Tagged Vitamins

Direct-to-Consumer Lab Tests, No Doctor Visit Required

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Credit Jon Krause

Two years ago, Kristi Wood was tired and achy and could not think clearly, and she had no idea why.

“I was in a fog and feeling awful,” said Ms. Wood, 49, who lives in Seattle and is an owner of a hiking supply company.

Ms. Wood had her blood tested by a consumer service called InsideTracker, which analyzes 30 hormones and biomarkers, such as vitamin levels, cholesterol and inflammation. After the service told Ms. Wood she had excessive levels of vitamin D, she cut back on a supplement she had been using and said she almost immediately felt better.

Now she has her blood drawn and tested by InsideTracker every four months to check everything from her blood sugar to her B12 levels which, she said, “allows me to be proactive” about her health. The services typically send their customers to a nearby clinic where they can have a vial of their blood drawn and sent for analyses. But InsideTracker also offers customers the option to have nurses show up at their home and draw blood. (Such services are different from another blood testing company that has been much in the news, Theranos, which aims to provide laboratory test results from a single finger prick.)

Home testing services like InsideTracker say they are empowering consumers, allowing them to spot metabolic red flags before they progress to disease. But critics say the services often lack proper medical oversight and convince healthy people that they’re sick, leading to unnecessary testing and treatment.

Those concerns have not stopped people from seeking home testing. The market for direct-to-consumer laboratory tests was valued at $131 million last year, up from $15 million in 2010,according to Kalorama Information, a pharmaceutical-industry research firm.

In December, New York Attorney General Eric T. Schneiderman accused two companies, DirectLabs and LabCorp, of violating a state law that requires laboratory tests to be carried out at the request of licensed medical practitioners.

DirectLabs had sold hundreds of health tests to consumers, ranging from checks for heavy metals and vitamins to screening for parasites and disease. But Mr. Schneiderman said the person fulfilling the medical practitioner role was actually a chiropractor who had never met, spoken to or followed up with any patients.

DirectLabs did not respond to a request for comment. DirectLabs and LabCorp agreed to pay fines, and DirectLabs ceased operating in New York. In a statement, Mr. Schneiderman said that allowing consumers to be tested for serious medical conditions without consulting a physician put “their health in jeopardy.”

Advocates of home testing, however, say such cases do not reflect industry practices. InsideTracker and another leading company, WellnessFX, said they worked with doctors who reviewed all test results.

Paul Jacobson, the chief executive of WellnessFX, based in San Francisco, said the company complied with all regulations and offered customers the option of consulting with a doctor, nutritionist or registered dietitian to discuss their results.

WellnessFX sells packages ranging from $78 to $988, offering analyses of 25 to 88 blood biomarkers, including vitamins, lipids, cardiovascular markers and thyroid and reproductive hormones. Depending on the results, the company also suggests supplements, foods and exercise.

“You need to offer solutions to people; otherwise, you’re just giving them meaningless information,” Mr. Jacobson said.

Tara Boening, the dietitian for the Houston Rockets of the National Basketball Association, said the team started using InsideTracker this season. The players look at their reports (deficiencies are highlighted in red), which include suggested corrective actions such as eating more red meat and leafy greens if they are low in iron. The players “have been really receptive” to the information, Ms. Boening said.

But some doctors say that there is no evidence that such monitoring makes a meaningful improvement in health. Dr. Pieter Cohen, an assistant professor at Harvard Medical School and an internist at Cambridge Health Alliance, cautioned that the levels of vitamin D and other biomarkers that were optimal for one person might be very different from what is optimal for another person. He said InsideTracker’s lab reports, for example, classified vitamin D levels below 30 ng/mL as “low” — even though a level above 20 is perfectly normal and adequate for most people.

Dr. Cohen said his major concern with direct-to-consumer blood tests was that they screened for so many biomarkers and created seemingly arbitrary ranges for what is considered normal. Then they give people advice that they already know they should be following.

“The best-case scenario here is you lose your money and then you’re reminded to get more sleep and to eat more fruits, vegetables and fish,” he said. “The worst-case scenario is that you end up getting alarmed by supposedly abnormal results that are actually completely normal for you.”

InsideTracker was founded by Gil Blander, a biochemist who did postgraduate research on aging at M.I.T. He said the idea behind InsideTracker was analogous to routine maintenance for cars.

“We decided, let’s try to do that for humans,” Dr. Blander said. “We can help you find a small issue today that might be a big problem in the future.”

Some, like Joseph Roberts, say the services are life-changing. Four years ago, Mr. Roberts a former Army Ranger and a retired master sergeant, was plagued by fatigue, depression and weight gain despite frequent exercise. Mr. Roberts, then 39, said doctors told him his symptoms were a normal part of aging.

Eventually, he decided to have his blood tested with InsideTracker, and the results surprised him, he said. He was told he had low testosterone and vitamin D, as well as excessive levels of vitamin B12.

Mr. Roberts cut back on daily energy drinks, which are loaded with B12. He also saw a doctor to discuss his testosterone levels. He learned his low levels were linked to a brain injury he had sustained as a result of a roadside bomb explosion in Iraq in 2003. He began testosterone-replacement therapy and now regularly checks in with a doctor. He also has his blood tested with InsideTracker every four months.

“I’ve had a huge improvement in my quality of life,” he said. “It’s money well spent.”

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Should You Take a Vitamin? Do You Know What a Vitamin Is?

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Credit Catherine Price

Many people can rattle off the names of the most popular vitamins and the foods that contain them in abundance. But understanding exactly what vitamins are and what roles they play in the body is far more complicated. In fact, though scientists recognize that there are 13 vitamins that are essential for good health, there is no real consensus on what they actually do and exactly how much of them we truly need.

Catherine Price, a science journalist, explores these questions and more in a book that was recently released in paperback, called “Vitamania: Our Obsessive Quest for Nutritional Perfection.” Ms. Price traces the history of vitamins from their discovery as lifesaving organic compounds that prevented strange diseases to their ubiquity today in foods, beverages and dietary supplements. Ms. Price sheds surprising light on the mythology surrounding vitamins and explains why even basic advice promoted by experts – like the nutrient requirements for healthy adults known as the recommended dietary allowance, or RDA – may be misguided.

Recently, we sat down with Ms. Price to discuss some of the most common misconceptions about vitamins, the reasons vitamin D testing can be misleading, and which questions you should ask yourself before deciding whether to take a multivitamin. Here are edited excerpts from our conversation.

Q.

Why did you write this book?

A.

I have Type 1 diabetes, which forces me to think about how food interacts with our bodies every time I eat. And yet when my husband turned to me out of the blue one day and asked, “What is a vitamin?” I realized I didn’t know the answer. Vitamins turned out to be a perfect subject for me. I love investigating things that seem so familiar to us that we never think to ask questions about them. They were a mystery hiding in plain sight, and I was intrigued.

Q.

How have vitamins changed the way we think about food?

A.

Vitamins were the first “superfoods”— they introduced the idea that there are particular foods, ingredients and dietary chemicals that have health benefits that go beyond mere nutrition. It turns out that there’s a direct line between the discovery and early marketing of vitamins and our current beliefs in the magical powers of kale. Learning about the history of vitamins made me much better at recognizing nutritional hype, which helps me make much better — and calmer — decisions about what to eat.

Q.

What are some of the most common misperceptions about vitamins?

A.

My biggest pet peeve is that when we hear the word “vitamin,” we automatically think of pills instead of food — and then use “vitamin” to refer to all dietary supplements. This is incorrect. There are only 13 vitamins, which are essential for health, compared to over 85,000 dietary supplements for sale in America. Also, we assume that scientists know exactly what vitamins do in our bodies and how much of each we need, but they don’t. We assume that all vitamins and dietary supplements are required to be tested for safety and effectiveness before they’re sold. But they’re not.

Q.

Should the average person take a multivitamin?

A.

Ask yourself what you eat. Does your plate look like the cover of a Michael Pollan book? Then you’re already getting plenty of vitamins and other nutrients from your food. Do you eat a lot of fortified foods like breakfast cereal and sports drinks? Then you probably don’t need to take a multivitamin either, because you’re essentially eating one. The people who benefit the most from multivitamins are those with restricted diets or health issues that make it hard to absorb nutrients from food, or who get most of their calories from foods that are so junky that they haven’t even been enriched with synthetic vitamins. Man cannot live on potato chips alone.

Q.

In your book you say it’s a bad idea to get tested for blood levels of vitamin D and other nutrients. Why?

A.

I wouldn’t say it’s necessarily bad — it’s more that it’s not particularly helpful. We know that vitamin D is essential for healthy bones, but the jury’s still out on what else it might do. This makes it impossible to determine what our requirements actually are, which in turn makes it impossible to figure out what an optimal level should be. And despite an ongoing standardization effort, results for the same blood sample can differ depending on which lab they’re sent to. It’s like taking an exam that doesn’t have an answer key — and that’s scored differently depending on who grades it.

Q.

Why is taking large doses of some vitamins a bad idea?

A.

It’s a bad idea to assume that just because something is essential in small doses, bigger doses must be better. Some vitamins are known to be toxic in high doses. Vitamin A is the most notorious. In some cases, high doses of vitamins that we thought would be helpful have been shown to cause more harm than good. In the 1990s, high doses of beta-carotene, which is a precursor to vitamin A, were tested as a possible prevention for cancer, but were eventually linked to an increased risk for lung cancer, especially among smokers. Remember: Even water can kill you if you drink too much of it.

Q.

In your book you argue that the “Percent Daily Value” figures on food and supplement labels are close to meaningless. Why?

A.

First of all, we each have different vitamin requirements, which means that 100 percent for me is not 100 percent for you. Second, the recommended dietary allowances aren’t meant as personalized recommendations to begin with. And third, most of the percentages in the “percent daily value” column on current food and supplement labels are calculated off of the RDAs from 1968. Yes, 1968. The FDA plans to use more updated recommendations in the next version of the nutrition and supplement facts panels, but for now, most of those numbers are still based on recommendations that are nearly a half a century old.

Q.

What are some of the most peculiar things you learned about vitamins while writing this book?

A.

That synthetic vitamin D is made by irradiating grease from sheep’s wool. That American politicians became convinced that thiamin deficiencies would make us lose World War II. That the guy who discovered vitamin B12 did so by eating raw meat, regurgitating it, and then tube-feeding it to his unknowing patients. And that before being affiliated with vitamins, Fred Flintstone and Barney Rubble used to advertise Winston cigarettes. It turns out that the story of vitamins is much bigger, weirder, more interesting and more useful than I ever could have anticipated.

Fruits and Vegetables to Fight Cataracts

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Credit Andrew Scrivani for The New York Times

Here’s another reason to eat your fruits and veggies: You may reduce your risk of vision loss from cataracts.

Cataracts that cloud the lenses of the eye develop naturally with age, but a new study is one of the first to suggest that diet may play a greater role than genetics in their progression.

Researchers had about 1,000 pairs of female twins in Britain fill out detailed food questionnaires that tracked their nutrient intake. Their mean age was just over 60.

The study participants underwent digital imaging of the eye to measure the progression of cataracts. The researchers found that women who consumed diets rich in vitamin C and who ate about two servings of fruit and two servings of vegetables a day had a 20 percent lower risk of cataracts than those who ate a less nutrient-rich diet.

Ten years later, the scientists followed up with 324 of the twin pairs, and found that those who had reported consuming more vitamin C in their diet — at least twice the recommended dietary allowance of 75 milligrams a day for women (the R.D.A. for adult men is 90 milligrams) — had a 33 percent lower risk of their cataracts progressing than those who get less vitamin C.

The researchers concluded that genetic factors account for about 35 percent of the difference in cataract progression, while environmental factors like diet account for 65 percent.

“We found no beneficial effect from supplements, only from the vitamin C in the diet,” said Dr. Christopher Hammond, a professor of ophthalmology at King’s College London and an author of the study,published in Ophthalmology. Foods high in vitamin C include oranges, cantaloupe, kiwi, broccoli and dark leafy greens.

”This probably means that it is not just vitamin C but everything about a healthy diet that is good for us and good for aging,” he added.