Several weeks ago, two studies that appeared in medical journals achieved widespread media attention and created concern among people who are using nutritional supplements. One study concluded that the use of multivitamins or of certain individual supplements was associated with small but statistically significant increases in the mortality rate. The other study found that taking vitamin E increased the incidence of prostate cancer. The discussion below explains why neither of these studies has changed my view that nutritional supplements are, for the most part, very safe.

Observational study: “adjusted” data and no proof of cause-and-effect

In one of the studies, 38,772 women (mean age, 62 years) from Iowa filled out a questionnaire three times over an 18-year period regarding dietary supplement use. During a total follow-up period of 22 years, the risk of dying from any cause was said to be 6% higher among women who took a multivitamin supplement than among women who did not take a multivitamin. In addition, the use of individual supplements of vitamin B6, folic acid, iron, magnesium, zinc, and copper were said to be associated with increased mortality rates.¹

A potentially serious problem with this study is that the researchers did not report actual mortality rates. Instead they compared “adjusted” mortality rates between supplement users and nonusers, by adjusting for a wide range of factors including caloric intake, cigarette smoking, body mass index, blood pressure, educational level, diabetes, use of hormone-replacement therapy, physical activity, and intake of fruits and vegetables. For each of these factors, the supplement users were in the “healthier” category (for example, less diabetes, less obesity, more physical activity, fewer smokers, and higher intake of fruits and vegetables), and would therefore have been expected to have lower mortality rates than the nonusers. Consequently, the mortality rate of the supplement users was presumably adjusted upward, when compared with the mortality rate of the nonusers. Epidemiology is a relatively crude and inexact science, and it is quite possible that the researchers “over-adjusted” the data, making the mortality rate among supplement users look higher than it really was. When the researchers adjusted the data only for age and caloric intake, there was no statistically significant difference in mortality rate between supplement users and nonusers, a point that was not mentioned in the media coverage of this study.

Another weakness of the study is that it was observational in nature. In contrast to randomized controlled trials, observational studies cannot prove cause-and-effect. There have been a number of instances in the history of medical research in which the results of observational studies were eventually contradicted by randomized controlled trials. For example, numerous observational studies suggested that the use of hormone-replacement therapy by postmenopausal women prevents heart disease, but subsequent randomized controlled trials demonstrated that hormone-replacement therapy either has no effect or actually increases the risk of heart disease.

One of the many potential sources of error in observational studies is what is known as “confounding by indication,” which in the present study would denote a failure to adjust for why the participants were taking nutritional supplements. To be sure, the supplement users were healthier than the nonusers according to the various parameters that the researchers measured. However, the supplement users may have been less healthy than nonusers according to a number of parameters that were not measured. Reasons that people might take nutritional supplements include recurrent migraines, asthma, persistent fatigue, recurrent infections, joint pains, or a family history of heart disease or other diseases. Some of these indications for supplement use may be associated with an increased risk of mortality.

Because of these weaknesses, the new study does not negate previous research demonstrating that vitamins and minerals can have a wide range of health benefits. One exception: the use of iron supplements by people who are not iron-deficient or who carry a gene for iron overload could have adverse consequences.

Vitamin E and prostate cancer: does the type of vitamin E matter?

In the other study, 35,533 men were randomly assigned to receive 400 IU per day of vitamin E (in the form of alpha-tocopherol) or placebo for an average of 5.5 years, and the men were then followed for a total of approximately 7 years. During that time, the incidence of prostate cancer was significantly higher by 17% in the vitamin E group than in the placebo group.²

Although the study was well designed from a technical standpoint, it suffers from an important weakness, in that the type of vitamin E used was not the same as the vitamin E that occurs in food. Vitamin E is found in food in 4 different forms: alpha-, beta-, gamma-, and delta-tocopherol. However, as is the case with most vitamin E research, the men in this study were given only alpha-tocopherol. Early research suggested that most, if not all, of the biological activity of vitamin E is due to alpha-tocopherol, but it is now known that at least one of the other components-gamma-tocopherol-has important functions. Furthermore, treatment with large doses of alpha-tocopherol has been shown to deplete gamma-tocopherol, potentially upsetting the natural balance of the different forms of vitamin E in the body. “Mixed tocopherols,” on the other hand, a supplement that contains all four types of vitamin E, would not be expected to cause such an imbalance.

In a previous study, both alpha-tocopherol and gamma-tocopherol inhibited the growth of human prostate cancer cells in vitro, but gamma-tocopherol was the more potent of the two.³ In another study, higher blood levels of alpha-tocopherol and gamma-tocopherol were each associated a lower risk of developing prostate cancer, but the protective effect of gamma-tocopherol was greater than that of alpha-tocopherol.⁴

Clinical trials that used alpha-tocopherol in doses lower than 400 IU per day did not find an adverse effect on prostate cancer incidence. In a double-blind study of male smokers, compared with placebo, supplementation with 50 IU per day for 5-8 years significantly decreased the incidence of prostate cancer by 32%.⁵ In a double-blind study of male physicians, supplementation with 200 IU per day (400 IU every other day) for 8 years resulted in a nonsignificant 3% decrease in prostate cancer incidence, compared with placebo.⁶ Thus, the effect of alpha-tocopherol on prostate cancer appears to be dose-related: protective at low doses (50 IU per day), neutral or modestly protective at intermediate doses (200 IU per day), and harmful at high doses (400 IU per day).

The totality of the evidence suggests that alpha-tocopherol has a protective effect against prostate cancer. However, when alpha-tocopherol is given by itself in large doses (such as 400 IU per day or more), it depletes gamma-tocopherol, which could more than negate any beneficial effect that alpha-tocopherol might have. If that is the case, then taking vitamin E in the form of mixed tocopherols would not be expected to increase prostate cancer risk, and might even help prevent prostate cancer. Further research is needed to examine that possibility.

Coffee’s Physiological Effects

Most people choose to consume coffee for the caffeine, seeking increased alertness, attention, and cognitive function. There is little debate that caffeine leads to these outcomes. Within 30-60 minutes of consuming coffee, peak levels are reached causing increased blood pressure, dopamine, adrenalin, noradrenalin, and cortisone levels. After days of regular coffee use, however, tolerance develops and these changes are no longer as drastic as with the first cup. This effect is similar to that experienced with pharmaceutical antidepressant use – the body adjusts the levels of catecholamines (dopamine, adrenaline, noradrenaline) and cortisone normally produced in anticipation of the surge that will happen once the coffee is consumed.  The consumer often experiences this tolerance as fatigue and morning grumpiness, because these chemicals are closely related to our circadian rhythm and our ability to feel awake in the morning.

In certain susceptible populations coffee consumption can lead to panic attacks and frank psychosis due to the high levels of catecholamines. It is clear that if these symptoms arise both coffee and caffeine consumption should be eliminated. For others the short-term effects of coffee are more subtle. Because the metabolism of coffee may take anywhere from 2-12 hours, with an average of 4-6 hours, many people may experience insomnia or difficultly staying asleep due to morning coffee consumption. In the average person, 15% of the caffeine consumed is broken down every hour.

This metabolism appears to be accelerated for smokers, which may evoke the classic combination of increased coffee and cigarette use together. In fact, when smokers do eventually quit smoking their metabolism quickly shifts back to prior levels and they may notice the initial catecholamine surges again from coffee consumption. People with liver disease will have the reverse affect, and metabolize coffee more slowly than the rest of the population. Pregnant women should also take note since coffee easily passes through the placenta and breast milk; these women should avoid large amounts of caffeine due to reports of it causing low birth weight. Currently, research shows that the daily level should be below 400mg for pregnant or breastfeeding women, but many doctors recommend strict avoidance when possible.

The Cons of Coffee

Because coffee acutely (i.e. quickly) increases the levels of circulating catecholamines, including dopamine, it quickly becomes an addictive substance. Over time the body adjusts the amount of circulating catecholamines in anticipation of the influx that coffee will bring. This often leads people to increase their coffee consumption, seeking that original high they once obtained. In the clinic, I have observed that most regular coffee consumers report that they are not “morning people” until they have their cup of coffee. For this reason I do not recommend regular coffee consumption, especially first thing in the morning. When people stop consuming coffee first thing in the morning, they quickly report higher energy in the morning as well as enhanced mood.

Coffee also is known to affect the distal colon, leading to increased motility and defecation. Due to the increased motility, nutrients may not be absorbed as effectively, leading to less nutritional availability. Additionally, coffee loosens the lower esophageal sphincter, the ‘valve’ between the stomach and esophagus, and increases stomach acid production. Both of these effects lead to increased incidence of acid reflux, or GERD, and stomach ulcers.

The Health Benefits of Coffee

Since coffee not only contains caffeine, but also other compounds, it is a difficult substance to research. Other compounds found in coffee include phenol chlorogenic acid (an antioxidant), potassium, magnesium, niacin (vitamin B1), kahweol, and cafestol.

Early research suggests that coffee, not caffeine, may lower the incidence of diabetes, Parkinson’s, symptomatic gallstones, and Alzheimer’s disease. The mechanisms responsible for these outcomes have not been identified, but solid research supports the claims with respect to the reduction in Parkinson’s and Alzheimer’s disease.

Undoubtedly coffee has been shown to increase cognitive performance, alertness and attention and improves these factors even in the event of sleep deprivation. Nothing, however, improves cognitive performance as effectively as a good night’s sleep, so don’t use coffee as a regular substitute.

Finally, although acutely we see a rise in blood pressure (i.e. don’t drink coffee right before going to the doctor’s office), research does not support the claim that coffee will cause long term hypertension. Current research suggests that individuals with high blood pressure are not likely to see it increase because of coffee consumption alone.

Also noteworthy is that this research does not discuss the cultural and ritual benefits of coffee consumption, which may provide their own beneficial role in many people’s daily lives.

Conclusion

The decision of whether or not to drink coffee rests with the individual. In the past I have recommended that patients avoid large amounts of coffee simply due to diuresis (increased urination) and subsequent dehydration, but current research has disproved this long-standing theory.  What my research has shown is that low to moderate coffee consumption may be beneficial in reducing the incidence of Parkinson’s, Alzheimer’s, symptomatic gallstones, and type 2 diabetes; but these benefits may come at a cost to some people. If you are experiencing insomnia, mood swings, acid reflux, fatigue, depression, gastrointestinal complaints, or chronic pain it may be beneficial to remove coffee for a period of 2-3 weeks to see if your symptoms improve.

I personally choose not to consume coffee every day, particularly in the morning, because my energy is higher without habitually drinking coffee.  I do, however, enjoy an occasional coffee, particularly a cafe americano, because I enjoy the flavor and the community aspect. My research demonstrates there are some psychological and health benefits to this sort of coffee consumption. In general, however, these benefits are not exclusive to coffee. Thus, if I were to experience any sleep, digestive, mental, or emotional disturbances I would stop drinking coffee altogether to make sure that my problem isn’t caused by something I was putting into my body. You can certainly get antioxidants, magnesium, and niacin from many other great foods; most of which won’t make you dependent or groggy in the morning.

As always, empower yourself with information and make informed decisions. You have the power to only control a few things in life, one of them is what you put in your body for nourishment. Choose wisely and enjoy.

References:

Arendash, GW and Cao C. Caffeine and coffee as therapeutics against Alzheimer’s disease. Journal of Alzheimer’s disease. 2010; Suppl 1: 117-26.

Caffeine, Mental Health, and Psychiatric Disorders. Journal of Alzheimer’s Disease. Vol 20: 239-48

Conde SV et al, Chronic caffeine intake decreases circulating carecholamines and prevents diet-induced insulin resistance and hypertension in rats. Br Journal of Nutrition. 2011 June 23:1-10.

Chou, T. Wake up and smell the coffee. Caffeine, coffee, and the medical consequences. West J Med. 1992 November; 157(5): 544-553.

Harris A, et al. Coffee, stress and cortisol in nursing staff. Psychoneuroendocrinology. 2007 May; 32 (4): 322-30.

Hindmarch I, et al. A naturalistic invetigation of the effects of day-long consumption of tea, coffee, and water on alertness, sleep onset and sleep quality. Psychopharmacology (Berlin) 2000 April; 149(3): 203-16.

Lorist, MM. Effects of caffeine on sleep and cognition. Prog Brain Res. 2011; 190: 105-17.

Neuhauser-Berthold, Beine S et al. Coffee consumption and total body water homeostasis as measured by the fluid balance and bioelectrical impedance analysis. Ann Nutr Metab. 1997; 41(1): 29-36.

Roehers, T and Roth T. Caffeine: sleep and daytime sleepiness. Sleep Med Rev. 2008 April; 12(2): 153-62.

“Do I need to take a multi-vitamin?” This question could simply be answered through observing the quantity and quality of foods that you enjoy or consume each day. Does your daily diet include a minimum of 4 servings of vegetables, 2 servings of fruit, and 3 servings of quality protein? I’ve found that these minimal servings are sufficient for optimal health. Our bodies require a nutrition spectrum that includes measurable units of nutrition represented by categories like; B vitamins, phosphorus, magnesium, vitamin K, proteins, vitamin C, iodine, etc to fuel it’s metabolic activity. These building blocks are found in abundance in a well-balanced diet of whole food products: fruits, vegetables, whole grains, nuts/seeds, and animal meat. Focus on changing the way you fuel your body, emphasizing whole foods in place of parts of the nutritional spectrum. If your diet consists of a great deal of processed food, fast food, or engineered food you are likely lacking these essential nutrients and you may be a candidate for taking a multi-vitamin.

But, not so fast, why we eat, how we eat and when we eat are almost as important as what we eat. A well-intentioned person with a well balanced diet yet poor habits may also find themselves in need of support. These poor habits include eating in front of the computer, or in the car, chewing food too quickly and swallowing large undigested portions of their food. This person is not taking advantage of all the minerals and vitamins available in their food. Therefore the ability to properly absorb all this food has to offer is challenged. Digestion and absorption play a significant role in my recommendation for supplements.

In order to have proper breakdown of food one must thoroughly chew the food and ease into a relaxed state. This will allow for all the proper channels of digestion to be optimized. When one eats quickly stomach acid and, subsequent, digestive enzymes have to work harder to breakdown the food was not thoroughly chewed.

Stress initially decreases the stomach’s ability to secrete hydrochloric acid (HCL) and we need HCL to breakdown our foods into the useable building blocks of amino acids, glucose, vitamins, and minerals. A person who eats on the go, at the workstation, or wolfs down their balanced diet does not need a multi-vitamin but lifestyle modification. Simply restructuring the way they eat can alleviate the need to supplement naturally.

For pregnant women, I always recommend a quality multi-vitamin for peri-natal and prenatal health. It is best to get a quality product that will give you an adequate folic acid level to ensure the health of your baby.

“How do I pick out the perfect, or at least the best multi-vitamin for me?”

Knowledge is power…making an informed decision is key. In lieu of naming supplement companies that I prefer, the following parameters should be used to evaluate your multi-vitamin:

When choosing any supplement make sure they carry the mark of one of the following professional, quality standards:

• Consumerlab Quality Product Seal
• NSF Mark[1]
• USP Verified Mark[2]

Iron only for high-risk groups

• avoid any vitamins that contain iron, unless you have been specifically advised by your doctor to take iron
• Check labels for lead-free guarantee[3]

Looking for specific minerals will enhance the absorption, and are less likely to cause intestinal upset. For example:

• Zinc (Zn): Zn sulfate is the most common zinc used but, a better choice would be an organic zinc such as: Zn acetate, Zn gluconate, Zn picolinate (best choice)
• Manganese (Mn): common to find Mn sulfate, but organic Mn might be gentler to stomach including: Mn gluconate, Mn ascorbate, Mn amino acid chelate
• Magnesium (Mg): common to find Mg oxide, Mg chloride, but a better choice would be Mg gluconate, Mg citrate[4], Mg aspartate, Mg amino acid chelate
• Calcium (Ca): Calcium citrate,[5]^,[6],[7]malate, and gluconate better absorbed than calcium carbonate. Smaller doses absorbed better, do not absorb more than 500 mg at once
• May need to take a separate Calcium and Magnesium supplement to get adequate dose, best dosed at evening meal for bone health

Vitamin D: natural source is best, D3 (cholecalciferol) is more potent than D2 (ergocalciferol)^[8]

Natural source for Vitamin E and carotenes, synthetic alright for others

Choose a product with extra Vitamin C, D, E, K if possible

Extra B12 for seniors

If you have any further questions about multi-vitamins, please feel free to give me a call at the clinic and schedule a free consultation. As a naturopathic doctor I had the fortune of having nutritional education as part of my curriculum, so I love talking about this stuff and am happy to offer any further educational pointers that may enhance your knowledge and ultimately your health. Be well. –Dr. K

^[8] Houghton LA, Vieth R. The case against ergocalciferol (vitamin D2) as a vitamin supplement. Am J Clin Nutr. 2006 Oct;84(4):694-7.

I’m so excited to start offering this exciting new weight loss course in partnership with ProAction Athletics! See below for our press release. Hope to see you next Sunday! ~Dr. K

Did you know?  95% of weight loss programs don’t work!  (National Weight Control Registry, 2010)  Most people will regain most or all of the weight they lost; some go on to gain even more. Additionally, people will do just about anything to drop a pound -  taking up extreme diets like the grapefruit, no-carb, and cabbage soup diets, or subsisting on prepackaged and processed foods.  The list goes on and on…the reason these and other diets don’t work is because they are just that: diets; something we perceive as a temporary fix to help us drop the pounds. Once we get to our goal, most of us start again with our old bad habits, such as consuming large portions, excessive sugar, and binge drinking and eating.

Two Oakland businesses have decided to team up and help change this trend. Guided by a family doctor and certified personal trainers, Life Camp is set to teach women how to eat better, sleep better, reduce stress and make exercise fun and enjoyable.

Designed by Dr. Sara Knuth and Sarah McClendon and Jennifer Lynch of ProAction Athletics, this 2 hour course will give women the tools needed to incorporate healthy lifestyle habits into their daily routines.  Even women not seeking to lose weight will benefit from this informational talk designed specifically with women in mind. To help achieve long-term goals the program will foster a relationship with the group that gives support to women looking to make lifestyle changes. Dr. Knuth will give examples of a healthy diet and discuss the defeating role of stress and poor sleep on your diet plan. Following this hour-long talk, Certified Personal Trainer, Jennifer Lynch, will lead a 45 minute workout set to incorporate the important addition of exercise to any health routine.   There will be 15 minutes at the end for any additional questions, comments and concerns.

Introductory Class: Sunday, April 3^rd from 10:00am-12:00pm. 2 hour class for only $20!  At ProAction Athletics, 3360 Grand Ave, Oakland (above Dominoes).

Reserve your spot now, class size is limited.  Go to ProAction Athletics’ website:  www.proactionathletics.com.  You can use your credit card or PayPal account. Stay tuned for more exciting programs and Life Camp dates.

Sara Knuth, ND is a Naturopathic Medical Doctor with extensive training in nutrition, physical medicine and counseling.  In her private practice, at Be Well Integral Healing Space in Oakland, she “empowers patients to take control of their health, prevent disease and achieve their health goals.” She offers comprehensive and individual medicine for the whole family, utilizing her clinical training in conventional and alternative medicine.

Jennifer Lynch is a certified personal trainer and works with ProAction Athletics on Grand Avenue in Oakland. ProAction Athletics’ mission is to inspire every woman to recognize her inner power while she works on her outer strength. They offer both daily boot camps and personal training designed to push you just outside of your comfort zone. They will stretch your boundaries and allow you to grow into your newly found confidence and smaller clothing.

Sound like something you’re interested in learning more about? Check out this article:

Author’s note:

After reading through this paper, it should be clear how gut health is an absolutely essential component for resolving food allergies and for overall health. Helping the gut to be restored to good health is not something to be left to someone who is inexperienced in doing this, because of the multisystem relationships. Nevertheless, due to the multifactorial effects of probiotics, HCL, digestive enzymes, particular nutrients and botanicals, these substances, when used appropriately, can often greatly decrease food allergies. In short, a functional health care approach is essential for management and resolution of food allergies.

Youths low in ‘sunshine vitamin’ may be more prone to allergies

THE QUESTION Too little Vitamin D can lead to bone problems and diseases. Might it also play a role in the development of allergies?

THIS STUDY analyzed data on 6,590 people, roughly half of them 21 years of age and younger and half older. The group was deemed representative of the U.S. population. Vitamin D levels were determined by blood tests, as was sensitivity to 17 common allergens. Among the youths, food and environmental allergies were greater in those with lower levels of Vitamin D. Young people deficient in Vitamin D were about twice as likely as those with higher levels of the nutrient to have peanut or ragweed allergies and nearly five times as likely to be allergic to oak. Allergies to dogs, cockroaches, shrimp, rye grass, Bermuda grass, birch, certain fungi and thistle also were more common in youths with the lowest Vitamin D levels. In adults, however, no link was found between Vitamin D levels and allergen sensitivity.

WHO MAY BE AFFECTED? People with low levels of Vitamin D. For most people, exposure to 15 minutes of sunshine three times a week enables the body to produce a sufficient amount of Vitamin D. It’s also available in some foods (dairy products and fortified cereals, for example) and in supplements. The amount needed varies by age, with current guidelines suggesting that people need 600 international units (IU) daily up to age 70 and 800 IU thereafter. Some experts, though, say those amounts are not sufficient.

CAVEATS The study did not test whether increasing Vitamin D levels through supplements or other means would affect allergy symptoms, nor did it determine why the association found in children was not replicated among the adults.
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FIND THIS STUDY Feb. 17 online issue of the Journal of Allergy and Clinical Immunology (www.jacionline.org/inpress).

LEARN MORE ABOUT Vitamin D at www.hsph.harvard.edu/nutritionsource and www.ods.od.nih.gov

- Linda Searing

The research described in Quick Study comes from credible, peer-reviewed journals. Nonetheless, conclusive evidence about a treatment’s effectiveness is rarely found in a single study. Anyone considering changing or beginning treatment of any kind should consult with a physician.

The Milken Institute says chronic disease is hurting the economy.

October 03, 2007|Lisa Girion | Times Staff Writer

The rapid rise in preventable chronic diseases — such as obesity and heart disease — over the last 20 years is hurting U.S. economic productivity, escalating treatment costs and causing unnecessary suffering, a new report says.

That’s the bad news.

The good news, according to the report by the Santa Monica-based Milken Institute, is that the trend can be turned around with healthy doses of prevention and early detection.

The report comes amid a national debate over healthcare, what it should include, and who should pay for it — including government, private insurers, individuals and employers.

The Milken report is part of growing pressure at the same time to allocate more health dollars for prevention and early detection — rather than just treatment.

Currently Medicare, the government’s health insurance program for seniors, and private insurers tend to pay more for surgeries and treatment procedures than for prevention counseling in a physician’s office.

Such payments are rooted in the healthcare needs of the population when the payment plans began decades ago.

The Milken Institute, a private economic think tank, joins a growing chorus of researchers and public health experts contending that such a system no longer serves the nation because the population is aging and because the incidence of obesity and preventable diseases among Americans of all ages, including children, has risen alarmingly in recent years.

The Milken report is one of the most ambitious attempts to quantify what is at stake in economic terms.

It says a reorientation toward prevention could avert 40 million cases of seven chronic diseases — cancers, diabetes, heart disease, hypertension, stroke, mental disorders and pulmonary conditions — in the year 2023.

That would reduce anticipated treatment expenses associated with the seven diseases and improve productivity by $1.1 trillion that year, it says.

The report does not put a price tag on prevention and early detection efforts.

But the authors suggest that the economic gains and reduced treatment costs would more than pay for such efforts.

“Good health is an investment in economic growth,” said Ross DeVol, director of the Milken Institute’s Center for Health Economics and the lead author of the report, titled “An Unhealthy America: The Economic Burden of Chronic Disease.”

The report recommends making rewards for prevention a part of any healthcare overhaul, and it urges a renewed commitment by policymakers to achieving a “healthy body weight.”

Reducing obesity alone to reasonable and achievable levels, the report says, could trim the incidence of disease by 14.8 million case in 2023, saving $60 billion in treatment costs and improving the nation’s economic output by $254 billion.

Institute founder Michael Milken said the nation had made great strides in improving cancer death rates but was failing to avert preventable diseases.

Milken, himself a cancer survivor, pointed the finger at high-calorie, high-fat foods, and he noted the rapid advance of obesity, which is linked to many escalating diseases, including diabetes and hypertension.

He called for a moon-launch-type mission to fight disease through prevention efforts, such as diet and exercise, and to improve outcomes with early detection.

“We have not contained the containable,” Milken said at a Washington news conference.

This “doesn’t take new medical breakthroughs or new Nobel Prizes to solve.”

The report was released at the news conference, held by the Partnership to Fight Chronic Disease. Former U.S. Surgeon General Richard Carmona, who serves as chairman of the coalition, said the report helped by identifying the “cost burden” of chronic disease.

“It’s truly staggering,” he said. “If we are unable to reduce the rate of chronic disease, the potential economic damage to our nation could be devastating.”

Carmona said the biggest problem with the current system was that it waits for people to get sick and then treats them at high cost.

“The system we have is archaic,” he said. “It really doesn’t work.”

Public health experts said the report should help focus the attention of presidential candidates and policymakers to the need to emphasize and encourage prevention, early detection and effective disease management.

“Most of the national policy discussion on healthcare is about financing mechanisms,” said Kenneth Thorpe, a public health professor at Emory University in Atlanta and executive director of the Partnership to Fight Chronic Disease.

This report “suggests that the urgent need to act now to reduce the amount of preventable illness as the country ages deserves equal focus,” he said.

Thorpe said the magnitude and growing burden of disease required new approaches.

“Solving the problem is not going to be done the way we’ve done things in the past — dialing up co-pays and deductibles,” he said.

The Milken research builds on a study by Thorpe that was released this week that found higher rates of cancer and chronic diseases among Americans age 50 and older compared with their European counterparts.

Thorpe blamed Americans’ diet and sedentary lifestyle.