22 replies to this topic

[opales]

http://news.gc.ca/cf...rticleid=213559

[Athanasios]

That is a misleading title.

[opales]

why? because the patient population had heart problems already? Are there any long-term studies with healthy people with heart problems as end-points?

[Athanasios]

"For patients with heart disease who have not had a previous heart attack, taking L-arginine is unlikely to present a risk and may provide benefits since L-arginine may help the body repair damage to blood vessels in the heart."

[scottl]

This has to do with....nitric oxide. I have a client taking it as it increases nitric oxide and lowers blood pressure. Doesn't last long but one of the companies offers a time release form. a review is here:

http://www.pdrhealth.../lar_0024.shtml

Opales you are quite hysterical and this is why often I don't care what people in ivory towers who are removed from treating people think.

Edit: and even if the link that you wrote is 100% true and represent the whole picture, again the patient population is:

"patients who have previously had a heart attack" and yet you titled this post:

"l-arginine CAUSING heart problems"

You seem to totally lack the understanding that results are only valid (if indeed the study is valid) for the patient population that was studied. This is a basic concept when evaluating studies.

[opales]

Opales you are quite hysterical and this is why often  I don't care what people in ivory towers who are removed from treating people think.

Dude I just posted a piece of news I thought people might find interesting (albeit admittedly perhaps with a bit alarmist title). Don't start giving any crap about ivory towers, researchers are not idiots (well not all of them at least). Relying on mere clinical impressions is careless because a) people tend to be biased in their cognition b) effects that take reasonable time to manifest are undetectable through such methodology.

Ever thought recommending some proven and more researched blood pressure lowering treatment?

[opales]

"patients who have previously had a heart attack" and yet you titled this post:

"l-arginine CAUSING heart problems"

You seem to totally lack the understanding that results are only valid (if indeed the study is valid) for the patient population that was studied.  This is a basic concept when evaluating studies.

Sorry for the misleading title, but you know the topic space is limited. Still think it's interesting.

Some reasonable generalisations must be made every time research is interpreted. It's called external validity and I am very aware of it. I am not sure you are an expert on it either. How many times have you relied on animal results when ingesting or recommending supplements (or avoiding say artificial sweeteners), how do you think the external validity compares there?

[scottl]

I just posted a piece of news I thought people might find interesting (albeit admittedly perhaps with a bit alarmist title?

***albeit admittedly perhaps with a bit alarmist title***

You keep doing this, and you keep doing this to warn us how dangerous supps can be.

Some reasonable generalisations must be made every time research is interpreted.It's called external validity and I am very aware of it.

Despite the fact that you are well aware of it, you keep doing it all over the place...pregnant women, patient who start with advanced heart disease,...it goes on and on. Again all to advance your agenda of supps being potentially dangerous.

[Shepard]

water CAUSES death!!!!

http://www.cbsnews.c...ain299435.shtml



It's only beer from now on.

[scottl]

Ever thought recommending some proven and more researched blood pressure lowering treatment?

heh. FYI this particular person is a nut and will not take any normal BP meds. This would not have been my first choice.

[scud]

Nice one Shepard!

[xanadu]

Actually, I think we need the Opales' of the world. They are a nice counter ballance to the wide eyed true believers. Of which I am sometimes one, though I try to maintain a healthy scepticism. Even when Opales is wrong, which he often is, he makes us examine our biases and thought processes. He makes us justify what we already believe. In the process, we often learn something new. Occasionally, we find that he was right and we were wrong. Even if he only was right one time in his whole career, he is doing a service. Keep up the work, Opales, and dig up that dirt to make us think again. The truth can never hurt us and lies will be exposed.

Not that I'm defending alarmist titles, just the general idea.

[Athanasios]

Actually, I think we need the Opales' of the world. They are a nice counter ballance to the wide eyed true believers. Of which I am sometimes one, though I try to maintain a healthy scepticism. Even when Opales is wrong, which he often is, he makes us examine our biases and thought processes. He makes us justify what we already believe. In the process, we often learn something new. Occasionally, we find that he was right and we were wrong. Even if he only was right one time in his whole career, he is doing a service. Keep up the work, Opales, and dig up that dirt to make us think again. The truth can never hurt us and lies will be exposed.

Not that I'm defending alarmist titles, just the general idea.

Not to take the thread off of the topic of bad titles but... [tung]

It is very important to talk about supplements objectively, meaning outside of one's own risk to reward ratio. It should be encouraged here for each person to find their own risk level independant of others. Sometimes people will hype all the benefits of a supplement like it is the second coming, despite reasons why others may not want to take it. Sometimes people will bash supplements like they are the most poisonous things on earth, despite them having some backing to be beneficial in certain circumstances. What is important is not the balance of the two types of incidences, but rather making sure that information is held in higher esteem than hype and bias. Posting in this manner would not only help the readers, but it would also help the poster himself.

[doug123]

Hey -- I like Opales' powerful skepticism. Scott easily balanced it out for us.

It's topics like this that help me remember that some of the supplements I take actually do something.

[opales]

***albeit admittedly perhaps with a bit alarmist title***
You keep doing this, and you keep doing this to warn us how dangerous supps can be.

Look the information was interesting (to me at least), as has been the case with the other news or articles I have posted too. Still, I do think there is a predominant view that "natural" supplements can do no harm (how many would stack dozens of prescription drugs like it was the most natural thing in the world?) but still can deliver for amazing results. Something has got to give at some point.

BTW, had I substituted "aspartame" for "l-arginine" this discussion would have taken a totally different tone.

As for seeking negative reports, my reasons for doing so is two-fold

a) few others are doing it. People have gotten more critical ever since the LM incident (mind you I was one of the few people who dared to challenge him in his prime), but there is still tendency with some people to opt for wishful thinking instead of cold risk-benefit analysis no matter what you say as it is a common human bias that should be recognized more readily

http://en.wikipedia......28prediction)

b) The second reason is the more important one. That is the asymmetrical nature of gains versus losses derived from pharmocological interventions due to the parallel multiprocess nature of the ultimate endpoint, death. That is, any one process any can bring an organism to an abrubt end but improving one process won't do much to entend life as other process still get you pretty much in time. If someone thinks I am wrong (or missing the point), please challenge me because this a very important question.

Despite the fact that you are well aware of it, you keep doing it all over the place...pregnant women, patient who start with advanced heart disease,...it goes on and on. Again all to advance your agenda of supps being potentially dangerous.

While I am not a medical scientist and thus my sense of external validity issues is of question, I hardly think you are an expert on such matters either scott. Your view of generalisabiity of results is black and white because of the contextual nature of the concept: obviously the generalisability is contingent upon the phenomenon at hand. You don't see people attacking AORsupport with rage when he cites the Nurses' Health study as evidence for the extensive amount of vitamin A in other formulations (ok, there is other eveidence too but point remains). Or few disagree that animal models might be better suited for study of degenerative diseases than for cognition which is probably the one trait that separates humans the most from the rest of animal kingdom.

Even as a more illustrative point, your position towards the homocysteine studies a while back was unreasonable and IMO missed the specific context in which results indeed had reasonable generalisability.

http://www.imminst.o...homocysteine&s=

You disregarded the results with a handwave as "irrelevant" because the study population was heart patients. However, unlike with l-arginine, the mechanism for homocysteine to exert it's harmful effects is the same for healthy and diseased populations alike. If that mechanism is being challenged as causal agent in heart disease (or at least lowering it with Bs) then hell yes it says something about the prevention of the disease also. The recommendations for taking Bs for heart disease prevention are based on mechanistical rationalisations based on homocysteine hypothesis, not impressive clinical evidence. Did the results mean that Bs can't absolutely help healthy people preventing heart disease? No. Does it cast doubt on their usefulness in that purpose? Yes it does.

Actually, I think we need the Opales' of the world. They are a nice counter ballance to the wide eyed true believers. Of which I am sometimes one, though I try to maintain a healthy scepticism. Even when Opales is wrong, which he often is, he makes us examine our biases and thought processes. He makes us justify what we already believe. In the process, we often learn something new. Occasionally, we find that he was right and we were wrong. Even if he only was right one time in his whole career, he is doing a service. Keep up the work, Opales, and dig up that dirt to make us think again. The truth can never hurt us and lies will be exposed.

Not that I'm defending alarmist titles, just the general idea.

Thanks for the encouraging pep talk, but I am still going to take on your casual comment of "opales being often wrong". If I have "warned" against possibe negative effects (or lack of positive effects), of course in time I will be proven wrong in some cases. But I don't think I have been wrong (at least not often) in the sense that I was being unreasonable or that my position was indefensibe given the available data. Even in case when I posted the critical article on vitamins and the more devouted supplement consumers attacked me with raging commentaries, the fact remains that scientific evidence for supplemental vitamin consumption remains weak (but is not non-existent), as stated by the recent NIH panel

http://www.imminst.o...&f=6&t=10567&s=

[scottl]

Opales,

Listen, you’re an OK guy. But the alarmist stuff is getting on my nerves. I realize you mean well, and please do keep us on our toes and provide devil’s advocate, but perhaps you could do it in a less alarmist tone.

Also and more importantly:

“Still, I do think there is a predominant view that "natural" supplements can do no harm (how many would stack dozens of prescription drugs like it was the most natural thing in the world?) but still can deliver for amazing results. Something has got to give at some point”

No Opales, nothing ever has to give. While I welcome your ideas (phrased….more gentilly if that is a word) I do not welcome you to force your ideas on me whether I like it or not. This is the specialty of a certain…flavor of political beliefs who like to force their way on everyone because they know best. I don’t like it there, and I don’t like it any better here. Whether you are right or not, no one appointed you deity and we do not ever have to believe as you do.

I’ll address the rest later.

[opales]

Opales

Listen, you’re an OK guy.  But the alarmist stuff is getting on my nerves.  I realize you mean well, and please do keep us on our toes and provide devil’s advocate, but perhaps you could do it in a less alarmist tone.

I rather enjoy being an alarmist

http://www.theonion....tent/node/30868

No Opales, nothing ever has to give. While I welcome your ideas (phrased….more gentilly if that is a word) I do not welcome you to force your ideas on me whether I like it or not. This is the specialty of a certain…flavor of political beliefs who like to force their way on everyone because they know best. I don’t like it there, and I don’t like it any better here. Whether you are right or not, no one appointed you deity and we do not ever have to believe as you do.

No I don't want to enforce my beliefs (at least here because as we are roughly in the same boat) but I do like to attack what I perceive as intellectually inadequately justified positions. That's of course a judgement call, which by default is flavored by subjective perception. But I would like to think I have been fairly open about my rationalizations for perceiving things the way I do.

[stellar]

Discussed already:

http://groups.google...c76bc24ae3b058c

[scottl]

Briefly,


1. Your views stand on their own and AORsupport (who you will note ain’t alarmist and which is one of many reasons for his much greater credibility) and aspartame are irrelevant.

2. I’m not interested in arguments relating to extending lifespan as I’ve said before as that’s not why I take/recommend this stuff.

3. “As for seeking negative reports, my reasons for doing so is two-fold

a) few others are doing it.”

You must be kidding. Have you not noticed that you read weekly negative stuff about supps but when is the last time you’ve read anything in the major new sources that is positive about any supp?

4. “While I am not a medical scientist”

This is a problem. I find when I screw up and say something that ain’t true it is much more likely to be an area where I do not have personal clinical experience.

5. “There is a predominant view that "natural" supplements can do no harm.”

Again people die from drinking too much water (there was a big story on it relating to marathon runners. The overwhelming majority of supps taken in reasonable doses are unlikely to cause harm, and given that I’m 47 I think the risk to benefit ratio is more the justified.

NB: I don’t recommend aggressive supp regimens to e.g. healthy 20 year olds.

6/ Opales, you don’t get the homocysteine bit:

If homocysteine damages arteries, and we can lower it with supps, that does not mean that if we take people with arteries that are already damaged and lower their homocysteine the body can fix the arteries.

[opales]

1. Your views stand on their own and AORsupport (who you will note ain’t alarmist and which is one of many reasons for his much greater credibility) and aspartame are irrelevant.

My or AORsupport's credibility is completely irrelevant to my point, which was providing an example of contextual nature of study generalizability. Comment my point rather than making irrelevant "personal attack"-like statements.

BTW, AORsupport works for supplement company, it is not in his interest to make people wary of supplements even when there would be reasons to do so (not to question his integrity or anything)

2. I’m not interested in arguments relating to extending lifespan as I’ve said before as that’s not why I take/recommend this stuff.

What the hell is the point of taking supplements to improve health if that does not improve overall longevity? Are you saying live fast die young or what? You do realize health and longevity correlate strongly.

3. “As for seeking negative reports, my reasons for doing so is two-fold
a) few others are doing it.”

You must be kidding.  Have you not noticed that you read weekly negative stuff about supps but when is the last time you’ve read anything in the major new sources that is positive about any supp?

Few here I meant. Maybe the negative reporting has to do the inherent properties of those substances than media bias, or the fact that negative reporting carries more informational value (due aforementioned asymmetrical nature of the gains derived vs. losses)?

4. “While I am not a medical scientist”

This is a problem.  I find when I screw up and say something that ain’t true it is much more likely to be an area where I do not have personal clinical experience. 

I really wish you had not taken this card up. I would rather see explicit argumentation that can be challenged rather than retorting to merits which cannot be challenged. If you think my generalisations are not valid, try to explicate why.

5. “There is a predominant view that "natural" supplements can do no harm.” 

Again people die from drinking too much water (there was a big story on it relating to marathon runners.  The overwhelming majority of supps taken in reasonable doses are unlikely to cause harm, and given that I’m 47 I think the risk to benefit ratio is more the justified.

NB: I don’t recommend aggressive supp regimens to e.g. healthy 20 year olds.

So because something is safe at reasonable doses but unhealthy at large doses, makes supplements safe also? I am not following your logic here.

On overwhelming majority of supps unlikely to cause harm is your subjective perception of the issue, thus of little substance, at least if you don't make your argumentation more explicit.

I am actually not sure how much the risk benefit calculations change as a function of age. Why is older folks supplementing less risk prone than young folks supplementing? I am not saying you are wrong, I am not just sure how the logic works. Please explicate that too.

6/ Opales, you don’t get the homocysteine bit:

If homocysteine damages arteries, and we can lower it with supps,  that does not mean that if we take people with arteries that are already damaged and lower their homocysteine the body can fix the arteries.

I don't think you have really thought your position through here. The fact that people have damaged enough arteries to have caused a heart attack, does not mean that arteries cannot get worse and thus *increase* the likelyhood of a secondary event. It's about *increasing* or *decreasing* the likelyhood of events, not about making patient completely devoid of them.

As a close analogy, lowering cholesterol should do squat for inhibiting secondary cardiac events by your logic. However, the effect of cholesterol lowering drugs is actually MORE pronounced when used to prevent secondary events (by more pronounced I mean that statins have clear effect on total mortalies when used to prevent secondary events, effect being of more debatable value when used to prevent heart disease altogether. You may ask AORsupport for verification). Do you disagree with my analogy?

[scottl]

Opales,

1. You wrote:

"You don't see people attacking AORsupport with rage "

I was explaining why that is so. His (former to my knowledge) associations are irrelevant. He does not make inflammatory posts/titles, he does not appear to have an axe to grind, and his integrity is impeccable (not that I always agree with him)


2. Me:
"I’m not interested in arguments relating to extending lifespan as I’ve said before as that’s not why I take/recommend this stuff."

Opales:
"What the hell is the point of taking supplements to improve health if that does not improve overall longevity".

Everything which improves health increases longevity?
Would be nice.

There is some such term squaring the circle or something like that i.e. remaining healthy as long as possible e.g. one can:

live healthy till 60 then live but be in suboptimal health for another 20 years...vs
being basically healthy and vital till 80 and then dieing.

No it is not quite that simple, but that is the idea. Yes I believe (and have seen in patients I've treated) that supps improve health. I avoid discussions of life lengthening since I have no idea if anything around now can do so (I'll skip the CR discussion).

3. "On overwhelming majority of supps unlikely to cause harm is your subjective perception of the issue,"

No it ain't. You've already seen what length's you had to go to to find potenial harm from folic acid. As an exercise try the same for all the b vitamins.

4. Re: age

I'm basing my recommendations on what is known now, knowing full well that things might turn out to be diferent 5 or 10 years from now. Thus for someone old like I (47) I'm willing to take and depending on the persons wishes/goals for supps be agressive. I"m less willing to recommend extensive supps to a healthy 20 year old as likely they have less to gain.


5. Re: homocysteine.

Here is where your lack of medical knowedge leaves you at a disadvantage. The anatomy and physiology of damaged arteries is different then normal arteries. Comparing their behaviour is like comparing apples and organges. Thus what I keep saying and you don't understand since you lack the medical background. Paul Waknfer (the morelife guy) puts it this way in Stellar's link above:

"So much has changed in people who get to the stage that they suffer an
MI, that it is not unreasonable that some of the same supplements which
help others remain healthy and prevent the disease will now make things
worse for them".

I'm not sure I totally agree...but the point is well taken: do not assume that things that help well people stay well/prevent disease will be as useful to people with disease. Cancer is the most striking example, but clearly there are others as here.


Re: cholesterol

This is a whole nother ballgame and not an appropriate analogy. Suffice it to say the things they are using to lower choleserol (statins) also inhibit inflammation and I have no trouble imagining that things that lower inflammation would work in more damaged arteries i.e. statins might well work on apples and oranges whereas lowering homocysteine might only be relevant to apples.
-----------------------------------------------------------------------------------------------------------------------------------

Opales,

You get the final word as enough is enough.

If you post in neutral tropic titles and learn enough to know the clinical relevance (or lack) of what you are posting, I will be happy to reply in kind. If you continue to post inflammatory thread titles and post material of questionable clinical relevance, then my replies will also be in kind.

Edit: to be clear, Paul Wakfur and other non-physicians seem to have a better grasp on clinical relevance, so I am in no way saying that one has to be a doc to understand my point of view.

Edited by scottl, 21 May 2006 - 08:28 PM.

[zoolander]

I agree that inflammatory thread titles are not good. It appears to be the same sort of fear mongering applied by the mass media to keep us on the back foot.

What are the rules and regulations regading thread titles?

Would it fair to say that if the thread title was a statement that you would expect that statement to be true?

Scottl, I totally agree with your views on supplementation. Anti-aging medicine is really just good preventative medicine. Supplementation and exercise (Smart lifestyle choices) should be geared towards maintaining what we have for longer. Whilst males may live to just over 70 years old, most of these males will spend the last decade of their life in sub-optimal health. Sarcopenia, cardiovascular disease, arthritis, and so on. In most situations this is NOT necessary.

There is so much we can do. I have personally trained many seniors. I have put them through strength training programs. 12 week strength training programs with low rep ranges. I trained them hard. I had a 74 year old pushing over 200 kilos on a leg press. I had a 75 year old come to me on the last week of the program and tell me that his doctor was gobbed smacked when he looked at his resting glucose levels (7.5+ to 5ish). As a part of the training programs I supplemented the seniors with whey protein. When I DEXA scanned them at the end of the 12 weeks the increases in lean mass were eye popping.

My point? People lives and their quality of life can be changed. As a researcher, it was a pleasure to say f**k the data! watching these seniors run around and laugh was rewarding enough. I recieved some personal thank yous from their wives as well. [lol]

I believe that both supplements and exercise can increase a persons quality of life. If an outsider came in looking for advice on supplements and saw inflammatory thread titles, they may be turned away. They may not read on because the thread is too scientific. So what are they left with? "L-arginine CAUSING heart problems"

My father has heart disease. Lets say for the sake of this thread that he has vascular dysfunction. So I do some research and make some choices based on articles such as this

L-Arginine improves vascular function by overcoming deleterious effects of ADMA, a novel cardiovascular risk factor.

Boger RH, Ron ES.

Clinical Pharmacology Unit, Institute of Experimental and Clinical Pharmacology, Center of Experimental Medicine, University Hospital Hamburg-Eppendorf, Germany. boeger@uke.uni-hamburg.de.

There is abundant evidence that the endothelium plays a crucial role in the maintenance of vascular tone and structure. One of the major endothelium-derived vasoactive mediators is nitric oxide (NO), an endogenous messenger molecule formed in healthy vascular endothelium from the amino acid precursor L-arginine. Endothelial dysfunction is caused by various cardiovascular risk factors, metabolic diseases, and systemic or local inflammation. One mechanism that explains the occurrence of endothelial dysfunction is the presence of elevated blood levels of asymmetric dimethylarginine (ADMA)--an L-arginine analogue that inhibits NO formation and thereby can impair vascular function. Supplementation with L-arginine has been shown to restore vascular function and to improve the clinical symptoms of various diseases associated with vascular dysfunction.

Publication Types:

    * Review


PMID: 15771559 [PubMed - indexed for MEDLINE]

I know one thing from my experiance.......if my dad happened to come accross this thread he would have skipped reading the linked article. He would have read the title and thrown away the 1/2 kilo tub of L-arginine. Thrown the tub away in fear of the L-arginine CAUSING heart problems.

I think we should all be careful about how we word topics. For or against supplements.

I can see where you are coming from Opales, trying to balance things out and all. I'm glad that you can provide the counter argument. However, if you are delibratly trying to instill fear into people reading the topic to get your point accross...well....shame on you.

Edited by zoolander, 22 May 2006 - 12:18 AM.

[Athanasios]

ha, you were willing to put in the fight I was not

props