Category Archives: Complementary and Alternative Medicine (Quacks)

Beware The Bitter Almond

As part of the Health Nuts Project, the skeptical cardiologist has been evaluating walnuts, hazelnuts and almonds which he plans to put in packets and distribute to patients and readers.

Previously, we discovered that most raw almonds from the US have been fumigated with a chemical called propylene oxide and that roasting almonds creates potentially carcinogenic chemicals.

Consequently, after considerable searching, I purchased raw organic almonds from a company called NutsinBulk. These turn out to be from Spain (where pasteurization of almonds is not required) and are quite tasty.

As I was munching on one of these almonds I suddenly noticed an incredibly bitter taste causing me to spit the chewed almond out. My first thought was that this almond had gone “bad” in some way. Perhaps a mold had crept into it. Looking at the pieces I had spit out, however, I could see no discoloration or other visible difference from the “normal” almonds.

Subsequent experimentation has revealed that about one in ten of these almonds is incredibly bitter and there is no way to predict this from  the external appearance of the almond.

The Source of Bitter Almonds

The sweet almond  that we are used to eating in the US is produced from one type of almond tree (Prunus amygdalus var. dulcis) and does not contain poisonous chemicals. However, the bitter almond that I encountered comes from a different type of almond tree (Prunus amygdalus var. amara).

Prunus amara trees were likely the original almond trees but over time the sweet almond trees have been selected for and now dominate. According to the LA Times and Paul Schrade, who provides bitter almonds to restaurants:

Until recent decades, most Mediterranean almond orchards were grown from seed, and the shuffling of genes resulted in a mix of bitter almond trees among the sweet. Growers liked to keep a few bitter trees around because they helped to pollinize the sweet varieties. The inclusion of bitter nuts gave snackers occasional unpleasant surprises, but they deepened the flavor of marzipan, almond milk and glazes for cakes. In Italy, bitter almond paste was traditionally used to make crisp amaretti cookies, and bitter almond extract flavored amaretto liqueur. In Greece, bitter almonds are used in soumada, a sweet syrup. (apparently cooking or adding alcohol eliminates the toxic cyanide)

There’s little large-scale cultivation of bitter almonds left in Spain and Italy, mostly just scattered trees remain, but it is still possible to buy raw bitter almonds at European specialty markets. Morocco and Iran now lead in commercial production of bitter almonds.

What Makes The Almonds Bitter: Amygdalin

The source of the bitterness is amygdalin:

A recessive gene causes bitter almond trees to produce in their shoots, leaves and kernels a toxic compound called amygdalin, which serves as a chemical defense against being eaten. When amygdalin is moistened, it splits into edible benzaldehyde, which provides an intense almond aroma and flavor, and deadly hydrocyanic acid, a fast-acting inhibitor of the respiratory system.

A variety of sources confirm that:

The lethal dose of raw bitter almonds depends on the size of the nuts, their concentration of amygdalin and the consumer’s sensitivity. But scientists estimate that a 150-pound adult might die from eating between 10 and 70 raw nuts, and a child from ingesting just a few.

YIKES!!!When I read this I was shocked. Could it be that consuming 10 of these raw  biter almonds would kill me.? How could I distribute these potentially lethal edibles to my patients?

Amygdalin (Laetrile) , Alternative Cancer Therapy and Quackery

In addition to bitter almonds, significant amounts of amygdalin are found in the stone fruit kernels of apricots, peaches and plums. A synthetic form of amygdalin called Laetrile achieved great notoriety in the 1980s as a cancer treatment. Although research had shown the chemical to be ineffective, it was embraced by “alternative” healers who claimed it was a “natural” cure for cancer which was being suppressed by a conspiracy between the US FDA, big pharma, and the the medical community.

Steve McQueen, suffering from pleural mesothelioma sought the care of a delisted American holistic orthodontist practicing in Mexico, William Kelley. The NY Times reported:

In July 1980, McQueen secretly traveled to Rosarita Beach, Mexico, to be treated by Mexican and American doctors using Dr. Kelley’s regimen. He received not only pancreatic enzymes but 50 daily vitamins and minerals, massages, prayer sessions, psychotherapy, coffee enemas and injections of a cell preparation made from sheep and cattle fetuses. McQueen was also given laetrile, a controversial alternative treatment made from apricot pits.

Although we hear little about Laetrile these days, like most snake oil it is still promoted by alternative medicine. For example, The notorious quack Dr. Mercola still promotes the idea that laetrile is a safe and effective treatment of cancer on his web site with a post that has been viewed over 700,000 times.

You Can Die From Eating Bitter Almonds

Certainly, there is considerable evidence that Laetrile can be toxic or lethal but bitter almonds can also cause lethal cyanide poisoning. A case report describes a woman with colon cancer who turned down potentially curative surgery/chemotherapy and turned to alternative treatments including Laetrile.  A helpful friend gave her a bag of bitter almonds for their “medicinal properties”, whereupon the woman consumed a slurry composed of 12 ground up almonds with water. Within 30 minutes she developed  severe cyanide poisoning with vomiting, abdominal pain, pulmonary edema, severe lactic acidosis and  loss of  consciousness.
Analysis of the bitter almonds showed they contained on average 6.2 mg of cyanide per almond. It is estimated that a lethal dosage of cyanide is 50 mg or 0.5 mg per kg body weight, thus the calculation that 10 almonds could kill someone weighing  60 kg or 132 pounds.
My  Search For Healthy Almonds Continues
The small amount of cyanide one gets from consuming a single bitter almond seems to have little effect. (Although the Mediterranean diet nutritionist Conner Middelman-Whitney , who spent time in Europe and encountered bitter almonds occasionally says that she does remember a weird, numb sensation in the mouth when they were consumed.)  It’s extremely unlikely that one of my patients would consume 10 of the bitter almonds (without reflexively spitting them out as I did) in a short period of time.
When I have consumed them I noticed no adverse effects but after such an encounter I stopped eating the almonds for the day.
However, I’m not interested in testing that theory. (Ability to taste amygdalin or smell cyanide varies between individuals, thus I can’t be certain that the bitter taste would serve as a reliable warning.)
Therefore,  I’ve concluded that I’m not going to distribute these potentially lethal almonds to my patients and will be removing them from the Dr. Pearson Health Nuts Packages.
My search for non-fumigated, non-cyanide-laced , non-carcinogenic almonds continues!
Cyanogenically Yours,
-ACP
N.B. Famous deaths from cyanide poisoning include Hitler and Alan Turing.

 

 

How To Spot a Quack Health Site: Red Flag #1, Primary Goal Is Selling Supplements

During the process of compiling the Cardiology Quackery Hall of Shame, the skeptical cardiologist has recognized that the #1 red flag of quackery is the constant promotion of useless supplements.

Such supplements typically:

-consist of “natural” ingredients

-are a proprietary blend of ingredients or a uniquely prepared single ingredient, and are only available through the quack

-have thousands of individuals who have had dramatic improvement on the supplement and enthusiastically record their testimonial to its power

-have no scientific support of efficacy or safety

-despite the lack of scientific data, the quack is able to list a series of seemingly valid supportive “studies”

-aren’t checked by the FDA

-apparently cure everything from heart disease to lassitude

I received an email today from a reader complimenting me on my post on the lack of science behind Dr. Esselstyn’s plant-based diet. The writer thought I would be interested in the work of a  Dr. Gundry.

I found on Dr. Gundry’s website an immediate and aggressive attempt to sell lots of supplements with features similar to what I describe above.

Dr. Gundry’s bio states “I left my former position at California’s Loma Linda University Medical Center, and founded The Center for Restorative Medicine. I have spent the last 14 years studying the human microbiome – and developing the principles of Holobiotics that have since changed the lives of countless men and women.”

Need I mention that “holobiotics” is (?are) not real.

Bonohibotically Yours,

-ACP

After writing this, I googled “red flag of quackery” images in the foolish hope that I might find a useable image. Lo and behold the image I featured in this post turned up courtesy of sci-ence.org. Here it is in all its glory, courtesy of Maki

2012-01-09-redflags2-682x1024

 

 

 

Are You Sabotaging Your Heart With Statin Drugs?

No, you are not “sabotaging” your heart with statin drugs. Neither are you “wrecking” your heart.

But that title probably got your attention if you are taking a statin drug and thought that it was helping your heart.

Typical appearance of Newsmax Health. Note that  the offer to assess cardiac risk is a self-serving promo of the book on natural cardiac cures written by the author of the article on the left which summarizes only the negatives of bypass surgery
Typical appearance of Newsmax Health. Note that the offer to assess cardiac risk is a self-serving promo of the book on natural cardiac cures, written by the author of the article on the left, which summarizes only the negatives of bypass surgery

This question is prominently displayed on the Health portion of a news website called Newsmax, that somehow interrupted my web surfing today. If you click on the banner, you will get to listen to the words of Dr. David Brownstein, “America’s most popular family physician.”

Dr. Brownstein, in my opinion, should more properly be termed “one of America’s most popular quacks, charlatans and purveyors of misinformation in order to market useless junk.”

What Brownstein says can be found on multiple similar sites across the internet which are promoting “alternative” or “natural” approaches to high cholesterol.

His claims can be summarized as follows:

  • statin drugs do nothing to protect you from heart attacks
  • statin drugs “weaken your heart,” muscles, cause fatigue and lower your sex drive, damage your kidneys and liver
  • statin drugs prevent the formation of cholesterol which is essential for brain, sex hormone and vitamin D production
  • 1/2 of people with heart attacks have normal cholesterol levels
  • CHF is increasing in frequency and it is related to an increase in statins and consumption of sugar and refined carbohydrates
  • Big pharma has perpetrated the biggest fraud in medical history on the American public by brainwashing doctors, beginning in medical school, to prescribe statin drugs

These claims resonate with patients who are reluctant to take medications and who feel that “natural” approaches to prevention and treatment are superior.

Brownstein uses a combination of alarmist rhetoric and pseudoscientific jargon that appeals to those seeking alternatives.

Let’s look at his claims.

Do Statins Prevent heart Attacks?

Statins unequivocally prevent heart attacks in patients who have had heart attacks or have evidence of advanced vascular disease due to atherosclerosis. This is called secondary prevention and there are almost no cardiologists/scientists with any credibility who dispute the value of statins in secondary prevention.

The only specific study that Brownstein cites is the ASCOT-LLA study, published in 2003 which looked at ten thousand patients with hypertension, no heart disease and low or normal cholesterol levels, half of whom got 10 mg of atorvastatin and half a placebo.

This was a primary prevention study and showed such a benefit of the atorvastatin on reducing heart attack and coronary deaths that the study was stopped early, at 3.3 years at which time 154 patients receiving placebo versus 100 receiving atorvastatin had had heart attacks or died from coronary disease.

This was a highly significant reduction in events. There are several ways to look at this data and present it to patients; Brownstein implies that “Big pharma” presented the most favorable way, which is that there was a 36% reduction in relative risk.

The absolute risk of an event in the atorvastatin group was 1.7% (2.7% in the placebo group), so the absolute risk reduction was from 2.7% down to 1.7% or 1%.

To help better understand the data, we can also look at the number needed to treat (NNT). The NNT is the inverse of the absolute risk reduction. So for the ASCOT trial, the absolute risk reduction was 1%. 1 divided by 1% is 100 — 100 people would need to be treated with atorvastatin (the generic of Lipitor) over the study period to prevent one heart attack. (For more discussion on the NNT check out this blog post and this paper on its limitations)

lipitorUnderstandably, Pfizer, the makers of atorvastatin, prominently displayed the 36% relative risk reduction in their direct to consumer marketing campaigns (featuring Dr.Robert Jarvik (proclaiming himself a doctor in direct to consumer videos), although he was never a licensed physician (see here for interesting discussion on the controversy that ensued)).

Until, the FDA compels them to do otherwise, big pharma will project their products in the most favorable light possible.

However, it is debatable whether presenting data to patients using absolute risk reductions or NNT info plus relative risk reductions results in better choices. As Mcalister has pointed out:

“For example, many British patients with atrial fibrillation who were likely to benefit from anticoagulant therapy because of their risk profiles and their similarity to the participants in randomized trials supporting the efficacy of warfarin declined warfarin therapy when presented with the data about their absolute risks and benefits.”

ASCOT really makes a strong case for taking a statin drug to prevent heart attacks, even in those with normal or low cholesterol levels, not the opposite, as Brownstein has implied.

Do Statin Drugs “Weaken” The Heart Muscle Or Cause Heart Failure?

After criticizing the now infamous “Seven Nations Study” of Ancel Keys, which found high fat consumption in countries with high rates of heart attacks, Brownstein trots out the weakest imaginable argument for statins causing heart failure: heart failure has increased in the last decades, statin use has increased, therefore statins are causing heart failure. 

Correlation does not equal causation!

There is no compelling evidence that statins cause heart failure or weaken heart muscle.

In fact, a recent review of heart failure and statins concluded that statins, while not reducing mortality in heart failure, do have favorable effects on reducing the rate of hospitalization for heart failure and increasing the strength of the heart muscle.

Statins may not be as beneficial in patients with heart failure, but they definitely don’t cause heart failure.

Much of the misinformation about heart failure and statins arises from sites like Life Extension, which promotes sales of its own preferred brand of vitamin CoQ10, ubiquinol. (According to their website, though, this is for altruistic reasons: “We at the Life Extension Foundation take a different view. Keeping our members in a youthful state of longevity is the most efficient way of maintaining the revenue stream we need to fund our scientific research projects. We had no problem reducing our margins to provide members with the clearly superior ubiquinol form of CoQ10.”)

As is typical for this slick organization (see my previous post here), the writing has the veneer of science but is all pseudoscience with references that are outdated, irrelevant or meaningless.

Statin Side Effects

I’ve written about statin side effects and the decision to take them based on analysis of risks and benefits here and here.
By far, the most common thing we see is myalgia, aching of the muscles, and this is reversible.
The bottom line is that the benefits of statins far outweigh the risks if you are at very high risk for heart attack and stroke.  The risks outweigh the benefits if you are at very low risk.
For those in the middle, I advocate a search for subclinical atherosclerosis either by vascular screening or coronary calcium detection.

Misinformation and Scare Tactics on the Internet

Brownstone is not the only purveyor of dangerous misinformation on Newsmax’s Health website. There seems to be a concerted effort to promote quacks and charlatans and any information on this website is suspect.

A good rule of thumb if you are searching for credible health information on the web:

Avoid sites that use scare tactics and inflammatory rhetoric to induce you to stop your prescription medication and buy a health newsletter or nutraceutical.

By the way, Big Pharma has not brainwashed me.

I have no ties to industry.

I stopped taking any pharma food or money years ago.

Listen all y’all, it’s not a sabotage!

-Boyishly yours,

ACP