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Big Business in Obesity
Managing Injuries
Supplements for Injuries
Environmental Protection
Ask Dr. J: Kidney Stones
References
In the Health News
Diet and Disease
Recipe of the Month: Buckwheat with Vegetables
Dear Friends,
Many of my readers in New England were distressed when I
wrote that I had moved to Florida, thinking that I had quit
the Northeast for good. However, I can reassure those of you
from the region that I will be returning sometime in the Spring,
and will again see patients in my two offices, Arlington,
MA, and Amherst, NH. I very much appreciate your concerns
and desire to have me in the area.
I made the move to Florida for a variety of reasons, but
as you might imagine, the primary one was the winter weather.
I am able to be outdoors more, and I’ll have an easier
time exercising year round. In addition, Iwill be able to
grow melons more easily, and papayas, which are impossible
in New England. This all fits in well with my commitment to
a healthy diet and lifestyle.
Reuters reported in October that many businesses are now
catering to the obese population, from vacation resorts with
stronger beds, wider stairs, and armless chairs, to companies
marketing larger towels, larger clothes hangers, and seat
belt extenders. According to the article, weighing scales
are now available that go up to 1000 pounds.
A spokesperson for the obese population, herself 324 pounds,
noted that the majority of the population is overweight, so
it is simply good business to cater to them. This may be true
from a business perspective, but overweight and obesity have
much wider implications. In fact, another “business”
thrives as a result of the high rate of obesity—health
care.
It was recently reported that one of the sectors of the
economy that was leading the recovery was health care, with
the implication that this was a social good. This may have
benefits for the economy, but is it not shortsighted to in
any way consider an increase in the utilization of health
care services as being good for the community? One of the
contributors to increased use of health care facilities is
the high rate of overweight and obesity.
With the increased risk of heart disease, hypertension, diabetes,
arthritis, cancer, and accidents among the overweight and
obese, it is not surprising to find that health care costs
are directly related to weight. Several studies show that
costs go up by 10, 36, and 45 percent as body mass index (BMI),
normally 18-22, rises to 25, 30, and then above 35 Kg/sq.m.,
which reflects obesity.
It is unfortunate that interest in diet and weight loss programs,
as well as fitness centers has been declining in spite of
the need for better health and weight control. A healthy diet
is inexpensive, and a regular walking program requires no
extra expenditure—except of calories.
While recent months have been both exciting and stressful
for me, I have also learned some lessons—such as the
importance of being patient and careful. What with buying
a home in Florida, packing up and selling a home in Cambridge,
putting the garden to bed in New Hampshire, and remodeling
the Florida house, I have managed to injure myself several
times.
Most recently, a stack of drywall that I was trying to reposition
became unbalanced and fell toward me. With some luck I was
able to slip out from under, but not before the edge of the
stack banged into my thigh (fortunately not breaking it),
skittered down and bruised the muscle. (However, the visible
bruise was unfortunately not dramatic enough to elicit much
sympathy.)
I believe that my high doses of dietary supplements contributed
to avoiding a worse injury and more bruising. In addition,
I modified my intake after the injury to promote the healing
and relieve some of the pain, and two days later my limp was
gone and I was back to running.
A number of supplements help to increase tissue and blood
vessel strength, reducing damage and bleeding in response
to trauma, or promote wound healing. Vitamin C is essential
in making the collagen in connective tissue. Bioflavonoids
and vitamin C reduce capillary fragility.
Research shows that after a variety of traumas, injury is
reduced with vitamin C supplementation. Swelling and tissue
injury are reduced after burns when vitamin C is given at
the time of the trauma. Intravenous administration of 14 mg/Kg/hour
(the amount in one study) translates to giving 1 to 2 gm orally
every hour.
Vitamin C also reduces damage and supports recovery after
exercise-induce muscle injury. This suggests that other injuries
would respond similarly. In one study, with only 400 mg daily
for two weeks before demanding exercise, muscle soreness was
reduced and function enhanced. Another report from 1982 stated
that from 500 to 3000 mg of vitamin C, administered to non-deficient
subjects, enhanced healing from surgery, injury, and leg ulcers
and improved the quality of collagen. Vitamin C and E enhance
recovery in critically ill surgical patients, reduce organ
failure, and lessen time in the ICU.
Capillary fragility leads to increased blood leakage and
the dramatic appearance of bruises in response to injury (the
kind that elicit sympathy). A variety of flavonoids improve
capillary resistance to trauma, up to 40 to 65 percent in
one study (this is studied by putting a suction cup on the
skin and measuring the vacuum pressure needed to cause capillary
rupture).
In another study, flavonoids were administered to patients
undergoing surgical hemorrhoid removal. Those who received
the supplements, but not those on placebo, had a much reduced
incidence of bleeding after the procedure.
Flavonoids also reduce acute and chronic inflammation, and
they protect against the oxidative damage. They also lessen
the swelling that accompanies injury.
Numerous studies support the role of zinc, arginine, vitamins
A, C, and E, and essential fatty acids in the healing process
from wounds, physical trauma, and burns. (In severe burns,
it may also be necessary to increase protein intake.)
After my injury, I added extra L-arginine and zinc to my
supplement program, even though I take some zinc regularly
in my multivitamin. Arginine improves both wound healing and
immune function in the elderly, enhancing white blood cell
function as a side benefit. Typical doses of arginine are
from 4 to 10 gms per day.
I also took bromelain as part of my healing program. Bromelain
is a pineapple-derived extract containing protein-digesting
enzymes and non-enzyme substances. It removes debris left
after tissue is injured, reduces swelling, accelerates healing,
and is anti-inflammatory. Research suggests that bromelain
relieves tenderness, as well as pain at rest and during motion
after blunt trauma to muscles.
Some side benefits of bromelain include reduction of platelet
aggregation, anti-thrombotic activity, interference with tumor
cell growth, stimulation of immunity, and, in animal studies,
inhibition of invasiveness of tumor cells.
Bromelain activity is measured in mcu (milk clot units).
Typical doses are 5000 to 10,000 mcu daily, more at the start
of therapy and tapering off as the healing progresses.
You don’t need to work at the EPA to worry about toxins
in the environment. With our Florida home remodeling , there
is an abundance of dust and fumes in the air, from plaster,
glues, wood, grout removal, and paint residues, as well as
the smoke that drifts in from the workmen who have their cigarettes
outside.
I can’t help but breathe these in, although I do as
much as possible to avoid the working areas and to have a
lot of cross ventilation. In order to help protect myself,
I vacuum with a HEPA filter to remove small particles. I also
do outdoor exercise regularly to help clear my lungs (running
on the beach also helps to clear my mind).
In addition to Vitamins C and E, and other antioxidants such
as coenzyme Q10, I recommend N-acetyl cysteine (NAC) to help
loosen mucous secretions, which helps the cilia lining the
airways to bring up the particles that get into the lungs.
It is also an antioxidant, protecting against a variety of
environmental toxins. I take 500 mg twice a day. This also
helps chronic bronchitis and obstructive lung disease.
Calcium D-glucarate helps the liver detoxify chemicals (Walaszek
Z, et al., Metabolism, uptake, and excretion of a D-glucaric
acid salt .... Cancer Detect Prev. 1997;21(2):178-90). Many
toxins are excreted after the liver attaches them to glucuronic
acid. In the intestines, this bond may be broken, and the
toxin reabsorbed and recirculated to the liver. Calcium D-glucarate
helps maintain the bond, so the toxin can be more readily
excreted. I take 500 mg twice a day, and I recommend higher
doses for more serious exposures.
Finally, I also take 500 mg of silymarin, a flavonoid complex
from milk thistle, that is known to support the liver, protect
it from toxins, and help regenerate damaged liver cells. It
is also known to help with liver damage from mushroom poisoning
(Enjalbert F, et al., J Toxicol Clin Toxicol. 2002;40(6):715-57).
Q. Do you have any suggestions for preventing
another kidney stone?
-- SK, via Internet
A. Kidney stones result from crystallization of substances
in the urine that grow to form a hard mass. They can lead
to severe pain if they become obstructed when they pass through
the ureter. Ultrasound destruction is the usual treatment,
the fragments being passed in the urine.
The most common stone is made of calcium oxalate. Oxalic
acid is present in some foods, such as spinach, rhubarb, strawberries,
beet greens, tea, and chocolate, among others. Limiting these
in the diet may help. Vegetarians have about half the rate
of kidney stone formation as meat eaters.
Limit your salt, sugar, and caffeine intake, but dietary
calcium appears to help by binding with oxalate in the gut,
thus limiting its absorption and reducing stone formation.
Drinking plenty of water helps by diluting the urine.
Magnesium and vitamin B6 (pyridoxine) reduce oxalate excretion,
and lower the rate of stone formation. Typical doses are 500
mg of magnesium and 100 mg of B6, the amounts in a good multivitamin-mineral.
Vitamin C is not associated with an increased risk of kidney
stones, in spite of the current medical myth.
Catering to Obese Becoming Big Business,
Reuters, October 24, 2003.
Thompson D, et al., Body mass index and
future healthcare costs: a retrospective cohort study. Obes
Res. 2001 Mar;9(3):210-8.
Quesenberry CP Jr, et al., Obesity, health
services use, and health care costs ... Arch Intern Med. 1998
Mar 9;158(5):466-72.
Matsuda T, et al., ... high-dose vitamin
C therapy on postburn lipid peroxidation. J Burn Care Rehabil.
1993 Nov-Dec;14(6):624-9.
Matsuda T, Effects of high-dose vitamin
C administration on postburn microvascular fluid and protein
flux. J Burn Care Rehabil. 1992 Sep-Oct;13(5):560-6.
Thompson D, et al., Prolonged vitamin C
supplementation and recovery from demanding exercise. Int
J Sport Nutr Exerc Metab. 2001 Dec;11(4):466-81.
Ringsdorf WM Jr, Cheraskin E, Vitamin C
and human wound healing. Oral Surg Oral Med Oral Pathol. 1982
Mar;53(3):231-6.
Nathens AB, ...antioxidant supplementation
in critically ill surgical patients. Ann Surg. 2002 Dec;236(6):814-22.
Galley P, Thiollet M, A double-blind, placebo-controlled
trial of a new veno-active flavonoid fraction (S 5682) in
the treatment of symptomatic capillary fragility. Int Angiol.
1993 Mar;12(1):69-72.
Ho YH, et al., Prospective randomized controlled
trial of a micronized flavonidic fraction to reduce bleeding
after haemorrhoidectomy. Br J Surg. 1995 Aug;82(8):1034-5.
Pelzer LE, et al., Acute and chronic antiinflammatory
effects of plant flavonoids. Farmaco. 1998 Jun 30;53(6):421-4.
Shi HP, et al., Supplemental L-arginine
enhances wound healing in diabetic rats. Wound Repair Regen.
2003 May-Jun;11(3):198-203.
Kirk SJ, et al., Arginine stimulates wound
healing and immune function in elderly human beings. Surgery
1993 Aug;114(2):155-9.
Maurer HR, Bromelain: biochemistry, pharmacology
and medical use. Cell Mol Life Sci. 2001 Aug;58(9):1234-45.
Masson M, Bromelain in blunt injuries
of the locomotor system. A study of observed applications
in general practice. Fortschr Med. 1995 Jul 10;113(19):303-6.
Regular exercise and increasing levels of exercise after
being diagnosed with cancer are both associated with improved
quality of life (Blanchard CM, et al., ...exercise [and] quality
of life in adult cancer survivors? Prev Med. 2003 Nov;37(5):389-95).
At least a half hour of exercise, three times a week, helped
compared with decreasing levels (usually as a result of depression,
despondency, fatigue or treatment), but this study did not
evaluate an effect on survival. Other studies suggest that
exercise helps survival in prostate cancer and other cancers
(Sawada SS, et al., Cardiorespiratory fitness and cancer mortality
in Japanese men... Med Sci Sports Exerc. 2003 Sep;35(9):1546-50),
while obesity increases recurrence and mortality in breast
cancer (Rock CL, et al., Can lifestyle modification increase
survival in ...breast cancer? J Nutr. 2002 Nov;132(11 Suppl):3504S-3507S).
A recent analysis showed the public health benefit of preventing
age-related macular degeneration, a leading cause of blindness,
with vitamins C, E, beta carotene and zinc (Bressler NM, et
al., Potential public health impact of ...AREDS report no.
11. Arch Ophthalmol. 2003 Nov;121(11):1621-4). A physician
ridiculously commented (Reuters, Nov 10, 2003) that they should
“only be used in intermediate or advanced disease.”
Why wait for an exam to show you are already diseased? How
is that preventive medicine?
The Mediterranean diet, rich in fruits, vegetables, fish,
fiber, and olive oil, but low in meat, reduces the signs of
inflammation that are risk factors for heart disease, and
the findings were independent of age, exercise, weight, sex,
or education. A related report showed that fish, such as sardines,
mackerel, and (wild) salmon, is also related to reduced risk
(Reuters, November 9, 2003). Farmed fish are not as healthful,
and the farming methods are not environmentally sound.
Buckwheat is thought of as a cereal grain, but it is really
an herb in the rhubarb family. It contains no gluten (for
those who are gluten sensitive). The edible portion is technically
a “fruiting body” that can be toasted after the
hull is removed (kasha), and eaten in a variety of dishes.
It is rich in protein and fiber. My mother used to coat kasha
with beaten eggs and stir it around in a dry skillet with
onions until it was dry and toasty. You can do this with or
without the egg. Then boil the mix in twice as much water
as buckwheat (with a little soy sauce, or replace water with
vegetable broth—organic is available from Imagine Foods),
adding garlic and cayenne pepper. Next, blend in some stir-fried
vegetables, such as diced carrots, celery, more onion, broccoli,
and herbs to taste. You can also add some diced tofu to the
vegetables.
drjanson@drjanson.com
November
through May: 386-409-7747
June
through October: 603-878-2256
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