Tuesday, September 11, 2007

How tough it is to navigate the waters of dietary supplements

Recently, there was an inquiry and subsequent discussion on a professional listserv on which I participate regarding the possibility of increasing platelets during cancer therapy with diet and dietary supplements. One responder (whom I greatly respect) suggested considering the use of a dietary supplement that contains compounds called alkylglycerols.

I have both a personal and a professional interest in this discussion as my own platelets levels have been lower than the normal range for decades, at least since my early 30's and even before I had any chemotherapy. The most likely reason is that my bone marrow (where platelets are produced) suffered some significant and irreparable damage secondary to the radiation therapy that was used to treat my neuroblastoma diagnosis when I was 6 months of age. Thus I have read a lot of information (research and testimonials) about various recommendations for improving platelet counts and platelet function (if you don't have many, it's good to have the ones you do have working well!).

In a nutshell, I have not found anything of any substantive value that has had a direct impact on improving my total platelet count, particularly when they were quite low (much less than 100,000). With all sincere respect, I admit that I probably think about this interesting information differently than my colleague and most other Registered Dietitians (even those highly knowledgeable about complementary medicine) because my training was first as a biologist, then a nutritionist. As such I am uneasy about the availability and promotion of certain dietary supplements like the alkylglycerols. Alkylglycerols are sourced from sharks that are a by-catch of unsustainable fishing practices. Also, the bulk of data bolstering the recommendation of this product are in vitro only. For these, and many other reasons, I see serious problems with this picture.

My biggest concern is that the economics clearly are being placed ahead of the science, which can have very serious consequences. As an example, when the New Zealand fishing industry finally figured out how to get rid of the layer of fat under the skin of the orange roughy fish, orange roughy became a fish highly promoted for "heart health" because it was so lean. Prior to that it was considered a junk fish, actually called "slimefish", and never eaten because the composition of the fat caused severe diarrhea when consumed.

Very rapidly, orange roughy was available to eat everywhere, and people were consuming a lot of it. The life cycle of the fish had not been studied adequately before it became all the rage. It turns out that the fish needs to be alive for at least 20 years or so before it is even sexually mature. Essentially the orange roughy population collapsed and is now under strict fishing management in Australia and New Zealand. Sadly, it is not necessarily regulated from other sources like China and Namibia, and it will take decades for the population to recover. It has been over 15 years since I have purchased orange roughy either for home use or at a restaurant.

How is this example related to the source of alkylglycerols? The source of this compound is from sharks caught in the trawling nets that are dragged along the bottom of the ocean (disrupting ecosystems in ways we have only begun to have a glimpse of understanding) in order to catch, you guessed it, primarily orange roughy in the deep waters off the coasts of New Zealand. Shark populations world-wide are at historically low levels with half of the 100 million killed each year the result of by-catch. One side of my brain says it seems good to use the by-catch for research on understanding how some molecules may promote health, but the other side of my brain argues that creating a hot market for a product from the by-catch before the science is really strong will only slow down if not eliminate reasons for the fishing industry to change damaging and non-sustainable practices.

Healthy people, healthy economies, healthy planet - it is really really hard to keep all the necessary factors in mind to guide our recommendations and actions as nutritionists (and as human beings). My first dream was to become an environmental biologist and that dream and early training still influence my thinking and actions.

More info about consuming fish that are good for us and good for the oceans can be
found at:http://www.montereybayaquarium.org/cr/seafoodwatch.asp

My bottom line: when considering the use of dietary supplements, read, read, read. Get much more complete information about the product you are considering than what you will obtain from anyone selling it (MLM, clinic or professional office, health store clerk, web site, etc). Seek out the advice of a Registered Dietitian (RD) who can help you determine your goals and then sort through the research available to help you make the best decision for your situation. Only you can really determine the big picture that is important to you (your comfort circle) for evaluating which supplements may provide benefit. Of course this same process is true for any CAM or conventional therapy.

I recently heard a friend say that getting old is not for wimps. I would expand that to say that taking charge of your health is not for wimps. However, if you don't do it, someone else will. Who better than you to know what is best for you? My approach is "Active Hope"; I hope I have given you some "food for thought" to make it your approach, too. :-)

Diana Dyer, MS, RD

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