Study finds that glucosamine is as good as placebo for chronic lower back pain

Many people who suffer with lower back pain rely on glucosamine supplements for some relief. But does the stuff really work? A new study shows that glucosamine was no different from a placebo in treating lower back pain.

The study, released Tuesday in the Journal of the American Medical Assn., was a large, double-blind, randomized placebo-controlled trial that included 250 adults with chronic lower back pain. It was conducted at the Oslo University Outpatient Clinic in Norway.

Chronic lower back pain plagues millions of people in the U.S., and treatments include physical therapy, medication and the use of glucosamine supplements. Glucosamine is naturally produced by the body and is found in healthy cartilage. Glucosamine supplements (usually combined with chondroitin) are typically taken for the pain and discomfort that accompanies osteoarthritis, because they are thought to restore cartilage and reduce inflammation.

Some studies have shown the supplement to be effective in treating some joint pain, but others show no benefit.

Among the participants in this study, half were randomly assigned to take 1,500 milligrams of glucosamine for six months, while the other half took a placebo for the same amount of time.

The participants were assessed at the beginning of the study and again at six weeks, three months, six months and one year. They were allowed to continue with their usual pain medication and therapies.

After six months, the test subjects were asked to rate their pain on a 24-point scale. At the beginning of the study, the glucosamine group's pain score was 9.2 on average, and the placebo group's was 9.7. After six months, pain decreased -- but by the same amount in both groups. The glucosamine and placebo groups’ pain scores were both 5.0. At one year, the glucosamine group's score was 4.8, while the placebo group's was 5.5. In both groups, about the same number of people continued to use analgesics and therapies during the trial.

Based on these results, the study authors concluded that recommending glucosamine to people with lower back pain wouldn't be a good idea. However, they added that more research is needed to see if glucosamine might work for some people with chronic lower back pain.

-- Jeannine Stein

Photo credit: Ken Hively / Los Angeles Times

Weight-loss supplements: These bad boys could make you very thin indeed!

Hey, don't say we haven't warned you that you can be playing with fire when you buy into some of the Internet hype on weight-loss supplements. And if you won't take our word for it, you could listen to a rash of recent safety warnings from the FDA.

But here's a twist we didn't see coming: The inclusion in some dietary supplements marketed for weight loss of a form of chromium that, in large doses, can lead to stomach ulcers, convulsions, kidney and liver damage and even death. The state of California considers it a carcinogen and wants to monitor the safety of the chemical -- called hexavalent chromium -- in California water supplies. Hexavalent chromium is an industrial byproduct used in the chemical and welding industries: It's the stuff that made Erin Brockovich famous.

Chromium is an essential trace mineral that is important for insulin function -- specifically, for the metabolism of fats and carbohydrates. While the evidence for its effectiveness as a weight loss agent is mixed, it's a popular ingredient in dietary supplements promising to help you shed pounds. Even the safe form of chromium (called trivalent, and often taken as a supplement by diabetics) can be toxic at levels as low as 200 micrograms a day. But for its evil twin, hexavalent chromium, California has considered a safe daily "public health goal" of 0.12 mcg in its drinking-water standards (the federal and California legal limits are, however, not so stringent).

The online tester of consumer products, ConsumerLab, has found that three chromium products marketed for weight loss contain quantities of hexavalent chromium way beyond that proposed limit: Mega-T Green Tea, Natural Factors Chromium GTF, and Dexatrim Max. A daily dose of Mega-T Green Tea Max had 220 times the maximum daily dose thought to be safe by California's proposed standard. Those three represented half of the six chromium products ConsumerLab tested, and one of a wide range of dietary supplements that ConsumerLab has tested for purity and adherence to their labeled ingredients.

Wholly aside from whether the products work as promised, ConsumerLab hasn't found many that are either free of contaminants or deliver what their labels advertise. 

ConsumerLab also echoes a recent package of articles in The L.A. Times about extremely high levels of caffeine in some of these products, and the dangers of mixing some dietary weight loss supplements with some prescription medicines.

--Melissa Healy

Book Review: 'Eat Your Way to Happiness' by Elizabeth Somer

Battling the blues? Put down that Prozac prescription and head for the pantry, says Elizabeth Somer, author of the new book "Eat Your Way to Happiness." It's time for a diet makeover.

Changing what and how you eat can dramatically improve your life, without the negative side effects of antidepressants, writes the registered dietitian and frequent morning TV show guest.

Somer says people who followed diet advice she gave in her 1995 book, "Food & Mood," have told her they've seen their energy increase, their memories improve, their PMS symptoms vanish, their extra weight drop off and even their depressions lift. (She emphasizes that people should always seek medical help for depression that lasts more than a month or is accompanied by other symptoms.)

In her new book, she shares some of their stories and offers updated nutritional information.

Included in "Happiness" is advice we hear from many quarters today: Eat a good breakfast; cut back on sugar, white flour and saturated fats; choose real food over processed food most of the time; exercise daily. But she also goes further, quantifying what we should aim for and including research to back up her claims.

For example, Somer writes that sugar today makes up 25% of calories in most American diets -- much of it coming from processed foods. But a diet in which even 9% of calories are from added sugar is a red flag for weight and health problems, she says, and too much sugar offers a temporary "high" that can end in fatigue and depression. The good news is that cutting back can bring immediate weight loss, mood improvements and increased energy. She says we should aim for no more than 6% of our calories from added sugar -- 30 grams, or 7 1/2 teaspoons, a day on a 2,000-calorie diet. (This doesn't include the sugar found in naturally sweet foods such as fruit.)

Somer lists a dozen "super mood foods" to include in our diets whenever possible. Nuts are in the No. 1 spot, and she recommends an ounce a day to raise metabolism, take the edge off hunger and help regulate blood sugar. Other must-eat foods include soy (a memory booster, she says), milk and yogurt, dark leafy greens and dark orange vegetables, broth soups (which help dieters feel satisfied on fewer calories, a secret to permanent weight loss), legumes, citrus and tart cherries (they contain melatonin, a hormone that helps regulate sleep).

She spells out potential brain- and mood-boosting benefits of eating omega-3 fats, especially DHA, found in fatty fish ("Prozac from the sea"). She also goes into the downside of eating fatty fishes -- the mercury they may contain -- and gives DHA-fortified alternatives.

Somer offers tips for how to eat to sleep better (one is to eat a light dinner no less than three hours before bedtime) and work with, rather than fight, cravings. She discusses supplements, beverages and the right vices in which to indulge (good news for dark chocolate lovers). She outlines an ideal diet -- think fresh fruits and vegetables, whole grains, milk and soy, lean protein. Her book also includes recipes and a two-week kick-start diet plan.

-- Anne Colby

Photo: "Eat Your Way to Happiness," Elizabeth Somer, Harlequin, $16.95

RELATED

Book Review: 'You: On a Diet'

Book Review: 'The 10-Minute Total Body Breakthrough'

Book Review: 'The Big Breakfast Diet'

Book Review: 'The Mayo Clinic Diet

Book Review: 'Denise's Daily Dozen'

Omega-3 fatty acids may protect against cell aging

Researchers from UC San Francisco reported today that people with heart disease who had high levels of omega-3 fatty acids in their blood had a lower rate of shortening of telomere length--a marker for aging--compared with similar heart patients who had the lowest levels of omega-3 fatty acids.

A telomere is a structure at the end of a chromosome that dictates the replication and stability of the chromosome. Shortening of the telomere means the cell is aging. Researchers have been examining various substances, such as vitamins, to see if they have an impact on slowing the telomere shortening rate. Meanwhile, other studies have demonstrated that omega-3 fatty acids are beneficial to heart health. The American Heart Assn. recommends increased intake of oily fish, which are high in omega-3 fatty acids, or the use of omega-3 fatty acid supplements for the prevention and treatment of heart disease.

Researchers don't know how omega-3 fatty acids may affect telomeres. But, they wrote: "Although the mechanisms involved remain incompletely understood, there is increasing evidence that omega-3 fatty acids exert direct effects on aging and age-related diseases."

The study is published in the Journal of the American Medical Assn.

-- Shari Roan

Photo credit: Beatrice de Gea  /  Los Angeles Times

Supplement quercetin doesn't help athletes

Quercetin is a dietary supplement that has been touted for its antioxidant and anti-inflammatory powers. It's popular with some cancer patients and athletes and is found in FRS Energy, the sports drink promoted by cyclist Lance Armstrong. But a new study shows that it doesn't improve athletic performance.

Researchers funded by the Coca-Cola Co. tested the supplement in 30 recreational cyclists. Half received 1 gram a day of quercetin in a sports drink while the others received a drink that did not contain the substance. The men's performance on a maximum-effort cycling test was recorded at the start of the study and again after using the sports drink for seven to 16 days. There was no difference in the performance in the two groups in several measures, including peak oxygen consumption, metabolic changes and strength loss following the test. The study was published online this week in the Journal of Applied Physiology.

Quercetin is found naturally in the skins of fruits, leafy vegetables, berries, black tea and red wine. Lab tests in mice have demonstrated a positive effect on running endurance while studies in humans have been mixed.

The results were disappointing, said the lead author of the paper, Kirk Cureton, a kinesiologist at the University of Georgia in Athens. "Our hypothesis, based on previous studies in mice, was that we would see positive effects. But our findings are important because they suggest that results from the animal studies shouldn't be generalized to humans," Cureton said in a news release.

-- Shari Roan

Photo credit: Genero Molina  /  Los Angeles Times

Finding a use for kudzu

Kudzu, the wild vine that has overtaken almost 10 million acres in the southeastern United States, may be more nutrient than nuisance. Previous studies have suggested a chemical in the vine may help alcoholics curb their addiction. Now a study, also in rats, shows kudzu can help regulate blood pressure, glucose metabolism and cholesterol levels.

Kudzu root, which is called Radix Pueraria, contains polyphenols, substances that are known to have a range of positive health effects. Kudzu is already available in health food stores as a dietary supplement marketed to women for menopausal symptoms. In the new study, researchers gave half of a rat population kudzu root extract and compared them to rats that didn't receive the extract. All of the rats were females prone to strokes (a type of lab rat often used as a model for human metabolic syndrome).

The findings, the authors wrote: "suggest that polyphenols in kudzu root may provide a nonpharmacological complement to traditional approaches for treating hypertension. The ability of a well-tolerated, safe and low-cost food additive to decrease hypertension is of considerable interest."

The study, performed by researchers at the University of Alabama, Birmingham, and Luther College in Decorah, Iowa, was published this week in the Journal of Agricultural and Food Chemistry. Studies in humans will be needed to evaluate the true worth of kudzu. And, scientists warn that supplements now sold in stores may be poorly absorbed and may also vary in concentration from bottle to bottle.

-- Shari Roan

Photo: Judy Hough / University of Connecticut via Bloomberg News

Good news or bad news on male enhancement products? Depends ...

At least one ingredient in some of those seemingly ubiquitous products might have had at least some effect. On the other hand, that ingredient was a drug, the Food and Drug Administration has found. Know what that means? Yep. They have to go ...

Nature & Health Co., based in Brea, has issued a recall (voluntary) of six dietary supplements marketed as male enhancement products.

Got the packets or bottle? Look for these names:

LibieXtreme
Y-4ever
Libimax X Liquid
Powermania
Powermania liquid
and (the best-named) Herbal Disiac

As it turns out, the FDA did a little testing and found that these products contain either tadalafil, a similar substance known as aminotadalafil or a chemical similar to sidenafil.

Tadalafil is a key ingredient in Cialis.

Sidenafil is a key ingredient in Viagra.

The presence of such ingredients may sound fine and dandy (no prescription needed), but users can't know how much of the chemicals were in the supplements, especially as they weren't listed as ingredients on the label. Nor can users know precisely how they might react with other drugs. Those are significant unknowns.

In any case, their presence means the supplements are actually drugs, the FDA says. And that means the supplement maker can't sell them.

The company says, possibly with a sigh: Fine, return them and we'll give your money back.

Here's the notice, with more details.

And here's more on tadalafil and sidenafil.

-- Tami Dennis

Calcium supplements not for weight loss

People who eat more dairy products have lower weights and seem to lose weight more easily, several observational studies published in recent year have suggested. But new research -- perhaps the best study to date on the issue -- shows calcium supplements have no effect on weight.

The study involved 340 obese or overweight adults, most of whom were women. They were assigned to take either 1,500 milligrams of calcium or a placebo with meals for two years. After the two years, there were no differences between the two groups in total body weight or body fat mass.

The dairy diet has been an especially popular topic in recent years, promoted by the dairy industry. Some scientists suggested that calcium can combine with fatty acids in the intestine to form insoluable soaps that are not absorbed. Others theorized that low calcium intake in the diet leads to more fat deposits. But the new study, by researchers at the Office of Dietary Supplements and Intramural Research at the National Institutes of Health, cast serious doubt on those theories. 

"Even though there may be other important reasons, such as fracture prevention ... calcium supplementation is unlikely to have clinically significant efficacy as a preventive measure against weight gain in persons who are already overweight or obese," the authors wrote. It's still possible that increasing one's intake of dairy products, however, may effect weight.

The study is published in the Annals of Internal Medicine.

--Shari Roan

Illustration: Peter Bennett / For The Times  

Could vitamin D be a key to successful dieting?

Another potential piece to the weight loss puzzle was unveiled recently when researchers discovered there may be a link between vitamin D levels and shedding pounds.

A study measured vitamin D levels in 38 obese men and women before and after they went on an 11-week diet in which 750 calories were deducted each day from their total caloric consumption. The participants also had their body composition and fat distribution evaluated using dual-energy X-ray absorptiometry and computed tomography.

In testing vitamin D levels before and after the diet, researchers discovered a relationship between levels of a precursor form of vitamin D (frequently used as an indicator of vitamin D levels) and weight loss; for every incremental increase of the substance, subjects lost almost a half-pound more while on their diets. Those who had increases in an active form of vitamin D also lost about a quarter-pound more.

Having higher levels of both forms of vitamin D at the start of the diet also forecast more weight lost in the abdomen. Excess abdominal fat has been linked to a higher risk of cardiovascular disease and type II diabetes.

Lead author Dr. Shalamar Sibley, an assistant professor of medicine at the University of Minnesota, cautioned, however, that a more controlled clinical trial is needed to see if vitamin D supplements will have any benefit in helping people lose weight via diets. The study was presented recently at the annual meeting of the Endocrine Society in Washington, D.C.

-- Jeannine Stein

Photo credit: Justin Sullivan / Getty Images

The dirt on dietary supplements

The Food and Drug Administration has cracked down on several manufacturers of dietary supplements lately. In March, the FDA identified three weight-loss products that were tainted with active pharmaceutical ingredients -- bringing the list of tainted products to 72. And earlier this month, the manufacturer of the weight-loss supplement Hydroxycut recalled the product after the FDA linked it to 23 cases of liver damage and one death.

Some nutritional supplements have real value. Folic acid taken by women of reproductive age can help protect against some birth defects and premature birth. Lutein improves eye health. Calcium helps bones. Vitamin D is important for numerous body functions. And omega-3 fatty acids can boost heart health. Others, too, appear to have at least some modest benefit.

But the 1994 passage of the Dietary Supplement Health and Education Act paved the way for a marketplace in which manufacturers of dietary supplements can churn out pure trash -- or worse, dangerous products -- with few repercussions. The situation is detailed in an in-depth piece in this week's Sports Illustrated titled "What you don't know might kill you." The article, by David Epstein and George Dohrmann, focuses in large part on sports supplements, but the lack of consumer protections extend to all forms of supplements.

According to the Sports Illustrated story:

• The industry is a "Pandora's Box of false claims, untested products and bogus science."
• "Today some of the biggest [supplement] companies are just big marketing departments."
• The industry "remains fertile ground for kitchen chemists with little or no formal education in science and nutrition -- and in some notorious cases former steroid users and dealers."
• Of DSHEA: "That legislation, heavy with lobbyists' fingerprints, razed virtually every barrier to entry into the marketplace."

It's good to see the FDA apparently stepping up its efforts to root out the bad players in the marketplace. But the agency is swimming upstream. It's time to re-examine the farcically named Dietary Supplement Health and Education Act (just how is this educational?) and implement laws that prevent consumers from becoming guinea pigs for unscrupulous kitchen chemists.

-- Shari Roan