Vitamins

Question:

Has anyone heard of Usana? I have been recommended to take The Essentials, Proflavanol, Biomega, Coquinone and Active Calcium. All of this will cost me nearly $300 a month so I'd love to know what you think Dr. Eric.

Dr. Eric:

Usana is a multi-level marketing (MLM) company that sells vitamins and other ³nutritional supplements². I¹m going to guess that the "distributor" of these products who is encouraging you to take them is either a relative or a "FOAF" (Friend Of A Friend). The way these MLM companies work is that they try to sign everyone up as a distributor. If your distributor signs you up, he/she gets a portion of the profits from all you sell. If you sign someone up, you get some of their profits, and then pass part of that along to the person who signed you up. Another name for these set-ups is "pyramid scheme".

The person at the top of the pyramid is collecting from every level below, so he/she makes some money, but the products have to be high priced to support even three or four levels of distributors. To become a distributor, one has to invest in LOTS of the products as "distributor stock".

The come-on is that you¹ll be able to sell the excess products to other members of your friends and family, and end up breaking even, or actually making money in the process. The truth is that you¹ll end up stuck with a lot of expensive vitamins. The only people who make money in these pyramid schemes are in the top level or two. But let¹s look at your basic question: will these supplements help your vasculitis?

The overall answer to that question is located on Usana¹s web page, where they state: ³This product is not intended to diagnose, treat, cure, or prevent any disease.² My question: then why am I taking it??? If it isn¹t going to treat, cure, or prevent my disease, what does it do (other than make my wallet thinner)? Another statement that concerns me is the one that says, ³These statements have not been evaluated by the Food and Drug Administration.

My question: then how can you make health claims? If the Food and Drug Administration hasn¹t evaluated the STATEMENTS, much less the products, who has? I can make up a statement that says that Doc Hoy¹s Magic Grass Clipping Extract will "support your immune system". If this isn¹t evaluated by the FDA or considered to be a claim to treat your disease, why would you want to try it? However, there is some truth on the Usana web site. Vitamins are good for you. Anti-oxidants help individual cells in the laboratory. (We¹re still not sure in the body, but why not try?) Everyone needs calcium to maintain strong bones. The question is whether we get more benefit from the Usana products than we can get from normal dietary sources.

The simple answer to that is "no". The body and its cells don¹t know the difference between calcium that comes from a supplement, a glass of milk, a spinach salad, or a glass of orange juice. The only question is whether you are getting enough calcium, or other vitamins and minerals, from your diet. In most Americans, the answer is, ³probably not², because most of us don¹t eat a well-balanced diet. Those who are taking prednisone also need additional calcium, because prednisone tends to increase calcium loss from bone. So that brings us down to the most basic of questions, ³should I take additional supplements and vitamins?"

My answer to that is, "If they make you feel better, yes, take them.² But make sure to let your rheumatologist, internist, and GP know EVERYTHING you are taking. If you are taking prednisone, you should also be taking additional calcium and vitamin D to prevent bone loss. Your doctor(s) should have already recommended that to you. OK, so you have decided to take all of the supplements that the Usana sales representative says you need.

Do you need to spend $300 per month for these? The short answer to that is no. You can buy a good multivitamin to replace what Usana calls the Essentials. I get a one month supply for about $5.00. If you eat ANY fruits and vegetables you get enough flavenoids, but if you insist on spending more money, you can buy a generic grape seed extract for about $7.00 a month. For the Biomega, just buy some Omega-3 Fish Oil Capsules. A one month supply should be about $10.00.

For the Coquinone, you want a generic Co-Q10, about $8.00 per month. The Active Calcium is the same thing as Calcium Citrate with Vitamin D, which I get at Wal-Mart for about $9.00 a month. So, if you want to take all the supplements, you can find THE SAME THINGS as the Usana products at Wal-Mart, Walgreen¹s, CVS, SavOn, or any of the chain drug stores for about $40.00 per month.

If the Usana sales rep is your cousin¹s oldest daughter, or the single mother who lives down the block, and you REALLY want to help her, buy the generics, and then send her a monthly gift of $100.00. You will save over half the cost, she will make more money, and you won¹t be supporting a dubious pyramid scheme.

I asked a friend of mine who is a clinical nutritionist, and her advice is this: eat a good mixed green salad every day, with seasonal fruits (grapes, melon, strawberries); eat a tuna or salmon salad sandwich two or three times a week; eat steamed or raw vegetables with dinner every night; take a multivitamin every day; take your calcium and vitamin D supplement every day, and you will get all the benefit that the $300.00 Usana supplements would give you.

Question

Have studies ever been done to see if herbal supplements such as Echinacea which boost the immune system actually be the "trigger" that sets off an autoimmune response? I know we've discussed in our group how taking such herbal immune boosters can be very dangerous to a PAN patient. However, is out of the realm of possibility that such elements could be what triggers the AI attack?

Dr. Eric

This ia a complex question, and it will require a complex answer. But anyone whoknows me knows that most of my answers are complex!

In my lab we are looking at possible triggers of AI disease. When we started this research, one of my graduate students took on the task of looking at herbal supplements that claim to boost the immune system. As she studied these herbals, we found many problems with the analysis.

Let's just look at Echinacea for example. There are at least three different species of the plant called Echinacea, and each one produces many biologically active substances. When we tried to isolate these substances, we found that they were expressed differently in virtually every plant we looked at. Depending on where the plant was grown, how old it was when it was harvested, the weather in that area, and factors that we could never define, the "active ingredients" varied from one plant to the next.

Then we decided to look at commercially available preparations of Echinacea, since this is the way most people would get the herbal. Of the preparations we bought at local health food stores and pharmacies,none of them were the same when we looked at them chemically. Thus, it is hard to say what you are getting when you buy "Echinacea". Which species? What active ingredients? How much of the active substances?

My student decided the problem was too complex to solve in her two year Master's program, and so she found a different topic to research.

Other studies have looked at Echinacea as a "booster" of the immune system, and have found conflicting results. Some studies have shown an increase in antibodies, some have shown an increase in T cell activity, some have shown an increase in cytokines, and some have shown no effect - increase or decrease - in immune function.My feeling about Echinacea and other herbal preparation is that we don't know enough about them to make a final judgement about whether they actually do anything to the immune system or not. As long as there is a question, however, I feel that it is NOT a good idea to take these substances that may actually increase immune function when one has an immune system that is over-active already. We need better information about the actual drug effect of these herbals.

To get back to Ed's original question, the simple answer is that we don't know enough about the pharmacologic activity of these herbals to say whether they might trigger the original hyperactivity in the immune system that leads to AI disease. My gastrointestinal sensation (gut feeling) is that they don't act as triggers (because most of them have no real drug effect), but more research is needed to prove this.


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