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Letting Go of Habits
Peptic Ulcer Management
Safer Natural Remedies
Arthritis and Food Allergy
Ask Dr. J: Strontium for Bones
References
In the Health News
Diet and Disease
Recipe of the Month: Broccoli Raab (Rapini)
Dear Friends,
Letting go of certain food attachments can be difficult,
but not as difficult as it might seem at first. Whether or
not we ate nutritious foods as part of our diets while growing
up, many of us also consumed a variety of foods that were
(and remain) unhealthful, including cakes, pies, candies,
cookies, ice cream, Jell-O, fried foods, meats (particularly
deep fried or grilled), and drinks such as milkshakes, sodas,
and Kool-Aid. These foods might still be associated with
memories of good times and comfort.
I remember the pleasures of a cookout with the extended
family, or the offer of an evening milk-shake as a treat
(before I realized that lactose intolerance was causing subsequent
digestive symptoms), or the summer outings to the clam shack
for steamers and fried clams. When confronted with suggestions
for improving the diet, people with these associations might
hang on to foods for their memories rather than for the actual
taste pleasures.
I am not saying that the taste pleasures are not real, but
that our tastes are mostly learned, and these can change,
especially if we make an effort to create new associations
(the smell of fast-food joints always makes me think of the
nauseating aroma of overcooked and rancid oils or shortening,
which is guaranteed to repel me). I remember creating just
such a negative association when I began learning about health
and was told that chocolate factories have a serious problem
with cockroaches, and as a result they have a certain maximum
allowable level of cockroach parts in their products. Whether
or not this is true, it altered my interest in chocolate
from that day forward, and makes me think twice before even
the occasional organic chocolate treat.
I was recently talking with a patient about the habits that
are hard to let go, one of which was a fried food. I pointed
out that the processed food industry advertises cooking oils
in commercial restaurant journals (that the public never
sees) claiming that their particular oil can be reused for
thirty days without changing it (at the end of the day they
skim off the surface crud then top it up and reheat the oil
the next day). This information may not lead to an immediate
habit change, but at least he is thinking differently with
a new motivation (in addition to avoiding future heart surgery).
Years ago I participated in discussions on a network health
forum, and one of the participants was talking about her
changing to a strict low-fat, low-sugar, vegetarian diet
to reverse her heart disease (she had had a coronary bypass
after a heart attack in her early forties). Another participant
asked her if the diet was not difficult, as she had given
up so many foods that are common in the western diet, and
to which she had been accustomed before her heart attack.
Her response remains with me to this day. She said that after
a short transition she found many delicious foods that fit
into her new dietary practices, and besides, she said, “there
is absolutely nothing edible worth dying for.”
Acid indigestion or heartburn is often the result of poor
diet and stress, but it may also be a symptom of a peptic
ulcer, an erosion in the lining of the stomach or first part
of the small intestine called the duodenum. In some cases
the ulcer breaks through a blood vessel and causes serious
bleeding, and more rarely it can actually perforate the wall
of the stomach or duodenum creating a medical emergency.
(“Peptic” refers to pepsin, a digestive enzyme
produced in the stomach.)
The typical picture that most people have of someone with
an ulcer is a highly stressed, overworked, type-A individual,
but this is not necessarily the case. In fact, most ulcers
are the result of an infection with a bacterium called Helicobacter
pylori (H. pylori), although other influences may contribute
to ulcer development. The presence of H. pylori does not
necessarily lead to an ulcer.
While stomach acid (hydrochloric acid) is highly corrosive,
the lining of the stomach is usually protected from its effects.
Only when this protection breaks down does an ulcer develop.
Smoking, alcohol, coffee (even decaf), sugar, salt, and fat,
and anti-inflammatory drugs, such as aspirin and ibuprofen,
are all associated with a breakdown of these defenses, leading
to peptic ulcer disease. Interestingly, excessive everyday
stress is not clearly associated with development of ulcers
(although it is undesirable in many ways).
Although heartburn is a common symptom of ulcer disease
(or simply acid indigestion), it is also common to have other
symptoms. Abdominal pain may or may not be present, and it
may masquerade as chest pain or a gnawing ache in the upper
abdomen. The pain usually comes and goes, often happens at
night, and is usually relieved by eating (but sometimes eating
can make the symptoms worse). It is also possible to have
an ulcer with no symptoms at all.
A test that is positive for blood in the stool may suggest
a bleeding ulcer. Several tests can reveal the presence of
H. pylori, including blood tests, but blood tests are less
specific than stool or breath antigen testing. If the diagnosis
is not clear, a barium X-ray may reveal an ulcer. Gastroscopy
is also helpful in establishing the presence of an ulcer,
and although it is a more invasive test, it may be necessary.
Typical medical treatments are mainly efforts to counteract
stomach acids with antacid drugs and drug therapies to eradicate
H. pylori. While antacids may relieve the symptoms temporarily,
they will not by themselves eliminate an infection. Drug
treatments are combinations, usually including two antibiotics,
such as amoxicillin and clarithromycin, and a gastric acid
reducer such as omeprazole (Prilosec). Bismuth subsalicylate
(Pepto-Bismol) is sometimes added. Combining the first three
is over 80 to 90 percent effective, with fewer side effects
than other treatments, but it is not free of side effects,
and H. pylori may develop antibiotic resistance.
Natural substances are effective against H. pylori and also
help to heal and protect the gastric and duodenal lining
cells. Fiber in the diet is helpful as a long-term treatment
because it absorbs and buffers stomach acid. Avoiding the
previously-mentioned irritant substances is an important
part of the overall treatment plan. In addition, taking supplements
may reduce or eliminate the need for any drugs, but this
is something you should consider with professional advice.
Turmeric, cumin, ginger, and licorice are all effective
in laboratory studies in killing H. pylori, as is Japanese
wasabi horseradish. In addition to killing the bacteria,
turmeric inhibits the adhesion of bacteria to the stomach
lining, further enhancing its benefits. Using such plant
extracts can overcome the resistance associated with antibiotic
use. Recent studies in animals have shown that turmeric can
inhibit gastric acid secretion, and reduce ulcer formation.
A clinical trial showed that turmeric (3000 mg) healed 76
percent of gastric ulcers within 3 months.
A study in 2002 showed that licorice extracts contain a
variety of flavonoids and isoflavones that can block the
growth of H. pylori in laboratory cultures. These compounds
were effective against both strains that were resistant to
antibiotics and strains that were sensitive to the drugs.
Other components of licorice help to relieve heartburn symptoms
by coating the esophagus and stomach with a protective substance
produced when the extract is chewed and mixed with saliva.
Mastic gum, a resinous substance from the Pistacia lentiscus
tree, is a traditional medicine that has been shown to kill
H. pylori and relieve ulcer symptoms. At the right concentration,
it can kill over 90 percent of the bacteria. Typical doses
of mastic gum range from 500 to 2000 mg daily for two to
three months. Other research shows that mastic gum is preventive
and therapeutic for leukemic and colon cancer cell growth,
induces apoptosis (programmed cell death), and it inhibits
tumor angiogenesis.
Other supplements that may be helpful for ulcers include
L-glutamine (2000 to 6000 mg daily), garlic, grapefruit seed
extract, vitamin C, vitamin A, and zinc. Lactobacillus acidophilus
(a probiotic supplement) is also beneficial in reducing H.
pylori infection in an animal model. A typical supplement
would be 10-20 billion organisms.
L-glutamine is a non-essential amino acid that is needed
for reproduction and healing of intestinal lining cells,
as well as maintenance of cellular energy. A recent study
in rats showed that grapefruit seed extract reduced gastric
acidity, improved blood flow to ulcer sites, and decreased
ulcer size. Combining supplements with a high-fiber diet
that is low in fat, sugar, and salt may reduce or eliminate
the need for medication.
Foods may play a role in making rheumatoid arthritis (RA)
worse. Many patients report such an association, and a new
study supports this claim. Researchers evaluated 14 RA patients
and compared them with 20 controls. Intestinal secretions
showed remarkably higher levels of food antibodies in the
subjects than in the controls.
The most common offending foods were milk, eggs, pork, and
codfish. Because antibodies to multiple foods were found
in each subject, the researchers suggested that many small
effects could add up to major symptoms. (Hvatum M, et al.,
The gut-joint axis: cross reactive food antibodies in rheumatoid
arthritis. Gut. 2006 Sep;55(9):1240-7.)
Avoid suspect foods and take supplements to help symptoms,
such as vitamins C and E, SAMe, fish oil, borage oil, curcumin,
and boswellia.
Q. Is strontium (for osteoporosis) dangerous, as some people
have told me?
DH, via Internet
A. Strontum is a chemical elemental mineral in the same
atomic family as calcium and magnesium. Strontium ranelate
and strontium citrate are used as supplements to enhance
bone density and reverse osteoporosis. A New England Journal
of Medicine study showed a 14 percent increase in bone density
of the spine in 3 years, an 8 percent increase in the hip,
and a 50 percent reduciton of spinal fracture risk in one
year. This is better than risky and expensive medications.
Strontium is not dangerous, and has no side effects. The
typical dose of elemental strontium for osteoporosis is about
700 mg per day, taken separately from supplements containing
calcium, with which it will compete for absorption.
Some people have a mistaken notion about strontium because
in the 1950s atomic testing created a dangerous radioactive
form called strontium-90, which deposited in bones and led
to bone cancer and leukemia. This is not found in any supplements,
so there is no danger. You will still need calcium, vitamin
D, ipriflavone, progesterone and other supplements for osteoporosis.
Peptic Ulcer Disease, Drug Digest, http://www.drugdigest.org.
O’Mahony R, et al., Bactericidal
and anti-adhesive properties of culinary and medicinal
plants against Helicobacter pylori. World J Gastroenterol.
2005 Dec 21;11(47):7499-507.
Kim DC, et al., Curcuma longa extract protects against gastric
ulcers ... Biol Pharm Bull. 2005 Dec;28(12):2220-4.
Mahady GB, et al., In vitro susceptibility of Helicobacter
pylori to botanical extracts... Phytother Res. 2005 Nov;19(11):988-91.
Prucksunand C, et al., Phase II clinical trial on effect
of the long turmeric (Curcuma longa Linn) on healing of peptic
ulcer. Southeast Asian J Trop Med Public Health. 2001 Mar;32(1):208-15.
Shin IS, et al., Bactericidal activity of wasabi... against
Helicobacter pylori. Int J Food Microbiol. 2004 Aug 1;94(3):255-61.
Fukai T, et al., Anti-Helicobacter pylori flavonoids from
licorice extract. Life Sci. 2002 Aug 9;71(12):1449-63.
Marone P, et al., Bactericidal activity of Pistacia lentiscus
mastic gum against Helicobacter pylori. J Chemother. 2001
Dec;13(6):611-4.
Koutsoudaki C, et al., Chemical composition and antibacterial
activity of the essential oil and the gum of Pistacia lentiscus
Var. chia. J Agric Food Chem. 2005 Oct 5;53(20):7681-5.
Loutrari H, Mastic Oil from Pistacia lentiscus var. chia
Inhibits Growth and Survival of Human K562 Leukemia Cells
and Attenuates Angiogenesis. Nutr Cancer. 2006;55(1):86-93.
Balan KV, et al., Antiproliferative activity and induction
of apoptosis in human colon cancer cells [by] Pistacia lentiscus
L. var. chia. Phytomedicine. 2006 May 16.
Cvetnic Z, Vladimir-Knezevic S, Antimicrobial activity of
grapefruit seed and pulp ethanolic extract. Acta Pharm. 2004
Sep;54(3):243-50.
Brzozowski T, et al., Grapefruit-seed extract attenuates
ethanol-and stress-induced gastric lesions... World J Gastroenterol.
2005 Nov 7;11(41):6450-8.
Zayachkivska OS, et al., Gastroprotective effects of flavonoids
in plant extracts. J Physiol Pharmacol. 2005 Mar;56 Suppl
1:219-31.
Brzozowski T, et al., Effect of probiotics ...in Helicobacter
pylori-infected Mongolian gerbils. Helicobacter. 2006 Feb;11(1):10-20.
a. Acupuncture provides effective relief for back pain and
improves function according to a large study of 11,630 patients.
At three months, twice as many acupuncture patients (52 percent)
as controls responded to the treatments (up to 15 sessions).
When the controls were then switched to treatment, they also
responded at the higher rate (Witt CM, et al., Pragmatic
randomized trial evaluating the clinical and economic effectiveness
of acupuncture for chronic low back pain. Am J Epidemiol.
2006 Sep 1;164(5):487-96.) The researchers noted that the
treatments were also relatively cost effective.
b. Supplements of vitamin D can cut the risk of pancreatic
cancer almost in half, according to two large studies with
a total of 122,198 subjects. Participants who took 300-450
IU of vitamin D per day had a 43 percent lower risk of pancreatic
cancer than those with the lowest intake; those who took
150-299 IU had a 23 percent reduced risk). (Skinner HG, et
al., Vitamin D intake and the risk for pancreatic cancer
in two cohort studies. Cancer Epidemiol Biomarkers Prev.
2006 Sep;15(9):1688-95.) Pancreatic cancer is particularly
deadly. Vitamin D also has known benefits in reducing the
risk of other cancers, such as colon and prostate.
A computer simulation study suggests that increasing the
amount of omega-3 oils from fish in the diet could save far
more lives from heart disease than cardiac defibrillators.
The dietary change could reduce deaths by over 6 percent,
an 8-fold greater effect than the estimate for wide distribution
of defibrillators. (Kottke TE, et al., Preventing Sudden
Death with n-3 (Omega-3) Fatty Acids and Defibrillators.
Am J Prev Med. 2006 Oct;31(4):316-323.) High-tech solutions
are often recommended in situations where simple lifestyle
changes would be better and cheaper.
I love this vegetable partly because it is so easy to grow
in both of my gardens, but I also love the slightly bitter,
mustardy taste of the leaves. It is usually sold with many
buds that look like broccoli (although it is not related
to broccoli and never forms a head). The buds will open to
bright yellow flowers if left growing in the garden. If you
grow your own, simply cut the larger leaves at the base and
the smaller central leaves will keep producing. It is simple
to cook by lightly steaming (especially the thicker stems
of bunches that you buy) and then stir-frying in olive oil
and garlic until tender. You can skip the steaming and stir-fry
a bit longer. You can add freshly ground pepper or cayenne,
fresh lemon juice, and cooked white beans, or make a mixed
stir-fry with onions, garlic, tofu chunks, ginger, and diluted
soy sauce and vinegar. Serve either recipe over brown rice
or millet.
drjanson@drjanson.com
Practice phone: 603-878-2256
180 Massachusetts Ave., Suite 303
Arlington, MA 02474
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