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Supesize the USA, et al.
Protecting Your Skin
Lifestyle/Supplements for Skin
Topical Skin Treatments
Ask Dr. J: Bursitis
References
In the Health News
Diet and Disease
Recipe of the Month: Mexican Bean-Stuffed Tortilla
Dear Friends,
Dear Friends,
The success of the recent film “Supersize Me”
has brought wide attention to the problem of fast foods and
obesity. Although McDonald’s claims that their nearly
simultaneous elimination of supersize portions had nothing
to do with the film, the timing would make this a “supersize”
coincidence. The rise of obesity in the US and in other countries
was revealied as parallel to the increase in fast food outlets
in the book, Fast Food Nation, just a couple of years ago.
Now, Congress is reviewing legislation to control what kinds
of foods are served in schools as an effort to stem the tide
of obesity, diabetes, and degenerative diseases that are increasingly
seen in young people. In fact, by the time kids are 15 to
19 years old, they already have atherosclerotic plaque in
their arteries (50 percent of their right coronaries and 100
percent of their aortas). This is not genetic. It is the result
of lifestyle, particularly sedentary lives in cars and in
front of televisions and computer games, combined with high-calorie
junk in the diet instead of food.
Even though the government and many health organizations
have been sounding the alarm in the past decade about the
serious problem posed by rampant obesity, the government has
contributed to the problem through the school lunch program.
They have done little in the way of education or financing
to promote healthier eating or to limit the amount of fat,
sugar, and other junk that dominate the caloric intake of
kids.
The only way to prevent this accelerating decline in health,
and consequent increase in health care costs, is through education.
As long as people choose harmful products from the marketplace,
the companies who make them will continue to do so. It is
encouraging that organic foods are the fastest growing segment
of the grocery industry. However, this is not enough when
dietary junk is also growing and infiltrating other countries.
(As these western habits invade other countries, it becomes
apparent that one of the most successful exports from the
US is disease.)
We can help by choosing whole, natural foods in our own diets
and setting the example for others. Choosing lots of vegetables,
fresh fruits, and other high fiber foods is a good start.
The more we choose better foods, the more the industry will
provide them for us. We can also help by being active in schools
to promote the availability of healthier foods in the school
meals and limiting the vending machine junk and soft drinks
that are little more than “liquid candy.”
It is also important to encourage increased physical activity
in children. That way they will not wake up at 30 years old
realizing that they are 30 to 50 pounds or more overweight
and having the difficult task of starting so late on the path
to health. It is easier to start early, but it is never too
late.
The skin is a remarkable organ and the largest in the body.
It provides a protective barrier from the elements, helps
to regulate body temperature, and blocks infectious organisms.
It also eliminates toxins, acts as a sensory organ, and very
importantly, allows exposure of cholesterol derivatives to
ultraviolet for the manufacture of vitamin D (cholecalciferol).
Each square inch of skin has up to 650 sweat glands, sebaceous
glands, numerous nerves and blood vessels, 65 hair follicles,
and melanocytes– the pigment cells. It also contains
fat and connective tissue that is both structural and elastic,
allowing the skin to stretch. Men tend to have somewhat thicker
skin than women.
Because the skin is highly exposed, it is also subject to
numerous degenerative problems. This is partly because in
acting as the defense barrier for our internal organs the
skin itself is readily affected by toxins and radiant energy.
In addition, the skin is a rapidly growing tissue, so it is
particularly vulnerable to some toxins, such as chemotherapy
drugs.
With aging and exposure to the elements, the skin is less
able to retain water and is damaged by oxidation and ultraviolet
light, becoming wrinkled and dry. It also loses elasticity
due to poor nutrition, such as lack of zinc and adequate vitamin
C, which may lead to poor collagen and elastin production.
The leathery skin of people who have spent their lives outdoors,
and the dry, wrinkled appearance of those who smoke is evidence
of the damage of ultraviolet and free radical exposure. Other
sources of free radicals damage the skin as well as internal
organs, so the skin is only the most visible evidence of the
aging process.
Maintaining a strong, elastic, and youthful skin is valuable
for both cosmetic and health reasons. Everyone wants to look
their best, but in this case, appearance is the result of
maintaining the integrity of the connective tissue and protecting
ourselves from free radical damage.
While we need sun exposure, it is all too easy to overdo
it. Excessive sun exposure causes sunburn, photodamage, and
skin cancers, as well as an aged appearance. If you plan to
be outdoors for extended times, protect yourself with clothing,
a hat, and sunscreen with protection from both UVB and UVA
(such as oxybenzone, avobenzone, zinc oxide, and titanium
dioxide). It is important to have some sun exposure in order
to make vitamin D. It is easy to be overly assiduous in avoiding
the sun or wearing sunblock, leading to inadequate vitamin
D production.
Diet also plays a role in protecting the skin. Actinic keratosis
(AK) is a skin cancer precursor related to sun overexposure.
In people who are prone to develop AK, switching to a low-fat
diet can markedly reduce the recurrence rate. In two studies,
those who changed to 20 percent fat had less than one third
the recurrences compared to those who stayed on their 40 percent
fat diet.
Vegetables and fruits are high in antioxidants that help
protect the skin from free radical damage and aging. Vitamins
C and E, bioflavonoids, and omega-3 fatty acids, selenium,
and carotenoids all provide such protection. Beta-carotene,
lycopene, tocopherol, and selenium administered for seven
weeks improved epidermal defenses and reduced the evidence
of skin damage from ultraviolet exposure, including redness,
sunburn, and peroxide formation.
Dietary sugar leads to sugar-protein complexes, or advanced
glycation endproducts (AGE), and cross-linking of collagen,
contributing to skin wrinkling. Reduction of sugar and refined
carbohydrates is important to protect the skin and other organs.
Fiber in the diet slows the conversion of carbohydrates to
sugar. L-carnosine supplements reduce the production of AGEs.
L-carnosine also has antioxidant and free-radical scavenging
properties that protect DNA. Other antioxidants likely to
be helpful in preserving healthy skin include proanthocyanidins,
coenzyme Q10, and alpha-lipoic acid.
Advertising for skin care products is full of hyperbolic
and unjustified claims for restoring youthful looks, and you
should be wary of these products. However, some products do
help preserve healthy skin and prevent cancer. Topical preparations
that contain antioxidants penetrate the skin and protect deeper
layers. Products containing both vitamins C and E, as well
as N-acetyl cysteine, offer enhanced antioxidant protection
compared to any of them alone.
Topical coenzyme Q10 has been shown to reverse photodamage,
decrease epidermal oxidation by UV, and reduce wrinkle depth.
It protects against the damage from UVA and suppresses the
enzyme that breaks down collagen. Some studies also suggest
benefits from topical application of alpha-lipoic acid, green
tea extract, silymarin from milk thistle, and ginger. These
ingredients are found in a variety of skin care products,
including some sunscreens, but they need more than token amounts
to be effective.
Controversy surrounds sun protection for several reasons.
As noted above, sun is essential for vitamin D production,
and vitamin D appears to prevent some cancers, such as breast,
prostate, ovarian, and colon. Sunscreens may not protect against
melanoma and basal cell cancers. Vitamin D appears to be important
to prevent basal cell and squamous cell cancer. Depending
somewhat on sun exposure, I advise taking supplements of 400
to 1000 IU of vitamin D.
If a sunscreen blocks only UVB, it allows people to stay
in the sun longer without burning, but it allows the UVA rays
to penetrate the skin for a longer time. UVA will cause skin
aging, wrinkling, and skin cancer. Even without burning, excessive
sun exposure is dangerous.
In summary, wear appropriate clothing for protection, wear
UVB and UVA sunscreen for extended sun exposure, eat a high-antioxidant,
low-fat diet, take supplements, and apply topical antioxidants
to the skin.
Q. I have hip bursitis, which is painful
and limits my activitiy. I prefer not to take steroid injections,
and I don’t want to take Vioxx. Do you have any suggestions?
—RB, Florida, via Internet
A. A bursa is a fluid-filled sac between
a tendon and a bone or a tendon and skin that helps to reduce
friction and aid movement. Trochanteric bursitis is inflammation
of the bursa of the hip.
Bursitis can be painful and debilitating, restricting motion
of the involved joint, with tenderness and swelling. It can
be brought on by injury from falls or contact sports, overuse,
as in tennis elbow, by infection, or rheumatiod arthritis.
It can be acute, or can persist as chronic bursitis.
In hip bursitis, the pain can radiate down the thigh and
it can also interfere with sleep. Typical treatments include
rest, caution when getting up or down in chairs, and anti-inflammatory
drugs or steroid injections. I prefer to start with natural
anti-inflammatories, such as standardized curcumin, (300 to
600 mg twice a day), standardized ginger (250 to 500 mg),
and bromelain enzyme (10,000 mcu 2 to 3 times daily).
Fish oil, as a source of omega-3 EPA and DHA, is also an
effective anti-inflammatory. Capsules with 300 mg of omega-3
(from 1000 mg of fish oil) are commonly available. Typical
doses range from 2 to 4 capsules, 2 to 3 times per day. GLA
from borage oil may also help. I also recommend high doses
of vitamin C (4000 to 8000 mg per day). You mentioned heartburn
from some of your supplements, so I suggest taking L-glutamine
(1000 to 2000 mg) along with your herbs and vitamins, and
being careful to avoid sugar, caffeine, and alcohol.
Strong JP, et al., Prevalence and extent
of atherosclerosis in adolescents and young adults.. JAMA.
1999 Feb 24;281(8):727-35.
Sies H, Stahl W, Nutritional protection
against skin damage from sunlight. Annu Rev Nutr. 2004;24:173-200.
Black HS, et al., Effect of a low-fat diet
on the incidence of actinic keratosis. N Engl J Med. 1994
May 5;330(18):1272-5.
Black HS, Influence of dietary factors
on actinically-induced skin cancer. Mutat Res. 1998 Nov 9;422(1):185-90.
Eberlein-Konig B, et al, Protective effect
against sunburn of combined systemic ascorbic acid (vitamin
C) and d-alpha-tocopherol (vitamin E). J Am Acad Dermatol.
1998 Jan;38(1):45-8.
Cesarini JP, et al., Immediate effects
of UV radiation on the skin: modification by an antioxidant
complex containing carotenoids. Photodermatol Photoimmunol
Photomed. 2003 Aug;19(4):182-9.
Bellei E, et al., Effect of alpha-tocopherol
and N-acetylcysteine on benzoyl peroxide toxicity in human
keratinocytes. J Biochem Mol Toxicol. 2004;18(2):107-14.
Hoppe U, et al., Coenzyme Q10, a cutaneous
antioxidant and energizer. Biofactors. 1999;9(2-4):371-8.
Sime S, Reeve VE, Protection from ... UV
radiation in mice by topical Pycnogenol. Photochem Photobiol.
2004 Feb;79(2):193-8.
Chen TC, Holick MF, Vitamin D and prostate
cancer prevention and treatment. Trends Endocrinol Metab.
2003 Nov;14(9):423-30.
Kamradt J, et al., Analysis of the vitamin
D system in cutaneous malignancies. Recent Results Cancer
Res. 2003;164:259-69.
Calder PC, N-3 polyunsaturated fatty acids
and inflammation: from molecular biology to the clinic. Lipids.
2003 Apr;38(4):343-52.
Leventhal LJ, et al., Treatment of rheumatoid
arthritis with gammalinolenic acid. Ann Intern Med. 1993 Nov
1;119(9):867-73.
Satoskar RR, et al., Evaluation of anti-inflammatory
property of curcumin... Int J Clin Pharmacol Ther Toxicol
1986 Dec;24(12):651-4.
Protective Effects of Curcumin against
Oxidative Damage on Skin .... J Trauma 2001 Nov;51(5):927-931.
Metabolic syndrome consists of insulin resistance with abdominal
obesity, high blood pressure, elevated blood sugar, and high
cholesterol, and contributes to an increased risk of diabetes,heart
disease, and early death. Regular exercise reduces this mortality.
In a sample of 19,223 men, all-cause and cardiac mortality
was much higher among those with metabolic syndrome. However,
high fitness levels eliminated the difference. (Katzmarzyk
PT, et al., Cardiorespiratory fitness attenuates the effects
of the metabolic syndrome on all-cause and cardiovascular
disease mortality in men. Arch Intern Med. 2004 May 24;164(10):1092-7.)
This indicates that exercise can overcome the effects of insulin
resistance.
a. Age-related macular degeneration is a leading cause of
blindness in the elderly. The risk of macular degeneration
is greatly reduced by increasing fruit consumption. In two
large studies of over 100,000 subjects followed for 12 to
18 years, researchers found that those who consumed three
or more fruits per day had a 36 percent lower incidence of
neovascular macular degeneration compared to those who consumed
less than 1.5 fruits per day. (Cho E, et al., Prospective
study of intake of fruits, vegetables, vitamins, and carotenoids
and risk of age-related maculopathy. Arch Ophthalmol. 2004
Jun;122(6):883-92).
b. A recent analysis of the overall (lipophilic and hydrophilic)
antioxidant capacity of foods shows a very high value for
blueberries, other berries, pears, plums, and apples. Nuts
(pecans and walnuts), beans (kidney, pinto, and red), and
spices were also very high. Somewhat surprisingly, perhaps
due to vitamin C, russet potatoes are rich in antioxidant
activity, diminished only a little by cooking. (Wu X, et al.,
Lipophilic and hydrophilic antioxidant capacities of common
foods in the United States. J Agric Food Chem. 2004 Jun 16;52(12):4026-37.)
Pressure-cook some red, kidney, or pinto beans (with that
high antioxidant activity) for 20 minutes, and then sauté
them until well mixed with garlic and onions, chili powder,
cayenne pepper to taste, olive oil, soy sauce, and some crushed
tomatoes. (Alternatively, you can buy cans of organic refried
beans.) Make some guacamole with mashed ripe avocado, blending
in some fresh crushed garlic, fresh lemon or lime juice, and
minced onion and tomato. Spread some of the beans and guacamole
on a warmed whole-wheat or corn tortilla, and then add some
shredded lettuce, minced cilantro, diced fresh bell peppers,
and tomatoes. (If you like, you can top this with a sprinkle
of organic grated cheddar cheese.) Fold it over and enjoy
a Mexican “sandwich.” The last time I made this,
I had some freshly cooked brown and wild rice that I added
to the filling.
drjanson@drjanson.com
Year-round phone: 386-409-7747
180 Massachusetts Ave.,
Arlington, MA 02474
225 North Causeway, New Smyrna Beach, FL 32169
3 Overlook Dr., Suite 3, Amherst, NH 03131
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