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
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, www.niddk.nih.gov/health) 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
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 supplements200 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.
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
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.
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.
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
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.
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 dont 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.
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).
Patients with Crohns 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.
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.
Click here to receive the Healthy Living newsletter free.
Diet and Exercise Dramatically
Delay Type 2 Diabetes...NIDDKD
Website Press release, August 8, 2001
van Veldhoven NH, et al., Children
with asthma and physical
exercise... Clin Rehabil 2001 Aug;15(4):360-70
ODonnell 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
metaplasia in smokers treated with folate...
JAMA 1988 Mar 11;259(10):1525-30.
Boman G, et al., Oral acetylcysteine reduces
in chronic bronchitis. Eur J Respir Dis 1983 Aug;64(6):405-15.
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;69:46775.