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Genes, Lifestyle, and Health
L-Carnitine Update
Lycopene and Blood Pressure
Imagery to Stop Smoking
Ask Dr. J: Vitamin C Safety
References
In the Health News
Diet and Disease
Recipe of The Month: Potato-Kale Soup
Dear Friends,
A recent article in Newsweek covered the intensity with which
people are searching for their geneological heritage, with
DNA analysis adding a new dimension to the ability to accurately
trace ancestry. In addition to satisfying their curiosity
about relatives they may never have known about, this genetic
code search gives people the ability to learn about potential
inherited diseases that are in their family tree.
It is interesting that 99.9 percent of our genes are the
same as every other human (and slightly less than that are
the same as our close relatives in the animal kingdom), while
a mere 0.1 percent of our genes account for the differences
among individuals. These are important differences, and biochemical
individuality suggests that each person's nutritional needs
are somewhat different from the next person's, but it is also
important not to lose sight of the fact that in many ways
we are very similar.
On some level our nutritional needs to maintain good health
are the same. For example, we may need different amounts of
water, but we all need water, and the variation in amount
has far more to do with physical activity, salt intake, and
illness than with genes. Similarly for protein: other than
during growth phases, healing from surgery or trauma, or kidney
and liver diseases that are worsened by too much protein,
the main variation in need relates to activity levels, and
it is usually accounted for by an increase or decrease in
caloric intake (a higher caloric intake of healthy foods will
contain more protein). As a result, you usually needn't make
a special effort to get extra protein.
It may be somewhat of a relief to think that our health problems
lie in our genes, whether it is obesity, diabetes, heart disease,
immune disorders, cancer, Parkinson's, Alzheimer's, or other
diseases, or even susceptibility to infections. However, I
am reminded of Shakespeare's comment in Julius Caesar that
"the fault, dear Brutus, is not in our stars, but in
ourselves that we are underlings", which I would paraphrase
as "it is not in our genes, but in our lifestyles, that
we are unhealthy." (I saw a cartoon once, where one person
excitedly exclaims to another "It's in our stars, our
stars! We're off the hook!) Well, we are not really off the
hook. How we choose to live our lives is the main determinant
of our present and long-term health (although genetic tendencies
do play some role).
The conclusion I draw is that we have enormous power to influence
the development of chronic degenerative diseases and to slow
the aging process. The "usual suspects" of diet,
dietary supplements, exercise, stress management, aesthetic
and spiritual pursuits, and satisfying relationships, almost
always trump genes in their effect on our health. Without
ignoring the influence of genes, for the most part we are
in control of our health destiny, and this is good news.
L-carnitine (LC) is an amino acid with numerous benefits
as a dietary supplement. I have previously reported its benefits
in heart disease, managing blood lipids, arterial disease
in the legs, and kidney disease. As acetyl L-carnitine, it
helps in the preservation of brain function when combined
with alpha-lipoic acid. Although LC is manufactured in the
body, with aging or stresses the production is reduced, making
supplements important to overall health.
LC has been helpful in conditions related to oxidative stress,
but it is not itself an antioxidant. It apparently increases
the expression of genes related to the production of two antioxidant
substances, heme oxygenase and nitric oxide. These two substances
are also anti-inflammatory and reduce excessive cell proliferation,
providing still further benefits from taking LC supplements
to reduce heart disease and cancer.
A recent article has noted that LC supplements help cancer
patients by reducing fatigue associated with both the disease
and with the chemotherapies used to treat it. Researchers
treated 12 advanced cancer patients who were on chemotherapy
with 6000 mg per day of LC for 4 weeks. Fatigue was significantly
decreased and quality of life improved, as measured on a standardized
symptom questionnaire. Patients with advanced cancer often
have muscle wasting (cachexia) but in these patients LC supplements
increased their muscle mass and appetites, important contributors
to survival and quality of life.
L-carnitine is necessary for the metabolism of fatty acids
for energy in the mitochondria. It is the critical transport
molecule to take the fatty acids across the mitochondrial
membrane. Depletion of LC impairs cellular energy production.
Cancer chemotherapy drugs increase the excretion of LC in
the urine, reducing the amount available to the cells. Also,
cancer patients have increased metabolic requirements for
LC.
An earlier study showed that LC protects against the development
of liver cancer in an animal model. Chronic inflammation (including
alcohol damage and hepatitis both of which contribute to the
development of cirrhosis) plays a role in the development
of liver cancer. Abnormal mitochondrial function that results
from the chronic damage leads to increasing oxygen free radical
production. LC significantly inhibits the formation of these
free radicals, reducing oxidative damage, inflammation, and
cancer risk.
In type I diabetics, nerve degeneration (neuropathy) is a
complication of high sugar levels, and controlling blood sugar
is one goal of therapy. However, even in young diabetics,
beginning signs of neuropathy can occur early. In 51 diabetics
averaging 12 years old, 75 percent of them had measurable
nerve conduction defects. Half were given supplements of 2000-3000
mg of L-carnitine per day for two months. At the end of the
study, those with the earliest stages of neurological deficit
had a 44-50 percent improvement in signs of neuropathy, while
those with more advanced deficits did not improve as much
(perhaps needing higher doses or longer treatment).
Lycopene is an antioxidant red carotenoid found in tomatoes
that helps to reduce the risk of heart disease, loss of vision,
and prostate cancer. A recent study in people with moderate
elevations of blood pressure shows that lycopene can significantly
lower systolic pressure (the higher number). Researchers evaluated
31 subjects from 30 to 70 years old with stage 1 hypertension
(systolic pressure of 140-159 and diastolic of 90-99).
Supplements of a tomato extract containing lycopene were
administered for four weeks, alternating with a placebo for
four weeks. While on the active substance, their systolic
blood pressures dropped by 10 points. Diastolic pressure dropped
by an average of 4 points. In addition, while on the tomato
extract, evidence of lipid peroxidation was also significantly
reduced. None of the subjects had been on medications for
hypertension. Any pressures over 120/80 increase the risk
of arteriosclerosis and other diseases. Lycopene also improves
lung function in people with asthma or chronic obstructive
pulmonary disease (COPD).
Lycopene has other benefits as well, including protecting
the skin from the effects of ultraviolet light. Volunteers
taking lycopene for 10-12 weeks had a decrease in the redness
response to UV, suggesting protection from sun exposure. In
an animal study, lycopene protected animals from the damaging
heart and kidney effects of Adriamycin, a cancer chemotherapy
drug.
Interestingly, lycopene is even more abundant in several
fruits than in tomatoes. Pink and red grapefruit, papaya,
red navel oranges, and watermelon all have higher lycopene
levels than fresh tomatoes, (20 to 72 mcg per gram, versus
8-42 for tomatoes), and their juices have even more. However,
tomatoes are higher when cooked or concentrated, as in sauces,
tomato paste, or juice.
Stopping smoking is notoriously difficult, but many people
still manage to stop, even if they have been smoking heavily
for many years. A new study shows that guided imagery helps
smokers in their efforts to stop. Subjects were divided into
two groups, both given counseling and educational sessions.
Of the 71 subjects, 38 were also trained in visualization,
and given a 20-minute audiotape to practice daily.
The tape included muscle relaxation, breathing exercises
to calm the mind, and visualizing themselves healthy and exercising.
In the intervention group, 26 percent were still abstinent
at the end of two years, while the control group had only
a 12 percent success rate. Visualization also helps other
health problems, such as headaches and arthritis.
In another study, a workplace counseling program also helped.
Of 223 subjects who complied (out of 308 who consented to
participate), smoking cessation was successful in 40-55 percent
after one year, and intensive counseling helped 96 percent
of those to maintain abstinence for another 12 months. All
successful participants reported an improved quality of life.
Q. I've had kidney stones. Can I still take supplements
of vitamin C?
DL, Florida, via email
A. Vitamin C does not cause kidney stones. This is a myth
that has been around since 1973, but no evidence of a problem
has surfaced in spite of the large number of people taking
large doses of vitamin C in a variety of forms. (Unfortunately,
a myth is something that never was true and always will be.)
The most common kidney stones are composed of calcium oxalate.
One of the best ways to avoid them is to be sure to drink
enough water. Normal amounts of calcium in the diet are usually
not a problem, and may even help to reduce intestinal absorption
of oxalate, reducing the formation of such stones.
Oxalate stones can be prevented with adequate dietary intake
of magnesium (400-500 mg as aspartate or citrate) and vitamin
B6 (pyridoxine, 100 mg), as well as adequate fluids. Reducing
animal protein in the diet can help by lowering the urinary
excretion of calcium. Vegetarians have a lower incidence of
kidney stones (vegetable protein may not be a problem).
Reducing salt intake and increasing potassium may also be
helpful in reducing calcium oxalate stones. A diet high in
vegetables, whole grains, beans, and fruits is very high in
potassium and low in sodium. Citrus fruits also contain lots
of citric acid, which may also help to prevent stone formation.
Eliminate caffeine (coffee, tea, chocolate) and sugar from
the diet. Both of these may increase calcium in the urine
and enhance stone formation. You do not need to worry about
vitamin C.
Calo LA, et al., Antioxidant effect of
L-carnitine and its short chain esters: relevance for the
protection from oxidative stress related cardiovascular damage.
Int J Cardiol. 2006 Feb 8;107(1):54-60.
Gramignano G, et al., Efficacy of l-carnitine
administration on fatigue... in 12 advanced cancer patients
undergoing anticancer therapy. Nutrition. 2006 Feb;22(2):136-45.
Chang B, et al., L-carnitine inhibits hepatocarcinogenesis
via protection of mitochondria. Int J Cancer. 2005 Feb 20;113(5):719-29.
Uzun N, et al., Peripheric and automatic
neuropathy in children with type 1 diabetes mellitus: the
effect of L-carnitine treatment... Electromyogr Clin Neurophysiol.
2005 Sep-Oct;45(6):343-51.
Sachan DS, et al., Decreasing oxidative
stress with choline and carnitine in women. J Am Coll Nutr.
2005 Jun;24(3):172-6.
Engelhard YN, et al., Natural antioxidants
from tomato extract reduce blood pressure... Am Heart J. 2006
Jan;151(1):100.
Mohanty NK, et al., Lycopene as a chemopreventive
agent in the treatment of high-grade prostate intraepithelial
neoplasia. Urol Oncol. 2005 Nov-Dec;23(6):383-5.
Ochs-Balcom HM, et al., Antioxidants, oxidative
stress, and pulmonary function in individuals diagnosed with
asthma or COPD. Eur J Clin Nutr. 2006 Feb 15; [Epub ahead
of print]
Stahl W, et al., Lycopene-rich products
and dietary photoprotection. Photochem Photobiol Sci. 2006
Feb;5(2):238-42.
Yilmaz S, et al., Protective effect
of lycopene on adriamycin-induced cardiotoxicity and nephrotoxicity.
Toxicology. 2006 Feb 1;218(2-3):164-71.
Wynd CA, Guided health imagery for smoking
cessation and long-term abstinence. J Nurs Scholarsh. 2005;37(3):245-50.
Hutter H, et al., Smoking cessation at
the workplace: 1 year success of short seminars. Int Arch
Occup Environ Health. 2006 Jan;79(1):42-8.
Baird CL, Sands L, A pilot study of the
effectiveness of guided imagery with progressive muscle relaxation
to reduce chronic pain ... Pain Manag Nurs. 2004 Sep;5(3):97-104.
a. Statin drugs for high cholesterol levels were thought
to reduce the risk of age-related macular degeneration, but
new research shows just the opposite. (McGwin G Jr, et al.,
3-hydroxy-3-methylglutaryl coenzyme a reductase inhibitors
and the presence of age-related macular degeneration in the
Cardiovascular Health Study. Arch Ophthalmol. 2006 Jan;124(1):33-7.)
In data from 2755 subjects, statins were shown to increase
macular degeneration by 13 percent, and after statistical
adjustments the number climbed to 40 percent. This was only
a trend, but it is important in considering whether to take
the medications, especially since safe alternatives exist
(policosanol, red yeast rice, niacin, and gugulipids, among
others).
b. Compounds found in soy and cruciferous vegetables (cabbage,
broccoli and others) enhance DNA repair, providing some explanation
as to why these foods help to prevent cancer. Genistein from
soy and indole-3 carbinol from the vegetables administered
to both breast and prostate cells increase the levels of two
proteins (BRCA1 and BRCA2) that enhance DNA repair. Combining
the two phytochemicals works even better. (Fan S, et al.,
BRCA1 and BRCA2 as molecular targets for phytochemicals indole-3-carbinol
and genistein in breast and prostate cancer cells. Br J Cancer.
2006 Feb 13;94(3):407-26.)
In a study of 14,850 men and women, the group with the highest
saturated fat intake, had a 4.3 percent lower bone density
than the group with the lowest intake. Men under 50 had the
most clear-cut effect, but it also affected women. This result
was after adjustments for age, sex, weight, height, race,
total energy, dietary calcium, smoking, weight-bearing exercise
and hormone replacement in women. The results were independent
of dietary protein and vitamin C. (Corwin RL, et al., Dietary
saturated fat intake is inversely associated with bone density
in humans: analysis of NHANES III. J Nutr. 2006 Jan;136(1):159-65.
In a skillet or wok, stir fry chopped onions and garlic
with some diced celery in olive oil (you can also add diced
carrots as an option). In a large soup pot, put in cleaned,
diced potatoes and more than enough water to cover. You can
also use some organic vegetable stock or broth (Imagine Foods,
Pacific Foods, or other brands) instead of some of the water.
Add a touch of cumin, chopped fresh parsley, thyme, fresh
ground black pepper, a bunch of chopped fresh dill, and a
small amount of soy sauce to taste (you can use sea salt if
you prefer). Put the stir fry mixture into the pot and cover
it to bring to a boil, and then simmer until the potatoes
are just starting to soften. While simmering the mix, mince
a bunch of fresh kale. Add the kale to the soup and cook until
this is tender. Sprinkle on some uncooked minced dill at the
end.
drjanson@drjanson.com
Practice phone: 603-878-2256
180 Massachusetts Ave., Suite 303
Arlington, MA 02474
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