Food & Nutrition

Will Dietary Supplements Harm You?


Will Dietary Supplements Harm You?

The Takeaway First

You may have heard a report showing that 23,000 emergency room visits every year are due to children and young adults taking dietary supplements. Scary, right? Not exactly. In this post, I’ll talk about why we need to be careful about hype and misinformation, and what you need to do to take supplements safely.

The Details

It has been estimated that 23,000 emergency room visits every year involve children and young adults who have taken dietary supplements (Geller et al., 2015). Every year, 2,100 people are hospitalized due to adverse side effects of supplements. With the exception of sexual enhancement and body building supplements, women are more affected than men.

  • Weight loss and energy products caused over 71% of adverse events with symptoms of faster heart rate, palpitations and chest pain.
  • Close to 60% of the study participants were between 20 to 34 years olds.
  • Reports were collected from 2004 to 2013.
  • Among those 65 years and older, choking on pills, mostly calcium pills, was most prominent side effect.
  • The number of ER visits and hospitalization was only 5% of those from pharmaceutical medications.
  • No deaths were reported from the consumption of dietary supplements.

(Geller et al. 2015)

My Take On This

Comparing dietary supplements to pharmaceutical drugs, a common occurrence, is inadequate. They work much differently and the intelligent use of both can be extremely helpful in improving health. Of course, I tend to begin with natural therapies first and work from there.

But it is worth noting that Geller and his research team did report that the 23,000 hospitalizations caused by supplements was tiny compared to the hospitalizations caused by pharmaceutical meds, but most reports keep ignoring that fact.

It is important to keep in mind that over 700,000 people get hospitalized from using pharmaceutical medicine annually (Budnitz et al. 2005). That’s about 2.5 people for every thousand. Additionally, medical drugs have caused 2,100 reported deaths over the past eight years. (Shepherd et al. 2012)

There are problems in the supplement industry, no doubt. There are tainted herbal sexual enhancement formulas, like what Lamar Odom was taking a few weeks ago. And young kids are notorious for consuming too many supplements designed to make them gain muscle and lose fat.

Also, weight loss supplements can have side effects if consumed at very high amounts because many contain stimulants such as caffeine or bitter orange (sineprhine). Stimulants decrease appetite and burn fat, but when taken at high amounts they can cause heart palpitations and chest pain.

What Should You Do?

Numbers are all relative. In 2013, there were over 4,000 pedestrian deaths compared to 188 by flight. But mortality from airplanes is far more impactful. When huge numbers are thrown at you by the media, they do not mean anything unless there is a reference point.

As always, don’t believe the hype.

A bigger problem than the hype and misinformation is tendency of people to take dietary supplements haphazardly, without expert guidance. Occasionally there will be an unwanted side effect (though this is uncommon) but the most common problem is inefficacy – either from using the wrong combination of nutrients or from too small a dose.

Who should you talk to? Experts in the use of dietary supplements are naturopathic doctors, functional medicine practitioners or certified nutrition specialists (CNS). Experts on the therapeutic use herbs include, but not limited to, professional members of the American Herbalist Guild.

With few exceptions, health store clerks don’t know more than you do about supplements. They just work there.

The Bottom Line

If you have seen that a group of supplements work for you, continue them. The chances of getting an adverse reaction are minimal. Always seek the guidance of an expert. Don’t believe the hype. Be smart. Be well.


Geller AI, Shehab N, Weidle NJ, Lovegrove MC, Wolpert BJ, Timbo BB, Mozersky RP, Budnitz DS. Emergency Department Visits for Adverse Events Related to Dietary Supplements. N Engl J Med. 2015 Oct 15;373(16):1531-40.

Budnitz DS1, Pollock DA, Weidenbach KN, Mendelsohn AB, Schroeder TJ, Annest JL. National surveillance of emergency department visits for outpatient adverse drug events. JAMA. 2006 Oct 18;296(15):1858-66.

Shepherd G1, Mohorn P, Yacoub K, May DW. Adverse drug reaction deaths reported in United States vital statistics, 1999-2006. Ann Pharmacother. 2012 Feb;46(2):169-75.

On Lamar Odom’s Tragedy and on ‘Herbal Viagra’

Lamar Odom

On Lamar Odom’s Tragedy and on ‘Herbal Viagra’

Basketball is my favorite sport. I like all levels of basketball: college, professional, Olympic, even high school. Here in New York City, high school basketball is big, and as a result, we praise any high school kid who is really good at the sport and follow their career.

One such player is Lamar Odom, who was a high school phenomenon at Christ the King high school in Queens, New York during the late 90s. He went on to have respectable a 10-year career on the NBA, although he may be better known to the masses as Khloe Kardashian’s ex-husband. Three days ago, he was found unconscious with white material oozing out of his mouth at a brothel near Las Vegas, Nevada.

Today, October 16, 2015 he is on life support at a hospital in Nevada.

Lamar Odom’s story is perplexing, tragic and simply sad. He has had a long history of addiction and substance abuse. What happened on October 13, 2015 that sent him to (what might possibly be) his death bed?

What we know:

Odom was snorting cocaine before a near fatal fall. He also took 10 tablets of “natural” sexual energy pills called Reload.

What’s scary about Reload is that the FDA issued a warning that this unnatural supplement contains sildenafil (Viagra) hidden in the ingredients list on the label.

Cocaine is a stimulant, causes the heart to beat faster and increases blood pressure. That level of stress to cardiovascular system can lead to a heart attack. Combining Viagra with cocaine can tear the body’s main artery, the aorta, which reduces blood to the brain. The overall outcome is often a stroke.

How big of a problem is the sexual supplement industry?

A very big problem. Virtually 25% or about 300 supplement formulas of sexual enhancement supplements are tainted with either Viagra, Cialis or Levitra.

This is a very big problem for two main reasons:

1. Taking ED pharmaceuticals unknowingly can be deadly as they cause widening of the arteries. This can be harmless and even beneficial in moderation, but too much can lead to low blood pressure. Excessively low blood pressure stresses the heart.

2. The bad publicity also stains the good players in the supplement industry, those who make legitimate and safe sexual health supplements.

Effective (truly natural) dietary supplements are not event driven; instead, their benefits accrue over time. Clinically, I notice that it takes about a week or so of daily use before experiencing satisfactory blood flow to sexual organs. A responsible sexual health formula gradually builds stamina, nourishes blood vessels, and improves your production of nitric oxide, which improves blood flow.

How to spot drugtainted sexual performance supplements:

  • If it sounds too good to be true, it is too good to be true.
  • Avoid supplements that claim to make your penis bigger. No dietary supplement does that.
  • Avoid anything sold in small packets of 2 to 10 pills.
  • Avoid anything with an FDA warning similar to those found on ED drugs. For example, “do not use with nitrates or do not use if you have heart disease or high blood pressure.”
  • Avoid supplements that promise fast results. No natural agent or combination of agents work that fast.

What should you do?

Buy supplements from trustworthy manufacturers, and do not expect immediate “home runs” when consuming them. Be suspicious of “magic in a bottle” claims. Understand that there is no short cut for improving your sexual health and vitality.  

Only by eating nourishing foods, exercising vigorously, making smart lifestyle choices, and consuming highquality dietary supplements will you earn your results, defy your age, and reclaim the sexual vigor that you once enjoyed. 

Here is an FDA list of sexual supplements shown to contain ED drugs.

Lamar Odom’s grim condition will require a miracle to overcome, I suspect. I wish our hometown basketball star, his two teenage kids and the rest of his family strength during this difficult period.

Happy #NationalCoffeeday ! Is Coffee Good or Bad for you?

IMG_1151Is coffee good or bad?

According to a study published in the New England Journal of Medicine, coffee is good for you.

Details of the study:

  • Over 400,000 men and women were analyzed were followed from baseline (1995–1996) until the date of death or December 31, 2008, whichever came first,
  • Among participants who completed the 24-hour dietary-recall questionnaire, 79% drank ground coffee, 19% drank instant coffee, 1% drank espresso coffee, and 1% did not specify the type of coffee they consumed.
  • With questionnaire’s assessing diet and lifestyle, a total of 33,731 men and 18,784 women died.
  • Participants resided in six states (California, Florida, Louisiana, New Jersey, North Carolina, and Pennsylvania) and two metropolitan areas (Atlanta and Detroit)
  • As compared with men who did not drink coffee, men who drank 6 or more cups of coffee per day had a 10% lower risk of death, whereas women in this category of consumption had a 15% lower risk. Similar associations were observed whether participants drank predominantly caffeinated or decaffeinated coffee.
  • Inverse associations were observed for deaths due to heart disease, respiratory disease, stroke, injuries and accidents, diabetes, and infections, but NOT for deaths due to cancer.
  • Note: Coffee drinking men had a slightly, non- statistically significant increase risk of cancer (Freedman et al, 2012)

My take on this:

Freedman’s study suggest’ that a dose-dependent amount of coffee of 6 cups a day, decaf or regular can protect against a variety of disease associated death’s except cancer. It is unclear why coffee drinking men had a slight increase in mortality. Does this mean men should stop drinking coffee? Or should men “gulp the java” for its decrease in mortality from other non-cancer related conditions?

Interestingly, another large prospective study in 2011 showed that men who drank three or more cups of coffee a day, decaf or regular, had a decrease chance of developing high risk, lethal prostate cancer (Wilson et al. 2011).

I think the take home message is the following:

Coffee seems to have protective qualities and one should not give up coffee for unproven health reasons. The typical mugs of coffee often used is the equivalent of 2 cups. 2 mugs a day or 4 cups a day should be more than enough.

The non-coffee drinker does not need to start drinking coffee if he or she choose’s not to. All studies cited are epidemiological and as valuable as they are, especially when studying a large population, they are not conclusive.

Mix green tea into the picture. Variety is key for disease protection with food as it is with beverages. Green tea has shown to have protective qualities in numerous studies including is one large prospective Japanese study that looked at over 49,000 men (Kurahashi et al. 2008).

It does not matter if it’s decaf or regular – so unless caffeinated coffee bothers you, drink the “high octane” kind. Caffeine may not be harmful, even possibly protective and it may keep you alert and your metabolism high.

Those who should probably abstain:

  • Men suffering from prostatitis or prostate enlargment – caffeinated beverages aggravates urinary symptoms. Decaf may be OK.
  • Women (and men) suffering from interstitial cystitis. A recent study suggest’ that caffeine consumption may aggravate symptoms (Friedlander et al. 2012). This includes caffeinated tea as well. Again, decaf may be OK.
  • Those with high blood pressure should probably abstain as well. While coffee drinkers with normal blood pressure will probably not become hypertensive from drinking caffeinated or decaffeinated coffee, hypertensive men and women should skip.

Finally, none of the studies cited mention whether or not adding milk or sugar makes a difference. I would guess it does. It would be only a guess. However, a drop of milk and a dab of sugar is likely harmless. Straight black is probably best.


Freedman ND, Park Y, Abnet CC, Hollenbeck AR, Sinha R. Association of coffee drinking with total and cause-specific mortality. N Engl J Med. 2012 May 17;366(20):1891-904.

Wilson KM, Kasperzyk JL, Rider JR, Kenfield S, van Dam RM, Stampfer MJ, Giovannucci E, Mucci LA. Coffee consumption and prostate cancer risk and progression in the Health Professionals Follow-up Study. J Natl Cancer Inst. 2011 Jun 8;103(11):876-84.

Shafique K, McLoone P, Qureshi K, Leung H, Hart C, Morrison D. Coffee consumption and prostate cancer risk: further evidence for inverse relationship. Nutr J. 2012 Jun 13;11(1):42.

Friedlander JI, Shorter B, Moldwin RM.Diet and its role in interstitial cystitis/bladder pain syndrome (IC/BPS) and comorbid conditions. BJU Int. 2012 Jun;109(11):1584-91.

Kurahashi N, Sasazuki S, Iwasaki M, Inoue M, Tsugane S. Green tea consumption and prostate cancer risk in Japanese men: a prospective study. Am J Epidemiol 2008; 167: 717

Should I go gluten-free?


The takeaway first

The last five years or so the gluten-free diet has been the most popular way of eating. Even the recent Wimbledon winner Djokavic and the New York Yankees slugger Mark Teixeira have adopted this new way of eating, which excludes wheat, rye and barley. While there is a real, clinical disease called celiac disease, where eating gluten products cause severe gastric problems, the type I’m talking about today is non-celiac gluten sensitivity. Most importantly, I want to know whether the whole thing is…BS.

By the way, Mark Teixieria hit a game winning homerun (update 8/10/15: 30 HR’s) this weekend. Not bad for a 35 year-old baseball player coming out of a year of injuries. He is having one of his best years at an age where most baseball players steadily decline. (I’m a NY Yankees fan)

Just saying…

What is celiac disease?

This disease is an autoimmune disease where your immune system attacks your intestines—but only when there is gluten in your diet. The fancy medical term for the process is small intestinal immune-mediated enteropathy (just in case you want to sound smart at your next cocktail party). Celiac disease occurs in 1% of the population, and the main symptoms include abdominal bloating and pain , chronic diarrhea , pale, foul-smelling, or fatty stool and rapid weight loss . Other common symptoms like chronic fatigue and irritability occur as a result of poor absorption of nutrients.

What is gluten?

Gluten is a protein made out of glutenin and gliadin. The elasticity created when the pizza man kneads dough before throwing it in the air is made from glutenin and gliadin combination. That’s the same molecule that gives bread its chewy texture. Gluten also traps carbon dioxide, which, as it ferments, adds volume to the loaf.

Why would non-celiac people want be on a gluten-free diet?

About 20% of Americans want gluten-free foods (I too choose gluten-free often). The reason why non-celiacs want to eat gluten-free is because they just simply feel great when they’re not eating glutinous grains. Symptoms like gastric bloating, irregular bowel movements and even headaches and joint aches have been relieved just by excluding gluten from the diet. These people suffer from what’s called non-celiac gluten sensitivity. The very first case of non-celiac gluten sensitivity was reported in the mid-1970s where a few young women reported gastric distention

and irregular bowel movements (Cooper et al., 1976) and experienced great relief when they cut gluten out of their diets. Only when gluten was re-introduced did the symptoms return (Ellis et al. 1978).

The science behind a gluten-free diet

Many would say there isn’t any science behind it at all

They just haven’t looked.

In one study, 920 adults without celiac disease and with irritable bowel syndrome (IBS) who self-reported gluten-based sensitivity were asked to maintain a gluten-free diet for 4 weeks. After about two weeks, one group was introduced again to wheat where 30% of them (the wheat group) developed IBS symptoms: abdominal pain, bloating and altered stool consistency (Carroccio et al., 2012).

Another study looked at 34 patients with IBS who self-reported gluten sensitivity and whose non-celiac status was confirmed by expert investigators. They received 16g of gluten per day or placebo for up to 6 weeks. Within the gluten group, 68% reported irritable bowel symptoms, such as abdominal pain, bloating, and stool inconsistencies, compared with 40% in the placebo group.

When comparing baseline parameters, patients with non-celiac gluten sensitivity are generally more likely to have nutritional deficiencies, another autoimmune disease, a lower mean BMI, and weaker bones than the general population; however, non-celiac gluten-sensitive people usually don’t have these extra problems.

In a case series of 1,000 patients with progressive ataxia (loss of control of body movements), 18% of patients were found to be sensitive to gluten consumption (Hadjivassiliou et al., 2013). This doesn’t mean that gluten gives you ataxia, though.

Small studies have even associated gluten consumption to depression (Peters et al. 2014) and psychotic, schizophrenic events (Kalaydjian et al. 2006). While these studies to not prove cause and effect, the association is pretty compelling.

For non-celiac endurance athletes, a short-term gluten-free diet had no overall effect on performance. It didn’t help gastrointestinal symptoms, wellbeing, or indicators of intestinal injury or inflammatory markers (Lis et al., 2015). Of course, this study was performed for about one week and to truly see benefit from a gluten-free diet it take about 90 days of complete abstinence from glutinous consumption.

Criticism of gluten-free diets

One Consumer Reports video makes several claims against the gluten-free label. I have problems with this video.

For example, the video claims, “Fat and sugar are sometimes used to replace the oomph in foods that gluten usually fulfills.” Yes, this may be true, but this claim has just as much oomph as saying that we shouldn’t be vegan because some donuts are vegan.

Sure, some foods marketed as gluten-free are crap, but that’s the worst way to be gluten-free.

The Consumer Reports video also claims that gluten-free foods are “not fortified with the same nutrients that foods with gluten [are fortified with].” Folic acid and iron are two examples given. My response? You can get folic acid, iron, and every other nutrient from foods that naturally contain them. Countless foods that are gluten-free are not marketed as such. Green leafy vegetables, for example, have all the folate and iron you could ever dream of, but nobody is calling them gluten-free.

There are two other big criticisms of gluten-free diets. Some say that gluten-free foods are expensive, but I reply that only the gluten-free label is expensive. All fresh produce is gluten-free, but it lacks the label. Why? Because produce has enough nutritional value on its own that it doesn’t need help from the gluten-free marketing campaign.

My take on gluten-free diets, and what you should do

I prescribe a gluten-free diet to all of my patients because it seems to relieve pain and inflammation. This is my experience, and I do whatever solves my patients’ problems.

Therefore, if you have pain or inflammation, I would suggest you try a gluten-free diet for 90 days. This doesn’t mean you have to buy gluten-free products or offer up your wallet as a ritual sacrifice to the gluten-free gods. All it means is that you cut out bread and pasta.

Same goes for my prostate cancer patients – they go mostly gluten-free as gluten wrecks the gut of most people and promote inflammation. In order to beat cancer you must have a strong gastro-intestinal system

If going gluten-free, follow these simple tips:

All fruits are naturally gluten-free. Eat those that have a low-glycemic index

All vegetables are naturally gluten-free. Eat plenty.

All meat, unless it’s processed, is naturally gluten-free. Go for the best fish (my

favorite is vital choice). Also go for grass-fed, organic meats.

Eggs are naturally gluten-free too, and very good for you. Get those from farms or farmers markets where the chickens roam freely and eat naturally (including worms.)

Many grains like quinoa and buckwheat are gluten-free. Eat them too.

As always, don’t eat processed foods or crappy gluten-free foods. But if you want a treat and will do a 90 day test, then eat a gluten-free treat.

Go easy on the alcohol, even if it’s “gluten-free.” By the way, tequila is gluten-free (wink, wink)

I suspect Djokovic’s and Teixeria’s gluten-free dietary benefits is mainly quicker recovery from the stress induced from playing their respective sport.

I know when I am 100% gluten-free, I can play long games of basketball or train for hours without feeling much pain afterwards.

If you have not done so, try going gluten-free. If anything, you will enjoy the challenge. OK maybe “enjoy” is an overstatement.


Carroccio, A. et al. Non-celiac wheat sensitivity diagnosed by double-blind placebo-controlled challenge: exploring a new clinical entity. Am. J. Gastroenterol. 107, 18981906 (2012).

Cooper, B. T., Holmes, G. K., Ferguson, R., Thompson, R. & Cooke, W. T. Proceedings: Chronic diarrhoea and gluten sensitivity. Gut 17, 398 (1976).

Ellis, A. & Linaker, B. D. Non-coeliac gluten sensitivity? Lancet 1, 13581359 (1978).

Kalaydjian, A. E., Eaton, W., Cascella, N. & Fasano, A. The gluten connection: the association between schizophrenia and celiac disease. Acta Psychiatr. Scand. 113, 8290 (2006).

Hadjivassiliou, M. et al. Transglutaminase 6 antibodies in the diagnosis of gluten ataxia. Neurology 80, 17401745 (2013).

Lis D, Stellingwerff T, Kitic CM, Ahuja KD, Fell J. No Effects of a Short-Term Gluten-free Diet on Performance in Nonceliac Athletes. Med Sci Sports Exerc. 2015 May 12.

Lis DM, Stellingwerff T, Shing CM, Ahuja KD, Fell JW. Exploring the popularity,

experiences, and beliefs surrounding gluten-free diets in nonceliac athletes. Int J Sport Nutr Exerc Metab. 2015 Feb;25(1):37-45.

Peters, S. L., Biesiekierski, J. R., Yelland, G. W., Muir, J. G. & Gibson, P. R. Randomised clinical trial: gluten may cause depression in subjects with non-coeliac gluten sensitivity—an exploratory clinical study. Aliment. Pharmacol. Ther. 39, 11041112 (2014).