Narrator:
0:01
Welcome to MedEvidence, where we help you navigate the truth behind medical research with unbiased, evidence-proven facts, powered by ENCORE Research Group and hosted by cardiologist and top medical researcher, Dr. Michael Koren.
Kevin Geddings:
0:17
For spending time with Dr. Michael Koren, of course, with ENCORE Docs, and he also heads up a team that's responsible for a great website, MedEvidence. com. That's MedEvidence. com a great place to go to get just good, accurate information. That's not particularly biased, right, Dr. Koren, it's just information we like to call the truth behind the data.
Dr. Michael Koren:
0:39
Thanks, Kevin, for helping us explore how to get the most out of the MedEvidence platform. It's been a valuable conversation so far. Maybe you can summarize it for people who just are starting with this podcast.
Kevin Geddings:
0:52
Yeah, we've been talking about how the website will help you do deal with issues like trying to determine risk versus benefits, the importance of who you are in terms of your genetic makeup, what your background is, what your socioeconomic status is. All these filters matter when you're looking at health-related information to try to figure out how it applies to you or your loved ones. We also thought we would talk in this segment about value and convenience, because when we see options out there for all the many supplements especially, and other things we can do for our health most people have a budget, right, Dr. Koren. They have to determine what is of true value for them and their loved ones.
Dr. Michael Koren:
1:32
Exactly. Yeah, that was a great summary. So again, the three tiers just to reiterate it for the audience is first, think in terms of risk versus benefit, not just good or bad. Everything could be good or bad, depending on circumstances. Then know who you are and how that's relevant for the medical decision-making. Now to the third tier, which is what's the value to you? The value in terms of dollars, the value in terms of time, the value in terms of other options. So, with all these things, sometimes the easiest way to illustrate the point is through an example.
Dr. Michael Koren:
2:05
This happens every day in my practice, so literally clinic. Yesterday I talked to a patient. He's like many other patients, some guy in his 70s. He's on probably about 14 supplements. I asked him why are you taking these things? Typically the answer is well, someone told me it was good. Okay, well, we can break it down and say well, there's always a risk versus benefit.
Dr. Michael Koren:
2:31
In this particular case, let's talk about zinc. That was one of the things that he was on. I asked him why are you taking zinc? He didn't really have an answer. Well, there's actually studies that have looked at zinc.
Dr. Michael Koren:
2:43
So in terms of the risk versus benefits just a quick overview I can talk about zinc for an hour, but in one minute what I would say is that everybody needs zinc. Zinc is very critical to many biochemical processes in your body, but you can also get zinc toxicity. So a typical element of zinc toxicity is something called a taxia, where you lose your balance or your muscle function is a little bit off, and that's well known to occur for people that overdo it with zinc. The other thing is that zinc interacts with other important elements that your body also needs. So when you take zinc, it's more difficult to absorb iron in copper. So that is a consideration. So if you're anemic and you're taking iron supplements, well maybe you shouldn't be taking zinc because that can affect the absorption of iron and copper. So all these things get into the element of kind of who you are, and then we get into sort of the value proposition. Well, zinc actually has some data showing that it's effective for people with macular degeneration, and so that's an eye condition of the elderly, and I think a lot of ophthalmologists recommend zinc supplements for patients that fall into that category. So if this fellow who I spoke with yesterday had mentioned that his eye doctor recommended it, I would say, okay, that's cool, that makes sense, you have a reason for taking it.
Dr. Michael Koren:
4:05
Another area where zinc has had some benefits is in trying to reduce the symptoms of oral illnesses. So a number of studies that have looked at using zinc immediately after developing some symptoms of an upper respiratory infection and typically that's going to be a liquid zinc or the zinc losanger that can absorb in your mouth and there may be some ways that those products reduce the severity of the illness and studies have borne that out. So the truth behind the data is, under those circumstances that helps, but there are no data to say that if you take one zinc pill every day, that you can prevent disease, and in fact there's some studies that show that that in fact doesn't happen. So, again, context and the use of it is important, and then you get into value. Well, if you're taking one zinc tablet every day to prevent viral diseases, well, you're probably making your urine very expensive by taking all these nutrients that are not needed. The other thing is that if you're somebody that likes breakfast cereal in the morning, well, take a look at the zinc content of that and you'll find that most breakfast cereals are actually fortified with lots of different nutrients, including zinc. So do you really need that 50 milligram zinc pill if you're getting a bunch of zinc in your multivitamin and your breakfast cereal? Well, the answer is no. So in terms of value, there's pretty much no value to that. Then the other thing that comes up is that there's a lot of different preparations for all these products that are marketed, and sometimes very expensive depending on the marketing, and there's a ton of examples of that.
Dr. Michael Koren:
5:41
So when you look at value, you might see something that says Chelated Zinc. Well, what does that mean? Well, what it really means is that the zinc is attached to something that makes it easier for your body to absorb. So the question is well, how easy is zinc for the body to absorb? And the answer is your body does a pretty good job of absorbing zinc. In fact, if you look at a run-of-the-mill zinc oxide, your body is going to absorb 50 or 60% of that.
Dr. Michael Koren:
6:07
So if the key-lated product costs two or three times more and brings it up to 70%, is that really worth it? I would say probably not. So, again, the devil is in the details, which we'll get into the next section, but here's an example of we all have to make consumer choices and you pay $20 or $5 for the same basic preparation. Now the flip side is that there are certain nutrients, for example magnesium, that your body doesn't absorb very well and as a cardiologist, I'm really focused on magnesium because magnesium is extremely important for a number of cardiovascular functions, including prevention of arrhythmias extra heartbeats. So some people be on magnesium supplements and maybe we're not getting their magnesium levels to where they need to be, and that person may need to consider a different salt than magnesium oxide, which is a commonly used salt that's inexpensive but may not be absorbed, as well as some of the other magnesium salts that are available in the market.
Kevin Geddings:
7:07
And Dr. Koren, I think there are also an issue as well with when the gentleman your patient was taking 10 or 14, however many supplements, it was how those might interact with other prescription medications.
Dr. Michael Koren:
7:18
Oh, absolutely. It's a really important factor. So there's many examples of how one can impact another and that's why, with pharmaceuticals, you're gonna get information about do you take it on an empty stomach or do you take it on a full stomach? Do you take it at the same time as other things? A great example of that would be you shouldn't take Viagra and nitroglycerin preparations at the same time because of a drug-drug interaction, and those things also happen between supplements. I mentioned already that zinc affects the absorption of iron and copper and, again, depending upon the medication we're talking about, nutritional supplements can actually affect the absorption of multiple different medicines and again, you have to get into the details and talk to your doctor about it or look up those specific elements online which can be readily available for patients.
Kevin Geddings:
8:14
Value and convenience, one of the aspects that you will appreciate more when you look at the website MedEvidence. com. That's MedEvidence. com and that website, Dr. Koren, designed to be easy for layman like myself, right?
Dr. Michael Koren:
8:28
It is. It is and we will drill into different issues. So another example of value and convenience, for example, would be fish oils, and we've done programs on fish oils and there are a ton of fish oil products out there and there are also drugs that are omega-3 fatty acids. So one of them that's on the market that's been approved by the FDA and proven in clinical trials that we participated in is a drug called the sepa. The generic name for it is called a cossipent ethyl and it's a specific type of omega-3 fatty acid called an EPA and a acid, and it's been shown in studies that probably that does better than just a generic fish oil product. But then again, if you have your doctor right for that, you may find that you get a bill for $500 a month and that's no price.
Dr. Michael Koren:
9:25
So the question is is it worth the $500 a month? Well, in some people it may be worth it. If you have super high coronary artery risk and you've had multiple complications and you happen to have high triglycerides, this may be something that's well worth that $500 a month. But there are alternatives, so there can be fish oils that are specifically prepared to have high levels of that EPA omega-3 fatty acid. There are also some generic versions of a eicosapentaenoic ethyl that may have not been approved by the FDA like Vascepa, but may have some value if you can't afford the $500.
Dr. Michael Koren:
10:03
And of course, the part of the value and part of what we do on mid-evidence is help people understand when is it really important for you and your doctor to go after your insurance company and see if they can get that Vasceoa paid for and when maybe you just go with a generic alternative. So these are the kind of questions that we address. The other thing, in terms of convenience, we do a lot of clinical research on convenience. So, for example, in the cholesterol space, there's a drug that we helped develop called inclisiran, and incliscerin a drug that you give three times the first year and then after that you just get it every six months. It helps control your cholesterol. Well, that's pretty darn convenient.
Dr. Michael Koren:
10:47
Yeah, well, but it may not replace taking a pill every night, and that's the funny thing. So we still recommend that you take statin. So, on one hand, it has this amazing property of being administered only once every six months. On the other hand, it may not stop you from taking a pill every night. So how do you balance those things? Well, that's why we have mid-evidence. So we'll have discussions about omega-3 fatty acids. We'll talk about them for cardiovascular disease, for psychiatric disease and for a number of other indications, and break down all the information with somebody who's a physician that has a really good understanding of the evidence but also understands the human elements of risk versus benefit, who you are and, ultimately, value and convenience, and we'll break those down for you on our MedEvidence platform.
Kevin Geddings:
11:37
Well, it all starts by looking at the website MedEvidence. com. That's MedEvidence. com.
Dr. Michael Koren:
11:44
And thank you very much for your interest, Kevin, and in our next session we're going to get into the devil in the details, which is the dose.
Narrator:
11:54
Thanks for joining the MedEvidence podcast. To learn more, head over to MedEvidence. com or subscribe to our podcast on your favorite podcast platform.
