Health Articles: Updates in Health and Medicine

2001 updates
2000 updates

Medical Updates

October, 1998- The interpretation and hyperbole that you see when medical research is reported and when American health habits are revealed constantly intrigue me. For example, a Dr. Scalia of Australia reported data from the Study of CoEnzyme Q10 Randomized for the Treatment for Congestive Heart Failure (SCORCH), which was sponsored by the Cleveland Clinic. The headline on the wire service read: “CoEnzyme Q10 not effective in treatment of congestive heart failure.” And just what did the study show? Well, it turns out 31 patients with severe left ventricular dysfunction were divided into two groups. One of the groups received coenzyme Q10 at 100 mg per day, and the other only a placebo. Oh, except for one detail-both groups were put on maximal drug therapy! All were on ACE inhibitors, nearly all had received furosemide, 76% had received hydralazine and 82% were on digoxin. The authors concluded that the coenzyme has no role in the current era of “…maximal medical therapy…” for CHF. What they’re really saying is that if you are willing to risk the side effects and expense of maximal medications, then coenzyme Q10 may not provide any further benefit.

You might think that the conclusion should really be: “In the face of overwhelming drug therapy, coenzyme Q10 may not add any further benefits, but we haven’t a clue from this study whether coenzyme Q10 helps congestive heart failure (even though we know from many other studies that it does).” That is the proper headline, but of course that does not promote the drug therapies. Proper health care would be to give maximal coenzyme Q10 and if the response is inadequate add some medications (or vitamin E, vitamin C, taurine, magnesium, chelation therapy…etc.). The patient might well do with far less medication.

October 1998- Two new studies shows again the value of a whole-food, plant-based diet. Whole grains may protect against chronic disease because of their nutrient density and high fiber content. The medical literature consistently shows lower cancer risk in those people with higher whole-grain intake. The overall likelihood of cancer was only 66 percent in those people with high compared to those with low whole grain intake.

The lower risk held true for colorectal cancers and polyps, gastric and other digestive tract cancers, endometrial and other hormone-related cancers, pancreatic cancer, and other cancers.

The second study shows that high intake of whole grain foods consistently reduced risk of neoplasm at all sites, except thyroid.

Jacobs DR Jr, et al., Whole-grain intake and cancer: an expanded review and meta-analysis. Nutr Cancer 1998;30(2):85-96

Chatenoud L, et al. Whole grain food intake and cancer risk. Int J Cancer 1998 Jul 3;77(1):24-8

November 1998- Magnesium in the treatment of PMS. Researchers administered 200 mg of magnesium oxide for two menstrual cycles and found a significant difference in weight gain, swelling of extremities, breast tenderness, and abdominal bloating in the second month. J Womens Health 1998 Nov;7(9):1157-65). The effects were highly significant, but only on these four symptoms of the 22 that they evaluated. The authors noted that they would like to see the effects of higher doses on patients with more severe symptoms. (They might also try a better-absorbed form of magnesium and combine it with vitamins B6 and E and some essential fatty acids and herbs.)

November 1998-Cardiologist reports the dangers of stents. At the American Heart Association meeting on interventional cardiology in Dallas (November 8-11), Dr. James E Tcheng (Associate Professor at Duke University Medical Center) said, “For those of you who think that stent implantation is the ‘end all and be all,’ because it creates a perfect environment that cannot support a thrombus, I would suggest that [assumption] is wrong…What we are doing [with intervention] is creating heart attacks…whenever you are blowing up a balloon in a patient’s artery, activating a rotablator, turning on a laser, etc, you are causing damage to the inside of the vessel…This sets your patient up for platelet adhesion and aggregation, vasoactive substance release, thrombus formation and the potential for abrupt closure and development of acute ischemic syndrome.”

December 1998- Antioxidants reduce cancer risk. In women with human papillomavirus infection, antioxidants appear to lower the risk of developing cervical intraepithelial neoplasia. Researchers at the Albert Einstein College of Medicine in New York found that high serum levels of vitamin E and vitamin C conferred protection against these neoplasias. There was a threshold for vitamin C, which did not show the benefits unless the blood levels were very high, whereas the vitamin E levels were inversely correlated in a linear fashion. Int J Cancer 1998;78:594-599.

December 1998- Leg cramps helped by B-complex vitamins. A report from Taiwan researchers shows that B-complex vitamins can treat nocturnal leg cramps as effectively as quinine in hypertensive elderly patients. The supplements included: fursulthiamine, 50 mg; hydroxocobalamin, 250 micrograms; pyridoxal phosphate, 30 mg; and riboflavin, 5 mg, and were compared with a placebo. After 3 months, 86% of the treatment group had significant remission of symptoms. The authors suggested that due to significant side effects from quinine, the B-vitamins should perhaps be considered the treatment of choice. Chan P, et al., J Clin Pharmacol 1998;38:1151-1154.

February 1999- Diet, exercise and gallstones. A recent report from Italy in the American Journal of Clinical Nutrition shows that a high body mass index, a high intake of refined sugar, and high levels of saturated fat in the diet all contribute to the risk of gallstones. On the other hand, exercise, high intake of monounsaturated fats, and a high intake of insoluble fiber all decreased the risk of developing gallstones. Curiously, cholesterol in the diet was also inversely associated with gallstones, suggesting it is animal fat, not cholesterol itself that is the problem. The difficulty is how to have cholesterol in the diet without animal fat. Trevisan M, et al., Am J Clin Nutr 1999;69:120-126.

February 1999- Diet and heart disease. A French study, The Lyon Diet Heart Study, has once again shown that a diet rich in fruits, vegetables, grains, beans, and fish dramatically reduces heart disease. As reported in Reuters Medical News, the “…rate of cardiac death and nonfatal infarction in the experimental group after 46 months (1.24 per hundred patients per year) is similar to that observed after 27 months (1.32). The rate in control subjects was 4.07 after 46 months, whereas it was 5.55 after 27 months.” These results were even more striking than the evaluation at 27 months. In other words, the rate of heart disease was less than 25% that of the control group. And what were they eating in that control group? — a “prudent Western-type diet.” Makes you wonder what is “prudent” about it. deLorgeril M, et al., Circulation 1999;99:779-785,733-735.

March 1999- Heart disease in youth. Dr. Jack Strong of LSU, reports that atherosclerosis begins as young as age 15. He and a multicenter team of the Pathobiological Determinants of Atherosclerosis in Youth study (JAMA 1999;281:727-735) found atherosclerotic lesions in even the youngest subjects, aged 15 to 19 years. They noted intimal lesions in 100% of the aortas and more than 50% of the right coronary arteries, and they worsened with age. It is clear that we must start lifestyle modifications as early as possible. These problems are not genetic; intervention must start with the parents and the schools. It will not help to have fast-food joints catering in those schools.

March 1999- Meat, iron and heart deaths. A diet that is high in heme iron, found mainly in meat and meat products, leads to more myocardial infarctions, and especially more fatal MIs, than a diet that is low in heme iron. In fact, the risk was nearly double. It appears that fat in meat is not the only danger. (Am J Epidemiol 1999;149:421-8.)

March 1999- Whole grains lower mortality. A recent report from the Iowa Women’s Health Study (Am J Public Health 1999;89:322-329) showed that older women who eat at least one serving of whole grain food per day are at “substantially lower risk” of dying from cancer, cardiovascular disease and other causes than women who do not. Overall mortality was 15 percent lower for older women who regularly consumed whole grains compared to those who did not. For refined grains the opposite was true. Although there are proponents of low carbohydrate diets, evidence continues to accumulate that the staples of the healthiest diets consist of vegetables, grains, legumes, fruits, nuts, and seeds.

April 1999- Exercise helps even if you don’t lose weight. A new study at the Cooper Institute with colleagues at the University of Houston has shown that even obese men will benefit from cardiovascular fitness exercise, in spite of their remaining obese (Am J Clin Nutr 1999;69:373-380). Fitness itself, independent of weight loss, was the key to decreased mortality from cardiovascular disease and from all causes. Of course, it is much less likely that obese people will be exercisers, but for those who do they can feel good about what they are doing even if they are not losing weight. They can be encouraged to continue or start their fitness training, knowing that they are receiving benefit regardless of their weight. Of course, exercise is one of the important components of a weight loss program. .

April 1999- More scientific support for vegetables. Another article supports the value of vegetables in the diet (Am J Clin Nutr 1999;69:712-718). Tomatoes, once feared as a poisonous fruit, contain the carotenoid lycopene. This study, from researchers at the University of Milan and colleagues in Connecticut, shows that lycopene can protect immune function by protecting DNA in lymphocytes from oxidative damage. After 21 days on tomato puree, compared to a control group who ate no tomatoes during that time, the plasma lycopene level went up in the study group, and exposure of their lymphocytes to hydrogen peroxide did markedly less damage than it did to the controls’ cells. Tomatoes have already been associated with decreased risk of prostate cancer. Lycopene is abundant in the retina, and it is considered a possible protection against macular degeneration.

April 1999- Vitamin E prevents strokes. At the annual meeting of the American Academy of Neurology, researchers reported that higher intake of vitamin E, primarily from supplements, could significantly reduce the risk of strokes by 53 percent. The mean total vitamin E intake of 27 IU per day for stroke patients was significantly lower than that of nonstroke subjects, whose mean total daily intake was 58 IU a day. These are relatively modest levels of vitamin E intake, but far more than the recommended amount of 15 IU daily. This information is in accord with the data showing that vitamin E prevents other ischemic diseases, specifically heart disease.

June 1999- Parathyroid hormone reduces osteoporosis. Parathyroid hormone added to estrogen supplements restores bone mass to normal levels in nearly two thirds of postmenopausal women with osteoporosis, according to the results of the first placebo-controlled study of parathyroid therapy in this population. The women on estrogen alone had a 1.5 percent increase in bone density in two years, but those who added injections of parathormone had an 11 percent increase in bone mass. (Roe B, Report at The Endocrine Society meeting, San Diego). This is significant for another reason — chelation therapy stimulates a parathyroid hormone release, and this may be the explanation for the increased bone density seen in many chelation patients (they are usually treated with chelation for cardiovascular disease).

Health Updates:

October 1998- In a news report, The Center for Science in the Public Interest suggested that American youths are consuming far too many soda pop beverages. Among 12- to 19-year-olds, boys consume 868 cans a year, and girls drink 628 sodas a year. We all know that what CSPI calls “candy in a can,” or “liquid candy,” is harmful, and health problems are the inevitable result.

The National Soft Drink Association called their product “perfectly safe and enjoyable,” but many physicians and consumer groups note that they can increase the risk of developing heart and kidney trouble, obesity and tooth decay. Gene Grabowski of the Grocery Manufacturers of America responded (perhaps with some commercial bias) that “They won’t be happy until they squeeze every bit of sweetness and joy out of life it seems.” What disturbs me is his equating sweetness with joy. This insidious concept compounds the obsession for dietary junk (think of the American average of two doughnuts a day!). It would be far better to equate joy with health and vitality, and not relate it to the consumption of junk. As physicians, we have a tough job countering that kind of propaganda.

October 1998 – Flavonoids are plant pigments that have a variety of nutritional and health benefits. They are often the active substances in therapeutic herbs. They are a good reason to eat a variety of vegetables and fruits in the diet, especially the most colorful selections. A new report confirms what many nutritionally oriented doctors have been saying for many years.

A Dr. John Folts and colleagues reported at a meeting of the American Dietetics Association that a mixture of flavonoids are better than aspirin in reducing the risk of heart attack by lowering the stickiness of your platelets. If the platelets are too active, the risk of blood clots in the arteries increases. Flavonoids inhibit the platelet activity by two mechanisms, compared to only one for aspirin, and without the risk of bleeding or other side effects such as ulcers. The flavonoid supplement that Dr. Folts used consists of extracts of grape seed, grape skin, bilberries and Ginkgo biloba plus quercetin, in a simple supplement of 20 milligrams per kilogram of body weight. This works out to about 1400 mg per day for a typical man.

February 1999- FDA Loses in court. In a six-year long suit brought by the American Preventive Medical Association, Citizens for Health, and Durk pearson and Sandy Shaw, the Federal Appeals Court ruled against the FDA, and ordered them to allow disclaimers on dietary supplement labels, and required them to define what they mean by “significant scientific agreement.” In the past, the FDA would disallow any health claims on supplement labels, claiming that there was not significant scientific agreement for the claim, without ever having to define what they meant. This allowed them to make arbitrary decisions to reject health claims, which has always been their policy. Now they cannot do that. As the court pointed out, “…the FDA appears quite reluctant to approve health claims on dietary supplements; only two are currently authorized.” The court claimed that the FDA rules violated the First Amendment to the Constitution, which allows free speech. APMA Attorney Jonathan Emord stated “This decision invalidates the FDA’s entire review regime for labeling claims on the basis that it is unconstitutional, arbitrary and capricious.” APMA president Dr. Ralph Miranda said, “…dietary supplement companies have been afraid to challenge this agency for fear of retaliation…the FDA will no longer be able to get away with continually raising the bar for supplement manufacturers in an effort to prohibit the dissemination of truthful, scientific information.”

February 1999- American Heart Association still negative about vitamins. In spite of the fact that antioxidant vitamins can reduce the recurrence of heart disease, and despite the fact that they are extremely safe and that most cardiologists are now favorable toward the use of antioxidants, the AHA still is reluctant to endorse them for prevention. (Tribble DL, Circulation 1999;99:591-595) They are not happy with the quality of the studies, they say, but talk to cardiologists and you will likely find that they are taking antioxidants themselves. The message is clear. Don’t listen to the AHA for advice on supplements. Adequate studies for them won’t be in until after many people die unnecessarily. Take your vitamins C and E and natural carotenoids, as well as a comprehensive multi-vitamin/mineral supplement.

March 1999- Smokers deny risks. Tobacco smokers are surprisingly unwilling to accept the risks that they face. Two thirds of them claim that they are not at an increased risk of cancer or heart disease. (JAMA 1999;281:1019-1021.) I suppose in spite of the enormous amount of information available to the public on risks, a tobacco addict is always able to rationalize their habit. As they say, denial is not a river in Egypt.

March 1999- Agricultural chemicals increase cancer risk. Exposure to agricultural fungicides increased the risk of non-Hodgkin’s lymphoma by a factor of 3.7. Exposure to any type of herbicide increased the risk of non-Hodgkin’s lymphoma by 60%. The risk was more than doubled for men exposed to either of two particular herbicides, glyphosate or 4-chloro-2-methyl phenoxyacetic acid. Cancer 1999; 85:1353-1360. This is just more evidence that organic (biodynamic) agriculture is the safest. It is important for the health of farmers as well as consumers. Choosing organic foods in the marketplace will help your health, and it will encourage your market to support organic growers.

April 1999- Cruciferous vegetables prevent cancer. In a report in the Journal of the National Cancer Institute (J Natl Cancer Inst 1999;91:605-613), cruciferous vegetables were shown to reduce the risk of bladder cancer in men. This food family includes broccoli, cabbage, and brussels sprouts. This particular report showed that this benefit was independent of the total intake of fruits and vegetables. The data were gathered as part of the Health Professionals Follow-up Study at the Harvard School of Public Health. Cruciferous vegetables (and many others) are consistently being proven helpful in preventing cancer and other diseases. There is no substitute for eating a wide range of vegetables, fruits, whole grains and beans in the diet, as they are consistently being reported as helpful in prevention. Of course, it is also helpful to take many dietary supplements in addition to your healthy diet, but they are really supplements, not substitutes for eating well.

April 1999- Another nail in tobacco’s coffin (or a smoker’s?). Smoking cigars and pipes increases an individual’s risk of developing lung cancer almost as much as cigarette smoking does, a European study suggests. (J Natl Cancer Inst 1999 April 21;91:660-661,697-701.) Those who smoke cigars, cigarillos or a combination of the two are nine times more likely to develop lung cancer than nonsmokers, and pipe smokers have nearly eight times the risk. Cigarette smokers have almost 15 times the risk of lung cancer compared to nonsmokers. This is particularly troubling because of the recent rise in the popularity of cigar smoking among sports figures and the acting crowd, as though this is glamorous. They seem oblivious of the risks of smoking, with the mistaken belief that cigars are safer — in spite of the known risks of oral cancer, and these newly reported risks.

May 1999- B6 for premenstrual symptoms. Vitamin B6 (pyridoxine) is helpful for premenstrual symptoms, and this has recently been confirmed in a review of nine studies of more than 900 women. Doses of B6 in the range of 50-100 mg daily were helpful in relieving depression associated with PMS without side effects. However, the authors were hesitant to make definitive recommendations until larger studies are done. (British Medical Journal 1999:318:1375-1381).

May 1999- Fish oil helps depression. In a study of omega-3 fatty acids derived from fish, researchers showed that depression could be reduced in patients with manic-depressive illness (bipolar disorder) with supplements. Improvement was significantly greater in the omega-3 fatty acid group than the control group on almost every assessment measure. (Arch Gen Psychiatry 1999;56: 407-412, 413-414, 415-416). The authors commented that the study was important for several reasons, not the least of which was the high patient interest in the natural treatment.

June 1999- Soy and red clover isoflavones have health benefits. Research findings presented at the Endocrine Society meeting in June showed that dietary supplementation with isoflavones, which are known to have estrogenic activity, may relieve menopausal symptoms and reduce the risk of osteoporosis and cardiovascular disease in postmenopausal women. The researchers reported on the effects of red clover derivatives and soy products. They found them to be a good alternative for women who cannot or do not want to take estrogen (or are enlightened enough to know that they would be better off without it), and the isoflavones had no side effects. The daily intake of isoflavones ranged from 40-60 mg, and with the soy study they noted that after just three months, there were significant reductions in bone resorption, increases in bone formation, antioxidant effects, and improvement of HDL cholesterol levels and the ratio of HDL to total cholesterol.

This means eat your tofu, tempeh, soy nuts, soy milk, and clover sprouts.

July 1999- Vitamin E and eye disease in diabetics. High doses of vitamin E have been shown to be helpful in diabetic retinopathy. This is a degenerative eye disorder due to reduced blood flow in the highly vascular retina. Kidney function was also improved, probably for the same reason — that vitamin E improves small artery function, and the kidney is also rich in such vessels. The researchers used 1800 IU of vitamin E, but if you take a variety of other supplements, such as vitamin C, bilberry, carotenoids, and ginkgo, you probably do not need such a high dose of vitamin E to get results. (Diabetes Care 1999;22:1245-1251.)

September 1999- Vegetarian diet helps diabetes. A new study in diabetics shows that vegetarian diets improve sugar control. Contrary to many of the recently touted high protein diets, this diet is high in fiber and complex carbohydrates. Those who adhered to the vegan diet (no animal products at all) lost more weight (twice as much during the twelve weeks of the study) and more than twice the reduction in sugar levels. (Prev Med 1999;29:87-91)

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From September to June, I see patients in New Smyrna Beach, Florida. Call 386-409-7747, or send an email to [email protected] to make arrangements.

In summer, I have a variable schedule, and I see patients in offices at the Rothfeld Center for Integrative Medicine in Waltham, Massachusetts. For appointments, send an email to [email protected] make arrangements, or call: 386-409-7747.

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Information herein is not medical advice or direction. All material in this newsletter is provided for information only. Its contents should not be used to provide medical advice on individual problems. Consult a health care professional for medical or health advice.