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Artery Problems Start Early
Flu Protection without Vaccine
Supplements against Viruses
Vitamin D and Osteoarthritis
Ask Dr. J: Prostate and PSA
References
In the Health News
Diet and Disease
Soba Noodle Vegetable Soup
Dear Friends,
For a the past five years I have been reporting in my medical
lectures about the early signs of atherosclerosis that are
now appearing in young adults in the U.S. In 1999, researchers
reported on their evaluation of arteries in almost 3000 subjects
from 15 to 34 years old (male and female, black and white)
who died of external causes. They found fatty deposits (called
intimal lesions–those occurring in the innermost lining
of the arterial wall) in the arteries of all subjects.
Even in the youngest group of 15- to 19-year olds, lesions
were present in 50 percent of their right coronary arteries
and 100 percent of their aortas, and the extent and severity
of the lesions (from fatty streaks to raised lesions) increased
with age, right up to the oldest group that they studied.
Now, researchers find that the problem can start even earlier,
and it is associated with obesity. In a new report, 100 obese
children from 6 to 14 years old were evaluated and compared
to 47 normal-weight children. The obese subjects had higher
blood pressures and higher cholesterol levels as well as a
greater tendency to insulin resistance. Of even greater concern
was that subjects as young as seven years old already had
thickening of their carotid arteries and greater stiffness
of the arterial wall. Arterial thickening and stiffness is
an early warning of developing coronary artery disease, so
it should be taken seriously. The obesity itself may be causing
the arterial damage in these children, or it may be the lifestyle
that leads to obesity, primarily poor dietary choices and
lack of exercise.
This is becoming an international problem, as Britain, Italy,
and other countries are seeing a rapidly growing incidence
of obesity. If this situation persists and worsens, and the
evidence suggests that the problem is increasing worldwide,
the associated explosion of health care costs that we are
already seeing will make health care unaffordable. It is therefore
important to encourage the initiatives that are beginning
in several school systems to expose children to healthier
eating, with more vegetables, fruits, whole grains (being
aware of childhood allergies to some grains), higher-fiber
diets, and organic foods. San Francisco banned sodas and snacks
from cafeterias. New York City and counties in Florida and
Washington state are also providing better school food–more
organic products and fresh fruit (in Washington they hold
down costs by offering only fruit for dessert).
If parents are not happy with the foods being offered at
their children’s schools, they can make a difference
by contacting the school district and asking them to make
healthier foods available. This does not mean smaller portions
of junk (although that would help also), but availability
of better food overall. Some object that kids still want their
junk, but improving the food that is available to them will
go a long way toward changing their habits and their tastes.
The shortage of flu vaccine is all over the news with medical,
financial, and even political implications. I have always
thought that the vaccine was administered too liberally, so
it will be interesting to see whether this shortage has any
effect on the incidence of flu (I would not be surprised if
there were fewer cases this year).
However, without even the potential protection of the vaccine,
you can do many things to help protect yourself, whether you
are someone at high risk or not. All of us should take precautions
against the flu, not only for our own health but for that
of our friends, families, and coworkers. I have never taken
a flu shot. Instead, these are the precautions that I take
myself.
One of the most effective protections is frequent handwashing
and the use of alcohol-based hand sanitizers. These have been
shown to be valuable methods to reduce the spread of infections
in hospitals, schools, and nursing homes. In the flu season,
it is wise to avoid shaking hands and use hand sanitizer when
it is unavoidable.
Beware of surfaces that might be contaminated, such as doorknobs,
telephone handsets, shared keyboards, and shared party dishes
and glassware. Stay away from people with obvious colds and
sinus infections, and if you are already ill, stay away from
work where you might transmit your illness to others. If sick
co-workers insist on coming to work, see if you can work at
home.
In addition, it becomes even more important to maintain your
immunity through healthful lifestyle practices. Regular exercise
boosts immune function, but be sure to dress appropriately
if you exercise outdoors. If you exercise indoors, remember
the hand sanitizer after using shared machines or equipment.
Repeated changes of temperature, and going in and out of
heated buildings with dry air may make your mucous membranes
more susceptible to infection. In cold climates, if you can
keep your environment humidified it will help protect those
membranes from drying out. At the same time make sure you
consume enough fluids to maintain hydration.
Fluid consumption includes water, sparkling water, diluted
fruit juice (very dilute, to avoid sugar excess), soups, and
herb teas, but not wine or beer, coffee, tea, or other caffeinated
drinks–their diuretic effect can cause fluid loss.
It also helps to avoid refined sugar in the diet, as this
can reduce your defenses. Sugar can reduce the ability of
white blood cells to attack viruses and bacteria, leaving
you open to a greater risk of infection. Five teaspoons of
sugar inhibits the white cells by 25 percent, and the amount
in two sodas or a pie and ice cream can knock them down by
90 percent.
Vitamin C is still my first choice in a supplement that helps
immunity and reducing both the severity and duration of viral
infections. In acute illness, intravenous vitamin C has been
effective for many patients. Typical oral doses are from 2
to 4 grams twice a day, and even much higher for severe symptoms.
Vitamin C enhances interferon production, improves white blood
cell function, and has direct antiviral effects.
Supplements of vitamin E (800 IU), zinc (30 mg), and selenium
(100 mcg) can reduce infection rates in elderly people. A
recent study of echinacea showed reduction of cold virus infections
from 82 percent to 58 percent in people inoculated with the
virus, but because the study only had 39 subjects, they could
not say it was a significant difference. In a study of children,
echinacea, propolis, and vitamin C reduced infections by 55
percent. A larger study showed that standardized echinacea
supplements reduced symptom severity and duration of colds
by 25 percent.
While elderberry extract has a history of use for viral infections
and some supportive research, a recent study confirms that
flu patients who take it recover an average of four days earlier
than those in the placebo control group.
One study of a nutritional mixture including vitamin E, folic
acid, B12, and lactobacilli showed increased natural killer
activity and improved numbers of white cells in the treated
group in response to flu immunization.
Other supportive nutrients include garlic, astragalus, maitake
(and other mushrooms), beta-glucan, Asian ginseng, and eleuthero
(Siberian ginseng). You are not defenseless against the flu
just because immunization is not available.
A number of studies have shown an association of low vitamin
D levels with increases in knee osteoarthritis. A recent report
on 221 subjects showed that 50 percent of them were deficient
in vitamin D based on blood levels. The researchers studied
knee pain, physical function, and muscle strength. They found
that low levels of vitamin D were associated with higher levels
of pain, disability, and muscle weakness.
Previous studies have shown an association between muscle
weakness and low vitamin D, with 100 percent of subjects in
a Minnesota study showing this correlation. This muscle weakness
may be contributing to the symptoms of osteoarthritis.
At the same time, low vitamin D is associated with falls
and hip fractures due to osteoporosis. Muscle weakness related
to low vitamin D may also be contributing to these falls.
It is easy to raise serum levels of vitamin D with some exposure
of the skin to the sun, and with dietary supplements. Sun
exposure is less reliable because elderly people tend to be
less efficient in making vitamin D in the skin. Also, in the
northern hemisphere and among darker skinned individuals vitamin
D manufacture may be inadequate. Typical supplements range
from 400 to 2000 IU per day, with some estimates that we need
a minimum of 1000 IU to maintain adequate blood levels.
Q. I have a rising PSA level and want to
know what to do to protect my prostate?
—TL, Connecticut, via email
A rising PSA, needs a urological evaluation to find out whether
it reflects prostate cancer. PSA (prostate specific antigen)
is sometimes elevated on one or two tests but then returns
to normal, so any biopsy or treatment should be delayed until
the elevation is confirmed. In one report, half of men who
had high PSA levels above 4 had normal tests when it was repeated
later.
The natural variation in PSA elevation can range from 4 to
10, and it can be high with benign prostate enlargement, prostate
inflammation, and after ejaculation, so a high level does
not automatically mean cancer, and most prostate cancers are
slow growing, so waiting to confirm the diagnosis is usually
not dangerous. While prostate cancer can be aggressive (usually
associated with a rapidly rising PSA), most of them grow so
slowly that men will have them for many years and then die
of some other cause.
Some of the same treatments for benign enlargement also help
prostate cancer. Symptoms of prostate enlargement include
frequent urination, urgency to urinate, nighttime urination,
difficulty starting or stopping, and weak urine flow. Helpful
supplements include saw palmetto (320 mg of standardized extract),
pygeum (100-200 mg, standardized), nettle (250 mg), zinc (30-50
mg), and essential fatty acids such as pumpkin seed oil.
The carotenoid lycopene (6 to 10 mg), found mainly in tomatoes,
helps to prevent prostate cancer. Higher doses (10 to 30 mg)
are associated with reduced cancer aggression. Soy isoflavones,
coenzyme Q10, vitamins C and E, selenium, and melatonin are
also protective supplements.
Strong JP, et al., Prevalence and extent
of atherosclerosis in adolescents and young adults... JAMA
1999 Feb 24;281(8):727-35.
Iannuzzi A, et al., Increased carotid intima-media
thickness and stiffness in obese children. Diabetes Care.
2004 Oct;27(10):2506-8.
Anderson TW, et al., Winter illness and
vitamin C: the effect of relatively low doses. Can Med Assoc
J 1975 Apr 5;112(7):823-6.
Riordan HD, et al., Intravenous ascorbic
acid: protocol for its application and use. P R Health Sci
J. 2003 Sep;22(3):287-90.
Barringer TA, et al., Effect of a multivitamin
and mineral supplement on infection .... Ann Intern Med. 2003
Mar 4;138(5):365-71.
Girodon F, et al., Effect of micronutrient
supplementation on infection... a controlled trial. Ann Nutr
Metab. 1997;41(2):98-107.
Sperber SJ, et al., Echinacea purpurea
for prevention of experimental rhinovirus colds. Clin Infect
Dis. 2004 May 15;38(10):1367-71.
Cohen HA, Effectiveness of...echinacea,
propolis, and vitamin C in preventing respiratory tract infections...Arch
Pediatr Adolesc Med. 2004 Mar;158(3):217-21.
Goel V, et al., Efficacy of a standardized
echinacea preparation (Echinilin) for the treatment of the
common cold... J Clin Pharm Ther. 2004 Feb;29(1):75-83.
Zakay-Rones Z, et al., Randomized study
of the efficacy and safety of oral elderberry extract in the
treatment of influenza A and B virus infections. J Int Med
Res. 2004 Mar-Apr;32(2):132-40.
Bunout D, et al., Effects of a nutritional
supplement on the immune response and cytokine production
in free-living Chilean elderly. JPEN J Parenter Enteral Nutr.
2004 Sep-Oct;28(5):348-54.
Josling P, Preventing the common cold with
a garlic supplement... Adv Ther 2001 Jul-Aug;18(4):189-93.
American College of Rheumatology, Improved
vitamin D levels may decrease knee disability in osteoarthritis
patients. October 17, 2004.
Holick MF, Vitamin D: importance in the
prevention of cancers, type 1 diabetes, heart disease, and
osteoporosis. Am J Clin Nutr. 2004 Mar;79(3):362-71.
Metabolic syndrome includes high blood pressure, blood sugar,
cholesterol, and insulin, low HDL, and abdominal obesity.
It is also referred to as insulin resistance or syndrome X,
and is associated with an increased risk of type 2 diabetes
and heart disease. A study of 6436 subjects from 1988 to 1994,
and 1677 from 1999-2000 showed that the condition is rising
in the United States. A small increase of 2.2 percent was
observed in men, but in women the rise was 23.5 percent.(Ford
ES, et al., Increasing prevalence of the metabolic syndrome
among u.s. Adults. Diabetes Care. 2004 Oct;27(10):2444-9.)
Weight control, exercise, and high fiber diets are essential
to prevent the otherwise likely rise in diabetes and heart
disease.
a. A high intake of folic acid reduces the risk of birth
defects and cancer. It now appears also to reduce the risk
of high blood pressure. Daily consumption of 800 mcg of folate
compared to 200 mcg was associated with a 29 percent lower
risk of hypertension among younger women and a 13 percent
reduction among older women. When supplements alone were considered,
the reduction was 48 and 40 percent in the two groups respectively.
(American Heart Assoc. Meeting Report, 10/11/2004). Folate
is found in beans, leafy greens, whole grains, and supplements.
b. In patients with ulcerative colitis, consumption of higher
levels of red meat or alcohol increases the likelihood of
relapses. In a study of 191 patients, the highest consumption
of red meat increased the odds of a relapse by 3-fold, and
processed meats by 5-fold. Alcohol consumption raised the
risk by 2.7 fold. (Jowett SL, et al., Influence of dietary
factors on the clinical course of ulcerative colitis: a prospective
cohort study. Gut. 2004 Oct;53(10):1479-84.)
Noodle soup is comforting in flu season, and soba (buckwheat)
noodles are my favorite (I use Sobaya organic brand). In a
large soup pot , sauté diced onions, crushed garlic,
a minced fresh hot pepper, sliced carrots and celery, and
grated fresh ginger in a small amount of olive oil (I use
2-3 onions, six cloves of garlic, 4 stalks of celery, 2 carrots,
and one pepper in an 8 quart pot). Add chunks of soft tofu,
and sliced mushrooms, and cook lightly, then add about 5 quarts
of water. When this is boiling briskly, add about two handfuls
of the noodles broken in half and boil this for about eight
minutes. Near the end of this time add two bunches of chopped
greens, (spinach, escarole, or green chard all work well),
soy sauce and cider vinegar to taste. Add some fresh, chopped
cilantro at the end. You can stir in a small amount of miso
when served.
drjanson@drjanson.com
Practice phone: 603-878-2256
180 Massachusetts Ave., Suite 303
Arlington, MA 02474
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