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
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, theyve
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 butchers 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
I dont 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
A report in the medical literature cited a large study showing
that St. Johns 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. Johns 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. Johns
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. Johns
wort, ignoring all those people with mild to moderate
depression who could benefit from this safe and effective
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. Johns
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. Johns wort can help with depression.
It is due to be completed later this year.
Combining St. Johns 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.
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 dont 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 drinkswhat 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
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.
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
Recent studies have shown that you can prevent cataracts
by choosing to eat properly and take dietary supplements.
You dont 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.
Although you now see a lot of ads for statin drugs to lower
cholesterol (cant escape those for Pravastatin in most
media), you dont 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
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
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.
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.)
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 Sobayathey 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 ratatouillea 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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Newsweek Magazine, Periscope,
Junk Food: United Snacks of
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Amy Norton, St. Johns
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