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Organic Vegetarian Travel
Too Many Vitamins??
Multivitamins-Multi-Benefits
Tap Water & Bladder Cancer
Ask Dr. J: Melatonin & Diabetes
References
In the Health News
Diet and Disease
Recipe of The Month: Noodles, Greens, and Beans
Dear Friends,
On a recent trip to England to see friends in London and
attend a wedding in Bath, I was pleasantly surprised at how
easy it was to eat according to the healthy principles that
I have followed for the past 31 years. I always make special
efforts when traveling, taking my own food on the plane,
for example, but I know it can be difficult to eat healthfully
in some circumstances.
Before I left, I learned that Whole Foods Market had taken
over seven health stores in England, including six in London.
Also in London, I found a large health store called Planet
Organic (with three stores in London). At their deli they
served prepared foods, from salads and soups to entrées,
all made with whole, organic ingredients. (Unfortunately,
Whole Foods Markets deli foods are usually not whole, as
they are often made with white rice and white flour, and
organic foods are unusual.) At Planet Organic, I was able
to sit down to eat some delicious foods and take some home
to share with the friends at whose house I was staying.
I also found some healthy food at Neal’s Yard, a quaint
little shopping area in Covent Garden. Two restaurants served
whole, vegetarian fare, including a selection of salads,
and one also had a variety of wheat-free baked goods for
food-allergic people. The food was not organic, but this
is a compromise that travel sometimes requires. An occasional
compromise is not my concern, but rather the everyday practices
that are with us all the time. The food was delicious and
healthful; I never recommend giving up pleasure for health,
as I know people won’t do it, and they don’t
have to.
It is interesting that in England even many of the supermarkets
carry a variety of organic foods, and one department store
(Marks and Spencer’s) has a food section with both
fresh, organic produce and a selection of prepared salads
(on my last day, I stopped at a gas station that carried
these fresh salads in their food section, an experience that
would shock me here).
Bath is a beautiful city, with Roman baths, elegant architecture,
a magnificent cathedral, and the wonderful meandering Avon
river. It also has a good health food store, two supermarkets
with organic foods, and a superb organic vegetarian restaurant
(Demuth’s), in business since 1970 (they do serve white
rice, but will serve brown rice if you call a day ahead and
request it). On a day trip to Stonehenge, the tour stopped
in Avebury, and a small village called Lacock (voted the
prettiest village in England), where we stopped at a pub
for lunch. Having prepared for the trip by making food, I
was delighted to find that the pub had three different vegetarian
selections (it seems that the demand for this is strong in
England), and they offered at least part whole wheat in one
of the meals. I was able to save the food I had made for
dinner that evening. While staying healthy during travel
can be difficult, it is by no means impossible with a little
effort—less effort in England than I have found elsewhere.
According to a report released by the Institute of Medicine,
Americans may be taking too many vitamins. A panel of 13 “experts” suggested
that while over half of Americans take vitamins, hoping to
live longer, healthier lives, “we don’t know
for sure that they’re benefiting from them.” This
is part of a recent spate of journal articles and journalistic
reports criticizing many common supplements that have good
data supporting their use for various conditions.
The data supporting the value of many supplements is quite
clear, whether for treating disease, preventing disease,
or simply feeling better. The report noted that the most
likely vitamin consumers were better nourished, in a higher
socio-economic group, and better educated, and thus less
likely to need the supplements. More poorly nourished people
are least likely to take supplements. Of course, the fact
that people who are more likely to need supplements are less
likely to take them is due in part to misleading reports
like this one.
The report says that “there are no good studies showing
people who take multivitamin or mineral supplements can prevent
chronic diseases such as cancer and heart disease.” This
is simply untrue. The large Nurses’ Health Study showed
that subjects who consumed the most vitamin E (primarily
from supplements) had a 34 percent lower heart disease mortality
than those with the lowest intake, and for those who took
vitamin E supplements for more than two years, mortality
was reduced by 41 percent.
A 2004 journal article suggested that certain nutrients
protect the heart from stress and age-associated decline
in function. These include coenzyme Q10, alpha-lipoic acid,
magnesium, and omega-3 fatty acids. A previous report by
these same researchers showed protection of the heart with
supplements of coenzyme Q10.
Other research shows benefits from taking multivitamins
and multiminerals. For example, a study of 178 patients with
small-cell lung cancer, a very aggressive tumor, showed that
those who took multivitamin-mineral supplements survived
40 percent longer than those who did not. This tumor has
99 percent mortality at one year. This does not mean that
supplements were a cure, but that they prolonged survival.
In other tumors and with other dietary supplements, cures
may be possible, as I noted last month.
A previous study of patients with the same tumor showed
that if they were given high-dose antioxidants, trace minerals,
and essential fatty acids that survival was dramatically
increased. The expected survival was one percent at the end
of one year, but 8 of these 18 patients were alive when the
study concluded at almost 3 years. Maybe the evidence is
not conclusive (it rarely is for almost any treatment), but
it is so strongly suggestive, and supplements are so safe
and relatively cheap, that it is sufficient evidence for
those “educated and better nourished” people
who have decided to take supplements.
A prospective study of over a million adult Americans showed
that those who took a combination of multivitamins and vitamins
A, C, or E had a 15 percent reduction in mortality among
non-smoking men. Supplements of L-carnitine can dramatically
help patients with heart attacks. In a study of 101 heart
attack patients, the group given 2 gms of L-carnitine per
day had half as many deaths and half as many recurrent heart
attacks as those given a placebo, and they had far less heart
failure and fewer arrhythmias.
Research showed that in patients with AIDS supplements of
multivitamins slowed the progression of the disease and delayed
the need for anti-retroviral drugs. Among 1078 women in this
double-blind, placebo-controlled study, multivitamins improved
T-cell counts and lowered levels of viruses. Other research
has also showed benefits in AIDS patients from taking multivitamins.
In pregnant women, fetal death was 2/3 higher among those
not taking supplements.
A study of age-related eye disorders (AREDS) showed that
supplements of vitamins C, E, zinc, and beta-carotene prevent
or delay the progression of macular degeneration (ARMD).
Another study showed that people with the highest levels
of lycopene (a carotenoid antioxidant) have the lowest rate
of ARMD. No conventional medical treatment is available for
macular degeneration. In addition, those with ARMD have a
higher mortality than those without the disease. Loss of
vision is the most feared disability, so anything that might
help would be of great value. Telling people that they may
be taking “too many” vitamins may deprive large
numbers of people of the benefits that are likely with virtually
no risk.
In recent months, medical and news reports have made it
appear that many supplements are ineffective. Policosanol
for cholesterol, St. John’s wort for depression, ginkgo
for memory, vitamin E for the heart, glucosamine sulfate
for arthritis, saw palmetto for the prostate, and antioxidants
have all come under attack. It is hard to avoid the thought
that these are all competing with expensive, highly touted
drugs, and that this has something to do with the reports.
Now even multivitamin-mineral supplements have been assailed.
While it is true that not all studies support extensive
benefits of multivitamin supplements, the evidence of benefit
is significant, and they are incredibly safe. Most people
would benefit by taking a variety of supplements, and it
is unwise to wait for the government to say it is OK.
A new review shows that consumption of tap water increases
the risk of bladder cancer. People who consumed more than
two liters of tap water had a 46 percent higher risk of bladder
cancer than those who consumed less than a half liter per
day (and it was even higher among men). Chlorine in tap water
combines with organic matter to create harmful substances,
including trihalomethane (THM).
Researchers evaluated 2729 patients with bladder cancer
and 5150 controls. The researchers found that total fluid
intake was not associated with any increase in risk, including
other sources of water, such as filtered or bottled waters.
In this study, THM exposure was independent of the increased
risk of bladder cancer, so other contaminants that are carcinogenic
must be present.
As in some other studies, this research showed a greater
risk of bladder cancer associated with coffee consumption.
More than five cups a day significantly increased the risk.
Previous studies have shown that THM is an independent risk
for bladder cancer. The level of THM in tap waters of developed
countries is directly related to chlorination, and cumulative
exposure increases the risk. Bottled and filtered waters
are better choices.
Q. Can I take melatonin if I am being treated for adult-onset
diabetes? Can I use it to help sleep?
MH, California, via internet
A. Melatonin is the pineal gland hormone that regulates
the body clock, promotes sleep, prevents jet lag, and helps
mood. As an antioxidant, it also protects the brain and other
tissues. While one small study suggests a possible negative
effect of melatonin on insulin activity, the bulk of the
evidence indicates that melatonin is actually helpful for
diabetics. It protects the beta cells in the pancreas by
reducing oxidative stress.
Typical doses of melatonin range from 1 to 3 mg just before
bedtime, using timed release tablets if you fall asleep easily
and wake up too early. You can monitor your blood sugar to
make sure it does not cause problems for you. Other natural
sleep aids include magnesium (300-800 mg), valerian (200-400
mg of standardized extract), 5-hydroxy tryptophan (5-HTP,
50-100 mg), and possibly passion flower, hops, or skullcap.
Stampfer MJ, et al., Vitamin E consumption and the risk
of coronary disease in women. N Engl J Med. 1993 May 20;328(20):1444-9.
Rosenfeldt FL, et al., Coenzyme
Q10 protects the aging heart against stress: studies in
rats, human tissues, and patients. Ann N Y Acad Sci. 2002
Apr;959:355-9; discussion 463-5.
Rosenfeldt F, et al., Response of the senescent heart to
stress: clinical therapeutic strategies and quest for mitochondrial
predictors of biological age. Ann N Y Acad Sci. 2004 Jun;1019:78-84.
Singh RB, et al., A randomised, double-blind, placebo-controlled
trial of L-carnitine in suspected acute myocardial infarction.
Postgrad Med J. 1996 Jan;72(843):45-50.
Jatoi A, et al., Exploring vitamin and mineral supplementation
and purported clinical effects in patients with small cell
lung cancer... Nutr Cancer. 2005;51(1):7-12.
Jaakkola K, Treatment with antioxidant and other nutrients
in combination with chemotherapy and irradiation in patients
with small-cell lung cancer. Anticancer Res. 1992 May-Jun;12(3):599-606.
Watkins ML, Multivitamin use and mortality in a large prospective
study. Am J Epidemiol. 2000 Jul 15;152(2):149-62.
Fawzi WW, et al., A randomized trial of multivitamin supplements
and HIV disease progression and mortality. N Engl J Med.
2004 Jul 1;351(1):23-32.
Fawzi WW, et al., Randomised trial of effects of vitamin
supplements on pregnancy outcomes and T cell counts in HIV-1-infected
women in Tanzania. Lancet. 1998 May 16;351(9114):1477-82.
Mares-Perlman JA, et al., Serum antioxidants
and age-related macular degeneration. Arch Ophthalmol 1995
Dec;113(12):1518-23.
Villanueva CM, Total and specific fluid consumption as determinants
of bladder cancer risk. Int J Cancer. 2006 Apr 15;118(8):2040-7.
Villanueva CM, et al., Disinfection byproducts and bladder
cancer: a pooled analysis. Epidemiology. 2004 May;15(3):357-67.
Kunze E, et al., Life style and occupational risk factors
for bladder cancer in Germany. A case-control study. Cancer.
1992 Apr 1;69(7):1776-90.
a. Some medications used to control blood pressure appear
to increase the risk of developing adult onset diabetes.
In three studies with 75,000 subjects, beta-blockers and
diuretic drugs (thiazides), led to a 20 to 45 percent higher
incidence of diabetes (Taylor EN, et al., Antihypertensive
medications and the risk of incident type 2 diabetes. Diabetes
Care. 2006 May;29(5):1065-70). Calcium channel blockers and
ACE inhibitors were not associated with this risk. Moderate
hypertension can usually be controlled with diet, exercise,
weight loss, and a number of supplements, including magnesium,
coenzyme Q10, vitamin C, fish oil, and garlic, among others.
Unless the blood pressure is at crisis levels, it is better
to try natural treatments first. Diabetes increases cardiac
risks and speeds aging.
b. School lunches in England are taking a turn for the better.
The government announced that, starting this year, they will
serve no sodas, or chocolate, and no “low-quality” meats,
and they will provide at least two servings of fruits and
vegetables. They will also limit deep fried foods, such as
potato chips, to no more than twice a week. Schools will
no longer have vending machines selling junk. This is a good
start, and sets a good example for other countries. (Chips
only twice a week for English school kids. Reuters, May 19,
2006.)
High sugar consumption increases the risk of breast cancer.
Women with the highest levels of sugar intake had 1.19 times
the risk of breast cancer. The relative risk increase is
small, but the problem is that risks are additive, and people
who eat high sugar diets usually also have other dietary
habits that increase their risks through chemical and animal
fat exposure. (Tavani A, et al., Consumption of sweet foods
and breast cancer risk in Italy. Ann Oncol. 2006 Feb;17(2):341-5.)
Soak chick peas for 4-8 hours, discard the soaking water,
and pressure cook them in fresh water for 22 minutes, letting
them cool while still under pressure. Boil water in a noodle
pot and cook soba (buckwheat) or whole wheat noodles until
just tender (soba takes about 8 minutes). In a wok or skillet,
sauté onions, garlic, shredded carrots, and diced
bell peppers in olive oil with fresh or dried thyme, oregano,
minced parsley, and cayenne to taste. When the onions soften,
add the juice from one lemon and a small amount of soy sauce.
Stir in, then add chopped fresh chard, spinach, or kale leaves
(not stems), or a mixture of any of them. Next, add the chick
peas, noodles, diced fresh tomatoes (or fire-roasted canned
tomatoes), and a garnish of grated Romano cheese. Cook until
the flavors are mixed or put in a casserole dish and bake
covered in the oven at 350° for 20 minutes.Continue simmering
to wilt the greens. Turn off the heat and fold in a bunch
of minced cilantro and garnish with a few drops of toasted
sesame oil.
drjanson@drjanson.com
Practice phone: 603-878-2256
180 Massachusetts Ave., Suite 303
Arlington, MA 02474
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