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June 2001

Letter from Dr. Janson
DHEA (and More) for Menopause
Vitamins Help Alzheimer's Disease
Lung Function and Mortality
In the Health News
Recipe of the Month: Tangy Sauce for Veggies
References

Letter from Dr. Janson
Dear Friends,
I just returned from the Scientific Conference of the American College for Advancement in Medicine (ACAM), and it was a great meeting attended by more than 350 doctors interested in cutting edge medicine. About 150 exhibitors also attended, not only to show their products to the physicians, but also to learn from the scientific sessions.

One of the researchers, John Classen, MD, reported on the higher incidence of type I diabetes (insulin dependent diabetes mellitus, or IDDM) in people who have been vaccinated for various childhood diseases and tuberculosis (the BCG vaccine, more common in Europe than in the US). The risk stems from immunizations given after the first eight weeks of life. IDDM is an autoimmune disease, resulting from destruction of the pancreas cells that produce insulin. Immunization against whooping cough (pertussis, the “P” in DPT), is strongly associated with increased diabetes. The same is also true for other immunizations, but is reversed if immunization is done during the first eight weeks.

What is especially interesting is the way the manufacturers and government agencies are able to deny the association. They simply cite studies that show the difference, but that are too small to be statistically significant, so they can point to “no difference” between the two groups. This erroneous conclusion is comparable to those from other manipulated data designed to show what the sponsors of the studies want to show. For example, the recent study on St. John’s wort that I reported in the last edition had problems beyond those that I mentioned.

Dr. Joseph Glenmullen, author of Prozac Backlash (his website is www.prozacbacklash.com), revealed that this study on major depression was too short for studies of St. John’s wort, which takes longer than drugs to work, and it did show a difference between the two groups in favor of St. John’s wort, but the difference was not “statistically significant.” One of the details not reported was that the researchers used a scale of depression that can show improvement (for example a drop in score from 24 to 12), but they did not count anyone whose score did not show “cure” (a drop in score all the way to 6).

Another feature of Dr. Glenmullen’s presentation was the report of side effects from anti-depressant drugs. Interestingly, the frequency of side effects in reports from the manufacturers of various drugs is different from that shown in studies done by their competitors (at least their financial interest may play to our benefit). He also went into the many other valuable treatments for depression and anxiety, including exercise, caffeine and alcohol avoidance, kava kava, valerian, and more.

The information on the value of alternatives to drugs and even surgery continues to impress me. I’ll continue to bring you reports from these important biannual ACAM meetings.

DHEA (and More) for Menopause
I have previously reported on the value of the hormone dehydroepiandrosterone, or DHEA. It is an adrenal hormone precursor, or “mother hormone,” as well as a free-radical inhibitor, but DHEA production declines with age, making it worthwhile to consider supplements.

DHEA reduces platelet aggregation, protects blood vessels from atherosclerosis, restores depressed immune function, and it reduces the damage from burns if administered after thermal injury. In addition, it reduces insulin resistance in obese patients, thereby improving their sugar regulation.

Some patients and colleagues have wondered if DHEA might increase the growth of some cancers, as it is converted to both estrogen and testosterone, but this appears not to be the case. DHEA provides protection against cancer by inhibiting the proliferation of cancer cells. It has been shown in animals to prevent and arrest the growth of malignant liver tumors, and the immune support it provides should help the body cope with cancer.

Men with prostate cancer tend to have lower DHEA levels than those without cancer, so it is unlikely that any connection exists between DHEA supplements and prostate cancer. Although some reports express concern about increased risk of other cancers, partly depending on levels of estrogen already present, the weight of the evidence suggests the opposite. It only slightly increases the level of estrogen, even with supplements of 50 mg daily.

In menopausal women, the normal levels of adrenal-derived testosterone drop, and DHEA supplements increase those levels and help to increase sexual interest and satisfaction, as well as energy, mood, and bone density.

The opinions on the right dose vary quite a bit, from 5 to 50 mg for women and 10 to 100 mg for men, and without a check of blood levels I would recommend staying with the lower doses for people over 50. This would mean taking 5 to 25 mg for women, and 10 to 50 mg daily for men. If you have your blood level checked (DHEA-sulfate is the appropriate test), it is then best to take the amount that brings your level into the normal range for a younger person.

Other Support for Aging and Menopause
Many other health habits help to reduce menopausal symptoms and reverse some of the effects of aging for anyone. One of these is regular exercise, including aerobic, stretching, and resistance training for maintaining muscles and bone density as we age, increasing physical capacity, controlling weight, increasing flexibility and suppleness, and reducing depression. This is an impressive array of benefits for something that is free, fun, playful, and can be implemented at any age.

Diet also helps if you avoid the junk and fast food that is so prevalent in the Western diet, and spend a little time with food preparation. Eat lots of fresh vegetables and fruits, plus some whole grains and legumes, and to that add some fish, seeds, and nuts, and perhaps some organic eggs and low-fat yogurt. Keep sugary foods and beverages to a minimum, as these contribute to bone loss and depression. (Notice that I do not recommend meat or chicken.) The ads for milk that promote it for bones are misleading! In countries with the highest milk intake, they have the highest rates of fractures from osteoporosis.

Finally, if you have specific menopausal symptoms you could take supplements of black cohosh (80 to 160 mg a day), agnus castus (400 mg), or dong quai (400 to 600 mg), gamma-linolenic acid (240 mg), and magnesium (500 to 1000 mg), as well as vitamin E (400 to 800 IU) and bioflavonoids (1000 to 2000 mg) for hot flashes.

If you have some associated depression and anxiety, you could take some St. John’s wort (300 mg three times a day–divided doses appear to minimize the sun sensitivity that is sometimes seen), or some kava kava (250 to 500 mg). Valerian (200 to 400 mg) also helps with anxiety. All of my herbal recommendations and doses refer to standardized extracts.

In addition to DHEA, other natural hormone replacement helps for menopause and aging. Natural estrogens from compounding pharmacies mimic the human estrogen balance, unlike Premarin, which is derived from horse urine and has a different composition. Natural progesterone is not the same compound as Provera, which is chemically modified and has a range of side effects. (For aging men, natural testosterone from a compounding pharmacist may be beneficial.)

Vitamins Help Alzheimer’s Disease
A recent study showed that low levels of both vitamin B12 and folate (folic acid), when considered together, are associated with twice the risk of developing Alzheimer’s disease. Even low amounts that are not usually considered “deficiency” levels were significant, and related to atrophy of the cerebral cortex. The association was even greater among those patients whose brain function was considered to be higher at the start of the study.

Vitamin B12 and folate are commonly low in elderly people, making this finding even more significant. Supplements of B12 and folic acid are simple to take and relatively inexpensive. I recommend a sublingual tablet of B12 for better absorption, usually 2500 mcg per day. Folic acid is usually available up to 800 mcg per day, but I often recommend up to 5000 mcg (5 mg) for patients. This new evidence shows further benefits from these nutrients.

In addition to B12 and folate, you can help yourself preserve brain function with other health practices. Other recent studies have shown that maintaining intellectual activity, physical activity, and practicing stress management can all contribute to prevention of brain deterioration. Community and family support contribute to maintenance of good intellectual function.

Try as much as possible to avoid toxic metals, such as lead and mercury, which may damage brain tissue. Mercury is a preservative used in contact lens solution and mercurochrome topical antiseptic, and it is also found in many vaccines. As I mentioned an earlier issue, it is also found in fish. Workers exposed to lead (from lead batteries, for example) have an increased risk of Alzheimer’s disease.

Supplements of vitamin E and ginkgo biloba both help maintain brain function, and ginkgo can apparently provide some reversal of decline for elderly patients who have already begun to lose cognitive ability. In one study the placebo group showed a decline over six months in all parameters that were studied, and the ginkgo group improved in most assessments. The dose of ginkgo that the researchers used was 120 mg daily of standardized extract.

Lung Function and Mortality
Good lung function is an important predictor of health and longevity, although this is not as well known as other risk factors for heart disease or cancer. The Buffalo Health Study followed 1200 people for 29 years. A greater ability to expel air from the lungs is related to lower mortality from all causes, and particularly to fewer heart disease deaths. This was independent of obesity, blood pressure, smoking, and other known risk factors.

This is especially important in light of another recent study showing that antioxidants can protect lung function. Vitamins C, E, and A, and carotenoids (beta-cryptoxanthin, lutein/zeaxanthin, and beta-carotene) were beneficial, independent of smoking, weight, and other variables. The strongest associations were with vitamin E, beta-cryptoxanthin, and vitamin A. Yet further reasons to eat a healthy diet, exercise for better lung function, and take your supplements.

In the Health News
•Lead is a nervous system poison, and children are particularly susceptible to the damage. Levels formerly thought to be “safe” are actually associated with decreased cognitive function (Lanphear BP, et al., Cognitive deficits associated with blood lead... Public Health Rep 2000 Nov-Dec;115(6):521-9). Although 10 mcg per dL is officially considered acceptable, in children 6 to 16 years old, for every 1 mcg/dL increase in blood lead level there is a significant reduction in arithmetic scores, reading scores, and nonverbal reasoning, and a 0.5-point drop in mean scores on a measure of short-term memory. The associations even held true for levels below 5 mcg. It appears that no amount of lead can be considered safe. Supplements of vitamin C and zinc can help remove lead, as can EDTA chelation therapy or DMSA treatment.

Diet and Disease
•A report from the FDA on herbs suggests that they harbor bacteria and fungi. But the conclusion that they might therefore be dangerous is misleading, because these products are foods, and our foods are also not sterile. Reliable manufacturers test raw materials to make sure their herbal capsules do not harbor pathogenic organisms. (Reuters Health, American Society for Microbiology Meeting, May 23, 2001)

•A diet high in apples and tomatoes can protect lung function, according to a report from the annual meeting of the American Thoracic Society (Reuters Health, May 22, 2001). British researchers tested the FEV1 (the volume of air you can expel in one second), and found that over a 10 year period regular consumption of apples and tomatoes, both rich in antioxidants, was directly related to preservation of pulmonary function. They also found that eating apples, tomatoes, and bananas was associated with less wheezing, a symptom of asthma.

Recipe of the Month
Tangy Sauce for Veggies

Often I just do not have time to prepare an elaborate meal, so I’ll just steam some vegetables and make an easy, tasty sauce to put over them. Usually I’ll just rinse and trim some broccoli or cauliflower, or I might add potatoes or butternut squash if I want to have more variety (start the potatoes and squash first as they take longer to steam). Then I blend some crushed garlic with sesame tahini (crushed sesame seeds, try health food stores for organic brands), fresh lemon juice diluted with water to taste, ground pepper, thyme, fresh or dried basil, a dash of cumin and cayenne, and other herbs. If I do make an elaborate dinner, I can serve these vegetables with lemon-tahini sauce as a side dish. Experiment on your own with different herbs and spices.

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References

DHEA (and More) for Menopause
Comstock GW, et al., The relationship of serum DHEA and its
sulfate to subsequent cancer of the prostate. Cancer Epidemiol
Biomarkers Prev 1993 May-Jun;2(3):219-21

Weksler ME, Immune senescence and adrenal steroids...
Eur J Clin Pharmacol 1993;45 Suppl 1():S21-3.

Arlt W, et al., DHEA replacement in women with adrenal
insufficiency...clinical effects on well-being, sexuality
and cognition. Endocr Res 2000 Nov;26(4):505-11.

Herranz L, et al., Dehydroepiandrosterone sulphate, body
fat distribution and insulin in obese men. Int J Obes
Relat Metab Disord 1995 Jan;19(1):57-60.

Labrie F, et al., Effect of 12-month dehydroepiandrosterone
replacement therapy... in postmenopausal women.
J Clin Endocrinol Metab 1997 Oct;82(10):3498-505.

Nagata C, et al., Serum concentrations of estradiol and
dehydroepiandrosterone... in peri- and postmenopausal
Japanese women. Metabolism 2000 Dec;49(12):1561-4.

Alzheimer’s Disease
Wang HX, et al., Vitamin B(12) and folate in relation to the
development of Alzheimer’s disease. Neurology 2001
May 8;56(9):1188-94.

Friedland RP, et al., Patients with Alzheimer’s disease have
reduced activities in midlife compared with healthy control-group
members. Proc Natl Acad Sci 2001 Mar 13;98(6):3440-3445.

American Academy of Neurology’s 52nd Annual Meeting.
(Reuters Health, May 8, 2001)

Oken BS, et al., The efficacy of Ginkgo biloba on cognitive
function in Alzheimer disease. Arch Neurol 1998
Nov;55(11):1409-15.

Le Bars PL, et al., A 26-week analysis of a double-blind,
placebo-controlled trial of the ginkgo biloba extract EGb 761
in dementia. Dement Geriatr Cogn Disord 2000
Jul-Aug;11(4):230-7.

Lung Function and Mortality
Schunemann HJ, et al., Pulmonary function is a long-term
predictor of mortality... Chest 2000 Sep;118(3):656-64.

Schunemann HJ, et al., The relation of serum levels of
antioxidant ... with pulmonary function in the general
population. Am J Respir Crit Care Med 2001 Apr;163(5):1246-55

 


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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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