In this first follow-on from Parkinson’s and nutrition: Essentials and basics to maximise health, I had a little think (whoa boy!) and decided to address some of the lesser-discussed problems in nutrition and try to explain why it can be tricky designing studies that give us contradictory outcomes (you know, from month to month scientists tell us which foods are bad for us then decide they are the best thing since sliced bread as the foodie saying goes). For those of you who have not seen the article mentioned above here is a link to it: https://eastmidlands-rsn.org/2017/06/13/parkinsons-and-nutrition-essentials-and-basics-to-maximise-health/
My first thought relating to food studies landed on isolated vitamin intakes and why does a lot of little amounts add up to so much more than a few large amounts even when both totals numerically are the same?
The answer is of course we evolved to live on available nutrition within our habitats and despite scientific rigor being applied to many studies over the years, interpretation of results has often been skewed because vitamins, minerals, phyto-nutrients, lipids etc. do not exist in a vacuum but interact with many other chemical combinations in the human body. For instance, relatively recently negative research results were published on vitamin E. Natural vitamin E exists in eight chemical forms (alpha-, beta-, gamma-, and delta-tocopherol and alpha-, beta-, gamma-, and delta-tocotrienol) that all have differing levels of biological activity. Alpha- (or α-) tocopherol is the only form that is recognised as meeting human requirements. Research indicated that large doses of E were dangerous to the heart and longevity generally. Having studied several meta-analyses (‘very large number of people involved’) I agree that large doses of E do not reduce mortality and can increase it. But what are the obvious flaws in assessing E this way?
1/ Large doses of E typically refers to more than 400 iu per day. Because E can be assessed as biological activity iu (international units) or by weight mg (milligrams) to compare here is a conversion formula:
1 IU of the natural form is equivalent to 0.67 mg of alpha-tocopherol.
1 mg of alpha-tocopherol is equivalent to 1.49 IU of the natural form or 2.22 IU of the synthetic form.
Note that the synthetic vitamin E is less potent than the natural substance ( if you take supplements look at the label), natural source E would typically be d-alpha-tocopherol but synthetic E would be labelled as dl-alpha-tocopherol. Okay, back to eating E from food; a very good daily average would be 9 mg (13.4 iu). If we accept that optimal levels of E intake would be higher than this (and some studies have shown non-statistically significant improvement with amounts up to 100iu) let’s be sensibly cautious and halve this amount; we are still left with a figure (50iu) which would fit into 400 iu 8 times over! I don’t know about you but if I were on an antitensive drug and suggested to the doctor that I should take 8 times the optimal dose (or 30 times the average daily dose) I think the poor doc would suspect that I had gone mad, yet many people routinely take huge doses of E and think it is beneficial. By the way, the daily intake figure I used was an average extracted from several countries who all use a different amount for their daily values.
2/ Also typically, many of these studies give the substance being studied in large doses to participants (or a placebo of course on double-blinded studies) but no other vitamins, minerals etc. Hold it right there! Food does not contain whopping doses of just 1 nutrient (except for refined items such as table sugar which is pure carbohydrate). We require many different nutrients but most of them only in tiny amounts (vitamins, trace minerals etc. otherwise known as micro-nutrients) and some much larger amounts, namely proteins, carbohydrates and fats; you guessed it they are the macro-nutrients!
Taking big isolated doses of single nutrients is, as we noted earlier, not the way our bodies have evolved to cope with food – but let’s play devils advocate for a minute and say it is. Now the question becomes what form do we take the nutrients in? Referring back to vitamin E again we know that it is made up of 8 similar forms and depending on the ratios of these in foods that contain it (fats as these are fat-soluble vitamins) you would get different outcomes using different foods. But hold on yet again – generally it is only d-alpha-tocopherol that is studied or used in supplements so we don’t have a full picture of the effects of all the 8 substances that make up natural E (and don’t forget many supplements use the dl form which is synthetic and less potent).
Perhaps a better example would be vitamin B: Not only are there quite a few vitamins that make up B – complex but there are multiple types of each B – vitamin. For example: B – 3 can be nicotinic acid or niacin or niacinamide or nicotinamide riboside or ….. well, you get the point. Each variation works differently in our bodies (large doses of niacin cause a temporary ‘prickly-heat’ dilation of blood vessels commonly known as the niacin flush). Some people like the feeling, many more don’t and stick with the other types of B – 3 that don’t have this effect. Also, look through the blog and you will find Miguel’s work with fruit flies and vitamin B – 3 which strongly suggests that this vitamin is beneficial for the Parkinson – type brain.
Where supplements can outdo food is in the type of each vitamin used which can be specific to genetic problems. The most well-known problem that Parky people may have being the MTHFR enzyme problem which makes the absorbing of folate or folinic acid or folic acid (all types of B – 9) very difficult. Among other problems one of its functions is to add back a methyl group to homocysteine in a process called remethylation. Space limitations prevent me from fully explaining the process so please believe me when I say high homocysteine levels are not good! A food supplement I take (remember, this is my informed choice as an adult taking responsibility for using supplements; this is not an endorsement from me, merely what I do for myself) contains folate in the form L-5-Methyltetrahydrofolate which is the biologically -active form in the human body and can be absorbed.
Absorption problems become common in our senior years for vitamin B – 12 which requires a substance secreted internally called ‘intrinsic factor.’ As this becomes scarcer in our digestive systems we become deficient (anaemic) and need B – 12 shots every few months. An easier way to deal with this is with the supplement I use which also contains Methylcobalamin which is – yep, you got it straightaway! – the active form of B – 12 in our bodies. While we are on the subject of diversity and forms of vitamins here is another example of different make-up. Vitamin B – 12 is cobalamin and is derived from cobalt. It is often combined with cyanide (I kid you not!) and labelled as cyanocobalamin on supplement labels. But it can get even more complicated: For example chromium is a metal and comes in trivalent and hexavalent molecular structures; trivalent form may enhance insulin metabolism, helping to control blood sugar. In contrast, hexavalent is highly toxic and a known carcinogen; much better suited to making shiny 1950s car bumpers.
So, we can see that nutrition is very complicated and there are long ‘chains’ of interactions in our bodies which do not work efficiently if even just 1 nutrient happens to be missing. That brings us to the title of this article, ‘ The symphony within’ as missing nutrients would be like an orchestra missing some of the players: You would still get music but it would be lacking finesse (poor health) and some parts may be missing altogether (vulnerability to diabetes, cancers, heart disease etc.). Another thing to consider: Many of us assume that natural vitamins found in food are superior to synthetic types which are made from all kinds of sources such as crude oil (yes really!).
The ‘whole-food’ followers believe in vitamins and minerals grown in hydroponic factories in plants similar to cabbages or in yeast which is essentially the same as brewers’ yeast; they argue that because the vitamins are ‘complexed’ in a food they are much more absorbable and only small amounts are needed for optimum health. The other side says that so long as you take in a wide variety of vitamins in larger-than-average dosages then you have covered your health as well as is possible.
What do I think? There are pros and cons on both sides of the argument but what really settles it for me is looking back at nutrition and what we now know compared to even 10 years ago. It is obvious that we don’t know everything and never will so a degree or 2 of mental flexibility is necessary but the old argument that drugs have a pronounced effect on us while food or food supplements do not does not make sense. When we eat (particularly carbohydrates) our blood sugar would zoom up out of control if not for the body reacting with insulin secretion that holds down blood sugar by shunting it into ‘storage depots’ where a different set of chemical reactions will free it for use when we need it and are not taking in food.
Spot the difference: Eat carbs – blood sugar will soar upwards – body uses insulin to bring blood sugar levels down to a safe working range.
Diabetic person: Eat carbs – blood sugar will soar upwards – body uses injected dose of insulin to bring down blood sugar levels to a safe working range.
All the above happens because of eating food so believe it that eating food can create drug-like effects in our bodies. That being the case you can see why paying attention to good nutrition is every bit as important as taking prescription medicines.
Well, we got there in the end (you did stick with me didn’t you?), the point being that a cure or total control of PD will probably come from a ‘war on several fronts,’ involving drugs and anti-side effect drugs and exercise and better nutrition and although we know a lot now we can see there will be plenty more to discover before we reach that goal! Next time: A closer look at vitamin C and D!