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January 2012

Psych meds no better than placebo
Flavonoids lower heart deaths
Vitamin D headlines distort data
Exercise may prevent Alzheimer’s

Psych meds no better than placebo

Placebos can have apparently powerful effects. No one is quite sure how placebos work when they do, and they are not a cure for cancer. However, they often make people feel better in a variety of ways, and this includes people with cancer, heart disease, and other serious illnesses. A recent article suggests that, in the treatment of depression, placebos (pills or other treatments without known physiological effects) have about the same benefits as the selective serotonin reuptake inhibitor (SSRI) anti-depressant drugs, such as Prozac, Paxil, Zoloft, and Celexa, among others.

This does not mean that if you are taking anti-depressants that are helping you that you should stop. It does mean that more research needs to be done and it is worth making other efforts to help depression with exercise, diet, and supplements. These have been shown in research reports to improve depression symptoms (but of course, we don’t know how much of this effect is due to placebo).

In this research, 156 patients with major depressive disorder were treated for 16 weeks. Half were given one medication for 8 weeks, and if they did not respond, they were given a different medication, for the next 8 weeks, both of which were SSRI drugs. The other half were given a placebo for 8 weeks, and those who did not respond were switched to another placebo for the next 8 weeks. (Barber JP, et al., Short-term dynamic psychotherapy versus pharmacotherapy for major depressive disorder: a randomized, placebo-controlled trial. J Clin Psychiatry. 2011 Nov 29. [Epub ahead of print])

After the 16 weeks, depression symptoms were improved in both groups, with no apparent difference between the groups. Prior to treatment, the Hamilton Rating Scale for Depression score was 14 or higher for at least two weeks. The only group that appeared to benefit from the medication more than the placebo was white women. It is apparent from this study that for most people these anti-depressant drugs are not worthwhile.

However, there may be subsets of patient groups aside from white women, or individuals, who do respond but were not studied as separate groups. Also, all patients in the study received some form of clinical management and this might have reduced the between-group differences. With the cost and potential side effects of the medications, I think we need better evidence that they work before recommending them. It is a good idea to check with your doctor before stopping any such medication, and refer them to this study to get an informed opinion.

Flavonoids lower heart deaths

Diets that include moderate to large amounts of plant-derived chemicals lower the risk of death from heart disease and strokes. Researchers analyzed the diets and lifestyles of 38,130 men and 60,289 women with an average age of 70 and 69 years respectively, and followed them for seven years. The diets were analyzed for total flavonoid composition, and seven individual flavonoids including anthocyanidins, flavan-3-ols, flavones, flavonols, proanthocyanidins and two others.

During the study, there were 1589 cardiovascular deaths among men and 1182 deaths among women. Men and women with the highest intake of total flavonoids had an 18 percent lower mortality risk compared to those with the lowest intake. The five flavonoids listed above were each associated with lower risk. In men, those with the highest flavonoid intake had a 37 percent lower risk of stroke mortality compared to those with the lowest intake. (McCullough ML, et al., Flavonoid intake and cardiovascular disease mortality in a prospective cohort of US adults. Am J Clin Nutr. 2012 Feb;95(2):454-64.)

Flavonoids are only found in plant foods, such as grapes, berries, citrus, legumes, cherries, eggplant, onions, kale, soy, and a wide variety of other plant sources. They often impart characteristic colors to foods (such as the yellow in apples and onions, the purple in grape and eggplant skins, and the deep red in cherries). It is not clear from this study that the flavonoids were solely responsible for all the benefits that were observed. These foods are also rich in other nutrients (such as magnesium and vitamins) and fiber. In many other studies these additional nutrients have been shown to be beneficial. In the data from this study, any increase in the intake of fruits and vegetables provided some benefit.

Vitamin D headlines distort data

Another negative news report on vitamin D suggests a bias against nutrients and supplements. The headline in HealthDay News on January 10th said “Too Much Vitamin D Could Be Harmful to Heart.” The text of the article pointed out that raising low levels of vitamin D to what they called normal would decrease CRP levels but that going higher than that would start to increase CRP levels. CRP (C-reactive protein) is a marker for inflammation that has been associated with higher heart risks.

The details of the study reveal a different picture. The data were derived from the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2006 and they included information on 15,167 participants. The serum vitamin D in the different groups ranged from 15 ng/ml in the lowest quartile up to 27 ng/ml in the quartile with the highest vitamin D levels.

And here lies the difficulty. Most recommendations now are to keep serum vitamin D levels at least above 30 ng/ml, and preferably from 40 to 100 ng/ml. The range of vitamin D in this study is relatively low at all levels, so it is not a fair conclusion to say that higher vitamin D levels might increase heart risks. In addition, the data were only related to CRP levels not heart deaths. (Amer M, Qayyum R, Relation between serum 25-hydroxyvitamin d and C-reactive protein in asymptomatic adults (from the continuous national health and nutrition examination survey 2001 to 2006). Am J Cardiol. 2012 Jan 15;109(2):226-30.)

This is especially relevant because of other studies that are directly related to cardiovascular mortality rather than the marker. In a study that I reported on in November, the researchers considered anything less than 30 ng/ml to be deficiency levels. Of the over 18,000 subjects that they studied, vitamin D levels below 30 ng/ml had a significantly higher mortality from heart disease and all causes. In fact, vitamin D deficiency was associated with a 2.64 times increase in mortality compared to normal levels. Those who took vitamin D supplements had a 61 percent reduction in mortality. These authors noted that vitamin D deficiency (levels below 30 ng/ml) has been associated with hypertension, peripheral vascular disease, diabetes, metabolic syndrome, coronary artery disease, and heart failure. Headlines such as the one from HealthDay News do a disservice to readers and are likely to cause more suffering and death.

Exercise may prevent Alzheimer’s

Exercise has benefits for brain function. It improves circulation, reduces stroke risk, enhances cognitive abilities, and improves mood. A new study shows that it also has some specific metabolic effects that might ward off Alzheimer’s disease in people who have a genetic marker that is associated with greater likelihood of developing the disease.
A total of 201 adults 45 to 88 years old with no cognitive abnormalities were recruited and then tested for an apolipoprotein-E (APOE) genetic variant associated with Alzheimer’s disease. They also reported their exercise status over the past 10 years, and were categorized as having high or low levels of exercise. Cerebrospinal fluid was analyzed for levels of beta-amyloid, a substance that is deposited in the brain of Alzheimer’s patients. (Head D, et al., Exercise engagement as a moderator of the effects of APOE genotype on amyloid deposition. Arch Neurol. 2012 Jan 9. [Epub ahead of print])
Only among the carriers of the APOE genetic variant for Alzheimer’s was there an association of exercise level with the level of amyloid in the CSF. Exercisers had less amyloid than sedentary subjects. Whether you know your genetic status, it is worth maintaining a physically active lifestyle for its many benefits and the possibility that it may help prevent this serious disease.

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From September to June, I see patients in New Smyrna Beach, Florida.
Call 386-409-7747, or send an email to to make arrangements.

In summer, I have a variable schedule, and I see patients in offices at the
Rothfeld Center for Integrative Medicine in Waltham, Massachusetts. For appointments, send an email to make arrangements, or call: 386-409-7747.

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Information herein is not medical advice or direction. All material in this newsletter is provided for information only. Its contents should not be used to provide medical advice on individual problems. Consult a health care professional for medical or health advice.