, one-ups Carl’s Jr.

In response to last month’s post about Carl Jr.’s fat fetish, conversation got going about occasional fast food indulgence (the temptations, the how-to’s, etc.) as well as whether we were placing too much blame on corporate marketing and not enough on individual immoderation. Reader Rachel offered this perspective:

I gotta say I don’t see anything wrong with indulging once in a while. I understand the popular opinion is that fast food is bad wrong and should be banished from the world. However, as Carla the first commenter stated “moderation”. We as individuals need to take responsibility for what we eat. The whole idea of “the companies made me eat it” is BS. We control our actions not the evil CKE empire. Yes it looks tasty, yes they market it that way- if they were to market cat food in the same way, would everyone eat that too? Come on now people, let’s start taking responsibility for ourselves and stop blaming the handsome fit young man enjoying the obscene mammoth burger for our lack of self control.

We’re all for taking control and responsibility for our own health (That’s what this blog is all about!), and we agree that innocent victim and evil corporate empire is an absurd representation of the situation. At the same time, we dislike shady, tricky, misleading, dishonest (did I miss anything?) marketing schemes. Carl Jr.’s ad campaign double-dog dares its target audience (which we’ll leave for others to dissect) to stick it to the “Man,” who is, by all estimation, a convenient amalgam of the medical establishment and every health advocate, representative and family physician they encounter. “Talk to the finger, doc! Real men don’t think about their health!” Gee, there’s an inspiring example.

We understand it’s free will at work here and that folks sometimes indulge for the sake of taste or lack of time, airport options, etc. But, let’s look at the real message. Clearly, the ad emphasis isn’t on enjoying their monstrosity burger as an occasional indulgence. Indulgence – the concept, even the very word screams “wuss” in this ad paradigm. “Indulgence (scoff)! This is lunch.”

Here’s the rub. These companies aren’t marketing their fare in the pattern of Baskin Robbins. We’re not talking “treat.” They’re out to sell their product as a “meal” and regular work day routine at that. There’s nothing random about the common image of workers riding together, grabbing their lunch through the drive through with hard hats still on. And the message translates. Life follows ads as much as the ads follow life, we’d argue. And it doesn’t bode well for those individuals down the road. But that part was missing, I believe, from the ad campaign.

Those guys’ choice? Ultimately, yes, but we tend to also find fault with the company that sold them on the daily habit and exploited the ignorance behind the choice. Selling self-destruction just doesn’t sit well with us. (And asking tax payers and/or insurance customers to pick up the tab later for these folks’ folly and these companies’ exploitive profit doesn’t exactly make our day either.)

And then there’s the issue of the seedlings. Happy meals, kids’ menus, cartoon contracts and Play Land (birthdays and play dates always welcome!). Start ‘em young. (Why does this strategy sound familiar?) Sure, blame the parents. We do. Yet, the same argument above holds. Only in this case, it’s the ruin of children’s health that brings in the profit. These kids see that it’s “their” restaurant, their colorfully boxed meal, their accompanying little toy prize, etc. Why, how generous of the corporation to be so thoughtful! Oh, and well-intentioned parents out there: be prepared for the guilt trips if you choose to blow off Ronald and his gang. The ads are careful to illustrate that loving, fun moms and dads take their kids to McDonalds. What’s wrong with you? (O.K., the seedling issue really brings out the fist-shaking curmudgeon in us. We’ll take a breath and back away from the soap box now.)

That all said, we get it that we all make our own choices. And we’re not about letting the perfect be the enemy of the good. Avid apples know that we cherish our sensible vices. What constitutes a sensible vice differs from person to person based on what people truly enjoy, what enhances their subjective sense of quality of life. Sure, we aren’t about to advise anyone to make fast food one of those, but that’s our perspective.

Admittedly, it’s hard to find decent studies about the health effects of an occasional fast food indulgence. There are simply too many variables: what kind of fast food, how much, how often, what the rest of the diet is like, how much exercise, etc., etc. A few studies and more informal experiments (ala “Super Size Me”) have analyzed physiological changes related to fast food consumption over a month’s period, and they aren’t too pretty (increasing blood pressure increase, building insulin resistance, abdominal fat gain, etc.).

One big beef of ours (pardon the pun) is the carb load in these meals. The white bread bun, the acrylamide-laced fries, the mammoth sodas… Can you feel your insulin rising just thinking about it? Clearly, leaving those elements off the table, as some readers said they do, makes a big difference. As for fat? Yes, we’re friends to fats, including the saturated crowd. But 1400 calories and 107 grams of fat in one sandwich seems like a waste of a day’s eating to us.

And what are you really getting with that 1400 calories? Not much in terms of nutrients. A heck of a disproportion in terms of omega ratio. Yikes. (Carl Jr. better be popping them fish pills.) Sodium galore and MSG to boot. Preservatives none of us can pronounce and few of us want to imagine, let alone see in action. (But in case you do, here’s the link to the infamous jar experiment from Super Size Me.)

Each of us makes compromises every day, and as prevalent as fast food is in our society, it’s bound to figure into the picture for many of us. At the end of the day, it’s all about informed choices. And as excessive as fast food ad campaigns might be getting these days, at least there’s more information out there about the foods themselves than there was ten or twenty years ago.
And, gee, it was those crazy health advocates who applied the pressure that eventually resorted in their disclosure! Too bad, Carl.

brainware3000, VirtualErn, soundfromwayout Flickr Photos (CC)

Further Reading:

Carl’s Jr.: ‘Feel Good About Being Fat’

How to Eat More Chocolate and Drink More Wine Every Day

They Did It! A 134-lb hamburger has been constructed! (I hope you can sense the sarcasm.)

Technorati Tags: fast food, compromises, indulgence, indulge, marketing, McDonalds, children, Carl’s Jr., Wendy’s, responsibility

Posted: Carbs, Diet, Health, Hype, Marketing, Men's Health, Nutrition, Raise Healthy Seedlings