Are endogenous nutritional supplements better?

Just a muse.

Endogenous substances are those that are already contained within our bodies. They are part of basic human equipment.

Exogenous substances are those that come from outside of our bodies. This includes various substances in foods, drugs (most, though not all), and pesticides.


I often mull over all of the tools we use in the Track Your Plaque program to achieve control over this thing called coronary plaque. It struck me that just about all the supplements we use that seem to provide outsized benefits are all endogenous substances themselves:

--Omega-3 fatty acids from fish oil
--Vitamin D
--l-arginine
--Niacin (vitamin B3)

Many of the other substances, though not directly relevant to our plaque-control efforts, but are among the most effective nutritional supplements, also supplement endogenous levels: calcium pyruvate, creatine, acetylcarnitine, DHEA, testosterone, progesterone, growth hormone, pregnenolone, phenylalanine, tyrosine, melatonin, etc.

Curiously, most drugs are not meant to directly supplement endogenous levels, but are designed either to enhance or block an enzyme (e.g., acetylcholinesterase inhibitors that block breakdown of acetylcholine; HMG CoA reductase inhibitors to block cholesterol synthesis; angiotensin converting enzyme inhibitors to reduce blood pressure), to exert toxic effects on an organism (antibiotics, antivirals), or to exert an entirely unique effect that does not ordinarily occur in the human body (some anti-cancer drugs, for instance). (This is an admitted, vast over-simplification.)

That's not to say that any endogenous substance is desirable or safe when supplemented. Cortisol, thyroid hormone, and estrogens are three examples of endogenous substances that have downsides when administered at slightly more than physiologic concentrations.

Nonetheless, it makes me wonder if the world of endogenous substance supplementation has not been fully explored. Are there other endogenous substances that are as potent and wonderful, for instance, as vitamin D but not yet fully appreciated? I'm sure there are.

Comments (6) -

  • Anonymous

    5/3/2008 11:20:00 PM |

    I don't know if this would qualify as an endogenous substance, but I've recently added the herb turmeric to my supplementation list. I take a capsule or two a day.  I'm on an e-mail list for supplement studies and marketing going on in health food circles, and it seems tumeric is receiving good press for its ability to help strengthen bones. Figure with the connection between brittle bones and heart disease, it's worth taking a little.

  • Jenny

    5/4/2008 12:43:00 PM |

    Dr. Davis,

    You mentioned that estrogen is a natural substance that causes problems if administered at higher than physiological levels.

    You do know, I hope, that all the data showing supposed problems from estrogen supplementation is from research studies where women were given MUCH too high doses. I've been using a dose of non-horse origen estrogen about 1/4 of what they used the studies and it makes a huge positive difference in my blood sugar, blood pressure, and weight with no negative effects on my endometrium (which my doctor has me get measured with ultra sound every so often.

    I'm very grateful that I have a good gynecologist who didn't react mindlessly to the research showing negative outcomes from estrogen.

    It appears to be protective against macular degeneration (which made my dad blind in his 90s) and for me it makes blood sugar control much, much easier.

    But the usual dose given women is much, much too high, and it isn't adjusted for body weight or titrated by observing symptoms. And hence the whole idea of supplementation has been nixed.

  • Anne

    5/4/2008 9:37:00 PM |

    That is interesting about the bones and tumeric. I recently added curcumin because my fibrinogen level was elevated. Maybe it will help with my bone loss too. That would be great.

    What is the difference between tumeric and cucurmin? Does it matter which I take? I could not find tumeric but I did find cucurmin 500mg.

  • Anonymous

    5/5/2008 1:57:00 PM |

    Hi Anne,

    I guess it is the curcumin found in the spice turmeric that is receiving positive press.  As mentioned I've seen some on bone health studies but have also seen heart health and diabetes write-ups too.  I'll post below a recent small rodent research paper on diabetes benefits of curumin:

    Curcumin may offer diabetes benefits: study
    By Stephen Daniells

    KEYWORDS

        * Phytochemicals, plant extracts

        * Diabetes

    GET THE LATEST MARKET REPORTS

        * curcumin
        * diabetes
        * cardiovascular health

    All market reports

    30-Apr-2008 - Curcumin, the natural pigment that gives the spice turmeric its yellow colour, could have benefits for diabetics, suggests a joint Korean-American study.
    A mouse model of diabetes was used to test the effects of curcumin on various variables and significant improvements were reported for insulin resistance and glucose tolerance, report the scientists from Sunchon National University and Kyungpook National University in Korea, and Columbia University in the US.

    Curcumin has increasingly come under the scientific spotlight in recent years, with studies investigating its potential benefits for reducing cholesterol levels, improving cardiovascular health, reducing the risk of Alzheimer's, and potential protection against cancer.

    If results of the new study, published in the journal Molecular Nutrition & Food Research, can be repeated in humans, it may suggest potential for the spice for diabetes management or prevention.

    Promising results for diabetic mice

    The researchers, led by Mi-Kyung Lee, used diabetic mice, so-called db/db mice, and non-diabetic controls, named db/+. The animals were fed diets with or without added curcumin (0.02 per cent) for six weeks.

    They report that the diabetic mice supplemented with curcumin experienced lower blood glucose levels, than the controls. The animals also lost less weight.

    Activity of the glucokinase enzyme in the liver was higher in the diabetic mice following the curcumin-supplemented diet than in the diabetic control group. This enzyme plays a key role in the conversion of glucose into glycogen, the body's main carbohydrate stores. This would blunt the glucose rise following the meal.

    The spice was also linked to reduced activity for other enzymes associated with the production of markers of cardiovascular health, such as free fatty acids, cholesterol, and triglyceride were also significantly lower following curcumin supplementation in the diabetic animals.

    Importantly, no effects were observed on blood glucose, plasma insulin, and glucose regulating enzyme activities in the non-diabetic animals, stated the researchers.

    "These results suggest that curcumin seemed to be a potential glucose-lowering agent and antioxidant in type 2 diabetic db/db mice, but had no affect in non-diabetic db/+ mice," they concluded.

    Potential market opportunities

    Significant additional research needs to be performed before anyone can contemplate recommending curcumin for diabetics, but if further studies support these preliminary positive findings, this may offer help for the estimated 19 million people affected by diabetes in the EU 25, equal to four per cent of the total population. This figure is projected to increase to 26 million by 2030.

    In the US, there are over 20 million people with diabetes, equal to seven per cent of the population. The total costs are thought to be as much as $132 billion, with $92 billion being direct costs from medication, according to 2002 American Diabetes Association figures.

    Source: Molecular Nutrition & Food Research
    Published online ahead of print 8 April 2008, doi: 10.1002/mnfr.200700184
    "Effect of curcumin supplementation on blood glucose, plasma insulin, and glucose homeostasis related enzyme activities in diabetic db/db mice (p NA)"
    Authors: K.-I. Seo, M.-S. Choi, U.J. Jung, H.-J. Kim, J. Yeo, S.-M. Jeon, M.-K. Lee

  • Richard A.

    5/6/2008 6:57:00 PM |

    Turmeric is about 4% curcumin. Turmeric and curcumin need fat like Vitamin d to be best absorbed. Lecithin also improves absorption.

  • Physical Therapy Supplies

    6/13/2011 7:46:31 AM |

    As much I know the large doses of cretin monohydrate are widely taken, particularly by athletes, as an endrogenic supplement; cretin supplements are also taken by patients suffering from gyrate atrophy, muscular dystrophy, and neurodegenerative diseases.
    Physical Therapy Supplies

Loading
To B or not to B

To B or not to B

Apoprotein B (apo B) is the principle protein that resides in LDL particles along with other proteins, phospholipids, triglycerides, and, of course, cholesterol.

There's a curious thing about apo B. Just like one child per family in China or one television per household in 1950s America, there is only one apo B for every LDL particle.

So measuring apo B, in effect, provides a virtual count of LDL particles. (Actually, VLDL particles, the first lipoprotein to emerge from the liver, also have one apo B per particle but LDL particles far outnumber VLDL particles.) While apo B structure can show limited structural variation from individual to individual, the effect on measured apo B is negligible.

One apo B per LDL particle . . . no more, no less. What about the other components of LDL particles?

The other components of LDL particles are a different story. Cholesterol and triglycerides in LDL particles vary substantially. Diet has profound effects on cholesterol and triglyceride content of LDL particles. A diet rich in carbohydrates, for instance, increases triglycerides in LDL particles while reducing cholesterol. This means that measuring cholesterol in the LDL fraction will be misleading, since cholesterol will be falsely low. LDL cholesterol is therefore a flawed means to assess the behavior and composition of LDL particles. In particular, when LDL particles become enriched in triglycerides, they go through a process that transforms them into small LDL particles, the variety most likely to cause atherosclerosis.

In other words, when the worst situation of all--an abnormal abundance of small LDL particles develops--it is usually not signalled by high LDL cholesterol.

Because apo B is not sensitive to the composition of LDL particles--high cholesterol, low cholesterol, high triglycerides, etc.--it is a superior method to characterize LDL particles. While apo B doesn't tell you whether LDL particles are big, small, or in between, it provides a count of particles that is far more helpful than measuring this deeply flawed thing called "LDL cholesterol."

(Even better: Count LDL particles and measure LDL size, since size gives us insight into sensitivity to oxidation, glycation, adhesiveness, ability to trigger inflammatory pathways via monocyte chemoattractant protein, various interleukins, tunor necrosis factor and others. This is why cholesterol panels should go the way of tie dye shirts and 8-track tapes: They are hopelessly, miserably, and irretrievably inaccurate. Cholesterol panels should be replaced by either apoprotein B or lipoprotein measures.)

Comments (11) -

  • arnoud

    12/5/2010 2:53:08 PM |

    The NMR Lipoprofile test provides LDL particle counts, and the VAP test provides Apo-B measurement.
    Is there a direct conversion factor to determine Apo-B for a given total LDL count, and vice versa?

  • Anonymous

    12/5/2010 2:55:39 PM |

    Hi Dr. Davis,
    Is there an advantage to ordering the VAP along with the NMR Lipoprofile?  Does the information from one or both of these two tests greatly improve on measuring the apo B and apo A ratio?
    Thanks,
    John

  • Dr. William Davis

    12/5/2010 2:56:28 PM |

    Hi, Arnoud--

    Apoprotein B and NMR LDL particle number are roughly correlated with a difference in units by a factor of 10. An LDL particle number of 1000 nmol/L is approximately equal to 100 mg/dl apo B.

    By the way, apo B is calculated on VAP, not measured.

  • Martin Levac

    12/5/2010 4:18:26 PM |

    LDL does not cause atherosclerosis. Thus, there is no possible gradient such as "most likely". It might look like a semantics argument but I'm really just exposing the flawed hypothesis behind the semantics.

    What is truly most likely, is that whatever causes atherosclerosis also causes small LDL.

    Carry on.

  • Eugene

    12/5/2010 5:39:07 PM |

    Hi Dr. Davis,
    Is there an advantage to ordering the VAP along with the NMR Lipoprofile? Does the information from one or both of these two tests greatly improve on measuring the apo B and apo A ratio?
    Thanks,
    E. John

  • Travis Culp

    12/6/2010 4:20:19 AM |

    I was previously unaware of this information; thanks for the heads up.

  • Anonymous

    12/8/2010 7:54:55 AM |

    Dr. Davis,

    I've been following your dietary advice for a few years (low carb, little to no wheat, lots of nuts and flax) and all my biomarkers are excellent... Except.. my serum phosphorus, which tends to be either above the normal range or at the very high end of the normal range... this isn't an issue with my kidneys since all other markers are optimal... I wonder if you've seen similar results before with this nut/flax rich diet?

    Thanks,
    David

  • Anonymous

    12/8/2010 10:04:41 PM |

    I had an ApoB of 43 mg/dl, an LDL particle number on NMR of 593 nmol/L, and an LDL on NMR of 78 mg/DL with particle size of 21.6 nm.  My ApoB seems much lower than my LDL particle number (even after adjusting for the factor of 10). Weird?

  • Might-o'chondri-AL

    12/9/2010 3:24:37 AM |

    Glycosaminoglycan (dermatan sulfate form, a bi-glycan) and ApoB together make the type of plaque that is rupture prone.

    The enzyme hyaluronidase increases glycosaminoglycan synthesis when lack ApoE. In animal models the aorta collagen increases, plasma volume drops, proteinuria rises, endothelium degrades and atherosclerosis begins.

    The poly-anion hyaluronate is available (water soluble) in a pectic polysaccharide as hyaluronic acid in fruit of Abelmoschus esculentus; "okra" is the plant in English.

    This may partiallly explain the autopsy analysis of the differences seen in arteries of Africans (who eat okra) & Westerners. Maybe the okra hyaluronate "uses up" the excess enzyme hyaluronase, which effectively "neutralizes" the Apoliprotein risk factors (ApoE deficiency & hypothetically here the ApoB excess).

  • karl

    12/17/2010 9:48:44 PM |

    My hunch is apo-b is correlated with oxLDL, but I've seen no papers that show that small LDL or apo-b count is more predictive than oxLDL.

    We know that high carb yields high blood sugar and that alone is oxidative of LDL. What if apo-b is correlated with oxLDL because both are driven by high BG?

    Unless this is separated out,  we might be wasting money on expensive apo-b tests instead of cheap oxLDL tests or even cheaper postprandial BG testing.

  • Adriana

    10/5/2011 12:23:43 PM |

    This is interesting as there are reports of okra water reducing some people's fasting blood glucose.

Loading