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January 2004

Perspectives on Life Changes
Fending off the Flu
Dietary Supplements for Flu
Policosanol and Cholesterol Revisited
Ask Dr. J: Allergies
References
In the Health News
Diet and Disease
Recipe of the Month: Mushroom Medleys

Perspectives on Life Changes

Dear Friends,

I have had an eventful year, with the death of my father after a mostly healthy life until 95 years old (perhaps helped by all those vitamins that he finally agreed to take and his lifelong abhorrence of butter), followed by my heart surgery to correct a congenital valve problem, selling our home of 20 years to move to Florida during the cold northeastern weather, and travel to Japan as a consultant. I managed to write all of my newsletters, almost on time, although with shortened versions after my surgery and just after the move to Florida.

All of this helps me to maintain perspective on what is important in life, such as healthy lifestyle, relationships, maintaining aesthetic interests, humor, and personal growth. In times of serious life changes, it is valuable to reflect on your goals, your dreams, and everyday interests, remembering to appreciate each moment along your path (achieving one goal just puts you on the next path to another).

Having many major changes in your life usually increases the risk of developing a serious illness. But this is a statistic, based on what often happens, and I believe that it is not inevitable to fall victim to circumstances. Taking good care of yourself removes you from the statistical norm. Whether you develop a serious illness or maintain vibrant good health is almost completely a function of lifestyle choices (but not always, so there is no reason to feel guilty if you do become ill).

When going through significant life changes it can be difficult to make the right choices—who finds it easy to exercise when overtaken by anxiety for a sick relative, to eat healthfully when time is limited, or to stay relaxed when changing jobs or houses? It is certainly helpful to have a good support system, as I have had, but it is also important to develop healthy living and personal interests over a long period of time so they become ingrained in your way of being. It is never too late to start taking good care of yourself through good health practices, but it is also never too early to start. That way, when life changes, good health habits will be as routine as brushing your teeth, and although you may encounter more difficulty it will not be impossible.

Fortunately, I have been practicing healthy living since 1975, when I was 31 years old (perhaps anticipating the inevitable repair of my heart valve). As a result, in spite of all the changes, I have recovered well from heart surgery, am feeling good and I’m back to running and other physical activity. We are starting a Florida garden, hoping for more tomato and basil crops, as well as flowers.

I hope my own experience can serve as an inspiration to my patients, my lecture audiences, and my readers. I wish you all a Happy New Year, full of peace and joy, and vibrant healthy living.

Fending off the Flu

The question always comes up at this time of year — “should I get a flu shot?” This is not easy to answer, as it depends on many variables. A flu shot might be advisable for someone who is at high risk of developing serious illness if they do get the flu, such as the frail elderly, asthmatics, chronic bronchitis or emphysema patients, those with poorly controlled diabetes, or with compromised immune systems (AIDS patients and advanced cancer patients).

Flu vaccines contain killed or attenuated viruses that stimulate the formation of antibodies to the most current strains of influenza viruses, but not to all of them. It is still possible to get the flu even if you are immunized. If you are severely allergic to eggs, you should not get injections of flu vaccine. Although toxins are present in the vaccines (aluminum, mercury, preservatives) the occasional exposure should not pose a serious risk, unless you are particularly sensitive.

Symptoms of the flu are much like a severe cold, with sneezing, coughing, congestion, and sore throat, usually with muscle aches, fatigue, and fever. Flu will usually last longer than a cold, and it is more debilitating. Even if you do get the flu, it is likely that you will fully recover, just as you would from a cold, but people at high risk may develop life-threatening complications.

I have not had a flu shot myself, so I take measures to prevent communicable diseases which are just good hygiene for everyone. They should also help protect you if you decide not to have a flu shot. Wash your hands and use hand sanitizer frequently, especially after being in public places or contacting people at parties. Take care not to share drinking glasses or utensils with anyone who might be ill.

In cold climates, it is important to humidify your home to prevent dryness of the mucous membranes in your sinuses, airways, and lungs. Healthy mucous membranes help to ward off infections. I always recommend, taking care of your health habits to maintain your immune system and prevent infections. Regular exercise, healthy diet, and stress management have all been proven to enhance immunity. Elderly people who do get a flu vaccine have an improved immune response if they are physically active.

Dietary Supplements for Flu

It also helps to take a variety of dietary supplements, not only to maintain your mucous membranes, but also to support your immune system and to kill flu viruses.

Vitamin C enhances immune function and improves the ability of white blood cells to fight off viruses. It also provides some symptom relief, and reduces the duration of the infection. Although not all studies agree, it appears that overall high doses of vitamin C do prevent and shorten viral infections, including flu. A 1999 report of a placebo controlled study showed an 85 percent reduction in cold and flu symptoms when subjects were given 1000 mg of vitamin C every hour for 6 hours and then 3000 mg daily.

Vitamin C has been controversial since Linus Pauling’s book was published in 1977, and the antagonism to it has led to some misleading scientific reports. A reassessment of one of the earlier negative reviews showed that indeed vitamin C significantly reduced severity and duration of viral infection symptoms.

A standardized extract of elderberry is effective in killing flu viruses in laboratory tests. Although laboratory tests do not always correlate with clinical results, elderberry does help. In a placebo-controlled study, 93 percent of the test subjects improved within two days, (compared to six days in the placebo group), and they were cured in two to three days (compared to more than 6 days in the controls). Although the study was small, it was very promising.

Elderberry extract also enhances immune function through its effect on cell messengers, and it contains antioxidants and flavonoids, including quercetin. It influences the balance of inflammation and anti-inflammatory processes. I usually recommend 1000 mg of standardized elderberry extract twice a day at the onset of symptoms, or if someone has been exposed to the virus, and then 500 mg twice a day until symptoms clear.

Echinacea (250 mg of standardized extract twice a day) enhances immunity and helps clear symptoms of flu more quickly. Garlic, ginseng, beta 1,3 glucan, and other supplements can also help immunity. Whatever you decide about the flu shot, it is a good idea to protect yourself in other ways at the same time.

Policosanol and Cholesterol Revisited

Policosanol, a mixture of waxy alcohols derived from sugar cane, rice bran oil, or wheat germ oil, has remarkable benefits for atherosclerosis that go beyond lowering cholesterol. Doctors recommend statin drugs to lower cholesterol, often even for people with normal serum levels, noting that these drugs have other benefits in stabilizing plaque and protecting endothelial cells.

A friend told me that she lowered her cholesterol from 224 to 178 by taking policosanol, but her doctor was concerned that she might not be getting “all the benefits” of statins (but of course she was also avoiding the side effects). I suggested vitamin C to protect the endothelium, and then reviewed the recent research on policosanol.

I found that policosanol is better than statins on many counts. In a comparative study with pravastatin, policosanol offered greater protection of the endothelium, better inhibition of platelet aggregation, and improved HDL levels. Compared to lovastatin it is better at reducing arterial thickening in animal studies.

While the most effective statin, Lipitor, is slightly better at lowering total cholesterol than policosanol, it does not raise HDL, so the risk reduction is identical. Policosanol equals Lipitor at lowering triglyceride levels, and it protects LDL cholesterol from oxidation. Oxidized LDL is a risk factor for atherosclerosis.

Policosanol has further clinical benefits. In a study of intermittent claudication (pain in the legs on exercise), policosanol treatment increased walking distance by 60 percent within 6 months, and at the end of two years by 200 to 300 percent. A recent 5-month study showed that policosanol was better than lovastatin for improving claudication, and it also lowered serum fibrinogen, a risk for heart disease.

Statins can cause a severe muscle breakdown called rhabdomyolysis, with leakage of cell contents into the circulation. They reduce the production of coenzyme Q10, increasing the risk and severity of congestive heart failure, and they may not reduce overall mortality. The evidence suggests that patients should be given low-cost policosanol (10 to 20 mg) instead of expensive statin drugs. It is time for the medical profession to learn and apply this information.

Ask Dr. J: Allergies

Q. I take a prescription allergy medication year round, and would like some natural replacements.
—LW, via Email

A. Allergies can often be managed without drugs. Cleaning the environment is the first step, with HEPA air filters and avoiding pets and other allergens. Eliminating food sensitivities can help. With sinus allergies milk is a common cause, but other foods may also give you symptoms. Stress can make allergies (and asthma) worse, and visualization techniques can help clear sinus congestion. You might also try allergy shots after serial dilution skin testing.

Supplements may reduce symptoms enough to eliminate drugs. Quercetin, a flavonoid that helps reduce histamine release (1200 mg daily), and stinging nettle (500 to 100 mg of standardized extract) have helped many of my patients. I also recommend vitamin C (3000 to 6000 mg) as an anti-histamine and anti-inflammatory. Gamma linolenic acid (GLA, 240 mg) may also help.

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References

Fending Off the Flu:

Kohut ML, Exercise and psychosocial factors modulate immunity to influenza... J Gerontol A Biol Sci Med Sci 2002 Sep;57(9):M557-62.

Gorton HC, Jarvis K, The effectiveness of vitamin C in...virus-... infections. J Manipulative Physiol Ther 1999 Oct;22(8):530-3.

Hemila H, Does vitamin C alleviate the symptoms of the common cold?—a review... Scand J Infect Dis 1994;26(1):1-6.

Hemila H, Herman ZS, Vitamin C and the common cold: a retrospective analysis... J Am Coll Nutr 1995 Apr;14(2):116-23.

Zakay-Rones Z, et al., Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract .... J Altern Complement Med 1995 Winter;1(4):361-9.

Barak V, et al., The effect of ...elderberry...on the production of human cytokines... Eur Cytokine Netw 2001 Apr-Jun;12(2):290-6.

Barak V, et al., The effect of herbal remedies on the production of ...cytokines. Isr Med Assoc J 2002 Nov;4(11 Suppl):919-22.

Bauer R, ...the effect and effectiveness of Echinacea purpurea extracts. Wien Med Wochenschr 2002;152(15-16):407-11.

Policosanol, Statins, and Cholesterol:

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.

Castano G, et al., Comparison of the efficacy and tolerability of policosanol with atorvastatin.... Drugs Aging 2003;20(2):153-63.

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

Castano G, et al., A long-term study of policosanol in the treatment of intermittent claudication. Angiology 2001 Feb;52(2):115-25.

Noa M, A comparative study of policosanol vs lovastatin on intimal thickening.... Pharmacol Res 2001 Jan;43(1):31-7.

Castano G, et al., Effects of policosanol and lovastatin in patients with intermittent claudication... Angiology 2003 Jan;54(1):25-38.

Omar MA, Wilson JP, FDA adverse event reports on statin-associated rhabdomyolysis. Ann Pharmacother 2002 Feb;36(2):288-95.

ALLHAT…Research Group, Major outcomes in...patients ...pravastatin vs usual care... JAMA 2002 Dec 18;288(23):2998-3007.

In The Health News

  • Coenzyme Q10 has a wide variety of health benefits, particularly for angina, congestive heart failure, and brain degeneration. A recent randomized, controlled, double-blind study shows that 120 mg of coQ10 daily for one year prevents recurrent heart attacks. Heart attacks were cut in half in the coQ10 group, and deaths were significantly reduced. Those treated with coQ10 had an increase in HDL levels and serum vitamin E. Both groups received the same level statin drug therapy, but the coQ10 made a dramatic difference. (Singh RB, et al., Effect of coenzyme Q10 on risk of atherosclerosis in patients with recent myocardial infarction. Mol Cell Biochem. 2003 Apr;246(1-2):75-82.)
  • Mild dehydration is common in the elderly and with extended or hot-weather exercise. You need adequate fluid, including water, soups, herb teas, and juices, as well as the fluid in fruits and vegetables (but not caffeine beverages). (Maughan RJ, Impact of mild dehydration on wellness and on exercise performance. Eur J Clin Nutr. 2003 Dec;57 Suppl 2:S19-23.) Dehydration reduces alertness, and concentration, causes headache, tiredness, and poor athletic performance, and increases the risk of kidney stones, some cancers, and perhaps diabetes and heart disease.

Diet and Disease

Amazon rainforest dwellers in Brazil accumulate mercury from fish in their diet. However, those who ate the most tropical fruit had much lower tissue mercury. The authors speculated that fruit phyto-chemicals and fiber might prevent absorption, promote excretion and protein binding, and influence mercury transport. (Passos CJ, et al., Eating tropical fruit reduces mercury exposure from fish consumption in the Brazilian Amazon. Environ Res. 2003 Oct;93(2):123-30.) If you include fish in your diet, be sure to maintain fiber and fruit consumption to protect against mercury.

Recipe of the Month: Mushroom Medleys

With the flu season in full swing, adding delicious mushrooms to your diet, such as shiitake, portobello, and others, may help support immune function, and they can be prepared in a variety of ways. Cooking increases the nutritional value by breaking down the cell walls. I like to pan-fry portobello, shiitake, enoki, and oyster mushrooms with some olive oil, garlic, pepper, and lemon. You can also try chicken-of-the-woods, morels, chanterelles, and crimini (young portabellos). These can all be skewered and grilled, alternating with tomato, bell pepper, tofu squares, and onion, and coated with crushed garlic, ginger, and dilute soy sauce. After cooking, they can be served on a bed of wilted greens (spinach, chard, beet greens, mustard greens, or radish tops) accompanied by brown rice or roasted potato. I have asked a local restaurant to make a meal like this for an evening out–it is amazing what you can get these days with advance planning.

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CONSULTATIONS:

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

From May to September, I have a variable schedule, and I see patients in offices at the Rothfeld Center in Waltham, Massachusetts. For appointments, send an email to to make arrangements, or call: 386-409-7747.

I also do phone consultations, as well as email and instant messaging consults.


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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