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Tag: multivitamins

  • A Look at the 5:2 Diet and the Fasting-Mimicking Diet  | NutritionFacts.org

    A Look at the 5:2 Diet and the Fasting-Mimicking Diet  | NutritionFacts.org

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    What are the effects of eating only five days a week or following a fasting-mimicking diet five days a month? 
     
    Instead of eating every other day, what if you ate five days a week and fasted for the other two? As I discuss in my video The 5:2 Diet and the Fasting-Mimicking Diet Put to the Test, the available data are similar to that of alternate-day fasting: About a dozen pounds of weight loss was reported in overweight men and also reported in overweight women over six months, with no difference found between participants on the 5:2 intermittent fasting regimen and those on a continuous 500-calories-a-day restriction. The largest trial to date found an 18-pound weight loss within six months in the 5:2 group, which isn’t significantly different from the 20 pounds lost in the continuous calorie restriction group. Weight maintenance over the subsequent six months was also found to be no different.
     
    Though feelings of hunger may be more pronounced on the 5:2 pattern than on an equivalent level of daily calorie cutting, it does not seem to lead to overeating on non-fasting days. One might expect going two days without food may negatively impact mood, but no such adverse impact was noted for those fully fasting on zero calories or sticking to just two packets of oatmeal on each of the “fasting” days. (The oatmeal provides about 500 calories a day.) Like alternate-day fasting, the 5:2 fasting pattern appeared to have inconsistent effects on cognition and on preserving lean mass, and it also failed to live up to the “popular notion” that intermittent fasting would be “easier” to adhere to than daily calorie restriction. 
     
    Compared to those in the continuous-restriction control group, fewer subjects in the 5:2 pattern group expressed interest in continuing their diet after the study was over. This was attributed to quality-of-life issues, with 5:2 fasting participants citing headaches, lack of energy, and difficulty fitting the fasting days into their weekly routine. However, as you can see below and at 1:53 in my video, there has yet to be a single 5:2 diet study showing elevated LDL cholesterol compared with continuous calorie restriction at six months. Nor has it been shown for a year. This offers a potential advantage over alternate-day regimens. 

    Instead of 5:2, what about 25:5, spending five consecutive days a month on a “fasting-mimicking diet” (FMD)? Longevity researcher Valter Longo designed a five-day meal plan to try to simulate the metabolic effects of fasting by being low in protein, sugars, and calories with zero animal protein and zero animal fat. By making the diet plant-based, he hoped to lower the level of the cancer-promoting growth hormone IGF-1. He indeed accomplished this goal, along with a drop in markers of inflammation, after three cycles of his five-days-a-month program, as you can see below and at 2:33 in my video. 

    One hundred men and women were randomized to consume his fasting-mimicking diet for five consecutive days per month or maintain their regular diet the whole time. As you can see in the graph below and at 2:47 in my video, after three months, the FMD group was down about six pounds compared to the control group, with significant drops in body fat and waist circumference, accompanied by a drop in blood pressure. 

    Those who were the worst off accrued the most dramatic benefits, as seen in the graph below and at 3:04 in my video. What’s even wilder is that three further months after completion, some of the benefits appeared to persist, suggesting the effects “may last for several months.” It’s unclear, though, if those randomized to the FMD group used it as an opportunity to make positive lifestyle changes that helped maintain some of the weight loss. 


    Dr. Longo created a company to market his meal plan commercially, but, to his credit, says “he does not receive a salary or a consulting fee from the company…and will donate 100% of his shares to charity.” The whole diet appears to be mostly dehydrated soup mixes, herbal teas like hibiscus and chamomile, kale chips, nut-based energy bars, an algae-based DHA supplement, and a multivitamin dusted with vegetable powder. Why spend 50 dollars a day on a few processed snacks when you could instead eat a few hundred calories a day of real vegetables? 
     
    How interesting was that? All-you-can-eat above-ground vegetables for five days would have the same low amount of protein, sugars, and calories with zero animal protein or animal fat. But we’ll probably never know if it works as well, better, or worse because it’s hard to imagine such a study ever getting done without the financial incentive. 

    To learn more about IGF-1, see my video Flashback Friday: Animal Protein Compared to Cigarette Smoking.
     
    In this series on fasting, I’ve covered several topics, including the basics of calories and weight loss, water-only fasting, and the types of alternate-day fasting, see them all in the related videos below. 
     
    I close out the series with videos on time-restricted eating: Time-Restricted Eating Put to the Test and The Benefits of Early Time-Restricted Eating. 
     
    If you want all of the videos in one place, I’ve done three webinars on fasting—Intermittent Fasting, Fasting for Disease Reversal, and Fasting and Cancer—and they’re all available for download now. 

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    Michael Greger M.D. FACLM

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  • The Safety of Fasting to Lose Weight  | NutritionFacts.org

    The Safety of Fasting to Lose Weight  | NutritionFacts.org

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    Why should fasts lasting longer than 24 hours and particularly for three or more days only be done under the supervision of a health professional and preferably in a live-in clinic? 
     
    Fasting for a week or two can actually interfere with the loss of body fat, as shown at the start of my video Is Fasting for Weight Loss Safe?. But, eventually, after the third week of fasting, fat loss starts to overtake the loss of lean body mass in obese individuals, as seen in the graph below and at 0:14 in my video. Is it safe to go that long without food? 

    Proponents speak of fasting as a cleansing process, but some of what is being purged from our bodies are essential vitamins and minerals. People who are heavy enough can fast up to 382 days without calories, but no one can go even a fraction of that long without vitamins. Scurvy, for example, can be diagnosed within as few as four weeks without any vitamin C. Beriberi, deficiency of thiamine (vitamin B1), may start even earlier in fasting patients. And, once it manifests, it can result in brain damage within days, which can eventually become irreversible.  
     
    Even though fasting patients report problems such as nausea and indigestion after taking supplements, all of the months-long fasting cases I’ve discussed previously were given daily multivitamins and mineral supplementation as necessary. Without supplementation, hunger strikers and those undergoing prolonged fasts for therapeutic or religious purposes (like the Baptist pastor hoping “to enhance his spiritual powers for exorcism”) have ended up paralyzed, become comatose, or worse. 
     
    Nutrient deficiencies aren’t the only risk. After reading about all of the successful reports of massive weight loss from prolonged fasting in the medical literature, one doctor decided to give it a try with his patients. Of the first dozen he tried it on, two died. In retrospect, the two patients who died had started out with heart failure and had been on diuretics. Fasting itself produces pronounced diuresis, meaning loss of water and electrolytes through the urine, so it was the combination of fasting on top of the water pills that likely depleted their potassium and triggered their fatal heart rhythms. The doctor went out of his way to point out that both of the people who died started out “in severe heart failure, complicated by gross obesity; but both had improved greatly whilst undergoing starvation therapy.” That seems like a small consolation since they were both dead within a matter of weeks. 
     
    Not all therapeutic fasting fatalities were complicated by concurrent medication use, though. One researcher writes: “At first he did very well and experienced the usual euphoria…His pulse, blood pressure, and electrolytes remained satisfactory, but in the middle of the third week of treatment, he suddenly collapsed and died. This line of treatment is certainly tempting because it does produce weight loss and the patient feels so much better, but the report of case-fatalities”—the whole part about killing people—“must make it a very suspect line of management.” 
     
    Contrary to the popular notion that the heart muscle is specially spared during fasting, the heart appears to experience similar muscle wasting. This was “described in the victims of the Warsaw ghetto” during World War II in a remarkable series of detailed studies carried out by the ghetto physicians before they themselves succumbed. In a case entitled “Gross Fragmentation of Cardiac Fiber After Therapeutic Starvation for Obesity,” a 20-year-old woman successfully “achieved her ideal weight” after losing 128 pounds by fasting for 30 weeks. “After a breakfast of one egg,” she had a heart attack and died. On autopsy, as you can see below and at 3:44 in my video, the muscle fibers in her heart showed evidence of widespread disintegration. The pathologists suggested that fasting regimens “should no longer be recommended as a safe means of weight reduction.” 
    Breaking the fast appears to be the most dangerous part. After World War II, as many as one out of five starved Japanese prisoners of war tragically died following liberation. Now known as “refeeding syndrome,” multiorgan system failure can result from resuming a regular diet too quickly. This is because there are critical nutrients such as thiamine and phosphorus that are used to metabolize food. Therefore, in the critical refeeding window, if too much food is taken before these nutrients can be replenished, demand may exceed supply. Whatever residual stores you still carry can be driven down even further, with potentially fatal consequences. This is why rescue workers are taught to always give thiamine before food to victims who have been trapped or otherwise unable to eat. Thiamine is responsible for the yellow color of “banana bags,” a term you might have heard used in medical dramas to describe an IV fluid concoction often given to malnourished alcoholics to prevent a similar reaction. (You can see a photo of them below and at 4:53 in my video.) Anyone “with negligible food intake for more than five days” may be at risk of developing refeeding problems. 
    Medically-supervised fasting has gotten much safer now that there are proper refeeding protocols. We now know what warning signs to look for and who shouldn’t be fasting in the first place, such as those who have advanced liver or kidney failure, porphyria, uncontrolled hyperthyroidism, and pregnant and breastfeeding women. The most comprehensive safety analysis of medically supervised, water-only fasting was recently published by the TrueNorth Health Center in California. Out of 768 visits to its facility for fasts up to 41 days, were there any adverse events? There were 5,961 of them! Most of these were mild, known reactions to fasting, such as fatigue, nausea, insomnia, headache, dizziness, upset stomach, and back pain. Only two serious events were reported, and no fatalities. You can see the chart below and at 5:58 in my video. 
    “Fasting periods lasting longer than 24 hr, and particularly those lasting 3 or more days, should be done under the supervision of a physician and preferably in a [live-in] clinic.” In other words, don’t try this at home! This is not just legalistic mumbo-jumbo. For example, normally, your kidneys dive into sodium conservation mode during fasting, but should that response break down, you could rapidly develop an electrolyte abnormality that may only manifest with non-specific symptoms, like fatigue or dizziness, which could easily be dismissed until it’s too late. 
     
    The risks of any therapy must be premised on the severity of the disease. The consequences of obesity are considered so serious that effective therapies could have “considerable acceptable toxicity.” For example, many consider major surgery for obesity to be a justifiable risk, but the keyword is effective. 
     
    Therapeutic fasting for obesity has largely been abandoned by the medical community not only because of its uncertain safety profile but its questionable short- and long-term efficacy. Remember, for a fast that only lasts a week or two, you might be able to lose as much body fat or even more on a low-calorie diet than a no-calorie diet. 
     
    Fasting for a week or two can actually interfere with the loss of body fat. For more background on this, see Is Fasting Beneficial for Weight Loss? and Benefits of Fasting for Weight Loss Put to the Test.
     
    If you’re wondering what the best way to lose weight is, I wrote a whole book about it! Check out How Not to Diet. 
     
    Interested in learning more about fasting? See related videos below. 

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    Michael Greger M.D. FACLM

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  • Do You Need a Multivitamin?

    Do You Need a Multivitamin?

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    In 2013, a group of five physicians from the Johns Hopkins School of Public Health and Warwick Medical School in the U.K. made a bold statement:

    “We believe that the case is closed—supplementing the diet of well-nourished adults with (most) mineral or vitamin supplements has no clear benefit and might even be harmful. These vitamins should not be used for chronic disease prevention. Enough is enough,” they wrote in an emphatic editorial in Annals of Internal Medicine, one of the most popular medical journals in the US.

    Their declaration was based on decades of large-scale studies that found no evidence multivitamins reduced the risk of heart disease or cancer, prevented memory decline, or lowered heart attack rates. 

    In science, however, the case is almost never truly closed. 

    This year, a randomized controlled study of more than 3,500 people over the the age of 60 who took multivitamins every day for three years found they performed better on memory tests after a year. After three years, the multivitamin group showed none of the age-related memory decline evidenced by the placebo group.  

    Does this mean the multivitamin naysayers should start taking vitamin supplements? Who can benefit from them, and who shouldn’t bother?

    Vitamins and Memory Loss

    Dr. Adam Brickman, a neuropsychologist and a professor at Columbia University, led the study on the impact of multivitamins on cognitive decline in older adults. He found people taking multivitamins (in this case, the study used Centrum Silver vitamins, though Brickman says it’s likely any high-quality multivitamin will replicate the same results) experienced a significant improvement in their memory as compared to those in the placebo group after one year, an effect that was sustained on average over the three years of the study. 

    “It’s certainly not a panacea for cognitive aging,” Dr. Brickman says, “but it is a reliable effect.”

    He pointed out that multivitamins are not a treatment for Alzheimer’s or dementia, and everyone should consult with a doctor before taking any supplements. While this study only included people over the age of 60, some research shows cognitive decline can begin as early as age 45. 

    A daily multivitamin is a low-cost, low-risk approach for those interested in covering all bases, but this approach should not come at the expense of eating a varied diet full of fruits and vegetables. A large study of more than 30,000 American adults found that while getting adequate amounts of vitamin A, vitamin K, magnesium, zinc, and copper were associated with a lower risk of early death, those benefits were only found when vitamins came through food, not supplements. 

    “No one is saying that taking vitamins is a replacement for having a healthy diet,” Dr. Brickman says, adding, “This is truly just a supplement that might enhance or bump things up a little bit.” 

    This means that if you do decide to take a multivitamin supplement to hedge your bets, it’s essential to also prioritize good nutrition, which means filling your plate with whole, unprocessed foods and eating a wide variety of fruits and vegetables, whole grains, and lean protein. 

    Vitamins for Athletes

    While the science isn’t clear about multivitamin supplements for the general population, Melissa Boufounos, a Canada-based certified holistic nutritionist who specializes in sports nutrition, says there are certain instances when a vitamin supplement is highly recommended: folic acid for women trying to conceive and during pregnancy, or with a condition like Crohn’s disease, which makes it difficult for the body to absorb nutrients.   

    “In some situations like that, a multivitamin could help fill some gaps where the food might not be processed by the body the way it’s supposed to be,” says Boufounos.

    If most people don’t need to take a multivitamin, what about athletes—especially endurance athletes who regularly push their bodies to the limit? 

    (Photo: South_agency, Getty)

    Alex Larson is a Minnesota-based registered dietitian who works exclusively with endurance athletes. She says when it comes to nutrition, she always starts with food.

    “That’s always the gold standard,” Larson explains, “and a supplement is not a replacement for a balanced diet.”

    Larson does recommend her athletes get an annual or semi-annual blood test to find out if they have any vitamin deficiencies, as well as consult with a primary care physician to make sure there aren’t any underlying medical conditions or medications that might conflict with supplements. Many of the female endurance athletes she works with find their iron levels are low, and she recommends an iron supplement—or better yet, iron-rich food—to help with performance and energy levels.   

    Boufounos agrees, saying she always takes a food-first approach with athletes. She approaches supplementation as a short-term solution to bridge any gaps while trying to correct dietary patterns. 

    “I never want to tell an athlete that they have to supplement long term because you also get into a situation where I think some people unintentionally rely on the supplement,” says Boufounos. 

    She especially sees this phenomenon with green powders, which often contain multivitamins. 

    “I’ve seen so many athletes supplement with a green powder that also had the multivitamin in it and then they’re like ‘Sweet, I don’t need to ever eat a vegetable ever again,’” says Boufounos. 

    How to Choose Your Multivitamin

    If you decide you do want to start taking a multivitamin, Boufounos says it’s important to make sure your supplement meets the recommended dietary allowance (RDA) for as many of the micronutrients as possible. Some supplements have 100 percent of the RDA for only a few vitamins, and the other ones don’t come close to the daily recommendations. 

    More than price, however, look at what’s included in the multivitamin. Boufounos says it’s not worth paying for extra micronutrients if they are in negligible amounts.  

    Both Larson and Boufounos say it’s essential to buy supplements that are third-party tested, especially if you’re an athlete in a tested sport, but also to make sure the supplements are safe and contain exactly what the label claims. Supplement companies that are third-party tested will always state that distinction clearly on their website or marketing materials. 

    Larson also recommends serious athletes who might be tested for their sport take supplements that are labeled NSF Certified for Sport or Informed Choice for Sport. 

    “I would be very careful about just typing in ‘multivitamin’ on Amazon and buying something because there are most definitely knockoffs on Amazon and that can get sketchy pretty quickly,” Boufounos says. She recommends buying supplements directly from the company’s website, not an online storefront. 

    If you plan to start taking vitamin supplements without consulting with an expert, Boufounos recommends sticking with a multivitamin, instead of selecting individual vitamins on their own.

    “It would be safer for an athlete to use a multivitamin if they’ve never done a blood test and never worked with a dietician or a sports nutritionist than it would be for them to just randomly pick any supplement off the store shelves,” Boufounos says, because you might pick supplements that work against each other.

    The science so far is clear about two things: multivitamins appear to help age-related cognitive decline but don’t seem to prevent chronic disease. The best multivitamin strategy—whether you’re an athlete or not—is to focus on food first, supplements second. 

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    Mallory Arnold

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