Letter from Dr. Janson
Summer Skin Protection (and More)
Birth Defects, Zinc and Folate
In the Health News
Recipe of the Month: Chickpeas and Rice
Why am I continually surprised when medical doctors make unfounded,
ignorant claims about dietary supplements or alternatives
in medicine? The latest example is from a group of so-called
aging experts from the International Longevity
Center, based in New York, in a critique of another anti-aging
medical organization (they complain that doctors make a living
doing alternative medicine, as if they dont with their
One of the doctors was quoted as saying, Antioxidants
have never been proven to be of any clinical benefit for any
illness, ever,which begs the question, what constitutes
proof?since there is a lot of evidence. It is almost
impossible to prove anything in the biological
sciences to a degree that would satisfy the most resistant
skeptic, but we have to make decisions about health care based
on the best evidence of the moment, not proof.
Physicians make recommendations every day based on their
interpretation of medical science, and the best experts come
up with different opinions. I attend a clinical conference
on some Friday afternoons, with some of the best cardiologists
in the Boston area. They present cases and ask each other
about what course of action to take. They often come up with
three, four, or even five different ways to manage a patient.
The physician in charge must decide how to manage the medical
condition, considering all of the opinions. And whether or
not the experts come to a consensus, the patient needs treatment.
Is this science? Is this art? No, this is a combination:
applying the art of medicine to the best information that
science has to offer. To ask anti-aging doctors to live up
to a higher standard of proof is unwarranted and
biased. Right now, the best evidence that we have suggests
that lifestyle, diet, dietary supplements (yes, including
antioxidants!), exercise, stress management, and many unconventional
treatments are valuable in the prevention, management, and
treatment of a variety of conditions. I point them out in
every issue of this newsletter.
Would I like more proof? Of course! Just as I would like
more proof of any conventional medical treatments (which are
often far more risky but not more scientific). However, we
cannot wait for perfect proof before we try to help our patients.
We are limited by uncertainty, but not incapacitated by it.
It is unwise to exclude any of the potential benefits from
what is called alternative medicine, complementary medicine,
nutritional medicine, anti-aging medicine, or simply good
medicine,(with or without conventional treatments).
Doctors who do so mistreat their patients, and they misunderstand
the value of medical science. They also diminish themselves.
Everyone suffers when such bias and ignorance remove the potential
benefits of comprehensive health care.
It is now no secret that skin is readily damaged by
excessive exposure to the sun or other sources of ultraviolet
light (such as tanning booths). Sunscreen can protect the
skin, but this may not be adequate during prolonged exposure,
and many sunscreens contain harmful chemicals.
When I grew up we spent summers at the New Jersey shore,
getting very tanned playing on the beach, swimming, and spending
virtually all day outdoors, and no one knew of sunscreen.
The risks of sun damage were little known 50 years ago.
While some sun exposure is needed for production of vitamin
D in the skin, and light received through the eyes stimulates
the pineal gland to help regulate the body clock, sun worship
leads to significant tissue damage. It also puts you at an
increased risk of developing skin cancer.
Skin cancer is increasingly common, and it occurs in three
forms, depending on the affected cells. The superficial layer
of skin, or epidermis, is made up of the outermost squamous
cells, the basal cells just beneath them, and the pigment
cells, called melanocytes. The dangerous kinds of cancer are
squamous cell cancer and melanoma. Basal cell cancers only
rarely metastisize, but they can grow locally.
Most of these tumors appear only on areas of the skin that
are exposed to the sun, so the correlation is quite clear.
Ultraviolet light leads to free radical damage to the superficial
cells that are most exposed. This results in premature aging
and wrinkles from protein cross linkages in collagen, and
is the likely cause of the cancers.
You need to be very cautious to avoid excessive exposure.
Even tanning is an indication of damage, so you should avoid
the sun in the middle of the day. When you are out, wear lightweight
but opaque clothing, stay in the shade, and use sunscreen
with SPF 15 protection. While this can help prevent squamous
cell cancer, it is not clear that it protects against melanoma.
By all means, avoid tanning booths.
Protecting the skin is important not only for itself,
but the skin is a visible model for how to slow down the aging
process and prevent free-radical diseases in general. Some
skin creams contain antioxidants, such as vitamin C, proanthocyanidins,
and coenzyme Q10. However, other than vitamins C and E, which
do help protect against ultraviolet light, it is not clear
that others are beneficial when applied topically.
A better idea is to protect yourself from free radical damage
by eating a diet with protective nutrients and taking supplements
that are known to offer protection. These have been shown
to lower the incidence of various cancers.
Choose a diet that is rich in fruits and vegetables. These
are high in vitamins and minerals, and they contain lots of
flavonoids, carotenoids, and protective phytochemicalsantioxidants
that protect us against free radical damage and cancer, and
maintain healthy and supple skin.
Avoid hydrogenated oils (margarine and shortenings), as they
interfere with immune function and disrupt the normal prostaglandin
metabolism. Prostaglandins regulate many different physiological
functions. The best oils are from seeds, nuts, beans, and
cold-water fish (as part of a healthy variety of foods). You
also find oils in some whole grains and a few vegetables,
such as avocados.
Most of the antioxidant supplements that I have talked
about so much are valuable in protection against the damage
from ultraviolet exposure. These include vitamin C (2000 to
4000 mg daily), vitamin E (400 to 800 IU), coenzyme Q10 (100
to 200 mg), selenium100 to 200 mcg), proanthocyanidins (50
to 100 mg), and other bioflavonoids (1000 to 2000 mg).
These also happen to be the ones that protect against premature
aging of tissues, including the skin, by preventing the cross-linking
of protein. The benefit is just more apparent in the skin.
Sun damage is cumulative, and is likely worsened by other
free radical exposure, as is evident in smokers, and on the
neck skin of outdoor workers.
In addition to free radical protection, nutrients help to
maintain the strength of connective tissue, and youthful looking
skin. Vitamin C, flavonoids, and MSM (methyl sulfonyl methane,
a sulfur source, 1000 to 2000 mg) are essential for production
of strong collagen, and zinc (15 to 30 mg) is essential for
elastin, the substance that helps maintain elasticity of skin.
This declines with age, as is evident if you pinch the skin
on the back of your hand to form a tent, and let go. It snaps
back flat when you are young, but takes its time when you
Adequate omega-3 oil, from flaxseeds, walnuts, and fish,
such as sardines or salmon, and gamma-linolenic acid (an omega-6
oil, from borage or evening primrose oil) help to balance
the prostaglandins. This does not mean eating a high fat diet,
or adding lots of oil to a healthy diet. If you prefer to
avoid fish, be sure to select some of the vegetarian sources
of omega-3 oils.
Regular exercise helps maintain the enzymes that protect
against free radical damage, such as superoxide dismutase
(SOD). To produce SOD you need adequate zinc, copper, and
manganese. You can certainly do your exercise outdoors, but
take precautions against excessive sun exposure.
These are the precautions I have been taking to help protect
my skin from the aging process and cancer. If you protect
your skin, the chances are high that you will be protecting
yourself from aging, cancer, and other age-related diseases.
Although the FDA has only recently acknowledged that
folic acid (or folate) supplements can prevent birth defects
(neural tube defects, or NTD), it has been well known in the
medical research for many decades, and even other government
agencies suggest folate supplements.
NTDs include spina bifida, a failure of the spine to
close, and anencephaly, a failure of the brain to develop.
When the spine fails to close, corrective surgery is required,
but these children often have multiple abnormalities, and
short survival. With anencephaly, there is a failure of the
brain to develop, leading to stillbirths or death shortly
The American Preventive Medical Association and several other
parties sued the FDA to allow manufacturers to say on their
labels that folate helps prevent birth defects, giving consumers
more information. Fortunately for the health of children and
freedom of speech, the FDA lost this suit. Before this lawsuit,
the FDA insisted that it was better to get folic acid from
food, rather than supplements, even though most of the research
was done with supplements. It is still a wise idea to eat
foods rich in folate, as they are also rich in many other
nutrients. Good food sources of folate are leafy green vegetables,
bananas, peas and beans, whole grains, and oranges.
Folate levels in foods do vary, so I recommend supplements.
Poor health habits increase the need for folate. Smoking,
drinking alcohol, taking birth control pills, and dieting
are among the habits that reduce folate in the body.
It is now apparent that in addition to folic acid, zinc is
also beneficial in preventing neural tube defects (NTD). Researchers
in India have correlated low hair zinc levels in pregnant
women with an increased incidence of NTD (the serum levels
were not correlated, but the serum is not a reliable way to
evaluate zinc levels). Another report shows that maternal
zinc supplements help to prevent birth defects.
Other helpful nutrients include vitamin B12 and pantothenic
acid, and it is good to have a broad spectrum of nutrients
in a comprehensive multivitamin-mineral supplement for extra
People at risk of peptic ulcers from low-dose
aspirin, appear to have an even higher risk if they also have
Helicobacter pylori in the stomach. The irritation of the
gastric mucosa caused by low-dose aspirin was much worse among
those testing positive for the bacteria, which is well known
to be associated with increased peptic ulcer disease. (Feldman
M, et al., Role of Helicobacter pylori...during long term/low
dose aspirin therapy... Am J Gastroenterol 2001 Jun;96(6):1751-7)
Gastric erosions are seen in one of six people on aspirin,
but in 50 percent of people who also have H. pylori.
A healthy low-fat diet with supplements of flax
seeds can slow the growth of prostate cancers (Demark-Wahnefried
W, et al., Pilot study of dietary fat restriction and flaxseed
supplementation... Urology 2001 Jul;58(1):47-52). Flaxseeds
contain both omega-3 oils, fiber, and lignans, substances
that may bind with testosterone and thus slow the growth of
prostate cancer. These subjects were instructed in a low fat
diet, with less than 20 percent of their calories from fat,
and within 5 weeks they had improved, and their cholesterol
levels had come down also. The average American diet is well
over 30 percent fat (high sugar intake makes this appear low).
A new report suggests that the risk of MS is much lower
on a vegetarian diet, and higher on a diet that contains a
lot of saturated fat. (Reuters Health, June 16, 2001). High
caloric intake also increased the risk. Even the protein source
made a difference. Men and women who ate predominantly vegetable
protein had a 60 percent lower risk of MS. They also found
that vitamins C, B1 (thiamin), and B2 (riboflavin), and fiber,
calcium and potassium were strongly protective.
I use this versatile combination as the foundation
for several meals. Pressure cook organic chick peas for 20
minutes and let them cool slowly (or add 5-10 minutes). Cook
brown rice using two parts water to one part rice (I use a
rice cooker to save effort; follow its directions). I keep
these in the fridge and combine them with some pepper, lemon
or vinegar, flaxseed or olive oil (or a mixture) and some
thyme or oregano as a snack. I also will have them with stir-fried
onions, garlic, and mixed vegetables to make a meal. Another
choice for the rice is to make a breakfast by warming it with
soymilk or Rice Dream, adding raisins, cinnamon, and banana
or other fruit. Chick peas can be put in salad, or if you
are ambitious you can mash them with garlic, lemon, and tahini
to make hummus.
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Physicians warn against anti-aging
therapies. Reuters Health,
July 16, 2001
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