Vitamin d – is more better?

November 30th, 2010   1 Comment

The Institute of Medicine’s 14 member panel has released the findings of their two year study of vitamin D and increased the recommended dietary allowance of vitamin D to 600 international units per day from the previous level of 400 international units per day. This is the second increase since the 1997 levels which were 200 international units per day.

The panel was formed at the request of the governments of the United States and Canada. The panel examined thousands of publications and studies in order to determine how much vitamin D and calcium people needed for good health, how much was too much and what is the level for deficiency.

Vitamin d testing has exploded over the last few years and labs have started reporting that levels below 30 nanograms per milliliter is a deficiency. The Institute of Medicine’s new study states that a level of 20 to 30 nanograms per milliliter to be the level that is needed for good bone health for practically all individuals, therefore, a deficiency would exist only below 20 ng/mL.

When labs use the below 30 nanograms level as a deficiency then an estimated 80 percent of the population is deemed vitamin d deficient. However, the Institute of Medicine is lowering that bar to 20 nanograms which would mean that we don’t actually have a vitamin d epidemic in the United States.

The medical community has released thousands of studies over the last several years supporting an increased need for vitamin d supplementation to levels between 1000 – 2000 IU and citing increased diseases in people with low levels of vitamin d. The media has highly publicized vitamin d as a panacea for the common cold to cancer. So how do we make sense of the new government study?

The government is required to issue one number which is supposed to be for everyone in the United States. Certainly, the government would not recommend one level for the people of Vermont and another for the people of Florida, but that is how vitamin d works based on your distance from the equator. And certainly there would be an uproar if our government made one recommendation for whites and one recommendation for blacks, but again that is how vitamin d works based on the color of your skin and its ability to absorb the sun’s rays and convert them to vitamin d.

“the committee emphasizes that, with a few exceptions, all North Americans are receiving enough calcium and vitamin D. Higher levels have not been shown to confer greater benefits, and in fact, they have been linked to other health problems, challenging the concept that “more is better.””

So the Institute of Medicine has to walk this very narrow line of making a recommendation that will work for every man, woman and child in this country – as their tagline on their website says “Advising the Nation”. So while medical evidence exists that where you live or the color of your skin will effect your vitamin d level, the committee had to ignore these facts in their recommendations and find a cautious level to establish for all.

Even with the recommended lower level of 20 ng/mL many people are still vitamin d deficient. If you want to heed the cautionary levels recommended by the IOM then test your vitamin d level and if it is below 20 ng/mL then take the recommended supplement of 600 IU per day. Test your vitamin d again in three months and see if there has been improvement. Many in the medical community will tell you that you cannot raise your vitamin d level on 600 IUs per day.

The one thousand page report issued by the IOM will be read in full by few and rehashed by many. Personally, I will not read the entire 1,000 report since I had trouble getting all the way through Dr. Holick’s 336 page book on vitamin d. However, I do know that I can have my vitamin d level tested and know that I need to be at minimum in the 20 – 30 ng/mL range. My recent vitamin d level came in at 14.6 ng/mL and I live in the sunny south and am white. Just to get to the cautiously safe level of 30 ng/mL means doubling my vitamin d level which will take additional supplementation and additional sun exposure. The good news is that I can test again and find out if I am making progress.

While the IOM report sounds like a cautionary warning, the truth is we still have the tools available to find out what works for each of us individually and this is not something the government will ever be able to do – determine what is best for you.

The FDA Ban on Four Loko – Why The FDA Isn’t Going To Take Your Rum And Coke Away

November 23rd, 2010   2 Comments

It’s been exactly a week since my last article on Four Loko (“Wilmington Takes A Harder Look At Four Loko”) and in that time a lot has changed. In fact, Four Loko went from being a potential menace (especially if you drink more than one) and college party favorite to a banned drink. How exactly did this happen so fast?

Well, actually, it didn’t happen that fast. According to Discover Magazine (in 2009) the FDA requested proof that the caffeinated alcohol drinks were safe back in 2009. The list of companies notified to look into their products’ safety is here. State regulators did not wait for the FDA – Michigan, New York, and Utah among other states banned the sale of Four Loko in their state before the FDA sent their warning letter on November 17.

Four Loko can cause violent behavior in students due to its high powered blend of alcohol and caffeine.

Students that drink Four Loko are more likely to engage in dangerous behavior, according to Federal officials.

These facts, and other developments (hospitalizations of binge drinking students, a study that showed that caffeinated alcohol drinks cause more sexual violence and more dangerous behavior in general) led to a not so rosy outlook for Four Loko and its kind. In fact, on Nov. 16 Phusion Products, the makers of Four Loko, presumably anticipating the FDA’s letter, announced they were removing caffeine, guarana, and taurine from their drinks.

The reaction to this was somewhat predictable.  Philly Post writer Jeff Billman in his article “Leave Four Loko Alone” said:

“But: Do you really think that banning Four Loko, or anything else for that matter, is going to stop kids from figuring out that if they chug a Red Bull in between sessions of Coors Light or Jose Cuervo or whatever cheap vodka comes in plastic jugs and in bulk from the BJ’s across the state line in Delaware, they’ll be able to stay awake longer and, consequently, drink more? I had that figured out well before the advent of Four Loko, and I can assure you that, in this, the information age, the kids today are much better informed on these things than I was as a college frosh in 1997. If I want a particularly late-night bender—a rarer and rare occurrence these days—downing one of those five-hour energy shots does the trick. Oh, and those are totally legal. So is downing one, and following it with six shots of Jack Daniel’s.”

Er, yes, that is true.  But comparing a five-hour energy shot with Four Loko is unfair.  After all, a five-hour energy shot does not contain alcohol.  Nor is it packaged with alcohol, and my guess would be if the packaging expressed that it works well with six shots of Jack Daniel’s that they would be receiving a letter from the FDA as well.  Vague comparisons of dissimilar products aren’t going to get you very far.

Meanwhile, over at the Miami New Times, you could hear Kyle Munzenrieder make the “nanny state” argument:

“In a treacherous blow to the personal freedoms of Americans and Capitalism itself the FDA is expected to ban the sale of caffeinated alcohol drinks as soon as next week. Yes, alcohol and caffeine, two perfectly legal and widely available substances will not be allowed to be sold together in one can. The move comes after in the midst of the Four Loko craze.”

You may have a point when you make that argument (I wouldn’t say the ban is necessarily a good or bad thing) but it’s not really fair to make that argument in this manner:

“Researchers are concerned that caffeine counterbalances some of the effects of alcohol and may lead drinkers to believer they are less drunk then they are. That’s a valid point, yet the mixing of the two substances isn’t going away any time soon. While the pre-made mixtures will apparently now be banned, it’s unlikely Americans will stop drinking these find mixtures of caffeine and booze:

Rum and Coke
Vodka and Redbull
Irish Coffee
Espresso martinis
Shots followed by a Five Hour Energy chaser
Cafecito and Cisco”

Yes, Americans are still going to drink rum and coke, but no, that’s not really the same thing. Irish coffee has not been the scourge of college campuses lately. Nor have rum and cokes. Why is that? Because they contain vastly different quantities of caffeine and alcohol. Make a 6.5 oz rum and coke with 40% ABV rum and your drink will contain 0.6 oz of alcohol and 14.5 mg of caffeine. Make a version of it more generously sized and you are still nowhere near Four Loko. This recipe calls for 4 oz of Bacardi white rum (37.5% ABV) and 8 oz of Coca Cola (35 mg of caffeine in a 12 oz can). This drink will probably cost you more at the bar, and still only have 23.3 mg of caffeine and 1.5 oz of alcohol (4 oz x .375). This is compared to Four Loko, which has one serving size (23.5 oz) and contains 156 mg of caffeine and 2.82 oz of alcohol. Even two of those hefty rum and cokes wouldn’t have as much caffeine as a Four Loko. I don’t that anyone ever binges on Irish Coffees, but if you are drinking an average sized Irish Coffee (a 7.5 oz serving, plus cream on top) you’re only going to consume about 0.6 oz of alcohol and 90 mg of caffeine. Again, just not the same.

Four Loko does not stack up against other mixed drinks in terms of caffeine - it stacks over.

Four Loko, towering over the competition.

The other problem in Four Loko land (as we’ve pointed out before) is the serving size. It’s a carbonated beverage so once you crack open the can, you’re more or less forced to consume/get rid of it or have it go flat. Unlike vodka (which Arrested Development’s Lindsay Bluth memorably and mistakenly believed “goes bad once it’s opened”) Four Loko cannot really be consumed in moderation. Fortunately we can cap our whiskey, rum, and vodka bottles. In fact, that’s part of the design – if vodka was packaged to “go bad” within a few hours, you can bet it wouldn’t be on the market.

Was the ban the smartest thing ever? That seems to me to be another debate. It also seems to me that comparing a mixed drink like a rum and coke to Four Loko does not have a place in that debate. After all, Four Loko is a real product on a real shelf – nobody is selling rum and cokes in a can. The FDA’s job is to regulate real products. And again, if they did sell rum and coke in a can, that would probably have not caught the FDA’s attention – if the can was 12 oz instead of 23.5. Caffeine and alcohol together are not necessarily going to send you to the hospital or make you have a violent freak out, but moderation when consuming the two simultaneously is more even important than when consuming one or the other separately. Phusion Products ended up creating a product that fell a little far outside the lines of moderation. Four Loko is just oversized in almost every sense (except price, which Cord Jefferson thinks may’ve played a role in its being banned). My guess is that if Phusion Products had not tried to create the craziest thing on the market, their product would probably still be on the market.

Post by Robyn Schelenz. Have any thoughts, comments, or disagreements you wish to share? Send me an email over at robyn at homehealthtesting.com and I’ll get back to you as soon as I can.

Headline photo by Ted S. Warren/Associated Press.

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Wilmington Takes A Harder Look At Four Loko

November 16th, 2010   2 Comments

Four Loko, the high alcohol high energy drink, has received a lot of attention lately (including from us – see “Alcoholic Energy Drinks More Than Most Can Handle” for more).  There has been some new discussion locally as North Carolina contemplates doing what New York state recently did by banning the drink. At the moment Governor Perdue has asked manufacturers to voluntarily stop selling alcoholic energy drinks in the state.

The University of North Carolina Wilmington’s Substance Abuse and Prevention Office notes that most of the kids on campus caught drinking have been drinking Four Loko (WECT 6).  The students of the school interviewed for the article made clear that it is potent stuff.  It does, after all, have a 12% alcohol content and enough stimulants in it to mask normal feelings of drunkenness.  But does that warrant a ban?

Why Ban Four Loko?

There are a few arguments on this.  Some have accused Four Loko of intentionally marketing to younger people.  The design on the cans is bright and colorful and looks more or less like any other energy drink you would buy.  By virtue of this association it seems that kids underestimate the punch that each can packs. Which leads us to the second point – the can is almost 24 ounces, twice as large as a beer.  The alcohol content is about three times that of a light beer.  Basically, finish one can of Four Loko (which is only a few dollars – the price is one of its selling points) and you’ll have had the equivalent of a six pack, and jitters on top of that.  You will most likely be drunk, or very drunk. And not only will you have consumed a six pack, you will also have simultaneously consumed the equivalent of two Red Bulls. Why’s that? Because one 8.3 oz can of Red Bull only has 76 mg of caffeine in it…while Four Loko has 156 mg of caffeine.

Four Loko, the latest popular target for college partiers and alcohol testing alike.

Four Loko

Designed For Drinking

That Four Loko is packaged in such a manner is part of the problem.  It is not so much the eye-catching design, but the size of the can that presents the issue (in my mind anyway).  Once you open the can, you’re going to have to drink it or throw it out – it’s a carbonated beverage and will go flat like a soda does if left to sit.  You’re not purchasing a can of the drink to have as an apéritif over a few days.  You’re drinking the whole thing once it’s opened, and as pointed out above, that will definitely make you drunk.  It’s immoderation by design.

The Stimulants

Then you have the fact that the beverage contains a number of stimulants.  Those stimulants are caffeine, taurine, and guarana.  When they mix with alcohol (in this drink and in many others, including cocktails) they can have unexpected effects.  As our previous blog noted, people drinking an alcoholic energy drink believe their motor coordination is better than those who do not have those ingredients in their drink.  If you do not feel as drunk as you are, you may be inclined to continue drinking, and the signals from your body that say you’ve had enough may not be clearly perceived.  This is the aspect of alcoholic energy drinks that leads to hospitalization.  But there are other negative effects too.

One of the stimulants in Four Loko.

Guarana, one of the stimulants in Four Loko.

A study at Wake Forest University in 2006 found that those who mix energy drinks with alcohol are more likely to sexually assault or be sexually assaulted, more likely to get in a car with a drunk driver, and more likely to require medical treatment (see the Daily Collegian for more info).  In other words it’s much more likely that destructive and risk-taking behaviors will be pursued. Aimee Hourigan of the UNCW Substance Abuse and Prevention Office in an interview with WWAY3 noted that “You’re more likely to get into a fight and have other negative consequences related because your body’s just not equipped to handle that much alcohol and stimulant at the same time.”

An Experiment

The actual effect of drinking a Four Loko was measured recently by a local Raleigh woman. Drinking four ounces every half a hour (a pace probably considered slow by college standards), she measured her blood pressure and pulse through the process.  When she started out her blood pressure was 116 over 64; in 4 ounces’ time it went up to 192 over 36 and her heart was racing at 154 beats per minute.  The woman, a registered nurse, had her verdict.  Feeling sick after 8 ounces, she stopped, and told WALB10 news that “if you’re not careful, you could kill yourself with this.”

A Matter of Taste

Finally, in terms of taste, people will disagree, but it seems clear that the drink wasn’t made for delicate meal pairings.  In comes in a number of sugary, fruit like flavors that make it more appealing.  All these factors considered, it’s hard to see that it’s anything other than a product made for binge drinking.

A Question of Law

Does this mean that a ban is required?  It remains to be seen if this is so.  The makers of Four Loko, Phusion Projects, recently published an open letter addressing federal and state inquiry into their beverage.  They do sell a version of the drink that contains less alcohol; it’s foreseeable that they may soon only be allowed to sell that version.  The popularity of the drink on college campuses is a problem somewhat larger than themselves – college binge drinking is always a problem, especially as it often occurs in crowded situations with many inexperienced if not underage drinkers.  Four Loko may be a little too potent for that setting, but that doesn’t mean it couldn’t potentially be enjoyed elsewhere.

As Wilmington and North Carolina in general examine this issue, let us know what you think by leaving comments or sending us an email at cs at homehealthtesting.com.  We’d love to hear from you (and remember, it’s easy to keep tabs on your BAC with a disposable and portable alcohol test kit).

For more info, including info on the FDA’s inquiry into alcoholic energy drinks, check out Time’s Healthland.

Headline picture by Taggart, originally for the New York Daily News.

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A Country Thing? Rx Drug Abuse Most Common In Rural Areas

November 9th, 2010   Add Comment

Prescription drug abuse is a major point of focus for our blog, as it is a problem the scope of which is still not fully understood.  Florida has received a lot of attention for its pain clinics, but it seems the areas in which prescription drugs are mostly abused are rural (which should come as no surprise to the viewer of the OxyContin Express).

According to a new study that will appear in the Archives of Pediatrics & Adolescent Medicine (see Science Daily for the full article), rural teens are more likely to abuse prescription drugs.  With adjustments for other factors made, the study found that rural teens were 26 percent more likely than urban teens to admit to prescription drug abuse.

In general, 1 in 8 teens reported prescription drug abuse at some point in their lives, itself a rather alarming statistic.  The study suggests that the greater tendency toward prescription drug use in rural areas may be the result of a lack of availability of similar illegal drugs, such as heroin.

While a heroin shortage in rural communities may sound like a good thing, it doesn’t seem like, based on these statistics, the country life is simpler or free of drug use.  In fact, not only is prescription drug use a problem in rural communities, but treating it may be more difficult than it would be in an urban community.  Rural teens may be less likely or have a harder time finding places that will help them deal with a substance abuse problem.  It is possible that their communities do not have the same awareness level as do larger communities or have the same ability to deal with a local drug problem.

We have documented extensively in our blog that prescription drug abuse can have as many consequences as illegal drug abuse.  For parents and policymakers alike, it’s something to think about.

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