Caveat Emptor

Late last year, I had the good fortune of taking on Dr. Michelle Bestic as a client here. After welcoming the addition of two beautiful twins into her family with her husband Dr. Dan Bestic, she decided it was time to get the focus back on her and getting her body into the condition it was in prior to pregnancy. As you’ll soon find out, Dr. Michelle is a wealth of information on all things regarding pharmacology. I am frequently asked my opinion on a variety of supplements, aids and pharmaceuticals. While I definitely have an opinion, I certainly don’t have the pedigree and background that someone like Dr. Michelle has. So, I was excited when she was willing and able to let me interview her with her thoughts on a lot of the topics that clients come to me about. Without further ado, I hope you enjoy our latest newsletter with Dr. Michelle Bestic!

Dr. Michelle, thanks so much for taking the time to do this. So that we can give the readers some more insight, could you briefly give a background on yourself?

MB: I graduated with my PharmD (Doctor of Pharmacy) in 2004, then did a two year post-doc fellowship in pediatric pharmacology and toxicology.  I have been working as a clinical pharmacologist and toxicologist since 2006.  I have published two book chapters, 10 peer reviewed articles and given numerous lectures to physicians, nurses, pharmacists and students about a wide range of toxicology and developmental pharmacology topics, including several on supplements. 

The fitness supplement industry is a multi-billion dollar monster. That tends to explain why there are so many companies looking for a piece of the pie. How do you generally regard a lot of what you see on the shelves at say, a nutritional supplement retailer? 

MB: Generally when considering supplements, the first thing I consider is "Do no harm." That is, I make sure that the supplement is not going to interact with any prescription or over the counter medication or potentially worsen any medical conditions.  The second thing I consider is the manufacturer of the company, does the company follow what we call "good manufacturing processes". Beware of the terms "standardized, verified or certified" as US law does not actually define these.  Look for a "seal of approval," however, this does not guarantee safety or efficacy it merely ensures the product was properly manufactured, contains ingredients listed on the label and doesn't contain harmful levels of contaminants. 

Finally, the last thing that I consider is that on average it takes prescription medications 17 years to make it to market from development, after tests on thousands of people. Yet, there are still medications that despite all of this testing still have to be removed from the market after hundreds of thousands of people take them and still cause awful side effects.  On average it takes a supplement less than 6 months with no FDA requirement of proving safety or efficacy. In fact, a company only has to demonstrate that it is "reasonably safe for human consumption" prior to hitting the market and typically do not need FDA approval prior to hitting the market. So yes, I tend to ignore a lot of the stuff in nutritional supplement stores, especially any "new" products out there because I know they haven't had any safety data collected.


Sadly, there are so many people looking for that "magic pill" that solves their weight loss puzzle or, by comparison, helps them get stronger, faster. Is there anything on the market that you would consider could do the job in either case? 

MB: There is nothing currently on the market that offers a "magic pill" for weight loss. Sorry!  I always tell people the same thing when they ask, the FDA and big pharmaceutical companies are not conspiring to keep you overweight or unhealthy.  If there was truly something out there every major pharmaceutical company would be producing it because they would make billions and there would be multiple agents out there just like there are 10 different types of cholesterol lowering agents

A lot of people are looking for the herbal or homeopathic remedy to cure what ails them. The belief is that if it's not a tried-and-true pharmaceutical that it "naturally" is better for them. How do you feel about that? 

MB: I sort of addressed the last question with the FDA testing and requirements.  However, I will add a couple of things.  First, anything and I mean absolutely anything can be a poison when taken in an incorrect amount.  Excessive water consumption has killed people. Also there is a misconception that "natural" equals "safe."  Opium and nicotine are also "natural" substances yet I don't think anyone would label them as "safe."  I had a patient once take too many fish oil tablets and ended up in the hospital with significant toxicity.  I am not saying that there aren't products out there that may help, just that if you are avoiding prescription medications because you think they aren't "safe" consider the fact that the supplement you are about to take has never had to prove safety data to anyone!

What do you consider the best resource for a layperson to determine whether or not they should be taking a supplement? 

MB: I would like to think that a health care professional would be the best source but sadly a lot of us don't really keep up to date on all of the supplement information and data.  I really like this website: http://nccam.nih.gov/  It is the national center for complimentary medicine and integrative health.  It has a pretty decent review of a lot of herbal products. I also like www.naturaldatabaseconsumer.com 

Because you see weight loss through a different lens than someone like myself, what would be a pharmacist's approach to safe and effective weight loss? 

MB: Most pharmacists don't take medications! Haha! Most would tell you however that the safest way to approach weight loss is through a healthy, balanced diet and physical activity.  Supplement use should be limited to just that, as a supplement to possibly fill in gaps in your diet.  Example, someone with low iron may need iron supplements.  If you don't eat a lot of fish, perhaps omega fatty acids.

What is interesting is that there are agents that will cause you to lose weight.  Taking too high of a dose of amphetamines or thyroid medication certainly works, but you can die in the process.  They are highly toxic to your heart in the doses needed to cause weight loss.

In your opinion, how much impact does the placebo effect have on supplementation?

MB: The placebo effect response varies widely in many studies depending on the condition being treated and how a placebo was introduced to a patient.  Interestingly, the more someone believes something (placebo or not) is going to work, the higher the rates of response.  There are certainly studies where the placebo effect was 0% and there are ones where the results were >50%.  In general, most references state and it is generally well accepted that the placebo effect is anywhere from 25-33% of individuals. 

If there were some general words of advice you could give to the public, but most importantly, to the health-conscious readers of this newsletter, what do you want them to know?

MB: General words of advice is that there is no substitute for a healthy diet and active lifestyle.  Nothing comes close to mimicking the health benefits produced by these two things.  To put this in perspective, the World Health Organization has estimated that if the major risk factors for chronic disease were eliminated which are lack of physical activity, poor nutrition, tobacco use and excessive alcohol consumption, at least 80% of all heart disease, stroke and type 2 diabetes and more than 40% of all cancers would be prevented.  If you wish to use a supplement in conjunction with a healthy lifestyle just consider the following - the supplement you are choosing may lack appropriate safety data, tell your healthcare provider to make sure there are no interactions with any disease states or medications, choose a reputable manufacturer and be conscious of the doses of the supplement you are taking, more is not always better.

I’d like to again take a moment to thank Dr. Michelle for all the great information. I also have to give credit to her for helping me with the title of this newsletter since I was having a writer’s block! I’ll speak for both of us in saying, I hope you were able to take some pearls of wisdom from our chat together!

The Answer's In Your Gut

I wanted to veer slightly from the path of motivational newsletters this go-round and take a more educational and informative route. Part of what inspired this particular newsletter is a conversation I was just having with a former client of mine. She keeps teasing me about coming back to train here but we’ll see (wink wink nudge nudge).

She was recently turned onto probiotics by a friend and was remarking how much better she was feeling by taking them. So, I thought I would keep this newsletter a bit shorter and give some insight into why she might be right.

It’s probably of little surprise to anyone that we have millions (billions, zillions) of bacteria floating in our body. When we get sick, many people go to the doctor to be prescribed an antibiotic with the aim of killing off the harmful bacteria that’s making us ill. However, antibiotics also kill the beneficial bacteria in our bodies too. Before you get concerned, you don’t lose all the beneficial bacteria but the good ones definitely take a hit!

When you consider the beneficial bacteria in your digestive system, these are our friends assisting with digestion and food absorption, body composition and metabolism. Sounds like something to have an abundance of, right?

Right.

Which is why my former client may be feeling better.

Now, you can find probiotics in fermented foods (kefir, sauerkraut, yogurt, kombucha, cheese, etc.) and you can find it in supplements. I personally like to get them from both foods and supplements. Rather than sway you to a certain brand, I’ll suggest you find something with a high strand count (at least 3 billion) and something that has to stay refrigerated (so you can have more live and active cultures).

However, probiotics in and of themselves aren’t the only solution. In addition, you’ll want to make sure you’re keeping your fiber and water intake high. These three will continue to move food through you as it was intended to do, maximize nutrient absorption, and yes, you’ll probably even drop some pounds as well. As always, consistency is key!

Lastly, remember that highly processed meats, excess stress, alcohol, certain medications (check side effects), and processed foods and preservatives can negatively impact your digestive system. If you can’t eliminate, do what you can to minimize those effects. No sense taking steps towards cleaning up a diet without ACTUALLY cleaning it up!

We can help you sort through the dietary madness!

All Hopped Up

Something interesting has popped up over the last couple of days in the fitness industry, notably over a controversy regarding the television show "The Biggest Loser". I thought I might give my two cents since this is currently trending and has been generating a fair amount of steam with the media.

Allow me to first give a slight recap: Jillian Michaels, who is arguably the most recognizable personal trainer in the nation right now was exploited for giving her team caffeine pills before a weigh-in. The host of the show uncovered this and penalized Jillian's team for being administered a non-authorized supplement per the rules and guidelines of the program.

Jillian stood by her decision that administering caffeine pills was a better alternative than letting her team get loaded up with coffee before a weigh-in. Her only apology came that she was sorry her team had to suffer over her "professional decision".

So, it becomes a matter of principle.

And to be fair, you almost have to penalize both parties.

Let's consider the show first:

Since it began, The Biggest Loser has been one of the most monumental and inspiring shows when it comes to weight loss and how the public perceives it. They should be applauded for showing people how difficult losing substantial weight can be. In addition, the viewers can see how former contestants have managed to either keep the weight off or (in some cases) regain much of it back. Another added plus, is the huge shift it has caused for corporations to start their own Biggest Loser contests in efforts to get their employees more mindful of their individual health and wellness.

Where I feel the show has betrayed the public is in how unrealistic the entire program is. The amount of work the participants have to endure is borderline insane. Instead of approaching weight loss with more mindfulness and balance, it's constantly about more, more, harder, faster, more.

Having run a business which specializes in weight loss, I can assure you: most people in a similar situation have no business pushing THAT hard.

And the show lets you see the grim side of that as well: when the injuries occur, or someone has to leave the show due to contraindicated exercise or program design.

Is it a bad show? Not necessarily. For the right person, it can be just the right amount of motivation to say "I need to start taking better care of myself. If "they" can do it, so can I".

Ultimately, if it gets someone off their butt...mission accomplished.

On to Jillian.

As fitness professionals, we have a lot of tools at our disposal for helping people lose weight. Nutritional counseling, high intensity training, supplement advice, etc.

Is caffeine a terrible thing to administer? Absolutely not. Many people do quite well with caffeine combined with exercise.

However, she does have guidelines to follow and her team paid the price for her executive decision.

One has to consider, Jillian committed a minor infraction on a show with already vastly unrealistic expectations.

But chock up a big win for the show. As soon as controversy rears its head, the show gets more attention, hence more views and don't you think that makes those commercial sponsors really happy?

Sadly, I find so many people who can regurgitate every detail about this show and in the same breath say, I wish I had time to exercise...

I'll let you marinate on that statement for a moment.

In my opinion, if the Biggest Loser wanted to offer a great service to it's viewers it would spend more time showing how the average person can make enough lifestyle changes to see the results they want. Instead, they'd rather show you what you can accomplish when you are forced to adhere to their competition, on their terms.

We can help you establish the guidelines without sacrificing your entire day to get there!