Presidential Healthcare center

We provide the same Preventive Executive Physical Program as received by the President of the United States.


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Knowing What’s In Your Supplements

Supplements 1Last week, the New York State attorney general’s office uncovered another example of what appeared to be widespread fraud in the dietary supplement industry. The office accused four of the country’s biggest retail stores of selling herbal products that in many cases were contaminated or did not contain any of the herb listed on the label.

For many readers, the news raised an urgent question: Which supplements can I trust?

Experts say that there is no guarantee that supplements will do what they say they do, or that they are safe or won’t interact with any medications Supplements 3you may be taking. But there are several steps people can take to give themselves some reassurance that at least some of the supplements they buy actually contain what they advertise on the label – and nothing else.

For one, you can look for products that receive a seal of approval from the United States Pharmacopeial Convention, an independent, nonprofit organization of scientists that sets high standards for medicine, food ingredients and dietary supplements. The United States Pharmacopeia has a voluntary program through which supplement companies can have their Supplements 4products and facilities tested and reviewed.

Companies whose supplements meet the group’s standards – which ensure purity, identity and potency, among other things – are allowed to carry an official “USP Verified” seal on their labels. The group maintains an evolving list of the brands that have received its seal and the places where they can be purchased.

Source: The New York Times


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Eating Certain Fats Might Offset Some Heart Risk From Weight Gain

good fats and bad fatsIf you’re going to overindulge and gain weight, at least try to make sure the extra calories come from unsaturated fats, a new study suggests.

When lean people pack on even a few extra pounds, heart disease risk factors in the bloodstream change – some for the better if the excess food contains unsaturated fats, versus saturated fats, researchers found.

Even a moderate weight gain of about three pounds for lean, young people clearly increased markers of heart disease risk factors like insulin resistance as well as signs of impaired vascular function, said senior author Dr. Ulf Riserus of the Unit for Clinical Nutrition and Metabolism at Uppsala Science Park in Sweden.

But unsaturated fats in the diet improved cholesterol levels despite the extra calories and weight gain, which is surprising, Riserus told Reuters Health by email.

For seven weeks, two groups of healthy, relatively lean adults ages 20 to 38 were told to keep to their habitual exercise level and daily diets, adding three to four muffins to their diets each day.Coconut

The researchers provided the 240-calorie muffins, with half their energy from fats. One group of 19 adults received muffins made with sunflower oil, polyunsaturated fatty acids (PUFA), while the other group of 20 people ate muffins made with palm oil, a saturated fat. The muffins were otherwise identical.

After seven weeks, each group had gained between two and three percent of their body weight, about 3.5 pounds (1.5 kilos) each, and waist girth increased by about one percent, but blood pressure did not change significantly.

This level of weight gain in the short term is probably not dangerous at all, Riserus said, but if weight accumulates over time, especially abdominal fat, there can be health consequences.

salmonBased on blood tests, the sunflower oil group had lower cholesterol and lipid levels at the end of the study than they had at the beginning of the study. For the palm oil group, cholesterol went up, according to the results in the Journal of the American Heart Association.

Both groups showed signs of increased insulin resistance, a diminished ability to process blood sugar that can be a warning sign for diabetes onset.

Riserus and his team had previously found that the type of fat in the diet determined how much of the excess calories were stored as abdominal fat and liver fat, he said.

“If the high-caloric diet was based on unsaturated fats rather than saturated fats, very little fat was stored as liver and abdominal fat, whereas the opposite was true for the diet high in saturated fats,” he said.

Saturated and unsaturated fats have different molecular effects on the liver, he said. Unsaturated fats signal the liver to take up cholesterol from the blood, he said.

“We believe our results are very relevant considering that a large part of most populations are in caloric excess and gradually gain weight over time,” Riserus said. “Although weight gain should be avoided, the results basically tell us that we may benefit from having enough unsaturated fats in our diets, irrespectively of how many calories we eat.”

The results support the American Heart Association recommendation to replace some saturated fats in the diet, like fatty beef, butter and cheese, with unsaturated fats like vegetable oils and nuts, he said.avacado

“I do not think people usually plan for weight gain, but, as we know, it just happens quite commonly,” said Ursula Schwab, an associate professor of nutrition therapy at the University of Eastern Finland in Kuopio.

“So, by following the guidelines regarding dietary fat, unintentional weight gain can be less harmful than in cases when the recommendations on the quality of dietary fat is not followed,” Schwab told Reuters Health by email. She was not involved in the new study.

All dietary polyunsaturated fats are beneficial, she said, but that is not necessarily the case for supplements.

In addition to sunflower oil, rapeseed oil and canola oil are good sources of polyunsaturated fats, Riserus said.

Source: Reuters


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Garcinia Cambogia: A Safe Supplement for Obesity?

Garcinia cambogia is yet another entrant in the growing list of natural supplements being marketed as the answer to obesity. G. cambogia is most well-known for its use as a spice. This product, which is classified as a fruit, is naturally found throughout southeastern Asia, India and western Africa.

One of nearly 300 species of Garcinia, G. cambogia is the one most studied for its weight-loss potential. G. cambogia grows as a small tree and produces a rusty-red round fruit.2 It is the rind of this fruit that is used for both culinary and therapeutic purposes.

garcinia-cambogia_20140107_527038Obesity is a tremendous health problem, not just in the United States but globally as well. An estimated 1 billion adults worldwide are overweight, and nearly one-third of those are considered clinically obese. In the United States alone, the overall cost of obesity was estimated by the CDC to be nearly $150 billion per year.

G. cambogia became popular as a weight-loss aid when it was noted to enhance satiety in its native regions. A secondary effect of the fruit is its potent laxative action.6 The active ingredient of G. cambogia is hydroxycitric acid (HCA).
The mechanism of fat metabolism is complex, and the role of G. cambogia in this process is debatable.

Metabolically, HCA appears to be the source of early satiety. This acid enters the energy-production process of the Kreb’s cycle and ultimately increases hepatic glycogen synthesis and inhibits formation of low-density lipoproteins.
This is thought to signal to our brains that we have had enough to eat. Some suggest that HCA interacts with the production of the adipose-controlling hormone leptin, but these claims have yet to be substantiated by clinical trials.

In a meta-analysis literature review, researchers identified only 23 trials that met review criteria. Fewer than half of those ultimately met the proper standards for well-done randomized, placebo-controlled trials.

After the final data analysis, use of G. cambogia was associated with a very slight (0.88 kg) weight loss over control groups, but also with twice the number of adverse GI effects.

Korean researchers studied the effects of G. cambogia, placebo, and another weight-loss supplement in 86 overweight adults in a 10-week randomized trial.  At the end of the study, no statistically significant weight loss was found in any of the three groups.

In another small trial, researchers studied 24 overweight adults over two weeks of daily intake of G. cambogia HCA extract. In addition to actual weight loss being monitored, 24-hour energy intake was tracked. By the end of the trial, energy intake was reduced by 15% to 30% in the 
G. cambogia group over placebo, with a very modest trend in weight loss.

Finally, a study in India focused on 60 obese individuals who were randomized to HCA plus two other supplements, or placebo. At the end of eight weeks, both HCA groups had a 5% to 6% reduction in weight and BMI. Food intake, total cholesterol, LDL cholesterol, and triglycerides all decreased in the HCA groups, and HDL levels increased.

Unfortunately, evidence-based literature demonstrates the potential for adverse events in G. cambogia/HCA. In addition to significant GI upset, increasing reports of hepatic injury are surfacing.

For example, researchers found that daily feeding with HCA supplement did result in decreased fat accumulation and glucose resistance in obese mice, but at the expense of significant hepatic fibrotic changes and inflammation.

Source: MPR


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Diet Safety Alert: FDA Sends Warning to Maker of CRAZE Dietary Supplement

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A popular and controversial sports supplement widely sold in the USA and other countries is secretly spiked with a chemical similar to methamphetamine that appears to have its origins as an illicit designer recreational drug, according to new tests by scientists in the USA and South Korea.

The test results on samples of Craze, a pre-workout powder made by New York-based Driven Sports and marketed as containing only natural ingredients, raise significant health and regulatory concerns, the researchers said. The U.S. researchers also said they found the same methamphetamine-like chemical in another supplement, Detonate, which is sold as an all-natural weight loss pill by another company: Gaspari Nutrition.

“These are basically brand-new drugs that are being designed in clandestine laboratories where there’s absolutely no guarantee of quality control,” said Pieter Cohen, an assistant professor at Harvard Medical School and a co-author of the analysis of Craze samples being published today in the peer-reviewed scientific journal Drug Testing and Analysis.

“It has never been studied in the human body,” Cohen warned. “Yes, it might make you feel better or have you more pumped up in your workout, but the risks you might be putting your body under of heart attack and stroke are completely unknown.”

Craze, which is marketed as giving “unrelenting energy and focus” in workouts, was named 2012’s “New Supplement of the Year” by Bodybuilding.com. A USA TODAY investigation published in July reported on other tests detecting amphetamine-like compounds in Craze.

While Walmart.com and several online retailers have stopped selling Craze in the wake of USA TODAY’s investigation, the product has continued to be sold elsewhere online and in GNC stores. In recent weeks, Driven Sports’ website, which offers Craze for sale, has said the product is out of stock. Detonate is sold by a variety of online retailers.

An attorney for Driven Sports, Marc Ullman, said the company had no comment on the latest findings that the compounds are actually more closely related to methamphetamine.

Cohen said researchers informed the FDA in May about finding the new chemical compound in Craze. The team found that the compound — N,alpha-diethylphenylethylamine — has a structure similar to methamphetamine, a powerful, highly addictive, illegal stimulant drug. They believe the new compound is likely less potent than methamphetamine but greater than ephedrine.

“There are suggestions about how it’s tweaked that it should not be as addictive as meth,” Cohen said. But because it hasn’t been studied, he said, its dangers aren’t known. The team said it began testing Craze in response to several failed urine drug tests by athletes who said they had taken Craze.

Driven Sports has issued repeated statements in recent months that Craze does not contain any amphetamine-like compounds, including posting test results on its website that it says prove the product is clean. In July, a USA TODAY investigation revealed that a top Driven Sports official — Matt Cahill — is a convicted felon who has a history of selling risky dietary supplements, including products with ingredients linked to severe liver injury and at least one death. Cahill is currently facing federal charges in California involving his introduction of another supplement, Rebound XT, to the market in 2008 that contained an estrogen-reducing drug, and this spring a grand jury was also investigating, USA TODAY has reported.

The newspaper’s investigation, which focused on several products sold over the years by Cahill’s changing series of companies, reported that tests by the U.S. Anti-Doping Agency in June 2012 and a government-affiliated forensic lab in Sweden in April 2013 had detected undisclosed amphetamine-like compounds in samples of Craze.

A month after USA TODAY published its report about Cahill and Craze, a team of South Korean scientists published an article in a journal of the Japanese Association of Forensic Toxicology saying they had found a methamphetamine-like compound in samples of Candy Grape flavor and Berry Lemonade flavor Craze.

The researchers, from the National Forensic Service in South Korea and the National Institute for Public Health and the Environment in the Netherlands, noted that the compound found in Craze was the same as that found in a crystalline powder seized by narcotics agents in December 2011 as a suspected illicit designer drug. In that case the powder was found in an unclaimed lost package shipped from Vietnam to South Korea, according to an earlier journal article published by the team in late 2012. “It appeared that the recipient of this article sought to abuse this chemical in the same way as amphetamines. There is a possibility that this chemical will be widely abused for recreational use in the near future,” they wrote at the time.

Instead, the same team soon found the compound in Craze.

The researchers noted that the compound had been patented in 1988 by Knoll Pharmaceuticals with claims of psychoactive effects, such as enhancing mental activities and pain tolerance. While it was never developed into a medicine, the patent described tests on animals and suggested an intended oral dose of 10 mg to 150 mg, with a target of 30 mg.

A suggested serving size of Craze yielded a dose of the compound of about 23 mg, the Japanese journal article said, and “it could be assumed that NADEP was added to the supplements intentionally for its pharmacological effects without adequate labeling.” The U.S. research team also found the meth-like substance at levels of 21 mg to 35 mg per serving in each of the samples tested from three separate lots of Craze.

Craze’s label does not disclose the compound found by the researchers. Instead it says the product contains dendrobium orchid extract that was concentrated for different phenylethylamine compounds. Phenylethylamines include a variety of chemicals “that range from benign compounds found in chocolate to synthetically produced illicit drugs,” according to the U.S. researchers.

The U.S. researchers noted that an “extensive” search of scientific literature does not find any evidence that the compound listed on Craze’s label has ever been documented as a component of dendrobium orchid extract. The U.S. research team included Cohen; John Travis, a scientist at NSF International, a Michigan-based testing and standards organization that has a dietary supplement certification program; and Bastiaan Venhuis of the National Institute for Public Health and the Environment in the Netherlands.

Although not part of the journal article being published today, NSF International announced that in separate testing they also have detected the same methamphetamine-like compound in the weight-loss supplement Detonate sold by Gaspari Nutrition. “Regulators may want to consider taking action to warn consumers,” NSF International said in a statement. Gaspari markets Detonate as containing “dendrobium extract.”

Last year Driven Sports posted a series of blog items on its website alerting customers that counterfeit versions of Craze were being sold. “Could there be counterfeit products, of course,” Cohen said. “Chances are this is more likely an effort by the manufacturer to distract regulators and consumers from what’s really going on here.”

Source: USA Today

Read more at Food Poisoning Bulletin.


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Acute Hepatitis and Liver Failure Following Use of Dietary Supplement

The Hawaii Department of Health (HDOH) was notified of seven patients with severe acute hepatitis and fulminant liver failure of unknown etiology. Patients were previously healthy and sought medical care during May-September 2013. Clinicians reported that the seven patients had all used OxyElite Pro, a dietary supplement marketed for weight loss and muscle gain, before illness onset.The HDOH, with the CDC and the Food and Drug Administration (FDA), initiated a public health investigation including patient interviews, medical chart reviews, and collection of supplement samples for analysis. Results from FDA product testing are pending. While the investigation is ongoing and these data are preliminary, clinical data, laboratory tests, and histopathology of liver biopsy specimens collected thus far suggest drug- or herb-induced hepatotoxicity. Drug- and herb-induced hepatotoxicity have been reported in association with exposure to a variety of drugs and herbs used as dietary supplements and can lead to severe acute hepatitis and liver failure.

Source: Center for Disease Control and Prevention


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FDA Warns Against Counterfeit Male Sexual Enhancement Product

The Food and Drug Administration warned on Tuesday of a counterfeit dietary supplement for male sexual enhancement that could be particularly harmful to patients with diabetes, high blood pressure, high cholesterol and heart disease. In a safety warning posted on its website, the FDA said the fake product is represented as “ExtenZe Maximum Strength” and looks similar to the actual product, ExtenZe, which is made by Monrovia, California-based Biotab Nutraceuticals Inc. The FDA said its analysis showed that the counterfeit ExtenZe contains sildenafil, an active ingredient in various FDA-approved prescription medicines, including Pfizer’s Viagra, for erectile dysfunction… Sildenafil may interact with nitrates — found in some prescription drugs and often taken by men with diabetes, high blood pressure, high cholesterol, or heart disease — and could lower blood pressure to dangerous levels, the FDA said.

Source: Reuters