April 2002

Letter from Dr. Janson: Prescription Drug Advertising
Alternatives to Cholesterol Drugs
Cholesterol: Other Treatment Options
Octacosanol Beats Statins
Reflux Esophagitis: Ask Dr. J
In the Health News
Recipe of the Month: Marinated Grilled Tofu
References

Letter from Dr. Janson: Prescription Drug Advertising

Dear Friends,
It is unusual for me to agree with the U.S. Food and Drug
Administration, but I have found one area of at least some common
ground. I am referring to the television, magazine, and newspaper
advertising of prescription drugs to the public, suggesting that
they request a prescription from their doctors.

The FDA has said that some of these ads are misleading, and
overstate the benefits of the drugs while underreporting the
risks of side effects, or the chances that the drug will not work
at all. However, it appears to me that the FDA is mostly paying
lip-service to regulating such ads, judging by the ones that I
have seen. I am all for an educated public, and ready access to
drugs that are beneficial, as long as the education is not
self-serving.

They often remind me of those Salem cigarette commercials where
people filling their lungs with ashtray contents are seen as
young, healthy, vibrant, and athletic, with beautiful skin, while
lounging around in an environment of brilliant, cloudless skies,
lush meadows, and pristine mountain streams. They just
misrepresent the product, which would be more accurately
portrayed by pictures of dirty, sweaty, exhausted men rising out
of the coal mines covered in soot and grime.

The drug ads for allergy, ulcer, arthritis, cholesterol-lowering,
sexual-dysfunction, and other medications often tell the viewer
to "ask your doctor" for more information, but the end result is
that people go to their doctors almost insisting on prescriptions
for these products, and the doctors feel pressured to prescribe
them. The doctor often thinks that the patient will go to another
doctor if they leave the office without their desired medication.
They might even wonder why the doctor is not up to date on the
latest benefit afforded by the drug companies.

While the FDA has reprimanded companies, most of the ads that I
have seen are still misleading, and the small print is usually
ignored, even when it is a whole page on the back of the ad in
the magazine. Perhaps the FDA is spending too much of its time,
budget, and staff resources trying to prevent truthful and
non-misleading advertising by dietary supplement companies,
promoting products that are quite safe and beneficial. However, a
few of the dietary supplement companies also promote their
products with ads that are misleading, and I am opposed to that,
too--it diminishes the reputation of alternative medicine,
already struggling for respect against the medical juggernaut.

Prescription drugs are the fastest growing expense in medical
care. Having semi-informed people, "educated" by advertising,
pushing doctors to prescribe medications for them does not help.
Fully informed people are more likely to choose alternatives,
such as dietary supplements and complementary medicine, which are
safe, effective, and relatively inexpensive.

Alternatives to Cholesterol Drugs
Speaking of drugs that are promoted directly to the public,
cholesterol-lowering medications are among the most widely
advertised. These drugs are hugely promoted because they are
generating enormous profits for the manufacturers. Numerous
studies show that they are effective in reducing cholesterol,
heart disease, and coronary mortality, but this does not tell the
whole story.

Such pervasive promotion diverts attention, not to mention
resources, from dietary controls and natural substances that are
even better than the drugs, but far less expensive. The ads offer
drugs to control a problem that usually has its roots in
lifestyle, so people may easily get the idea that they can ignore
their diets, since the drugs will correct the effects of their
poor choices. In addition, because these ads are paid promotion,
rather than public education (although the companies often refer
to their ads as informational), they minimize the potential drug
side effects and costs.

For example, one of these drugs, Baycol (cerivastatin) was
removed from the market when it was discovered that the side
effect of muscle degeneration was far more frequent than
expected. This side effect, called rhabdomyolysis, leads to
muscle breakdown products passing through the kidneys and causing
kidney failure and death. Other statins can also cause this side
effect, as well as hepatitis, jaundice, other liver problems,
gastrointestinal upsets, reduced platelet levels, anemia, joint
pains, headache, sore throat, runny nose, and skin rashes. It is
unfortunate that the public does not have the opportunity for
balanced education about these products.

Cholesterol: Other Treatment Options
A study published in the Journal of the American Medical
Association shows that even though statin drugs lower
cholesterol, they also lower serum levels of valuable
antioxidants. For example, they cause a 20 percent decline in
beta-carotene, a 16 percent drop in vitamin E, and a 22 percent
reduction of coenzyme Q10, all of which are important nutrients
for the heart.

These researchers were actually studying how a diet rich in
vegetables, fruits, nuts, and whole grains can lower cholesterol
in addition to any lowering effect from the statins. What they
found was that diet still plays an important role in managing
cholesterol. In addition to its safety, it has many other
benefits unrelated to the heart.

This study showed another damaging effect of the statins: an
increase in serum insulin levels. Insulin is essential for
maintaining a normal blood sugar, but high levels are associated
with a condition called insulin resistance, a risk factor for
heart disease and the development of diabetes. The diet reduced
serum insulin levels, reversing some of the negative drug
effects.

Octacosanol Beats Statins
While you may not have heard of it, a substance called
octacosanol is more effective than the statin drugs in lowering
cholesterol, and it has other benefits also. This is the main
component of a complex called policosanol, and the research is
impressive. In studies doing direct comparisons with statin
drugs, the octacosanol was superior.

Octacosanol is a waxy alcohol derived from sugar cane or wheat
germ. In a study of octacosanol and Pravachol (pravastatin), 10
mg daily of either product lowered LDL- cholesterol by 19.3
percent, the drug only 15.6 percent, it lowered total cholesterol
by 13.9 percent (the drug only 11.8). The drug did not affect
triglycerides or HDL, but octacosanol raised the good HDL by 18
percent, and lowered the triglycerides by 14 percent.

The change in the ratio of total cholesterol to HDL was lowered
25 percent by octacosanol, compared to only 15 percent by
pravastatin. Inhibition of platelet aggregation reduces heart
disease, and this effect was greater with octacosanol than the
drug. Further, octacosanol protects the LDL from oxidative
damage, and oxidized LDL is the most damaging form.

From all this information, octacosanol is clearly a superior
choice: it is without side effects, and it is far less expensive
than the medications.

These benefits have been known for more than ten years, but
clearly the vast majority of people know of the drugs, while the
natural and inexpensive alternative remains mired in obscurity.

Other dietary supplements also help maintain healthy cholesterol
levels and reduce heart disease risk. Niacin, or vitamin B3,
lowers cholesterol, and appears to have some of the same
antiinflammatory effects as the statins, apparently a part of
their benefit profile. Slow release niacin does not cause as much
of a flush reaction as the plain niacin, but it has caused some
liver function abnormalities in a few patients. Taking a
non-flush form of niacin, inositol hexaniacinate, provides the
same cholesterol effects without the liver changes, but it is
more expensive. Effective niacin doses are 1500 to 3000 mg daily.

Vitamins E and C reduce total cholesterol and raise HDL levels,
but not as much as octacosanol. They also protect the LDL from
oxidation, and in clinical studies they reduce heart disease. It
is impossible to get therapeutic levels of vitamin E (400 to 800
IU) from the diet. Vitamin C is easier to find in foods, and on a
diet rich in raw fruits and vegetables it is possible to get over
2000 mg daily, but it is likely that you will need supplements to
get this amount. The bioflavonoid quercetin is anti-inflammatory
and inhibits oxidation of LDL.

Chromium supplements in the range of 200 to 400 mcg daily reduce
total cholesterol and raise HDL levels, and up to 1000 mcg also
help control blood sugar levels. As diabetes is a heart risk
factor, this in itself is an important benefit.

In earlier issues, I have discussed the benefits of red yeast
rice, pantethine, garlic, and L-carnitine, but octacosanol
appears to be one of the best supplements for the heart,
particularly when combined with exercise and a mostly vegetarian
diet (plus fish with omega-3 oils), and soy foods such as tofu,
tempeh, and soymilk.

Ask Dr. J
Q. My friend has chronic reflux. Are there any natural
treatments? (C.N., Australia)

A. Gastroesophageal reflux disease, or GERD is a disorder of
digestion with stomach acid backing up into the esophagus and
causing irritation, heartburn, belching, and abdominal pain.

With chronic irritation and inflammation, the mucosa of the
esophagus is damaged, and it is more prone to the development of
cancer.

Sometimes the symptoms are due to hiatal hernia, in which a
portion of the stomach slips above the diaphragm, or if the
sphincter is not working properly to restrict stomach acid
regurgitation. The same symptoms might be indicative of a gastric
or peptic ulcer, so careful evaluation is essential for proper
treatment. Most of the time, the symptoms are not due to excess
stomach acid, but to poor diet, overweight, and food allergies.

While acid blocking drugs are often prescribed, it is usually
better to avoid them unless an ulcer is present. Treatment
involves reducing symptoms and preventing complications from
esophageal irritation. Eating a high fiber diet helps to buffer
the stomach acid, while low fiber foods, such as sugary, fatty
snacks appear to increase symptoms, as do caffeine and alcohol.

Chewing a licorice extract, called deglycyrrhizinated licorice
(DGL) can soothe the symptoms of heartburn by coating the mucosa.
It also helps with ulcer disease. L-glutamine is an amino acid
that helps heal the lining of the entire digestive tract, so it
is useful for inflammatory bowel disease as well as esophagitis.

Folic acid helps to repair damaged mucous membranes. I also
suggest high amounts of lutein, niacin, vitamin B6, zinc, and
vitamin C, which have been shown to prevent esophageal cancer.

In The Health News
a. Polluted air is not only damaging to the lungs, but it also
causes the arteries to constrict, reducing blood flow to tissues.
(Experimental inhalation of pollutants causes acute arterial
vasoconstriction. Circulation, 2002, March 12, as reported in
Reuters Health). Researchers evaluated fine particulates and
ozone, and found that even a two hour exposure to levels found in
the air of many cities led to significant reduction in size of
the brachial artery. Arterial constriction could be a trigger for
heart attacks. To reduce the consequences of pollution, and
arterial spasms, take antioxidants and arterial relaxants, such
as vitamins C and E, magnesium, ginkgo biloba, and arginine, and
exercise regularly.

Diet and Disease
a. Consuming soy isoflavones appears to modify estrogen hormones
in premenopausal women, lengthening the time between menstrual
cycles, and decreasing levels of estrone and estradiol, two
strong estrogens that stimulate breast tissue, and lead to
increased cancer risk. (Kumar NB, et al., The specific role of
isoflavones on estrogen metabolism in premenopausal women. Cancer 2002;94(4):1166-1174.) The researchers gave 40 mg per day of genistein, and compared the results with placebo, in 68 women from 25 to 55 years old. This amount of genistein is found in a cup of tofu, a cup of soymilk, or supplements.

b. Eating omega-3 oils, particularly from fish, reduces the risk
of heart disease. A new review shows that 1 to 2 fish meals a
week lowers the incidence of heart attacks, and people who have
had heart attacks have reduced overall mortality, as well as
fewer recurrent heart attacks (Nordoy A, et al., n-3
polyunsaturated fatty acids and cardiovascular diseases. Lipids
2001;36 Suppl:S127-9.) Omega-3 oils are also in ground flaxseeds,
flaxseed oil, and walnuts, and these foods also reduce cardiac
risk.

Recipe of the Month: Marinated Grilled Tofu
Here is a good recipe for that healthy tofu. Cut half-inch slabs
or 1 1/2 inch cubes of firm tofu. Marinate them for a few hours
or overnight in a mixture of balsamic vinegar (or lemon if you
prefer), crushed ginger and garlic, fresh-ground pepper (I use a
mix of black, green, red, and white), thyme, and a small amount
of soy sauce. Add other herbs and spices to taste, such as cumin,
chili powder, or cayenne pepper. Put the slabs on a grill or a
griddle, and cook on each side until brown. For the cubes, skewer
them, alternating with mushrooms, onions, red peppers, cherry
tomatoes, and zucchini, and grill these healthy shish kebabs.
Serve either with brown rice or millet (try cooking these in
vegetable broth--I buy an organic one from Imagine Foods),
steamed broccoli, and a salad.

Note:
This month I'd like to recommend a link to a newsletter with
valuable health articles. The newsletter is called Red Flags
Weekly, and they ran a recent interesting article on coenzyme Q10
(www.redflagsweekly.com/features/Q10.html). I suggest that you
visit and look for yourself. At the end of this newsletter, I
have posted the philosophy of the site, whose editor is Nick
Regush, who used to be with ABC News with Peter Jennings.

Click here to receive the Healthy Living newsletter free.

References

Editorial:
Rosenthal MB, et al., Promotion of prescription drugs to
consumers. N Engl J Med 2002 Feb 14;346(7):498-505.

Wolfe SM, N Engl J Med 2002 Feb 14;346(7):524-526

Statin Drugs and Octacosanol:

Jula A, et al., Effects of diet and simvastatin on serum lipids,
insulin, and antioxidants... JAMA 2002 Feb 6;287(5):598-605.

Abookire SA, et al., Use and monitoring of "statin"
lipid-lowering drugs... Arch Intern Med 2001 Jan 8;161(1):53-8.

Castano G, et al., Effects of policosanol and pravastatin on
lipid profile, platelet aggregation and endothelemia .... Int J
Clin Pharmacol Res 1999;19(4):105-16.

Canetti M, et al., A two-year study on the efficacy and
tolerability of policosanol... Int J Clin Pharmacol Res
1995;15(4):159-65.

Menendez R, et al., Effects of policosanol treatment on the
susceptibility of ...(LDL) ... to oxidative modification in
vitro. Br J Clin Pharmacol 2000 Sep;50(3):255-62.

Gouni-Berthold I, et al., Policosanol: clinical pharmacology and
therapeutic significance...Am Heart J 2002 Feb;143(2):356-65.

Pryor WA Vitamin E and heart disease: basic science to clinical
intervention trials. Free Radic Biol Med 2000 Jan 1;28(1):141-64.

Dwyer JH, et al., Oxygenated carotenoid lutein and progression of
early atherosclerosis: the Los Angeles atherosclerosis study.
Circulation 2001 Jun 19;103(24):2922-7.

Engelen W, et al., Effects of long-term supplementation with
moderate pharmacologic doses of vitamin E .... Am J Clin Nutr
2000 Nov;72(5):1142-9.

Reflux Esophagitis:
Goso Y, et al., Effects of traditional herbal medicine on gastric
mucin against ethanol-induced gastric injury in rats. Comp
Biochem Physiol C Pharmacol Toxicol Endocrinol 1996
Jan;113(1):17-21.

Kolarski V, et al., Erosive gastritis and
gastroduodenitis--clinical, diagnostic and therapeutic studies.
Vutr Boles 1987;26(3):56-9.

Zhang ZF, et al., Adenocarcinomas of the esophagus and gastric
cardia: the role of diet. Nutr Cancer 1997;27(3):298-309


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From September to June, I see patients in New Smyrna Beach, Florida. Call 386-409-7747, or send an email to to make arrangements.

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Information herein is not medical advice or direction. All material in this newsletter is provided for information only. Its contents should not be used to provide medical advice on individual problems. Consult a health care professional for medical or health advice.

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