November 15, 2023 • 12 mins
Ready to continue your navigation through the complex labyrinth of medical decision-making? We have delved into crucial matters such as risk vs. benefits, understanding the role of genetic makeup, background, and socioeconomic status in health decisions, and in this episode, we will discuss the value of convenience when selecting supplements and health products.
Dr. Koren not only enlightens us with theoretical knowledge, but also brings it to life with real-life scenarios from his practice. Our discussion takes a dive into the intricate world of zinc supplementation, breaking down its uses, potential interactions, and value. This episode is a treasure trove of insights on how to make informed health choices in a world overflowing with overwhelming health information. So, step in and gain a new perspective on health-related information, while also learning how to separate fact from fiction.
Part 1: Risk Vs Benefits - Release November 1, 2023
Part 2. Who You Are - Release November 8, 2023
Part 3: Value and Convenience - Release November 15, 2023
Part 4: Dose, the Devil is in the Details - Release November 22,2023
Be a part of advancing science by participating in clinical research.
Have a question for Dr. Koren? Email him at askDrKoren@MedEvidence.com
Listen on Spotify
Listen on Apple Podcasts
Watch on YouTube
Share with a friend. Rate, Review, and Subscribe to the MedEvidence! podcast to be notified when new episodes are released.
Follow us on Social Media:
Facebook
Instagram
X (Formerly Twitter)
LinkedIn
Want to learn more? Checkout our entire library of podcasts, videos, articles and presentations at www.MedEvidence.com
Music: Storyblocks - Corporate Inspired
Thank you for listening!
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Narrator (00:01):
Welcome to MedEvidence , where we help you navigate the
truth behind medical researchwith unbiased, evidence-proven
facts, powered by ENCOREResearch Group and hosted by
cardiologist and top medicalresearcher, Dr.
Michael Koren.
Kevin Geddings (00:17):
For spending time with Dr.
Michael Koren, of course, withENCORE Docs, and he also heads
up a team that's responsible fora great website, MedEvidence.
com.
That's MedEvidence.
com a great place to go to getjust good, accurate information.
That's not particularly biased,right, Dr.
Koren, it's just information welike to call the truth behind
(00:37):
the data.
Dr. Michael Koren (00:39):
Thanks, Kevin , for helping us explore how to
get the most out of theMedEvidence platform.
It's been a valuableconversation so far.
Maybe you can summarize it forpeople who just are starting
with this podcast.
Kevin Geddings (00:52):
Yeah, we've been talking about how the website
will help you do deal withissues like trying to determine
risk versus benefits, theimportance of who you are in
terms of your genetic makeup,what your background is, what
your socioeconomic status is.
All these filters matter whenyou're looking at health-related
information to try to figureout how it applies to you or
(01:12):
your loved ones.
We also thought we would talkin this segment about value and
convenience, because when we seeoptions out there for all the
many supplements especially, andother things we can do for our
health most people have a budget, right, Dr.
Koren.
They have to determine what isof true value for them and their
loved ones.
Dr. Michael Koren (01:32):
Exactly.
Yeah, that was a great summary.
So again, the three tiers justto reiterate it for the audience
is first, think in terms ofrisk versus benefit, not just
good or bad.
Everything could be good or bad, depending on circumstances.
Then know who you are and howthat's relevant for the medical
decision-making.
Now to the third tier, which iswhat's the value to you?
(01:53):
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 throughan example.
This happens every day in mypractice, so literally clinic.
Yesterday I talked to a patient.
He's like many other patients,some guy in his 70s.
(02:15):
He's on probably about 14supplements.
I asked him why are you takingthese things?
Typically the answer is well,someone told me it was good.
Okay, well, we can break itdown and say well, there's
always a risk versus benefit.
In this particular case, let'stalk about zinc.
That was one of the things thathe was on.
(02:35):
I asked him why are you takingzinc?
He didn't really have an answer.
Well, there's actually studiesthat have looked at zinc.
So in terms of the risk versusbenefits just a quick overview I
can talk about zinc for an hour, but in one minute what I would
say is that everybody needszinc.
Zinc is very critical to manybiochemical processes in your
(02:55):
body, but you can also get zinctoxicity.
So a typical element of zinctoxicity is something called a
taxia, where you lose yourbalance or your muscle function
is a little bit off, and that'swell known to occur for people
that overdo it with zinc.
The other thing is that zincinteracts with other important
(03:16):
elements that your body alsoneeds.
So when you take zinc, it'smore difficult to absorb iron in
copper.
So that is a consideration.
So if you're anemic and you'retaking iron supplements, well
maybe you shouldn't be takingzinc because that can affect the
absorption of iron and copper.
So all these things get intothe element of kind of who you
(03:37):
are, and then we get into sortof the value proposition.
Well, zinc actually has somedata showing that it's effective
for people with maculardegeneration, and so that's an
eye condition of the elderly,and I think a lot of
ophthalmologists recommend zincsupplements for patients that
fall into that category.
So if this fellow who I spokewith yesterday had mentioned
(03:59):
that his eye doctor recommendedit, I would say, okay, that's
cool, that makes sense, you havea reason for taking it.
Another area where zinc has hadsome benefits is in trying to
reduce the symptoms of oralillnesses.
So a number of studies thathave looked at using zinc
immediately after developingsome symptoms of an upper
respiratory infection andtypically that's going to be a
(04:21):
liquid zinc or the zinc losangerthat can absorb in your mouth
and there may be some ways thatthose products reduce the
severity of the illness andstudies have borne that out.
So the truth behind the data is, under those circumstances that
helps, but there are no data tosay that if you take one zinc
pill every day, that you canprevent disease, and in fact
(04:43):
there's some studies that showthat that in fact doesn't happen
.
So, again, context and the useof it is important, and then you
get into value.
Well, if you're taking one zinctablet every day to prevent
viral diseases, well, you'reprobably making your urine very
expensive by taking all thesenutrients that are not needed.
The other thing is that ifyou're somebody that likes
(05:06):
breakfast cereal in the morning,well, take a look at the zinc
content of that and you'll findthat most breakfast cereals are
actually fortified with lots ofdifferent nutrients, including
zinc.
So do you really need that 50milligram zinc pill if you're
getting a bunch of zinc in yourmultivitamin and your breakfast
cereal?
Well, the answer is no.
So in terms of value, there'spretty much no value to that.
(05:27):
Then the other thing that comesup is that there's a lot of
different preparations for allthese products that are marketed
, and sometimes very expensivedepending on the marketing, and
there's a ton of examples ofthat.
So when you look at value, youmight see something that says
Chelated Zinc.
Well, what does that mean?
Well, what it really means isthat the zinc is attached to
(05:49):
something that makes it easierfor your body to absorb.
So the question is well, howeasy is zinc for the body to
absorb?
And the answer is your bodydoes a pretty good job of
absorbing zinc.
In fact, if you look at arun-of-the-mill zinc oxide, your
body is going to absorb 50 or60% of that.
So if the key-lated productcosts two or three times more
(06:10):
and brings it up to 70%, is thatreally worth it?
I would say probably not.
So, again, the devil is in thedetails, which we'll get into
the next section, but here's anexample of we all have to make
consumer choices and you pay $20or $5 for the same basic
preparation.
Now the flip side is that thereare certain nutrients, for
(06:32):
example magnesium, that yourbody doesn't absorb very well
and as a cardiologist, I'mreally focused on magnesium
because magnesium is extremelyimportant for a number of
cardiovascular functions,including prevention of
arrhythmias extra heartbeats.
So some people be on magnesiumsupplements and maybe we're not
getting their magnesium levelsto where they need to be, and
(06:54):
that person may need to considera different salt than magnesium
oxide, which is a commonly usedsalt that's inexpensive but may
not be absorbed, as well assome of the other magnesium
salts that are available in themarket.
Kevin Geddings (07:07):
And Dr.
Koren, I think there are alsoan issue as well with when the
gentleman your patient wastaking 10 or 14, however many
supplements, it was how thosemight interact with other
prescription medications.
Dr. Michael Koren (07:18):
Oh, absolutely.
It's a really important factor.
So there's many examples of howone can impact another and
that's why, with pharmaceuticals, you're gonna get information
about do you take it on an emptystomach or do you take it on a
full stomach?
Do you take it at the same timeas other things?
A great example of that wouldbe you shouldn't take Viagra and
(07:43):
nitroglycerin preparations atthe same time because of a
drug-drug interaction, and thosethings also happen between
supplements.
I mentioned already that zincaffects the absorption of iron
and copper and, again, dependingupon the medication we're
talking about, nutritionalsupplements can actually affect
the absorption of multipledifferent medicines and again,
(08:05):
you have to get into the detailsand talk to your doctor about
it or look up those specificelements online which can be
readily available for patients.
Kevin Geddings (08:14):
Value and convenience, one of the aspects
that you will appreciate morewhen you look at the website
MedEvidence.
com.
That's MedEvidence.
com and that website, Dr.
Koren, designed to be easy forlayman like myself, right?
Dr. Michael Koren (08:28):
It is.
It is and we will drill intodifferent issues.
So another example of value andconvenience, for example, would
be fish oils, and we've doneprograms on fish oils and there
are a ton of fish oil productsout there and there are also
drugs that are omega-3 fattyacids.
So one of them that's on themarket that's been approved by
(08:49):
the FDA and proven in clinicaltrials that we participated in
is a drug called the sepa.
The generic name for it iscalled a cossipent ethyl and
it's a specific type of omega-3fatty acid called an EPA and a
acid, and it's been shown instudies that probably that does
(09:10):
better than just a generic fishoil product.
But then again, if you haveyour doctor right for that, you
may find that you get a bill for$500 a month and that's no
price.
So the question is is it worththe $500 a month?
Well, in some people it may beworth it.
(09:30):
If you have super high coronaryartery risk and you've had
multiple complications and youhappen to have high
triglycerides, this may besomething that's well worth that
$500 a month.
But there are alternatives, sothere can be fish oils that are
specifically prepared to havehigh levels of that EPA omega-3
fatty acid.
(09:51):
There are also some genericversions of a eicosapentaenoic
ethyl that may have not beenapproved by the FDA like Vascepa
, but may have some value if youcan't afford the $500.
And of course, the part of thevalue and part of what we do on
mid-evidence is help peopleunderstand when is it really
important for you and yourdoctor to go after your
(10:12):
insurance company and see ifthey can get that Vasceoa paid
for and when maybe you just gowith a generic alternative.
So these are the kind ofquestions that we address.
The other thing, in terms ofconvenience, we do a lot of
clinical research on convenience.
So, for example, in thecholesterol space, there's a
drug that we helped developcalled inclisiran, and
(10:35):
incliscerin a drug that you givethree times the first year and
then after that you just get itevery six months.
It helps control yourcholesterol.
Well, that's pretty darnconvenient.
Yeah, well, but it may notreplace taking a pill every
night, and that's the funnything.
So we still recommend that youtake statin.
So, on one hand, it has thisamazing property of being
(11:00):
administered only once every sixmonths.
On the other hand, it may notstop you from taking a pill
every night.
So how do you balance thosethings?
Well, that's why we havemid-evidence.
So we'll have discussions aboutomega-3 fatty acids.
We'll talk about them forcardiovascular disease, for
psychiatric disease and for anumber of other indications, and
(11:20):
break down all the informationwith somebody who's a physician
that has a really goodunderstanding of the evidence
but also understands the humanelements of risk versus benefit,
who you are and, ultimately,value and convenience, and we'll
break those down for you on ourMedEvidence 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 sessionwe're going to get into the
devil in the details, which isthe dose.
Narrator (11:54):
Thanks for joining the MedEvidence podcast.
To learn more, head over toMedEvidence.
com or subscribe to our podcaston your favorite podcast
platform.
Welcome to MedEvidence , where we help you navigate the
truth behind medical researchwith unbiased, evidence-proven
facts, powered by ENCOREResearch Group and hosted by
cardiologist and top medicalresearcher, Dr.
Michael Koren.
Kevin Geddings (00:17):
For spending time with Dr.
Michael Koren, of course, withENCORE Docs, and he also heads
up a team that's responsible fora great website, MedEvidence.
com.
That's MedEvidence.
com a great place to go to getjust good, accurate information.
That's not particularly biased,right, Dr.
Koren, it's just information welike to call the truth behind
(00:37):
the data.
Dr. Michael Koren (00:39):
Thanks, Kevin , for helping us explore how to
get the most out of theMedEvidence platform.
It's been a valuableconversation so far.
Maybe you can summarize it forpeople who just are starting
with this podcast.
Kevin Geddings (00:52):
Yeah, we've been talking about how the website
will help you do deal withissues like trying to determine
risk versus benefits, theimportance of who you are in
terms of your genetic makeup,what your background is, what
your socioeconomic status is.
All these filters matter whenyou're looking at health-related
information to try to figureout how it applies to you or
(01:12):
your loved ones.
We also thought we would talkin this segment about value and
convenience, because when we seeoptions out there for all the
many supplements especially, andother things we can do for our
health most people have a budget, right, Dr.
Koren.
They have to determine what isof true value for them and their
loved ones.
Dr. Michael Koren (01:32):
Exactly.
Yeah, that was a great summary.
So again, the three tiers justto reiterate it for the audience
is first, think in terms ofrisk versus benefit, not just
good or bad.
Everything could be good or bad, depending on circumstances.
Then know who you are and howthat's relevant for the medical
decision-making.
Now to the third tier, which iswhat's the value to you?
(01:53):
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 throughan example.
This happens every day in mypractice, so literally clinic.
Yesterday I talked to a patient.
He's like many other patients,some guy in his 70s.
(02:15):
He's on probably about 14supplements.
I asked him why are you takingthese things?
Typically the answer is well,someone told me it was good.
Okay, well, we can break itdown and say well, there's
always a risk versus benefit.
In this particular case, let'stalk about zinc.
That was one of the things thathe was on.
(02:35):
I asked him why are you takingzinc?
He didn't really have an answer.
Well, there's actually studiesthat have looked at zinc.
So in terms of the risk versusbenefits just a quick overview I
can talk about zinc for an hour, but in one minute what I would
say is that everybody needszinc.
Zinc is very critical to manybiochemical processes in your
(02:55):
body, but you can also get zinctoxicity.
So a typical element of zinctoxicity is something called a
taxia, where you lose yourbalance or your muscle function
is a little bit off, and that'swell known to occur for people
that overdo it with zinc.
The other thing is that zincinteracts with other important
(03:16):
elements that your body alsoneeds.
So when you take zinc, it'smore difficult to absorb iron in
copper.
So that is a consideration.
So if you're anemic and you'retaking iron supplements, well
maybe you shouldn't be takingzinc because that can affect the
absorption of iron and copper.
So all these things get intothe element of kind of who you
(03:37):
are, and then we get into sortof the value proposition.
Well, zinc actually has somedata showing that it's effective
for people with maculardegeneration, and so that's an
eye condition of the elderly,and I think a lot of
ophthalmologists recommend zincsupplements for patients that
fall into that category.
So if this fellow who I spokewith yesterday had mentioned
(03:59):
that his eye doctor recommendedit, I would say, okay, that's
cool, that makes sense, you havea reason for taking it.
Another area where zinc has hadsome benefits is in trying to
reduce the symptoms of oralillnesses.
So a number of studies thathave looked at using zinc
immediately after developingsome symptoms of an upper
respiratory infection andtypically that's going to be a
(04:21):
liquid zinc or the zinc losangerthat can absorb in your mouth
and there may be some ways thatthose products reduce the
severity of the illness andstudies have borne that out.
So the truth behind the data is, under those circumstances that
helps, but there are no data tosay that if you take one zinc
pill every day, that you canprevent disease, and in fact
(04:43):
there's some studies that showthat that in fact doesn't happen
.
So, again, context and the useof it is important, and then you
get into value.
Well, if you're taking one zinctablet every day to prevent
viral diseases, well, you'reprobably making your urine very
expensive by taking all thesenutrients that are not needed.
The other thing is that ifyou're somebody that likes
(05:06):
breakfast cereal in the morning,well, take a look at the zinc
content of that and you'll findthat most breakfast cereals are
actually fortified with lots ofdifferent nutrients, including
zinc.
So do you really need that 50milligram zinc pill if you're
getting a bunch of zinc in yourmultivitamin and your breakfast
cereal?
Well, the answer is no.
So in terms of value, there'spretty much no value to that.
(05:27):
Then the other thing that comesup is that there's a lot of
different preparations for allthese products that are marketed
, and sometimes very expensivedepending on the marketing, and
there's a ton of examples ofthat.
So when you look at value, youmight see something that says
Chelated Zinc.
Well, what does that mean?
Well, what it really means isthat the zinc is attached to
(05:49):
something that makes it easierfor your body to absorb.
So the question is well, howeasy is zinc for the body to
absorb?
And the answer is your bodydoes a pretty good job of
absorbing zinc.
In fact, if you look at arun-of-the-mill zinc oxide, your
body is going to absorb 50 or60% of that.
So if the key-lated productcosts two or three times more
(06:10):
and brings it up to 70%, is thatreally worth it?
I would say probably not.
So, again, the devil is in thedetails, which we'll get into
the next section, but here's anexample of we all have to make
consumer choices and you pay $20or $5 for the same basic
preparation.
Now the flip side is that thereare certain nutrients, for
(06:32):
example magnesium, that yourbody doesn't absorb very well
and as a cardiologist, I'mreally focused on magnesium
because magnesium is extremelyimportant for a number of
cardiovascular functions,including prevention of
arrhythmias extra heartbeats.
So some people be on magnesiumsupplements and maybe we're not
getting their magnesium levelsto where they need to be, and
(06:54):
that person may need to considera different salt than magnesium
oxide, which is a commonly usedsalt that's inexpensive but may
not be absorbed, as well assome of the other magnesium
salts that are available in themarket.
Kevin Geddings (07:07):
And Dr.
Koren, I think there are alsoan issue as well with when the
gentleman your patient wastaking 10 or 14, however many
supplements, it was how thosemight interact with other
prescription medications.
Dr. Michael Koren (07:18):
Oh, absolutely.
It's a really important factor.
So there's many examples of howone can impact another and
that's why, with pharmaceuticals, you're gonna get information
about do you take it on an emptystomach or do you take it on a
full stomach?
Do you take it at the same timeas other things?
A great example of that wouldbe you shouldn't take Viagra and
(07:43):
nitroglycerin preparations atthe same time because of a
drug-drug interaction, and thosethings also happen between
supplements.
I mentioned already that zincaffects the absorption of iron
and copper and, again, dependingupon the medication we're
talking about, nutritionalsupplements can actually affect
the absorption of multipledifferent medicines and again,
(08:05):
you have to get into the detailsand talk to your doctor about
it or look up those specificelements online which can be
readily available for patients.
Kevin Geddings (08:14):
Value and convenience, one of the aspects
that you will appreciate morewhen you look at the website
MedEvidence.
com.
That's MedEvidence.
com and that website, Dr.
Koren, designed to be easy forlayman like myself, right?
Dr. Michael Koren (08:28):
It is.
It is and we will drill intodifferent issues.
So another example of value andconvenience, for example, would
be fish oils, and we've doneprograms on fish oils and there
are a ton of fish oil productsout there and there are also
drugs that are omega-3 fattyacids.
So one of them that's on themarket that's been approved by
(08:49):
the FDA and proven in clinicaltrials that we participated in
is a drug called the sepa.
The generic name for it iscalled a cossipent ethyl and
it's a specific type of omega-3fatty acid called an EPA and a
acid, and it's been shown instudies that probably that does
(09:10):
better than just a generic fishoil product.
But then again, if you haveyour doctor right for that, you
may find that you get a bill for$500 a month and that's no
price.
So the question is is it worththe $500 a month?
Well, in some people it may beworth it.
(09:30):
If you have super high coronaryartery risk and you've had
multiple complications and youhappen to have high
triglycerides, this may besomething that's well worth that
$500 a month.
But there are alternatives, sothere can be fish oils that are
specifically prepared to havehigh levels of that EPA omega-3
fatty acid.
(09:51):
There are also some genericversions of a eicosapentaenoic
ethyl that may have not beenapproved by the FDA like Vascepa
, but may have some value if youcan't afford the $500.
And of course, the part of thevalue and part of what we do on
mid-evidence is help peopleunderstand when is it really
important for you and yourdoctor to go after your
(10:12):
insurance company and see ifthey can get that Vasceoa paid
for and when maybe you just gowith a generic alternative.
So these are the kind ofquestions that we address.
The other thing, in terms ofconvenience, we do a lot of
clinical research on convenience.
So, for example, in thecholesterol space, there's a
drug that we helped developcalled inclisiran, and
(10:35):
incliscerin a drug that you givethree times the first year and
then after that you just get itevery six months.
It helps control yourcholesterol.
Well, that's pretty darnconvenient.
Yeah, well, but it may notreplace taking a pill every
night, and that's the funnything.
So we still recommend that youtake statin.
So, on one hand, it has thisamazing property of being
(11:00):
administered only once every sixmonths.
On the other hand, it may notstop you from taking a pill
every night.
So how do you balance thosethings?
Well, that's why we havemid-evidence.
So we'll have discussions aboutomega-3 fatty acids.
We'll talk about them forcardiovascular disease, for
psychiatric disease and for anumber of other indications, and
(11:20):
break down all the informationwith somebody who's a physician
that has a really goodunderstanding of the evidence
but also understands the humanelements of risk versus benefit,
who you are and, ultimately,value and convenience, and we'll
break those down for you on ourMedEvidence 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 sessionwe're going to get into the
devil in the details, which isthe dose.
Narrator (11:54):
Thanks for joining the MedEvidence podcast.
To learn more, head over toMedEvidence.
com or subscribe to our podcaston your favorite podcast
platform.
Popular Podcasts
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.
Therapy Gecko
An unlicensed lizard psychologist travels the universe talking to strangers about absolutely nothing. TO CALL THE GECKO: follow me on https://www.twitch.tv/lyleforever to get a notification for when I am taking calls. I am usually live Mondays, Wednesdays, and Fridays but lately a lot of other times too. I am a gecko.