(No emergencies or surgery- these must go to nearest polyclinic or hospital ER). .
or consultations by Telephone/email where appropriate.
update December 08, 2014
Aspirin, paracetamol, other NSAIDs, and codeine in periodic conservative analgesic use have not been reported to cause hypoglycemia eg a few gm a day solo or in combination in well adults- despite deliberate overdose of these being notorious for causing fatal bleeding or liver failure with hypoglycemia, or respiratory failure.
But increasingly tramadol is incriminated in dangerous hypoglycemia: Tramadol Use and the Risk of Hospitalization for Hypoglycemia in Patients With Noncancer Pain JAMA Intern Med.December Tramadol is an increasingly widely used weak opioid analgesic , associated with adverse events of hypoglycemia. Analysis in United Kingdom Clinical Practice of treatnent with tramadol or codeine for noncancer pain between 1998 and 2012 included 334 034 patients, of whom 1105 were hospitalized for hypoglycemia during follow-up (incidence, 0.7 per 1000 per year) and matched to 11 019 controls. Compared with codeine, tramadol associated with increased risk of hospitalization for hypoglycemia in the first 30 days of use (OR, 2.61 [95% CI, 1.61-4.23]). This 30-day increased risk was confirmed in the case-crossover analyses (OR, 3.80 [95% CI, 2.64-5.47]). Conclusions tramadol (in contrst to codeine), TRIPLED risk of hypoglycemia requiring hospitalization. Additional studies are needed to confirm this rare but potentially fatal adverse event.
update 4 March 2013 BAN DICLOFENAC? four years on, another call comes for the virtual banning of diclofenac, from no less than the Canadian Medical Association Journal , based on a new metanalysis of NSAID risks by University Toronto’s McGettigan and Henry .
As this column has long pointed out, diclofenac is apparently still the only NSAID that can kill suddenly without warning. There are many far safer alternatives eg naproxen, ibrufen; and no compelling clinical evidence or reason to use it let alone cox2 inhibitors except false beliefs and heavy marketing.
So as this columnist concluded in 2009, it is blatant fraud, negligence and potential indefensible homicide to continue recommending let alone using diclofenac simply for profiteering.
21June 2009 It is 4 months since this column last addressed nonsteroidal anti-inflammatory drugs NSAIDs.
A new study (from USA, UK and Canada – Ray 2009) of NSAIDs claims that in those with ischemic heart disease, the popular NSAIDS -diclofenac, ibuprofen or rofecoxib(Vioxx) – increased serious heart disease/ death by about 50-67% compared to nonusers; whereas naproxen over some 111000 patient years of use gives no significant risk or benefit.
A new study from Denmark (Fosbol 2009) this year looked at a million healthy individuals with no hospital admissions or selected therapy. Compared to no NSAID use, ibruprofen and naproxen gave no added risk of death/ myocardial infarction; diclofenac gave 67% increased risks, and the two coxibs (rofecoxib Vioxx; celecoxib Celebrex) increased risk 100%.
So we are led to believe that naproxen or ibuprofen is the NSAID mild-to-moderate analgesic of choice. Naturally the American Colleges and academia – who represent the Disease Industry, not patients- recommend yet other potentially toxic drugs- like the magical proton pump inhibitors- to counteract the adverse NSAIDS..
But is this just a myopic view beloved of big pharma, to promote their snake oils.?
Another new study from Denmark (Gislason 2009) of 110 000 patients after admission for heart failure in the 12 years 1994-2005, showed that 57% died; 9000 (8%) were rehospitalized with acute heart attack and 40 000 (38%) were rehospitalized with heart failure. Thus heart failure in a well-nourished population has a poor prognosis. In 36 000 who had used NSAIDs compared to non-users, risk of death was doubled on diclofenac; increased~67% on (rofe-or cele)coxibs; and was significantly increased 22-31% by all other NSAIDs including naproxen and ibruprofen.
It is common cause after 20 years that injected diclofenac is the only NSAID that can unpredictably cause sudden death. So it’s administration risks culpable homicide when it is totally unwarranted. No cases of sudden death from any oral NSAID including aspirin appear on Medline, apart perhaps from the risk of hyperacute asthma (Asamoto 1999).
But what of gastrointestinal bleeding risks of NSAIDS? a 2007 study in Japan (Yajima) scoped all orthopaedic patients who took NSAIDs for more than 4 wks: oral diclofenac increased risk of erosive gastric lesions sixfold. A new review from Seattle (Schlansky 2009) refers to Helicobacter synergism in all NSAID use.
WHAT IS THE NEED FOR NSAIDS? The Wikipedia entry on NSAIDs sums it up: it has almost four times as much text on the numerous adverse effects of NSAIDs as on their uses- in fact the article does not discuss the advantages of NSAIDS as analgesics; in fact it states plainly that alone just “their gastrointestinal effects are estimated to result in 103,000 hospitalizations and 16,500 deaths per year in the United States”.
All designer drugs are dangerous in overdose. Without overdose, paracetamol has no risk – and the Wikipedia entry thereon is balanced and highly favourable even for infants. We know well that paracetamol- a fatal liver toxin in overdose- should not be marketed without a built-in simple liver (and antineuritic) protective of eg (carbo-or N-acetyl-)cysteine, alphalipoic acid and vitamin BCo. But the Disease – Big Pharma Industry is not interested in prevention- Only Disease Pays. And Regulators, lobbyists and legislators protect their source of work and income- the Drug Industry.
Fish oil (EPA+DHA) is probably the most beneficial NSAID supplement we have (- perhaps ahead of other front-runners like vitamins C, D, magnesium and CoQ10-) halving all sudden deaths, and reducing by at least a third all major chronic degenerative diseases from CVD to diabetes, arthritis, learning, depression, behaviour disorders. Industry wont pay for head-on comparative trials. But the trial evidence suggests that fish oil and oral EDTA have better risk-benefit than aspirin and other antiplatelet agents, NSAIDs and warfarin.
We know that for moderate trauma and small – medium (even knee) joint pain/ contusions, self-massage with any natural NSAID like arnica or wintergreen is all that is needed, combined if necessary orally with up to 3 to 4gm paracetamol /day +- if needed a little codeine. Prior 2002 found no significant difference in pain relief between paracetamol and naproxen in tension headache.
For more serious pain, short of strong opioids, there is in fact no overall trial evidence that weak opioids or NSAIDs are better than eg hypnotherapy, or acupuncture, or judicious paracetamol; to which latter if necessary a little codeine can be added as step-up analgesia. The latter agents have none of the deadly risk of NSAIDs. Amadio 1984 showed that of Peripherally Acting Analgesics: ” paracetamol at up to 4 g per day compares favorably in analgesic potency to aspirin and other NSAIDs, and should be considered the treatment of choice for mild-to-moderate pain”. Skovlund 1991 showed no significant difference between naproxen and paracetamol in postpartum uterine spasms.
Six RCTs – five in mostly European peoples and one in Hong Kong- found paracetamol equal to diclofenac (Voltaren) – March 1994 in arthritis; Brevik 1999 and Kubitzek 2003 in dental surgery; Hoogewijs 2000 and Woo 2006 after trauma; and Munishankar 2008 after Caesarian section. In a Cochrane analysis 2003, Towheed showed that in the one placebo-controlled RCT in osteoarthritis, paracetamol was clearly superior to placebo with a similar safety profile. And the general principle of therapy applies, that if required, combination of analgesics from different groups is better than single drug therapy. But given the many potentially fatal risks of the NSAIDs – compared to paracetamol, opioids and if indicated aspirin – there is no compelling reason to add NSAIDs for pain.
We know that it is negligent to initially sentence people with spontaneous mild-moderate head/neck/backache or tendonitis at the shoulder, elbow, knee etc to bedrest, NSAIDS, opioids or referral for xrays, scans or surgery. 95% will settle rapidly with reassurance, posture instruction and simple topicals and paracetamol analgesia. Otherwise most pain will disappear with firm reassurance with brief simple laying on of hands eg massage and traction with gentle rotational manipulation and instruction in auto-reinforcement – pressure point eg earlobe pressure, or acupuncture, or hypnosis. And most of the remainder resolve quickly with simple targeted injection with a little local anaesthetic plus depot steroid.
And we know that with judicious use, topical corticosteroid injection – never mind judicious brief systemic steroid (corticosteroid, calciferol, testosterone) has little or no risk and far greater target and multisystemic benefit than NSAIDs; and for chronic conditions, like fish oil at least address the underlying pathogenic mechanisms/causes- whereas NSAIDs and paracetamol ignore these.
Is drug-speeded resolution of inflammation essential and beneficial except for the drug vendor? A careful RCT by Bradley ea from Indiana University in 1992 observed that “joint tenderness and swelling, presumptive evidence of synovitis, may not be a priori indications for use of an antiinflammatory drug, or predict greater responsiveness to treatment with an antiinflammatory drug than to a pure analgesic, in symptomatic treatment of patients with knee osteoarthritis”.
So why are synthetic NSAIDs and especially the Coxibs still used? Why do academics and Regulators still allow, promote them for routine use, other than to profit Big Pharma, and cause perhaps a quarter million deaths a year globally?
The linked bad nutritional -and lifestyle – choices – Salt-Stroke – smoking- – hypertension- obesity – diabetes – heart – kidney disease – are quoted by S.A. Stats 2010 from death certifications as rising to 24% of deaths after age 50 years, leading even infections at 20% as the commonest causes of seniors’ death in South Africa. Nonnatural causes ie violence account for only 5%, and cancers only about 4%.
update 8 August 2013 the OregonUniversity Linus Pauling Institute website still promotes the numerous benefits of fishoil.
update 2 August 2013 the Topol- Rowen- Peskin rejection of need for fish oil EPA+DHA was not supported by the recently NEJM-published R&P 5 year trial in Italy, which compared modified ie patented ethylester marine essential fatty acids with olive oil.
This R&P trial was thus not a trial of fish oil (concentrate or otherwise), nor placebo-controlled, since olive oil is hardly a placebo- in the 13.4year Spanish EPIC trial published last year , olive oil dramatically reduced all-cause mortality by 1/4 and CVD mortality by 44%. The full 2013 NEJM R&P paper is inexcusably silent in omitting this cardinal fact that it was no ways placebo-controlled- placebo means an inert comparator.
the 2010 Nordic study ( Dyerberg ea Copenhagen University- who first reported in 1978 the association between marine omega3 PUFA and health in Eskimos) http://www.nordicnaturals.com/images/pdfs/tgstudy.pdf details the better bio-availability of natural ie triglyceride- bound fish oil- EPA+DHA compared to that in processed ethylester low-triglyceride omega3 products- as used in the R&P and GISSI trials of patented commercial designer products. .
2 June 2013 Its some 4 years since this healthsite started promoting marine oil for optimal development and health.
what say you to the latest hype about the predictable negative result of the Italian N-3 Cardiovascular Risk and Prevention trial R&P from the NEJM? ie that omega3 oil was no better than olive oil.
the major problem is that the R&P trial didnt use natural clean FISH OIL, nor in primary prevention.
Nowhere does it say it used fish oil- it says N-3 ie omega3, and in patients with multiple vascular disease. Nor does the original 2010 R&P plannng paper state that in fact it used a patent formula of chemically changed ethyl esters in tertiary prevention,
like the GISSI trial used apparently patent branded altered Om3 after heart attacks – it wasnt natural clean fish oil..
the GISSI abstracts 1999 and 2008 also dont mention fish oil.So it wasnt natural fish oil like I use and promote- clean codliver oil or clean om3 concentrate from clean factories in northern Europe and now even from Cape Town.. The R&P abstract paper cleverly doesnt mention the brand Omega3 name- but Pfizer funded the trial…Its the “top” journals likely up to their old tricks, publishing probable infomercials paid for in this case by Pfizer and mates, without making that clear.I cant see if these Italian trials used Lovza/Omacor or whatever Big Pharma chemically altered snakeoils.But looking at the extensive debate already around Dr Topol’s condemnation of real fishoil supplement, many commentators fell into the same trap- they didnt notice that R&P didnt use fish oil, but about 850mg/day ethyl esters of omega3.
Synthetic patent designer drugs dont do what the natural food/supplement/human biophysiologic product does.
Ethyl esters eg ethinylestradiol, and xenohormones eg Premarin, are dangerously different from estradiol. Look at the controversy, the danger in using altered natural products eg:
slowrelease niacin instead of natural niacin.
or neurontin/lyrica or benzos instead of natural GABA to bind to the GABA receptors. or anabolic steroids eg methyltestost instead of testosterone. or methylprogesterone Provera instead of progesterone. or margarine instead of butter !. or methanol – dangerously different from ethanol; or synthetic substitutes for natural digoxin…
or the Women’s Health Initiative- which through gross misrepresentation stopped many women from using beneficial physiological human HRT for 10 years, despite the bad design of the WHI that used long-proven risky xenohormones (premarin, provera) at dangerous older age, while in the first 6 years it enormously benefitted women in the first decade after menopause.. .It’s dis-ingenouos of Messrs Rowen, Topol and Peskin not to state this, that the R&P TRIAL DIDNT USE FISH OIL..
Dr Rowen and Mr Peskin are heavily promoting their own PEO Parent Essential Oil Brand of Omega6 plant oils. The evidence is that such combination is excellent benefit- but I see no science, no reason not to balance it with clean fish oil since this is now so deficient in general diet.But surely Prof Topol is doing patients a huge disservice in backing the R&P trial in dumping fish oil -when that trial didnt use fish oil, and makes no conclusion about fish ol?
I await the full copy of the R&P study – which the NEJM mysteriously doesnt make available on line as they usually do with any seriously important new study.. .No-one doubts that good plant oils , good mixed diet have benefit.there is no doubt that a few gms of fish oil a day have huge benefit.
Its the balance that matters- and the avoidance of smoking, sloth, adiposity, refined sugars and cooked animal fats that matters.so I see no reason to change from taking/ recommending daily a tsp (or 4) of codliver oil (ie about 800 – 3000mg EPA+DHA) ,
and olives/ mixed nut/plant/olive oils on salads/pasta etc ,
what say you?…
REBUTTAL OF: IMPACT OF ADVERSE NEWS MEDIA ON PRESCRIPTIONS FOR OSTEOPOROSIS: EFFECT ON FRACTURES AND MORTALITY
18 months ago a warning was published about the risk of Negligence Damages for Prescribing Bisphosphonates- Fosomaxes- for common osteoporosis.
A year later an updated review of the evidence rebutted the attempt by an Australian group (Phillip Sambrook MD, BS, LLB, FRACP ea ) to promote routine use of bisphosphonates, blame the news media for wrongly sensationalizing these largely unnecessary drugs’ rare but lethal adverse effects.
Now three other eminent Australian professors, of Oral and Maxillofacial Surgery and Endocrinology (Paul Sambrook, Chris Nordin and Alastair Goss) publish a further rebuttal of Phillip Sambrook ea for serious errors in underestimating by at least twentyfold both the incidence and the seriousness of bisphosphonate risks.
In a USA case for damages against Merck, for irreversible osteonecrosis- resulting in jaw amputation- following Fosamax, a patient was last year awarded $1.5million . This American class action is about over 1500 Fosamax cases against Merck. So far two related case against Merck have been dismissed. But all such cases are on appeal. The robust American tort system may yet hammer Merck. .
As recently as october 2010 Merck staunchly defends Fosamax’s safety for osteoporosis.
The FDA has recently added a warning about Fosamax-related thigh fractures.
But no evidence has ever been published that the catastrophic risk of bisphosphonates- however rare- is justified for routine osteoporosis when
1.In common osteoporosis, Bisphosphonates have no multisystemic benefits except for halving fracture risk, and
2.Appropriate combination of natural supplements- as this column has repeatedly revewed -approximately halve all risks ie of both osteoporosis fractures and all other common major diseases of aging, and thus chronic disability and deaths, without any significant risks.
Curent Authority statements eg from the Mayo Clinic simply fail to say this- why risk bisphosphonates? New reports in November-December of dozens of osteonecrosis cases on bisphosphonates have just appeared on Pubmed from Italy, Germany, Romania and Spain.
In fact a major international study has just beeen published showing the obvious, that survival in the elderly is strongly linked to gait speed and mobility. It is common cause that such integrated function is dependent on optimal joint, neuromuscular and cardiovascular integration- to which (- unlike the score of natural human micronutrient supplements that deplete with age-) bisphosphonates and strontium contribute nothing except bone density.
Fosamax lobbyists studiously avoid the plain truth that it is not osteoporosis; but frailty – falls – that is the chief cause of major elderly fractures- and that bisphosphonates and strontium may make bones appear denser.
Its too early to judge strontium ranelate (which also has rare but catastrophic risk- the DRESS syndrome); but fosamaxes in some cases make bones more brittle; without in the slightest combating senescence frailty ie muscle, mobility, vascular, cancerous, arthritic, immune, mood, cognitive and neurological deterioration (unlike the multinutrient microsupplements – vitamins, minerals and biologicals like fish oil, chondroglucosamine, sex hormones which together halve all chronic major degenerative diseases and premature mortality) ..
August 15, 2010 Regulators like the FDA and WHO the world health organization and their worldwide equivalents are notorious for bowing to their chief funders- Big Pharma- in registering new designer drugs on the flimsiest evidence, often despite vociferous objection from some honest assessor at the Regulator; then waiting till there is an uproar of complaints over the drug before they belatedly demand more evidence of cost-benefit from the manufacturer, and admit that key adverse data were suppressed from the outset- as happenened and is still happening most notoriously in the case of aspartamate Canderal.
And what was obvious from the word go, that in the case of last year’s swine flu vaccines and the spurious pandemic declaration, the Regulators/WHO expert committees were heavily loaded with biased specialists paid by vaccine manufacturers.
But why are the fosamaxes and other bisphosphonates still allowed to be prescribed for osteoporosis? When the first report of long bone fracture associated with them first appeared on Pubmed 16 years ago (Guanabens 1994) and they are unnecessary -indeed contra-indicated – for osteoporosis. Not for nothing does a recent ABC Good Morning America broadcast ask: “Fosamax: Is Long Term Use of Bone Strengthening Drug Linked to Fractures”?
This review is in fact an update on The Fraud of Modern Medicines.
A recent review from Oxford lists the myriad adverse effects of bisphosphonates. They say “All four currently approved nitrogen-containing bisphosphonates have a favorable tolerability and safety profile.” But why don’t they discuss the reality which is that although all these adverse effects may be infrequent, why risk such serious complications such as 30% incidence of oesophagogastric symptoms?; oesophageal stenosis and cancer?, toxiderma, atrial fibrillation, eye, muscle bone joint pain?; or incapacity from jaw and teeth loss or longbone fracture related to bisphosphonates for osteopororis?, when bisphosphonates are clinically unnecessary and unjustified for osteoporosis.
Why dont they state the truth, that there are no head to head trials against the basket of proven natural supplements, comparing fracture and global benefits versus risks of bisphosphonates ? Most reviews eg Wikipedia say bisphosphonates are “ the leading prescription for osteoporosis”; but this is simply for the same reasons that statins are for lipidemia, angiotensin blockers for hypertension and sulphonylureas/ glitazones are for type 2 diabetes, and aspartame is for artificial sweetening- because drug companies market such hoped-for $billion rainchecks overwhelmingly, and fund no comparative trials against the gold standard old supplement basket that makes most hazardous modern drugs like statins, glitazones and bisphosphonates mostly redundant.
Filleul ea from Univ Mona, Belgium have just reviewed the world literature from 2003-2009, finding 2400 cases of BIOJ bisphosphonate induced osteonecrosis of the jaw. of these about 215 were not cancer cases. Such cases very rarely occur without cancer. So why risk them?
So why does an Australian team bewail decreased use of the fosamaxes? Impact of adverse news media on prescriptions for osteoporosis:effect on fractures and mortality. Their statistical modelling is perhaps no more than promotion of bisphosphonates since it ignores the high number of adverse effects that bisphosphonates cause long term; and the major reduction in allcause disability and premature mortality that balanced appropriate supplements ( instead of bisphosphonates ) produce. Why would the lead author of so many papers- Professor Phillip Sambrook – promote bisphosphonate as the prime pharmacological prevention, and only calcium and vitamin D as the supplementary prevention of osteoporosis fractures? when the evidence so strongly favours safe multisupplements including appropriate lowdose hormone balance as preventative against all major chronic diseases? Can a new-drug proponent who sits on the medical advisory boards of and has received speaker fees from Amgen, Merck Sharp & Dohme, Novartis, Sanofi-Aventis and Servier. be considered objective ? Their critique of the media for publicizing the potential disaster from bisphosphonates is hollow when they fail to mention the numerous potential risks, and the numerous benefits instead from supplements.
Geusens, Sambrook ea in 2008 published a major review on Drug Insight: choosing a drug treatment strategy for women with osteoporosis-an evidence–based clinical perspective.. ‘The most important clinical determinant in the clinical choice of drug therapy for fracture prevention is a woman’s fracture risk; second is the evidence for fracture prevention in terms of spectrum, size and speed of effect. Other determinants include the potential extraskeletal benefits and safety concerns of the drugs.” But they again studiously avoid considering supplements (vitamins plus minerals plus appropriate hormone combination) as one of the drug regimes, especially as osteoporosis is simply one of the co-morbidities of aging, and far less of a risk for premature death and disability than stroke, cardiovascular, cancer, diabetes, frailty, dementia, arthritic disease and premature death – all of which can along with fractures be avoided and mitigated by the basket of supplements. So their review is surely biased in excluding all but new designer patent drugs while excluding the best and safe anabolics. .
It is well proven from observational studies that longterm use of appropriate natural supplements reduce all-cause mortality by at least a third: In the Womens’ Health Initiative WHI, appropriate hormone replacement HRT reduced all-cause mortality i.e. deaths from vascular disease, cancer and fractures by 1/3 as well. In the UKPDS the plant extract metformin reduced all-cause mortality also by 1/3. Understandably, metformin halves the incidence of new diabetes by reducing insulin resistance, hence it also reduces fracture risk let alone cancer and vascular disease risk .
Incontestable data shows that epidemic deficiency of vitamin D , vitamin C, magnesium, vitamin B especially B6, vitamin K, fish oil, and prime hormone dysregulation (thyroid, insulin, cortisol vs androgens and estrogens) in first-world aging populations are associated with increased mortality from all degenerative diseases especially fracturing, cardiovascular and cancer. It also showed that vigorous supplements of balanced vitamins, minerals (especially B,C,D,K, and Ca, Mg, Zn, Bo, Mn, Se, Cr), fish oil, and human sex (co)hormones (testosterone, progesterone, estradiol, metformin) drastically reduce all morbidity and especially fractures even (perhaps especially ) in the well-off over nourished..
In contrast to bisphosphonates- which are aimed solely at reducing fracture in the at-risk elderly and thus reduce all-cause mortality by perhaps 10%- these supplements in appropriate doses and balanced combination reduce all-cause aging disease and preventable premature mortality by at least 50%, without any adverse risks. .
Neville-Webbe ea (2010) note that bisphosphonates have anti-cancer potential. So use it for terminal cancer fracture pain. Why use it for anticancer potential in those with just osteoporosis when the basket of supplements (including approriate HRT, vigorous dose vitamin D and if approriate metformin) gives safe global protection against all the major aging diseases?
Just the reduction in excess diet omega6 oils will mean that only 10% of the current necessary omega3 daily allowance (3.5gm) will be essential.
In 2007 a leading team from the International menopause Society Genazzani ea warned that “Recent controversies with hormone replacement therapy (HRT) have caused much concern in women and their health-care providers. As a result, the number of HRT users in USA has fallen dramatically. Consequently, the potential HRT-induced reduction in fracture risk is lost so that, in the next few years, we can expect an excess of 43,008 fractures per year in women aged 65 – 69 years. In addition, the recent evidence on the merits of early initiation of HRT on cardiovascular disease risk and neurocognitive function and the effect of type and combination of hormones on breast cancer risk now require an urgent review by the regulatory authorities of their recommendations about HRT.”
Now – 8 years after the debacle the WHI caused – the Endocrine Society has at last come out with a Position Statement admitting the grave consequences from the hysterical misinterpretation of the early release of the Womens Health initiative results in 2002-2004, especially in rising fracture and colon cancer rates from avoidance of appropriate HRT in menopausal women across midlife. . Let alone, as Genazzani ea said above and we discussed at international, UK and European menopause meetings in 2003-2006, the potential loss of benefit against breast cancer, heart, stroke, depressive, diabetic and neurocognitive problems.
In conclusion: A major intervention is required from governments, world authorities to reduce all-cause morbidity and mortality : by drastically curtailing the marketing and prescription of rarely essential prescription designer drugs like bisphosphonates, and strontium ranelate for osteoporosis; by insisting on increasing universal intake of proven natural multisupplements that are increasingly deficient in the food chain for the poor, for infants, youngsters and the multiplying aging- in the latter, including appropiate HRT; and by forcing the processed food industry to stop stuffing foods and drinks with not just salt and aspartame but also fructose, sucrose, various growh hormones, and omega6 oils.
But neither Big Pharma manufacturers, governments, so-called independent regulators, nor university and private practice leaders or retail pharmacists will do so, promote evidence-based supplements over risky new drugs- there is too much money at stake from lost taxes. research funding, lower under-patent snake-oil sales and far less major disease and hospital admissions.
So it is up to patients and honest healthcare providers to insist that evidence-based supplements – not trading practice based on huge marketting and snakeoil preaching for profiteering – be prescribed for prevention/ managing the major diseases of aging including osteoporosis.