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June 2000

Letter from Dr. Janson
Additional Supplements for Enhanced Protection
Alpha-lipoic Acid
Hormones for Aging—Melatonin and DHEA
U.S. Diet Still a Problem
Indicators of Heart Disease
In the Health News
In the Mailbag
References

Letter from Dr. Janson
Dear Friends,
I promised you more on aging and how to slow it down. I have already covered diet, stress management, and exercise, and some of the supplements that might be of help. In a sense, almost any dietary supplement that you take might help, except iron if you already have enough (iron is a "transition metal" and excess may be a source of increased free-radical damage, a leading cause of accelerated aging and degenerative diseases).

Additional Supplements for Enhanced Protection
To slow the aging process, you need to focus on protecting your brain, heart, lungs, digestive tract, and the organs most commonly involved in cancer. You also want to maintain your energy, your vision, strength, and ability to enjoy your later years.

Supplements that can help provide vibrant and vital later years also help to provide energy and better function at almost any age. It is not necessary to take all of the valuable supplements (even though I take most of them, myself). Choose the basic ones plus those that seem right for your specific needs.

Prevention of brain aging is clearly desirable. Not all substances that you take will pass into the brain, but those that do can protect the brain from aging, vertigo, loss of memory, ringing in the ears (tinnitus), loss of balance, and degenerative diseases such as Parkinson's disease, strokes, and Alzheimer's disease. In addition to the important role of vitamin C in the brain (it uses more than any other organ), others that may help include ginkgo biloba, proanthocyanidins and alpha-lipoic acid.

Several of the flavonoid compounds in ginkgo biloba help to enhance memory as people get older. In test tubes, these substances protect nerve cells because they reduce damage from a free-radical compound called "A-beta amyloid." In another study in mice, ginkgo preserved the activity of an important energy production enzyme called ATPase, and itreduced the damage that results from low blood flow.

Both studies used a standardized extract, and one found that the non-standardized extracts did not work because they did not contain enough of the active compounds. I recommend 60 to 120 mg of standardized extract twice a day. Ginkgo also helps relieve migraines, vertigo, and tinnitus. Animal studies also show that ginkgo helps to protect the retina, especially in diabetics.

Proanthocyanidins (PAC) are another group of compounds related to flavonoids (many of the active substances in herbs and botanical remedies are flavonoids, a beneficial collection of plant pigments). Supplements come mainly from pine bark, grape seeds and grape skins (related substances called anthocyanosides are found in blueberries and cranberries). Each of these PAC's has a slightly different chemical makeup, so it is good to take a mixture of more than one source for the full benefits.

PAC's help to maintain elasticity of the skin by preventing the destruction of the "elastin" component of the connective tissue. As a result they not only help maintain youthful skin, but also improve the strength of blood vessels, including veins and arteries. They are commonly included in supplements that help with varicose veins.
Other benefits of PAC's include reduced inflammation and enhanced immune function. I usually recommend a mix of grape seed and pine bark sources, at about 100 to 200 mg per day.

(By the way, you might also see these under the name OPC or PCO, other terms for the same substances. When flavonoids were first discovered, they were called "vitamin P" because they reduced the permeability of blood vessels.)

Alpha-lipoic Acid
Also called thioctic acid because of its sulfur content, this supplement is a potent antioxidant that protects both water- and fat-soluble tissue components both inside and outside of cells. It helps regenerate vitamins C and E, and it increases the level of coQ10 and glutathione, another valuable antioxidant for the brain.

Unlike some antioxidants, lipoic acid is able to get into brain tissue to have its beneficial effects. It is one treatment for diabetic neuropathy (the nerve damage in the extremities that leads to pain and/or numbness and tingling), and it also helps control blood sugar and prevent cataracts.

Many degenerative brain diseases are the result of oxidative damage, and lipoic acid is one of the supplements that can help with Parkinson's disease, Alzheimer's, and possibly multiple sclerosis.
The usual dose of lipoic acid is about 1000 mg a day for diabetics, and anywhere from 300 to 600 mg for antioxidant benefit or as preventive medicine.

Hormones for Aging—Melatonin and DHEA
By now you may have read about DHEA, melatonin, estrogen, testosterone, and growth hormone. I believe it is wise ot be more careful with hormones than with other dietary supplements. Having said that, supplements of all of these hormones may be very beneficial as people age.

Melatonin is one of the safest supplements for age-related problems. It is a hormone produced in the tiny pineal gland (about th esize of a pea) in the base of the brain, and it is one of the most potent antioxidants (it scavenges the dangerous hydroxyl free radical).

In addition to its antioxidant function, melatonin is the controller of the biological clock that determines the daily body rhythms. It promotes sleep, reduces depression, enhances immune function, and protects blood vessels. It also helps adjustment to jet lag and shift work. Your own production of melatonin declines with age, so supplements are a good idea as you get older. The usual dose of melatonin is 3 mg at bedtime, with a range from 1/2 mg up to 6 mg.

Dehydroepiandrostrone is considered one of the "mother" hormones in the adrenal gland because other hormones such as testosterone and estrogen are made from it. DHEA levels decline with age. High levels are associated with a decreased risk of heart disease. Supplements in animals inhibit the development of a variety of tumors and enhance immune function.

Because of its role as a hormone precursor, I recommend that people take DHEA if they have low blood levels, as is so common in the elderly. The typical dose for women is 5 to 10 mg, and for men it is from 25 to 50 mg.

In addition to the important lifestyle changes I mentioned in May, almost all dietary supplements can help slow the aging process and provide protection from degenerative diseases.

U.S. Diet Still a Problem
Consumption of healthy levels of fruits and vegetables is appallingly low in the United States. Even after the big campaign to encourage people to eat up to 9 servings a day, starting in 1990, the numbers of people who ate a mere five servings a day increased from a paltry 19.0% to a measly 22.7% in the six succeeding years (with no recent increase). Both numbers are extremely low.

An even worse finding is that obese people actually reduced their already low consumption of these healthy foods. Consumption by sedentary people stayed the same. These are just the people who need to eat more healthy foods and fewer fatty, rich, sweet desserts and animal products if they are going to improve their health and weight.

Depression and Heart Disease
Evidence continues to mount that there is a serious association between mental state and physical disease. It has been known that depression is linked to deaths and recurrent heart attacks in people who already have heart disease. In a recent study, depression was associated with the development of heart disease.

In both men and women, the risk of new heart disease was over 70 percent greater in depressed patients than in non-depressed patients. This demonstrates the importance of both treating depression and preventing heart disease.

Regular exercise and a healthy diet often help to relieve depression (and, not coincidentally, also help with heart disease), and a number of dietary supplements are also beneficial. Vitamin B3 (niacin), vitamin C, St. John's wort, and 5-HTP may help in mild to moderate depression.

The typical dose of St. John's wort is 300 mg of standardized extract three times a day.For 5-HTP it is 50 to 100 mg twice a day. Both of these influence serotonin levels in the brain and are extremely safe, although St. John's wort might cause sun sensitivity in some people and it might interact with some medications–don't take it with other antidepressants without medical advice. (Melatonin, mentioned in the article on aging can also help with depression.)

Recommendations for heart disease include a high-fiber, mostly-vegetarian diet and aerobic exercise. Supplement with vitamins C and E, B-complex, coenzyme Q10, and omega-3 oils, as well as magnesium, L-carnitine, and a variety of flavonoids.

Indicators of Heart Disease
I just returned from a medical conference and was exposed to an increasingly common phenomenon—academic researchers who present scientific studies on "alternative medicine."

Dr. Paul Ridker's presentation showed that cholesterol in the blood is not the best predictor of heart disease. He confirmed that blockage of the arteries is an inflammatory process, not just fatty deposits. However, free-radical damage and inflammation of the arteries may be caused in part by oxidized fats. You can reduce these risks through lifestyle change and dietary supplements.

He showed that one of the best tests to predict heart disease is a "high-sensitivity CRP" test, now available at testing labs. The CRP, or C-reactive protein, is an old test for inflammation, but the new high-sensitivity test, when combined with the cholesterol/HDL ratio, is probably the best choice for evaluation of heart disease risk.

As heart disease involves the inflammatory process, it is beneficial to take anti-inflammatory supplements. These include vitamin C (4000 mg daily) and several botanicals, including curcumin from turmeric, bromelain from pineapple, and ginger extract, plus many others.

You also want to improve your blood lipid ratios with exercise, diet, garlic, and vitamin E. In addition, a new study shows that niacin raises the level of good cholesterol (HDL) better than a common drug called gemfibrozil. It's also better than the drug for the other lipid levels. The doses ranged from 1500 to 2000 mg daily.

In the Health News
• A new study shows that ginseng can help diabetics and normal subjects metabolize sugar. When given a sugar drink, those people who had been given a dose of ginseng 40 minutes earlier handled the sugar better and cleared it from their systems more quickly than those given a placebo. (When the ginseng was given at the same time as the sugar drink, only the diabetics benefited. I usually recommend 200 to 400 mg of standardized extract twice a day. (Arch Intern Med 2000 Apr 10;160(7):1009-13.)

• A new review article concludes that Ginkgo biloba is valuable for traumatic brain injury (reducing the edema, inflammation, and free-radical toxicity, and improving memory and cognitive function), Alzheimer's disease, stroke, hardening of the arteries to the brain, macular degeneration, and normal aging (see the lead article in this issue). (Arch Phys Med Rehabil 2000 May;81(5):668-78.)
Diet and Disease

• Yet another study shows that meat consumption increases your risk of disease. An Italian team reviewed the relationship of red meat to cancer. Three groups were analyzed: high, moderate, and low meat consumption. Those in the highest meat consumption group had significantly increased odds of getting cancer of the stomach, colon, rectum, pancreas, bladder, breast, uterus, and ovaries. (Int J Cancer 2000 May 1;86(3):425-8.) Add this information to the considerable evidence of a protective role for fruits, vegetables, whole grains, and legumes, and it becomes clear what the best diet is for overall health.

In the Mailbag
I advise against adding refined sugar to the diet, but one reader asked me about the use of artificial sweeteners. I recommend avoiding them, whether it is aspartame (Nutra-Sweet, Equal), saccharin (Sweet 'n Low), or acesulfame. Aspartame causes neurological problems in many people.Saccharin is suspected of causing cancer in humans (we know it does in rats). The National Toxicology Program just took it off the list of carcinogens, but they are ignoring important evidence. In addition, none of these artificial ingredients have ever been shown to help with weight loss or diabetes, for which many people take them. You will be healthier with very small amounts of natural sweeteners.

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References

Slowing and Reversing Aging
Quirion R, et al., Jan 2000, 33rd annual Winter Conference on Brain Research (As reported in Reuters Health, Jan 31, 2000.)
Pierre S, et al., NeuroReport 1999;10:47-51.

Taillandier J, et al., Treatment of cerebral aging disorders with Ginkgo biloba extract. A longitudinal multicenter double-blind drug vs. placebo study. Presse Med 1986 Sep 25;15(31):1583-7

Tixier JM, et al., Evidence by in vivo and in vitro studies that binding of pycnogenols to elastin affects its rate of degradation by elastases. Biochem Pharmacol 1984 Dec 15;33(24):3933-9

Ziegler D, Gries FA, Alpha-lipoic acid in the treatment of diabetic peripheral and cardiac autonomic neuropathy. Diabetes 1997 Sep;46 Suppl 2:S62-6.

Packer L, et al., Neuroprotection by the metabolic antioxidant alpha-lipoic acid. Free Radic Biol Med 1997;22(1-2):359-78.

Reiter RJ, Functional diversity of the pineal hormone melatonin: its role as an antioxidant. Exp Clin Endocrinol Diabetes 1996; 104(1):10-6.

Skene DJ, et al., Use of melatonin in circadian rhythm disorders... Acta Neurobiol Exp (Warsz) 1996;56(1):359-62.

Herrington DM, Dehydroepiandrosterone and coronary atherosclerosis. Ann N Y Acad Sci 1995 Dec 29;774():271-80.

Kim HR, et al., Administration of dehydroepiandrosterone reverses the immune suppression induced by high dose antigen in mice. Immunol Invest 1995 May;24(4):583-93.

U.S Diet
Li R, et al., Trends in fruit and vegetable consumption among adults in 16 US states: Behavioral Risk Factor Surveillance System, 1990-1996. Am J Public Health 2000 May;90(5):777-81.

Heart Disease
Ridker PM, et al., C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med 2000 Mar 23;342(12):836-43.

Guyton JR, Extended-release niacin vs gemfibrozil for the treatment of... cholesterol. Niaspan-Gemfibrozil Study Group. Arch Intern Med 2000 Apr 24;160(8):1177-84

 


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CONSULTATIONS:

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

I primarily do phone consultations, as well as email and instant messaging consults.


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.

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