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Exercise As Animals Do
Phytochemical Update
Phytochemicals Against Cancer
Fats and Prostate/Breast
Cancer
Ask Dr. J: Atrial Fibrillation
References
In the Health News
Diet and Disease
Recipe of the Month: Garden Ragoût
Dear Friends,
Although it is hardly news that exercise is good for us,
recent reports further document some of its benefits. Regular
exercise in 30- to 60-year old people adds years of improved
physical capacity in later life, including greater ability
to walk and get out of chairs, and improved cognitive function.
Unfortunately, most of us lead sedentary lives no matter
what our occupations, and in order to maintain health, we
need to participate in a regular exercise program. I usually
recommend significant physical activity every day, and my
patients are frequently surprised at this, having heard that
two to four times a week is sufficient. This may be helpful
compared to being a couch potato, but it is far less activity
than most of our ancestors did, and far less than prehistoric
humans and other animals.
In the biographical novel about John and Abigail Adams (Those
Who Love, by Irving Stone), it is noteworthy that in addition
to helping write the constitution and his other political
work, John was constantly mending fences, clearing his property,
as well as horseback riding, and walking (the two major means
of transportation), and Abigail was tending the house and
growing food in the garden, so both of them were very physically
active.
I often ask my patients and audiences “How often does
a gorilla exercise?” Of course, they have to exercise
every time they want to eat! In the wild they spend hours
a day foraging for food. They also play and are otherwise
active. In captivity, zoos have started to scatter food around
the gorilla habitat so they would be able to forage instead
of just being given the food at mealtime. It would not be
excessive for humans to aim at higher levels of activity
to mimic our animal relatives. We need to keep in mind that
we are animals and behave accordingly (within certain limits,
of course!). In the course of human development, physical
activity was an integral part of everyday life. Fitness training
has greater benefits than moderate activity.
It is unfortunate that schools have dropped requirements
for physical activity. Gym classes have been dropped from
curricula, kids are driven everywhere, and they watch TV
and play on computers, often to the exclusion of exercise,
although a relatively few participate in school sports. If
we are going to stem the tide of obesity, lack of fitness,
the early onset of diabetes, and a variety of chronic degenerative
diseases, we need to encourage being physical as a routine
part of life at all ages. However, if it is not enjoyable,
nobody will do it. I happen to love the near-exhaustion of
running, weight workouts, and garden maintenance, but it
may take some time before you begin to enjoy your chosen
activity.
I by no means want to discourage the intellectual part of
life or eliminate computers (or even television, although
it contributes to poor eating habits and inactivity). However,
awareness of our animal nature and physical needs will go
a long way to prolonging healthy years and reducing suffering
and disability.
The word “phytochemical” literally refers to
any “plant-derived” chemical, but in nutritional
science they are simply non-essential substances derived
from food products that have influences on human metabolism.
Fortunately, a wide variety of these chemicals have healthful
properties that are involved in disease prevention and treatment.
By definition, phytochemicals are only found in vegetarian
food sources. Many of them are antioxidants, many are flavonoids
and polyphenols, but others have a variety of chemical effects.
Curcumin is a mixture of polyphenols found in turmeric.
Quercetin is a flavonoid found in yellow onions and apples.
A recent study shows that people with precancerous colon
polyps who take supplements of these two phytochemicals have
a highly significant reduction of the size and number of
lesions. Researchers studied five patients with familial
polyposis, administering 480 mg of curcumin and 20 mg of
quercetin three times a day. This is a typical dose of curcumin
and a low dose of quercetin compared to many supplements.
Within six months, these patients had a 60 percent drop
in the average number of polyps, and a 50 percent reduction
in average polyp size. While many polyps are benign, these
patients had an inherited disorder called Familial Adenomatous
Polyposis, with hundreds of polyps that are likely to become
cancerous. The authors speculated that the benefits derived
from the curcumin because the quercetin dose was so low.
(This same combination of curcumin and quercetin protects
the kidneys in graft recipients.)
In tissue studies, quercetin and other flavonoids and phytochemicals
protected retinal pigment epithelial cells from oxidative
damage. In addition, quercetin promoted the production of
cellular detoxification enzymes. A review article on lung
disease suggested protection from numerous antioxidant phytochemicals,
including curcumin, quercetin, and the green tea polyphenol,
EGCG (epigallocatechin gallate). Earlier studies have shown
that EGCG inhibits inflammation in pulmonary lining cells.
EGCG and other green tea catechins also have other benefits.
They appear to act as ACE inhibitors (blocking angiotensin
converting enzyme to help lower blood pressure; this is typically
done with drugs called ACE inhibitors such as Captopril and
Lisinopril). These are also prescribed to protect the kidneys
in diabetics who are on insulin, and for congestive heart
failure, but they may have side effects, such as a persistent
cough, headaches, and dizziness. Extracts of Panax ginseng
have similar ACE inhibition effects. Neither EGCG nor ginseng
has the side effects of ACE inhibitors (an isolated case
report in France of hepatitis after consuming green tea extract
suggests a possible contaminant or massive dose).
Phytochemicals have antioxidant, anti-inflammatory,
and anti-cancer effects. Many are mild estrogens that block
the effects of stronger estrogens in the body. Some detoxify
carcinogens or promote cell rejection of such damaging chemicals.
In these several ways phytochemicals prevent and possibly
treat a variety of cancers, including breast and prostate
cancer.
Genistein and other isoflavones, found in soybeans, soy
products such as tofu, and other beans, are protective against
breast and other cancers. In addition to their mild estrogenic
effects, they are antioxidants and lower cholesterol levels.
Isoflavones block tumors from producing new blood vessels
that the tumors require for growth (a process called angioneogenesis).
Sulforaphane is an antioxidant in broccoli (and other cabbage
family vegetables) that increases the activity of cancer-protective
enzymes. It also induces programmed cell death in cancer
cells (apoptosis). Sulforaphane is another phytochemical
that reduces tumor growth by blocking angioneogenesis. In
addition to its benefits in cancer, it appears to protect
retinal cells from macular degeneration and lower blood pressure.
Coumaric acid is a phenolic antioxidant found in tomatoes,
peanuts, garlic, carrots, and brown rice and other whole
grains (it is in the cell wall fiber, thus not present in
refined grains). Studies of cultured cells show that it can
protect against growth of colon, breast, and stomach cancer
cells.
The best way to be sure you are consuming beneficial phytochemicals
is to choose a wide variety of plant-based foods, including
fruits, vegetables, beans, whole grains, seeds, and nuts,
and these foods happen to be the basis of a diet plan that
provides many other benefits.
The ratio of omega-3 to omega-6 fats in the diet may play
a role in prostate cancer. While no one knows the exact ratio
of fats that are required by humans, research suggests that
Western diets are too rich in omega-6 fatty acids derived
from corn oil and safflower oil. Omega-3 fatty acids are
found in cold-water fish and flaxseeds, with smaller amounts
in walnuts and soybeans.
An animal study showed that when the typical Western-diet
ratio of omega-6 to omega-3 fats (15 to 1) was compared to
a diet containing equal amounts of the two fats, prostate
cancer cells grew more slowly, and the tumors were smaller
in the intervention group (both groups received 20 percent
fat in the diet, which is lower than common Western diets).
The treatment group also had lower PSA levels (Kobayashi
N, et al., Effect of altering dietary omega-6/omega-3 fatty
acid ratios on prostate cancer... Clin Cancer Res. 2006 Aug
1;12(15):4662-70).
One diffculty in interpreting this for humans is that most
omega-6 vegetable oils available in the market are so highly
processed that they are unhealthy in and of themselves. Nonetheless,
increasing omega-3 fats in the diet has other benefits in
reducing inflammation, heart disease, and breast cancer.
In animal models, an earlier study showed that omega-3 oils
reduced the growth and metastases of implanted breast cancers
(Rose DP, Connolly JM, Effects of dietary omega-3 fatty acids
on human breast cancer growth and metastases in nude mice.
J Natl Cancer Inst. 1993 Nov 3;85(21):1743-7).
While saturated fats and high total fats in the diet increase
the risk of breast cancer, omega-3 fats appear to decrease
the risk, although some studies show no link between fish
consumption and breast cancer incidence. Omega-3 fats do
help the health of patients who have undergone breast cancer
surgery, increasing their strength, reducing severe weight
loss, and improving liver and pancreatic function (Stehr
SN, Heller AR.Omega-3 fatty acid effects on biochemical indices
following cancer surgery. Clin Chim Acta. 2006 May 16; [Epub
ahead of print].
Q. I am concerned about my father’s atrial fibrillation.
Can niacin help him?
MS, Virginia, via internet
A. I have not seen documentation that niacin is specific
for atrial fibrillation, but it is useful for so many conditions
that I would not be surprised to find that it helps this
too. However, many other supplements and some dietary changes
are helpful for atrial fibrillation, an irregular heartbeat
often accompanied by a rapid pulse. Prolonged episodes (over
24 hours) increase the risk of strokes from blood clots due
to blood pooling in the atrial chamber.
I suggest avoidance of all stimulants, such as caffeine
and alcohol, as well as sugar and food additives. Refined
foods are depleted of important minerals, such as magnesium,
so I tell all my patients to eat only whole foods (for many
other reasons as well).
Supplements of magnesium (500-1000 mg daily) and taurine
(1500-3000 mg) both help to stabilize cell membranes and
reduce excitability, and I have found in practice that they
often help with atrial fibrillation. I give the magnesium
intravenously for atrial fibrillation. Other supplements
for the heart include hawthorn (standardized, 250-750 mg),
omega-3 fish oil, coenzyme Q10 (200-600 mg), and L-carnitine
(1000-3000 mg).
Kramer A, et al., Exercise, Cognition and the Aging Brain.
J Appl Physiol. 2006 Jun 15; [Epub ahead of print]
Patel KV, et al., Midlife Physical Activity and Mobility
in Older Age The InCHIANTI Study. Am J Prev Med. 2006 Sep;31(3):217-24.
Manini TM, et al., Daily activity energy expenditure and
mortality among older adults. JAMA. 2006 Jul 12;296(2):171-9.
Cruz-Correa M, et al., Combination treatment with curcumin
and quercetin of adenomas in familial adenomatous polyposis.
Clin Gastroenterol Hepatol. 2006 Aug;4(8):1035-8.
Hanneken A, et al., Flavonoids protect human retinal pigment
epithelial... Invest Ophthalmol Vis Sci. 2006 Jul;47(7):3164-77.
Rahman I, Kilty I, Antioxidant therapeutic targets in COPD.
Curr Drug Targets. 2006 Jun;7(6):707-20.
Wheeler DS, et al., Epigallocatechin-3-gallate...inhibits
...proinflammatory signal transduction in cultured respiratory
epithelial cells. J Nutr. 2004 May;134(5):1039-44.
Persson IA, et al., Tea flavanols inhibit angiotensin-converting
enzyme activity...J Pharm Pharmacol. 2006 Aug;58(8):1139-44.
Gloro R, et al., Fulminant hepatitis...with hydroalcoholic
extract of green tea. Eur J Gastroenterol Hepatol. 2005 Oct;17(10):1135-7.
Asakage M, et al., Sulforaphane induces inhibition of human
umbilical vein endothelial cells proliferation by apoptosis.
Angiogenesis. 2006 Jul 5; [Epub ahead of print]
Gao X, Talalay P, Induction of phase 2 genes by sulforaphane
protects retinal pigment epithelial cells against photooxidative
damage. Proc Natl Acad Sci. 2004 Jul 13;101(28):10446-51.
Wu L, et al., Dietary approach to attenuate oxidative stress,
hypertension, and inflammation in the cardiovascular system.
Proc Natl Acad Sci 2004 May 4;101(18):7094-9.
Hudson EA, et al., ... extracts of brown rice that inhibit
the growth of human breast and colon cancer cells. Cancer
Epidemiol Biomarkers Prev. 2000 Nov;9(11):1163-70.
Ferguson LR et al., Antioxidant and antigenotoxic effects
of... hydroxycinnamic acids... Mol Nutr Food Res. 2005 Jun;49(6):585-93.
In patients with congestive heart failure
(CHF), supplements of the amino acid L-arginine can improve
exercise tolerance and functional capacity. Subjects with
stable CHF were stress tested before and after six weeks
of supplementation and compared to subjects who did not receive
the supplements. Heart rates were lowered in the treatment
group, and lactate buildup (from muscle activity with inadequate
oxygen) was also reduced by L-arginine (Doutreleau S, et
al., Chronic L-arginine supplementation enhances endurance
exercise tolerance in heart failure patients. Int J Sports
Med. 2006 Jul;27(7):567-72.)
Typical doses of L-arginine are from 1000 to 6000 mg.
a. High density lipoproteins (HDL, the good cholesterol)
are anti-inflammatory and relax blood-vessels. A meal high
in saturated fats reduces these beneficial actions, while
a meal high in polyunsaturated fats enhances them. Researchers
found these effects within six hours after eating. (Nicholls
SJ, et al., Consumption of saturated fat impairs the anti-inflammatory
properties of high-density lipoproteins and endothelial function.
J Am Coll Cardiol. 2006 Aug 15;48(4):715-20.) The unsaturated
fats also enhanced the beneficial effects compared to fasting
levels. Heart attacks after meals high in saturated fats
would be more likely based on these effects, in addition
to the long-term damage from inflammation and blood vessel
constriction.
b. Treatment with 1000 mcg of chromium helps control diabetes,
improves insulin sensitivity, and reduces weight gain seem
with drug therapy. (Martin J, et al., Chromium picolinate
supplementation attenuates body weight gain and increases
insulin sensitivity in subjects with type 2 diabetes. Diabetes
Care. 2006 Aug;29(8):1826-32.) In 37 patients, those treated
with chromium and glipizide had better sugar control and
less weight gain than those on the drug and placebo.
Garden vegetables this time of year beg to be picked and
put directly into a recipe (if not eaten before making it
to the kitchen). Sauté onions and garlic with some
olive oil, minced fresh basil, oregano, thyme, and ground
pepper. Add diced zucchini, summer squash, tomato, and a
dash of soy sauce or sea salt. Add some previously roasted
eggplant and mix well. I like to add some fresh cilantro
(since it is abundant in my raised beds). This makes a delicious
side dish or you can simmer it with cooked pinto beans to
make a main course to serve with brown rice or whole grain
bread. Another serving idea is to make savory polenta as
in last month’s recipe, pour it into an oiled, low,
round dish with a decorative arrangement of fresh basil leaves
on the bottom. When the polenta sets, you can turn it over
on a serving dish to show the basil, cut into wedges and
cover it with the garden ragoût.
drjanson@drjanson.com
Practice phone: 603-878-2256
180 Massachusetts Ave., Suite 303
Arlington, MA 02474
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