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September 2001

Letter from Dr. Janson
Dietary Help for the Lungs
More on Diet and the Heart
In the Health News
Recipe of the Month: Peach Banana Puree

Letter from Dr. Janson
Dear Friends,
Studies continue to show the benefits of lifestyle change in managing or preventing chronic, degenerative diseases, such as heart disease, strokes, cancer, arthritis, and diabetes. An interesting report on diabetes from a division of the National Institutes of Health appeared recently that must have given drug companies some serious concern.

This study showed that people with poor blood sugar control, who are at greater risk of developing type 2 diabetes, can reduce that risk somewhat by taking the drug metformin (Glucophage), but they did far better with modest lifestyle changes, such as regular exercise and diet. The participants were put on a low fat diet and 30 minutes of walking 5 times a week.

The group on the drug reduced their risk by 30 percent, compared with an almost 60 percent reduction in the subjects who adopted the lifestyle changes. They did not have to exercise heavily or starve themselves to see these dramatic benefits. The results of this study were so striking that the government ended the study a year early.

Also, the benefits for the diet and exercise group were consistent through many ethnic groups: African Americans, Hispanic Americans, Asian Americans, Pacific Islanders, and American Indians, who are considered to be at high risk for diabetes, making it unlikely that this is a genetic condition. The lifestyle changes were also effective for all weights, and all age ranges. By comparison, the drug regimen was ineffective for those subjects who were older or those who were not as overweight.

It is interesting that on another area of the website of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDKD, they have information on alternative medicine, apparently no longer able to ignore it. They report that acupuncture and biofeedback might help the pain of peripheral neuropathy, a nerve degeneration common in diabetics.

They then mention dietary supplements. They admit that studies show chromium helps insulin function (it is a part of “glucose tolerance factor,” or GTF). They go on to say that due to insufficient evidence “no recommendations for supplementation yet exist.” They are incorrect in that. Many physicians and researchers include chromium supplements–200 to 1000 mcg per day– as part of their treatment protocols for diabetes. It is only the NIDDKD that is behind the times.

They also say that magnesium and vanadium are helpful in controlling blood sugar and reducing the complications of diabetes, but they again make no recommendations, saying that researchers want to understand how they work first. This is an unnecessary restraint when such a serious disease can be prevented or relieved with such simple, safe measures.

Dietary Help for the Lungs
I have previously reported on the benefits of maintaining good lung function as a way to improve longevity and well being. In that report, apples and tomatoes were shown to protect the lungs and improve lung function tests. Now another study supports the value of good nutrition in helping preserve the lungs by preventing and treating chronic obstructive lung disease.

A good measure of lung function is the forced expiratory volume in one second (FEV1), or the ability to expel a large volume of air quickly. This function is impaired in patients with chronic bronchitis and emphysema (the combination referred to as chronic obstructive lung disease, or COLD), as well as asthma, and other lung diseases. Using a dietary intake questionnaire, Dutch researchers showed improvements in FEV1 from a high intake of several phytochemicals found in fresh fruits and tea.

They studied catechins, flavonols, and flavones found in apples, pears, and tea, as well as other fruits and vegetables, in over 13,000 adults, and they looked for changes in FEV1, in addition to improvements in symptoms, such as cough, phlegm production, and shortness of breath. They concluded that a high intake of these phytochemicals was beneficial for both symptoms and tests of lung function.

Other dietary practices may also make a difference in lung health. Patients with chronic lung disease were given caloric supplements in a study comparing the effects of a carbohydrate-rich source with a fat-rich supplement. The higher fat supplement produced more shortness of breath than the carbohydrates. A diet high in vegetables, fruits, whole grains, and beans provides the most beneficial antioxidants and phytochemicals.

More Lung Support
Other health practices can also preserve lung function. I am sure I do not even have to mention the importance of not smoking. Regular exercise increases lung capacity and helps maintain circulation, supporting the capacity of the lungs to oxygenate the blood. Many studies have shown that exercise is valuable for chronic lung disease, reducing symptoms and improving measures of lung function.
Patients with chronic lung disease who participate in regular exercise rehabilitation programs show reductions in shortness of breath and greater exercise capacity, in addition to better psychosocial function. Moderate aerobic exercise is the usual practice in these rehab programs.

Other studies show that asthmatics benefit from a regular exercise program, with increased exercise tolerance and easier breathing. Children with asthma also benefit from exercise. They increase their maximal work load, their oxygen uptake, and their endurance, while showing a beneficial decrease in their heart rates. Interestingly, exercise also enhanced their self-esteem and coping behavior.

A number of studies show that yoga and related activities can improve lung function even when conditions are relatively advanced. In one study of 570 asthmatics, subjects were able to reduce or eliminate many of their medications by practicing yoga positions and meditation after a 2 to 4 week training program. They also improved in their measures of lung function, and the more they practiced the better results they had. They maintained these benefits for up to five years.

Supplements for The Lungs
Dietary supplements play a role in lung health. Antioxidant nutrients, such as vitamins A, C and E, coenzyme Q10, and carotenoids enhance FEV1, lung capacity, and oxygenation of the blood, and they protect mucous membranes. Most people do not get enough of these vitamins in their diets, so supplements are valuable.

Folic acid and selenium are both associated with a reduced risk of lung cancer. Often, soil and crop selenium levels are low, partly due to farming methods and partly to prehistoric glacial activity. The usual recommended amount of selenium is 200 mcg per day, readily available in multivitamins or as an individual supplement.

N-acetyl cysteine (NAC), a sulfur-containing amino acid, is useful in treatment of chronic lung disease because it helps to loosen secretions, making it easier to clear the bronchial passages. NAC is a precursor of the antioxidant glutathione. It protects the liver from toxins, and it may also help prevent cancer. Typical doses of NAC are 500 to 2000 mg per day.

More on Diet and the Heart
The relationship between coffee consumption and heart disease has been controversial. Many years ago, articles appeared showing an increased risk of heart disease in people who consumed more than six cups of coffee a day. Later studies suggested that “moderate” coffee consumption did not raise cardiovascular risks. Some research claimed that perhaps the difference between filtered and boiled coffee was significant. (Boiled coffee has more “terpenoids” that are known to raise cholesterol levels.)

A new article in the American Journal of Clinical Nutrition suggests that even the consumption of filtered, caffeinated coffee could increase risk factors for heart disease. The researchers took regular coffee drinkers and put them on a program of no coffee, 1 to 3 cups a day, or more than 4 cups a day. The relationship to decaf is not clear.

Those participants who abstained from regular coffee had a reduction of cholesterol and a lowered homocysteine compared to their own blood levels before the study. Elevated homocysteine is another risk factor for heart disease. Boiled coffee apparently has a greater effect on cholesterol levels, as the decline was less after abstention from filtered coffee.

Of course, coffee has other ill effects, including increased stomach acid production and reduced function of the esophageal sphincter, which might exacerbate the symptoms of ulcers or heartburn, also known as gastro-esophageal reflux disease (GERD). In addition, caffeine is a stimulant that often leads to a post-caffeine depression.

In order to reduce levels of cholesterol and homocysteine, it is beneficial to make dietary changes and to take various dietary supplements. Homocysteine is made from the amino acid methionine, found in high amounts in meat, chicken, and eggs. Of course, the fat and cholesterol in meat are not helpful either (however, cholesterol consumption is not as important as the cholesterol that you make in the liver, or the oxidation of cholesterol from inadequate intake of antioxidant nutrients).

Folic acid, found in vegetables and whole grains, can reduce the level of homocysteine. Supplements are usually needed to make sure you have an adequate amount if your blood level of homocysteine is high. The typical dose is 800 to 5000 mcg a day, depending on your level of homocysteine.

Additionally, supplements of vitamin B12 (cobalamin, 1000 to 2500 mcg daily) and vitamin B6 (pyridoxine, 50 to 200 mg daily) can help lower homocysteine. If you have a very high level, and these don’t bring it down to a safer range, you can also take betaine (trimethyl glycine, 6000 mg daily) or choline (2000 mg daily) as part of your supplement regimen.

I have often reported on dietary supplements for the heart. These include coenzyme Q10, magnesium, L-carnitine, vitamins E and C, L-arginine, selenium and others. Phytochemicals, such as the flavonoid quercetin (found in apples and yellow or red onions) and proanthocyanidins are also effective antioxidants.

Fish oil and other sources of omega-3 fatty acids, and gamma linolenic acid can lower blood lipids, and platelet aggregation. Many herbs, such as garlic and hawthorn berry are also beneficial.

In the Health News
It is sometimes claimed that the risk of developing osteoarthritis is increased among people who exercise regularly, due to chronic minor joint damage. Now a study has shown that regular exercisers are not at increased risk of developing osteoarthritis, unless they have a significant injury to a joint. (Sutton AJ, et al., A case-control study to investigate the relation between low and moderate levels of physical activity and osteoarthritis of the knee... Ann Rheum Dis 2001 Aug;60(8):756-64.) After a knee injury the risk of osteoarthritis was greatly increased. Some sports are riskier than others. Be sure to warm up and stretch adequately to prevent injury (and choose safer sports).

Diet and Disease
•Patients with Crohn’s disease, a chronic inflammatory bowel disorder, have elevated levels of oxidation byproducts called “reactive oxygen species.” The measures of their oxidative stress are significantly increased, and their levels of antioxidant nutrients are depressed. (Wendland BE, et al., Lipid peroxidation and plasma antioxidant micronutrients in Crohn disease. Am J Clin Nutr 2001 Aug;74(2):259-64). This results in increased lipid peroxidation, a cardiovascular risk factor. This may be one of the explanations for the association of chronic inflammation with heart disease. The antioxidants that were lower included ascorbic acid, alpha- and beta-carotene, lycopene, and beta-cryptoxanthin.

•Research shows that chronic alcohol consumption, especially liquor, can increase the likelihood that colon cancer will be unstable, with an increased likelihood of spreading. Interestingly, refined grains such as white flour, were also associated with this increased risk. (Slattery ML, et al., Int J Cancer 2001 Aug 15;93(4):601-7.) Diet is related to cancer prevention, and high-fiber whole grains are far better than refined foods.

Recipe of the Month: Peach Banana Puree
This is a great summertime dessert in the height of peach season. I combine two peaches, two bananas, and a half cup of strawberries (any or all of these can be frozen to make the puree more like a sorbet). I like to add a small piece of ginger, which gives the dessert a pleasant tang, usually using about a half-inch piece, depending on taste. I use a VitaMix, but you can use a food processor or a blender, even if the bananas are frozen (the peaches are usually too hard for a regular blender if they are frozen). I puree them for about a minute or until smooth. If you want to thicken it up, you can add ground flax seeds or a small amount of apple pectin and let it sit in the refrigerator. This is a very refreshing blend for evenings on the patio. Guests will never know how easy it is.

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Diet and Diabetes
Diet and Exercise Dramatically Delay Type 2 Diabetes...NIDDKD
Website Press release, August 8, 2001

Lung Function
van Veldhoven NH, et al., Children with asthma and physical
exercise... Clin Rehabil 2001 Aug;15(4):360-70

O’Donnell DE, et al., Older patients with COPD: benefits of
exercise training. Geriatrics 1993 Jan;48(1):59-62, 65-6.

Gosselink R, et al., Exercise training in COPD patients: the
basic questions. Eur Respir J 1997 Dec;10(12):2884-91.

Nagendra HR, Nagarathna R, An integrated approach of yoga therapy
for bronchial asthma... J Asthma 1986;23(3):123-37.

Schunemann HJ, et al., The relation of serum levels of
antioxidant vitamins C and E, retinol and carotenoids
with pulmonary function...Am J Respir Crit Care Med 2001

Fujimoto S, et al., Effects of coenzyme Q10 administration on
pulmonary function and exercise performance in patients with
chronic lung diseases. Clin Investig 1993;71(8 Suppl):S162-6.

Fleet JC Dietary selenium repletion may reduce cancer incidence
in people at high risk who live in areas with low soil selenium.
Nutr Rev 1997 Jul;55(7):277-9.

Knekt P, et al., Is low selenium status a risk factor for lung
cancer? Am J Epidemiol 1998 Nov 15;148(10):975-82.

Heimburger DC, et al., Improvement in bronchial squamous
metaplasia in smokers treated with folate...
JAMA 1988 Mar 11;259(10):1525-30.

Boman G, et al., Oral acetylcysteine reduces exacerbation rate
in chronic bronchitis. Eur J Respir Dis 1983 Aug;64(6):405-15.

Diet and The Heart
Christensen B, et al., Abstention from filtered coffee reduces
the concentrations of plasma homocysteine and serum cholesterol--
a randomized controlled trial. AJCN, 2001 Sep;74(3):302-307.

Stolzenberg-Solomon RZ, et al. Association of dietary protein
intake and coffee consumption with serum homocysteine
concentrations... Am J Clin Nutr 1999;69:467–75.



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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.