Vitamins, supplements and

[Guest guest]

There has been some talk in the past weeks about vitamins and

supplements that were suggested could be needed by us. The topic is a

complicated one. First I want to point out some general things on the

topic and then some about specific supplements.

Among the sciences nutrition is in one of the worst states. I don't say

to insult anyone in the field. It isn't the fault of those doing

research in nutrition or those that have the job of educating and

treating others about it. The problem is that what happens in the body

for and due to nutrition is so complicated that science has not had the

tools needed to understand it at the level that is really needed to make

some of the conclusions that are often speculated. Much of what we hear

as nutrition gospel is actually just speculation. It is often

speculation based on some science and it is often the best guess there

is as to what is happening but it is also often wrong. What looks simple

like 2+2 leads to the speculation that 4 is the answer but often the

situation only looks like 2+2 and is in fact much more complicated and 4

is not the answer or at least not the complete answer. In other cases

the data was bad or even faked to start with. That isn't just a problem

in this science it is a problem for a lot of sciences. Some claims in

nutrition actually have political reasons for their existence. Still we

need to make choices and nutritionists have to do the best job they can

with the data such as it is. That means that some of what they claim is

actually wrong and changes over time. Remember when coffee, tea, wine,

and eggs were bad and sucrose was worse than fructose?

Here is an example that goes to the recent discussions. Research has

shown that DNA can be damage by oxidation. That is a chemical reaction.

There are also chemicals that can reduce or slow down the oxidation

reactions. These are called antioxidants. Problem: it is likely that

some aging and cancers are cause by this type of damage. This looks like

2+2 and the simple answer is 4, antioxidants, take more antioxidants and

have less cancer risk and slow down aging. About ten years ago we were

regularly hearing in the news that we should be getting more

antioxidants for these reasons. I will admit I bought into it. I should

have had some doubts as should have anyone that has knowledge of how the

immune system works. For those that don't see where this is going, the

immune system uses oxidation to attack cells it wants to destroy. These

could be germs or even some types of cancer cells. Now our 2+2 looks

like 2+2+F(i), where F(i) is an immune function. Is the answer still 4?

For some cancers it may still be 4 but the complete answer is much more

complex. In recent years evidence from studies has come out that some

cancer risks are increased if you take large doses of some common

antioxidants supplements, including some antioxidant vitamins. We could

have seen that coming.

If you have achalasia do you need more antioxidants? In one form of this

question the assumption is that achalasia causes us to have poor

nutritional intake. That may be true for some but many of us get as good

of nutrition as we would have without achalasia. For many it just means

that eating can be frustrating and take more time than it should but in

the end they eat what they would have anyway. For others there may be

choices made for easier food to get down but that alone does not mean

they are substituting bad choice that would leave them needing more

antioxidants. Then there are those that are almost starving or are

starving. How much do they need? No one knows how much anyone needs, nor

do they know what combination of the thousands of antioxidants that are

in the world would work best. What has been shown is that some amount

may help protect against some cancers but too much of some may increase

your risk of cancer. If a person that is near starving takes a lot of

one antioxidant or even a lot of a combination by supplements it may be

possible that cancer risk will be increased not decreased. More data is

needed to know. Until there is better data we have mostly speculation

which could be very wrong.

Again, If you have achalasia do you need more antioxidants? There is

some evidence that achalasia is an inflammation disorder. That is, there

seem to be inflammation in the tissue where the nerves are being damaged

and destroyed in achalasia. Inflammation is caused by oxidative

processes. Here again we seem to have something as simple as 2+2 and the

simple answer would be reduce the inflammation and one way to do that

would be antioxidants. One of the reason aspirin may be good for so many

things is that it is anti-inflammatory. So it seemed that perhaps other

things that are anti-inflammatory may be good for achalasia. That is

just speculation and I admit that I have shared that speculation in this

support group, but I present it only as speculation. Along that line of

though things such as turmeric have been discussed. Turmeric is food

(spice) and if people want to try adding some of it to their meals that

seems harmless to me. One person though took the idea further and

started taking large amounts of curcumin which is extracted from

turmeric. I questioned the wisdom of taking large doses of the

supplement. That person is no longer posting in this group but I believe

from things that have been past to me that the large doses did not work

out well. But what about other antioxidants? We need to ask the

question, is the inflammation in the esophagus the source of the

destruction? Perhaps the immune system is going bonkers in this case but

it could also be that the inflammation is from the immune system doing

what it suppose to. Either way we are back to 2+2+F(i). Better data is

needed to go beyond the speculation.

I find it ironic that many people who would tend to take antioxidant

supplements are the same people who take other supplements to boost

their immune systems. If you think of the immune system as being the

body's attack dog they want to make theirs a large pit bull with a good

bark and strong bite, but when they take lots of antioxidants they may

be muzzling it so it only has the bark and bite of a chihuahua. Better

data is needed to be sure.

Changing the subject now to B vitamins, especially B12. First, let me

say that B12 seems to be harmless so you probably safely load up on it

if you want to. But do you need it? Again, just because a person has

achalasia does not mean they also are low in B12. Vegetables do not

provide any B12. You get most of your B12 from meat dairy and eggs. If

you aren't eating enough of those kinds of foods you could have a B12

problem. It takes stomach acid to brake down the food to release the

B12. If you are on a PPI or H2 blocker to prevent acid reflux you could

have a problem with B12 but many people will do fine even on those

medications if they eat enough of the right foods. The stomach also

makes a substance called intrinsic factor which is also used for the

absorption of B12. Damage to the stomach, even surgery can cause the

stomach to produce less intrinsic factor. The heller myotomy should not

cause that problem but a gastric pull-up esophagectomy could. Some

Autoimmune problems can cause problems with intrinsic factor. As we age

it becomes harder to absorb B12 and people over 50 may have problems but

not everyone develops a problem. Diabetics taking metformin may also

have problems with B12 but most do not. The main things achalasia would

contribute to that list is the need for medications to prevent acid

reflux after a myotomy (if needed) and esophagectomy (which most don't

have done). Otherwise we probably have the same risks as others our age

who eat the same diets we do. For some diet may be a problem but for

many of us diet is not a B12 issue.

If you want more B12 what should you do? First we need to clear up a

couple of confusing topic. First, B12 is absorbed in more than one way.

The main way is with intrinsic factor and special cells that are used to

work with it. The second is through what is call passive absorption. In

passive absorption the B12 is absorbed by the gut, including the mouth

and esophagus, without the use of any special cells or substances like

intrinsic factor. Most of the B12 people absorb is through cells that

work with intrinsic factor. When the intrinsic factor system does not

work passive absorption is what is left. Second, sublingual (under the

tongue) pills use passive absorption, but there is nothing special about

the passive absorption ability of the mouth. Many people are confused

about that, even people who should know better. The main, justifiable,

reasons to use sublingual pills is because a person has trouble

swallowing pills or the medication will be destroyed in the stomach. B12

pills can be chewed and are not destroyed by the stomach so these are

not justifiable reasons in this case. If you have problems with low

stomach acid or intrinsic factor if you take large enough doses of the

regular pills, not the sublingual, you will absorb enough B12, without

sublinguals or shots saving a lot of money. In achalasia stomach acid is

usually just reduced not stopped when being treated for acid reflux.

Therefore, one may just need a little more B12. In that case changes in

food choices may be enough or an occasional supplement may be enough.

The liver can store enough B12 to last years if there is not a problem

with the intrinsic factor system. Eating liver is a very good to way to

get large amounts of B12. Some B12 supplements are just dessicated beef

liver powder. To get large doses of B12 pills with beef liver are often

fortified with cyanocobalamin (a form of B12). Some people are

needlessly afraid of cyanocobalamin because of the cyanide it contains.

The amount of cyanide is very small an does not at that level cause

toxicity. The cobalamin (B12) part of cyanocobalamin is used to treat

cyanide poisoning so not only is the amount of cyanide very small it

also comes with its own antidote. Some foods like cereals are fortified

with B12. Energy drinks sometimes contain a lot of it and other B

vitamins. Because the liver can store a lot of B12 you don't need to get

a lot every day. That is why B12 shots are generally done once a month.

So, you could take a little extra B12 everyday, or a lot in one large

dose pill once a week or month as needed and save some money.

B12 also comes in B complex supplements. These are supplements that

contain more than one kind of B vitamin. There are 8 real B vitamins and

some other substances that are sometimes called B vitamins, such as

substances from cyanobacteria (spirulina) and algae even though these

other substance may not be of value to us. Of the 8 most are very safe,

but two, B6 and B3, can be toxic. According to the Office of Dietary

Supplements (ODS) at the National Institutes of Health the upper safe

level of B6 is 100mg daily and the recommended daily dose is 2mg or

less. MedlinePlus also at the NIH says the safe B3 amount is 35 mg or

less and the recommended amount is half that. According to a GNC web

site GNC Big 100® (Vitamin contains 100 mg of both B6 and B3. (Some

B complexes contain even more of each.) Some people have problems with

B6 if they take even less than 100mg a day. Not at first but over time.

The safe level of B6 probably needs to be lowered, but even many doctors

are unaware of the problem and will miss it as the cause of them. 100mg

of B3 probably is not a problem for most people even though it is above

the safe amount. As a treatment for high LDL cholesterol and low HDL

1000 - 3000 mg of B3 is often used, but liver tests must be done to

watch for liver damage. Many patients can not take those levels without

liver damage. One of the problems with complexes like this is that

people often don't know that their B vitamin complex is adding to the

does of these medications. Add to the B complex an energy drink such as

5-Hour Energy®, which according to GNC has 33mg of B3 and 40mg of B6,

and a daily multivitamin and fortified foods and you could be getting

150 mg of each of these two B vitamins before you even take medication.

The study cited in the link below reported neurological symptoms of

toxicity in 103 women who took an average of 117 mg/day of B6 for an

average of 2.9 years. The study has some weaknesses but it is hard to

completely dismiss.

Characteristics of pyridoxine overdose neuropathy syndrome.

http://www.ncbi.nlm.nih.gov/pubmed/3630649

B6-Toxicity discussion at MedHelp (interesting stories).

http://www.medhelp.org/posts/Nutrition/B6-Toxicity/show/2642?page=1

Vitamin D and calcium are also suggested by some that we should

supplement. Your body should make D when exposed to sun light. Some

foods naturally contain small amounts of D but most people, at least in

the US, get most it by eating fortified foods, such as milk and orange

juice. There are two forms of D, D2 and D3. D2 is synthetic while D3 is

our natural form. Some metabolites of D2 are not natural either. For

large doses D3 may be a better choice. With achalasia some people who

are not eating enough in general may not be eating enough foods high

enough in D. A lot of people without achalasia don't get enough D in

their food, so it isn't surprising that we could have a problem too.

Some of us also take PPIs. There are studies that report an association

between taking PPI long-term and having bone fractures (not necessarily

a cause and effect relation, even though it is often reported that way,

even by people in this group who have been told better). D is important

for calcium absorption and keeping bones healthy. 2+2 right? Take extra

D and calcium for the bones. Maybe not. First, as I said the evidence on

PPIs is association not causation so PPIs may not be a problem anyway.

Second, while D is generally not toxic per se, the effect on calcium can

be. I had my D checked and found that I was low. Which was a surprise

because I get a lot of sun and figured it would have been enough for me,

but I guess I must be old enough that my production of D from sun shine

has been reduced too much. Which happens as we age. In my case even

though I was low in D I was not low in calcium and if I had taken D with

calcium I would probably have cause my calcium level to become too high,

hypercalcemia, not a good thing. You don't have to take D to cause

hypercalcemia but it is much easier to cause it while taking D and

calcium together. Just taking too much calcium can cause it. Did you

know too much calcium is toxic? Sometimes called Milk Alkali Syndrome it

can destroy your kidneys. If you are taking supplements of either D or

calcium it is good to tell your doctor in case he wants to check your

levels. One of the things hypercalcemia can do is cause uncontrollable

erratic blood pressure. There are other problems listed in the following

article:

Mayo Clinic - Vitamin D Toxicity

http://www.mayoclinic.com/health/vitamin-d-toxicity/AN02008

Article by a diabetes bloger about her case of D toxicity

http://diabetesupdate.blogspot.com/2010/06/too-much-vitamin-d-and-calcium-troubl\

e.html

Very interesting and has some good links.

MedScape - Milk Alkali Syndrome

http://emedicine.medscape.com/article/123324-overview

Celseton, Achnical, Achlotab and Achlitin are herbal supplements that

the maker(s) claims are for treating achalasia.

First, it is illegal in the US to make such claims without FDA approval.

These are not from the US though, in spite of the FDA disclosures on the

sites. Three years ago when I first checked out Achlotab and Achlitin

and achalasia-options.com the site was connected to a London address

that was the address of a company that provided virtual offices for

companies from around the world. That address is still used by some of

the web sites for " Society for the Promotion of Alternative Health. " See

message 51583. Another thing I found then was that if you look at the

FAQ at: http://achalasia-options.com/faqs.html you will notice it talks

about " Skin Abscess sufferers " in the " What is the purpose of this

website " section of the page. Three years later and that has not been

fixed. So what, you ask. Check these out:

http://www.myelodysplastic-options.com/faqs.html

http://uterinefibroids-options.com/faqs.html

http://jockitch-options.com/faqs.html

for more see:

http://www.google.com/#q= " Skin+Abscess+sufferers "

I estimate that about a hundred of these hits are these kind of pages.

You have to let Google show the redundant pages.

Today Celseton is connected to an address in Norway that is a Mail Boxes

Etc. location, with the name " Oslo Health Solutions. " There is an

interesting article about OHS at:

http://www.tv2.no/underholdning/hjelperdeg/internasjonal-helsesvindel-med-kontor\

-i-norge-2912298.html

You will probably have to put that URL into a translator, such as:

http://translate.google.com/

Check out:

Now for some real fun! Goto: http://www.celseton.com/ Notice the

statement saying " After eight years of extensive research and

development work, we take pride in presenting to you an all natural

product for Achalasia! " Wow, eight years of research on an herbal cure!

And, its for a rare disease like achalasia. Who would believe it? Now

copy " After eight years of extensive research and development work " and

use it in a search like:

http://www.google.com/#q= " After eight years of extensive research and

development work "

Looks like eight years is the exact amount of time needed to develop a

" natural product for " any of hundreds of diseases. That's a lot man

years! Thank-you " Gordon's Herbal Research Center " in New Zealand. You

can also search on that name. Not as much fun though.

Next, goto: http://www.achnical.com Look at that, Achnical " has been

shown in clinical trials to provide a complete Achalasia cure rate in

90% of subjects. " Let's try to find them on PubMed. Try this:

http://www.ncbi.nlm.nih.gov/pubmed?term=achnical

No luck there. Maybe it was under the ingredients. After checking the

http://www.achnical.com/formula.html page we can try:

http://www.ncbi.nlm.nih.gov/pubmed?term=Arillus Myristicae Elephant

Creeper Nutmeg Saffron Serpentine

No luck there either. Arillus Myristicae is the spice mace. That give us

two possible searches:

http://www.ncbi.nlm.nih.gov/pubmed?term=mace AND achalasia

and

http://www.ncbi.nlm.nih.gov/pubmed?term=Myristicae AND achalasia

No luck. If the studies were published it wasn't indexed with PubMed.

Time for more fun! Notice the Testimonials section on the right side of

the achnical.com pages. I like the second one, " Results in 7 Days - JML

June, 2007 " Let's put that into a search:

http://www.google.com/#q= " Results in 7 Days - JML June, 2007 "

Wow, WOW, that JML was one sick puppy. I am surprised JML lived out the

seven days to see results having those hundreds of diseases. I see one

of JML's conditions was Polymyalgia Rheumatica. Let's see what the cure

for that is at: http://www.melgical.com/formula.html " Ingredients of

Melgical " :

Arillus Myristicae, Elephant Creeper, Nutmeg, Saffron and Serpentine . "

And on the main page it says, " Melgical has been shown in clinical

trials to provide a complete Polymyalgia Rheumatica cure rate in 90% of

subjects. " Look familiar? I wonder if JML knew that or bought a separate

bottle for each disease at $80 a bottle, and took the pills for all of

them each day of the seven days?

These guys at:

PO Box 2175

Paleagade 7

DK-1231

KBH K

Denmark

don't give a company name. The copyright is " -2009

company name. " Maybe " company name " is it.

Achlotab is also on the web at Achlotab.com which is a Oslo Health

Solutions site that lists their address as:

Suite 329

Youngstorget

NO-0028 Olso

Norway

Achlitin, (BTW: it is " Homeopathic. " How wonderful. Not!), is at

http://achlitin.com they are one of the Berlin Homeo Products web pages

and list their address as:

Markgrafenstr. 56, Suite 110

Berlin 10117

Germany

Who are these people? Check out " One Sick Mother " :

http://onesickmother.typepad.com/my_weblog/

and on the left under Scams click " SPAH: The Medical Scam Clearinghouse. "

Time for a review site:

http://www.achalasiaproducts.com/

Look at those products. Guess who is behind this? It claims to be by

made by an achalasia suffer. Maybe it was JML our achalasia suffer with

all those other diseases. If you take the statement from the page that

says, " it's nearly impossible to determine which treatments work and

which ones don't. If all of them claim to use natural ingredients " and

dump that into a search engine guess what you get? Yep, this person not

only has hundreds of disease but has tried the products for all of them

from all the sources. Good thing these products are " safe! "

One Sick Mother did a good article on the above reviews and who is

behind them:

http://onesickmother.typepad.com/my_weblog/2009/08/herbal-product-reviews-scam.h\

tml

Entertainers often provide medical advice. Some of these entertainer are

MDs. My problem here is that almost all of the entertainer MDs I know of

seem to be in the business of entertainment first and health second. So,

they choose to give advice that is more likely to cause people to come

back and be entertained than to give accurate information. This is just

human nature. My primary doctor once said to me that GIs are in the

dilatation business and surgeons are in the surgery business so guess

with treatment for achalasia each is likely to suggest? It isn't that

they are being evil they believe in their products. The entertainer

believes in his show and his producers and staff who may be making more

of the " health information " decisions than you would expect. Buyer

beware, whether it is doctors, entertainers or herbalist. There are good

ones and bad ones and all are likely a little biased, and as we have

seen above some are evil.

Last, if you try any of the things discussed here please tell your

doctor, or better yet, check with him first.

notan