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May 2001

Letter from Dr. Janson
St. John's Wort in the News
Junk Food Nation
Vitamins that Prevent Cataracts
Diet "As Good As" Drugs (or better?)
In the Health News
Recipe of the Month: Whole Grain Pasta with Pesto
References

Letter from Dr. Janson
Dear Friends,
Recently I had an online chat on a health forum about the development and acceptance of “alternative” or “complementary” medicine (which I call simply “good medicine”) by mainstream medical professionals. My correspondent was wondering in a plaintive tone why it takes so long for such new ideas to become accepted. She was also wondering about the constant criticism from mainstream doctors and medical researchers that this form of medicine is not properly documented.

I pointed out that the statement that complementary or natural medicine is not researched is simply an opinion, and is neither a well-founded nor researched statement, and it is a very unscientific position. This attitude is usually the voice of ignorance - just ask the medical researcher if he or she has looked at the literature at all, and if so, where and for what? For example, have they done a Medline search on rutin in the treatment of vascular disease and found that there are no double-blind studies? If they say yes, they’ve looked, then they have missed those that have been done, if they say no, you can point to ignorance as a poor basis for a scientist to draw conclusions.

You could repeat this scenario for many other treatments, including glucosamine sulfate for osteoarthritis, horse chestnut and butcher’s broom for varicose veins, folic acid and B12 for homocysteine reduction, or birth defect prevention with folic acid, and I could go on and on.

The next question, of course, is how much medicine as it is practiced is based on the kind of studies being demanded of alternative medicine. It is easy to find examples of common practices with little documentation, such as coronary bypass surgery or angioplasty, amoxicillin for ear infections, lidocaine for treatment of acute MI, many blood pressure medications, the as yet unproven value of regular mammograms, and more. Just last month, I reported on the unnecessary appendectomy that has been standard practice. Most doctors are familiar with the overuse of antibiotics for viral infections, and placing tubes in children without adequate evidence of benefits. Once a doctor is treating a patient with more than one or two drugs, they are in the realm of undocumented treatments.

Medicine does not depend on such research; it uses it as a stepping off point, and then applies research using the art of medicine, whether it is in mainstream or complementary/natural treatment.

I don’t doubt that there is quackery and ineffective medicine being performed, but it is not exclusive to unconventional treatments. I venture to say, without much risk of error, that the unconventional treatments, including those that may be ineffective, are far less damaging than drugs and surgery, and many of them are at least as well documented as the mainstream treatments.

St. John’s Wort in The News
A report in the medical literature cited a large study showing that St. John’s wort did not work for patients with serious depression any better than a placebo. In the study, from Vanderbilt University and published in the Journal of the AMA, they did not evaluate St. John’s wort for treatment of mild to moderate depression, and the researchers did note that many patients do not respond well to any treatment.

Many prior (and larger) studies have shown that St. John’s wort is valuable for depression if it is mild to moderate, and that it is as good as many medications, but better tolerated and without drug side effects. Yet this researcher was quoted as saying, “If someone is depressed enough to be treated, the answer is ‘no’ for treatment with St. John’s wort,” ignoring all those people with mild to moderate depression who could benefit from this safe and effective remedy.

Needless to say, many in the medical community, the media, and antagonists to natural remedies and alternative medicine are using this study to try to discredit all treatments outside of the mainstream. They are ignoring (or ignorant of) all the research that supports the many non-drug therapies and alternatives to surgery.

This is but one study among many, and no doubt it is important to the continuing evaluation of this treatment, but it does not mean that depressed people should not try St. John’s wort as a treatment, nor that they should avoid other natural remedies that may work with it or independently. Science is made up of numerous studies that need to be taken as a whole, looking at the preponderance of the evidence, and then drawing conclusions based on the current state of knowledge. It is not wise to base decisions on one report.

Another study being done at Stanford, and sponsored by the National Institute of Mental Health and the National Center for Complementary and Alternative Medicine is designed to show whether St. John’s wort can help with depression. It is due to be completed later this year.

Combining St. John’s wort with kava kava can help depressed and anxious patients. SAMe, melatonin, and 5-HTP (5-hydroxytryptophan) can help people who may not respond to other natural treatments. In addition, a comprehensive program of diet, exercise, and other supplements (vitamin B complex and C, for example) can also help with depression without side effects.

The conclusion of the researchers was that people would be better off using “established” drugs, such as Prozac, Zoloft, and Paxil, and it is true that some people do respond well to those medications. However, it is also true that they have frequent and significant side effects, including serious agitation and aggressive behavior, anxiety, insomnia, loss of appetite, decreased libido, and tremors. It is no wonder that people are looking for alternatives.

Junk Food Nation
I was disheartened to see a report in Newsweek called “United Snacks of America” listing the sad situation of official glorification of dietary junk (note that I don’t say junk food, because it is not food!). Newsweek reported that in Snohomish, Washington, they have an official state candy; in Bell Buckle, Tennessee, they have an official celebration of a cola and cookie combo; in Sterling, Colorado, they have a celebration of a cereal (700 bags of the stuff were a gift to the town, containing 673,000 calories); Hastings, Nebraska proclaimed the city the home town of Kool-Aid (and annual U.S. consumption is more than 2 gallons per person); and Salt Lake City, Utah has made Jell-O the official snack.

How sad this is for anyone trying to educate people to choose better health habits. Another city has granted one cola exclusive rights to sell in the city. Not that it matters which cola someone drinks—what is unfortunate is this further example of government support of dangerous substances (all of these snacks and drinks are more damaging to health than illegal drugs).

In one town, one school proclaimed a one-brand cola day, and they actually sent a student home for wearing a T-shirt with another brand label emblazoned on it.

It makes me realize that those of us who teach better eating habits will not be out of work for a long time to come. Perhaps the American obsession with junk has a silver lining for me and my colleagues in this field.

Vitamins That Prevent Cataracts
As people age, one of the most feared problems that they may face is loss of vision. Among the causes of visual deterioration is cataract formation, or cloudiness of the lens of the eye. The lens is exposed to light and oxygen, both of which can lead to free radical damage, which is one cause of cataracts. Dietary sugar is another contributor to cataract formation.

Recent studies have shown that you can prevent cataracts by choosing to eat properly and take dietary supplements. You don’t have to simply expect them to appear as a function of aging. University of Wisconsin researchers followed a group of people for five years, and they report that people who had taken supplements containing vitamins E and C for 10 years or more reduced their risk of cataract by 60 percent. Neither smoking nor dietary variation had any influence on the benefits from the vitamin supplements.

Another study suggested that vitamins or the foods (fresh fruits and vegetables) that contain them are very important for cataract prevention. The specific markers were lutein and zeaxanthin (in the carotenoid family), and vitamin E, especially gamma-tocopherol (the form found in mixed tocopherols as opposed to just plain alpha-tocopherol). You can find vitamin E supplements that are particularly high in gamma tocopherol. Other studies confirm that lutein and zeaxanthin as well as other antioxidants are protective against cataract formation.

Certain nutrient deficiencies lead to cataract formation, particularly vitamin A, niacin, thiamin, and riboflavin. These are readily available from a healthy diet, as well as in multivitamin supplements. Essential fatty acids also help, such as gamma-linolenic acid and omega-3 oils.

A comprehensive approach to cataract prevention means avoiding excessive exposure to ultraviolet light, avoiding tobacco smoke (one ofthe most serious sources of free radical damage in humans), eating a healthy diet with lots of fruits and vegetables, and taking various supplements to control free radicals and oxidative damage. These should include adequate amounts of minerals that support free radical protection, such as zinc, manganese, copper, and selenium.

Diet “As Good As” Drugs (or better?)
Although you now see a lot of ads for statin drugs to lower cholesterol (can’t escape those for Pravastatin in most media), you don’t need them to achieve the benefits of cholesterol reduction. It turns out that a diet high in fiber and rich in fruits, vegetables, and nuts will have the same effect.

The highest fiber diet with nuts worked the best, but the other two diets, with more cereal grains and fewer nuts, had some beneficial effects. The best diet contained 100 grams of fiber, compared to 40 grams and 25 grams. The total cholesterol reduction was 20 percent, while the bad LDL cholesterol was lowered 30 percent.

The researchers thought it might be difficult for people to stay on such diets with modern lifestyles, but they can and do to avoid drug side effects. I would also add antioxidant vitamins, garlic, red yeast rice, and chromium for further benefits.

In the Health News
•Air pollution can make it harder for people with hypertension to lower their blood pressure. A new German study has shown that pollution may alter the part of the nervous system that controls blood pressure. Particulate matter in the air, as well as sulfur dioxides were directly associated with blood pressure elevations. Other studies have shown that pollutants from cars and factories in U.S. cities were related to the risk of death. (Ibald-Mulli A, et al., Effects of air pollution on blood pressure: a population-based approach. Am J Public Health 2001 Apr;91(4):571-7.) It is possible that the increased risk of death is related to chronic lung inflammation, which appears to increase the risk of heart disease.

Diet and Disease
•In February I reported on the risk of excess mercury in fish, but since then I have seen a report from the Environmental Working Group and U.S. PIRG stating that the FDA Advisory did not go far enough in its warnings. The FDA guidelines do not account for the mercury already present in women before becoming pregnant, and they are based on levels considered acceptable in a 150 pound man. The list of additional fish to avoid includes tuna, sea bass, Gulf Coast oysters, halibut, pike, and largemouth bass, and reducing consumption of cod, pollock, mahi mahi, blue mussel, Eastern oyster, and Great Lakes salmon. (Brain Food: What Women Should Know About Mercury Contamination in Fish, EWG, April, 2001)

•Ginger can relieve nausea and vomiting of pregnancy (morning sickness). Researchers have shown that capsules of 1000 mg of ginger could work within four days without side effects. The same authors earlier reported that vitamin B6 is helpful. (Vutyavanich T, et al., Ginger for nausea and vomiting in pregnancy:.. Obstet Gynecol 2001 Apr;97(4):577-82.)

Recipe of the Month
Whole Grain Pasta with Pesto

I grow lots of basil in the garden, and I love it fresh in salads, but I also make pesto sauce for my pasta. This is a simple combination of basil, garlic, and olive oil, with some pine nuts or walnuts all blended together in a food processor. I then boil whole grain noodles (I like Kamut Soba from a company called Sobaya–they are an organic noodle made with kamut and buckwheat; ask your health food store to carry them), strain out the water, and cover them with the pesto. You can add an optional sprinkle of grated romano sheep cheese. I also make ratatouille—a sauteed mix of tomato, eggplant, peppers, zucchini, yellow squash, garlic, and onions, and mix the two different flavors over the same pasta dish. Serve this with a small salad for a delicious summer meal (or freeze the pesto for winter).

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References

Junk Food Nation
Newsweek Magazine, Periscope, Junk Food: United Snacks of
America, March 26, 2001

St. John’s Wort and Depression
Amy Norton, St. John’s Wort Not So Great for Depression. Reuters
Health, April 16, 2001.

Shelton RC, et al., Effectiveness of St John’s Wort in Major
Depression: A Randomized Controlled Trial. JAMA 2001
Apr 18;285(15):1978-1986.

Woelk H., Comparison of St John’s wort and imipramine for
treating depression: randomised controlled trial.
BMJ 2000 Sep 2;321(7260):536-9.

Vanoni C., Treatment of depression with St. Johns wort in general
practice. Schweiz Rundsch Med Prax 2000 Dec 21;89(51-52):2163-7.

Cataract and Vitamins
Garner B, et al., Formation of hydroxyl radicals in the human
lens is related to the severity of nuclear cataract.
Exp Eye Res 2000 Jan;70(1):81-8.

Mares-Perlman JA, et al., Vitamin supplement use and incident
cataracts in a population-based study.
Arch Ophthalmol 2000 Nov;118(11):1556-63.

Olmedilla B, et al., Serum concentrations of carotenoids and
vitamins A, E, and C in control subjects from five
European countries. Br J Nutr 2001 Feb;85(2):227-38.

Moeller SM, et al., The potential role of dietary xanthophylls
in cataract and age-related macular degeneration.
J Am Coll Nutr 2000 Oct;19(5 Suppl):522S-527S.

Hammond BR, et al., Smoking and lens optical density.
Ophthalmic Physiol Opt 1999 Jul;19(4):300-5.

Diet versus Drugs
Jenkins DJ, et al., Effect of a very-high-fiber vegetable,
fruit, and nut diet on serum lipids and colonic function.
Metabolism 2001 Apr;50(4):494-503.

Heber D, et al., Cholesterol-lowering effects of a proprietary
Chinese red-yeast-rice dietary supplement.
Am J Clin Nutr 1999 Feb;69(2):231-6.

Bordia A, et al., Effect of garlic (Allium sativum) on blood
lipids...
Prostaglandins Leukot Essent Fatty Acids 1998 Apr;58(4):257-63.

 


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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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