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October 2001

Letter from Dr. Janson
Heartburn or GERD
Ask Dr. J
In the Health News

Recipe of the Month: Lentil-Lemon Soup

References

Letter from Dr. Janson
Dear Friends,
Although the focus on our personal health sometimes seems trivial and self-centered in the light of “larger” world events, it is important to remember that each of us is as important as the next, and taking care of ourselves is part of taking care of the entire world community. If we do our best to lead healthy, fulfilling, caring, enriching lives, we will be setting an example for those around us. It may appear to be a small part to play, even trivial, but each one of us moving in the right direction moves the world in the right direction—and that may be the best that we can do in creating a harmonious, healthy, and spiritual world.

In attempting to achieve our own health, we have to rely on ourselves. When I spoke last year for an audience of insurance executives, I remembered that many people think that they buy health insurance from insurance companies. But this is not the case. These companies sell medical treatment insurance, to help after you have a problem. And the government also only finances medical treatment. People don’t even get health from their doctors, as most doctors focus almost exclusively on treatment of diseases—to be fair, most people don’t go to doctors until they have something that they think needs treatment.

However, health is something that you can give yourself. The way to do this is to take good care of your lifestyle. You don’t need to worry that you might have a genetic propensity for a disease, because even if it were true, you can’t do anything about that. Most of the time genetics plays a small role in the development of disease, while almost 90 percent of the time lifestyle choices—such as diet, exercise, stress management, participation in cultural and spiritual activities, and fulfilling relationships and work—are the major determinants of long-term health.

For some people this seems like too much responsibility, and they begin to feel guilty if they get ill, which is not at all what I have in mind. I simply mean that we have the opportunity to do much about our health by choosing to do so, and thereby influencing our children, family, friends, and acquaintances. For example, recent reports confirm that diet and exercise are the best and most cost effective ways to reverse hypertension, while another report shows that exercise reduces breast cancer risk. Yet another study suggests that simple, inexpensive vitamin supplements may be the best way to prevent heart disease. And another report shows that prolonged high levels of sugar, a direct result of eating and drinking sugary foods and beverages, can kill pancreatic beta cells that produce insulin, and thus may increase the risk of diabetes.

We all have the opportunity to create a healthier world for ourselves and everyone else. But it involves taking charge of our health habits and our lives, and setting a good example for those around us.

Heartburn or GERD
So many people have problems with acid indigestion that it is almost considered a normal part of living. However, it is not normal, just common. It is related to dietary choices, among other health habits. You might recognize this because of the advertising on television, which often juxtaposes ads for fatty, sugary, additive-laden junk with ads for histamine antagonist drugs (such as Pepcid and Axid) and acid-neutralizing drugs (such as Tums and Rolaids).

Antacids are among the most popular drugs in terms of sales, both by prescription and over the counter. The symptom of heartburn, or a burning sensation in the chest, is not necessarily the result of too much acid. It may be that the stomach lining is not resistant to the effects of the acid, or that the acid rises into the esophagus, which does not have a protective mucosa.

This is called gastro-esophageal reflux disease (GERD), associated with either hiatal hernia or poor functioning of the esophageal sphincter. Helicobacter pylori, a bacterium associated with peptic ulcer disease, may not be related to simple heartburn symptoms, but ulcers can cause the same symptoms.

Symptoms of GERD are more frequent in obese people, and are aggravated by food allergies, or consumption of sugar, caffeine, and alcohol. High dietary fiber seems to reduce the symptoms, possibly by absorbing stomach acid, and helping to push food through the digestive process. Drinking adequate water is also important.

The stomach acid itself is not necessarily the cause of the problem, as we all need acid for proper digestion, and heartburn symptoms also appear in people with low stomach acidity. Counteracting the acid with drugs can lead to poor digestion in addition to side effects.

A recent report shows that antioxidants are more protective of the mucosal lining cells than histamine-antagonist drugs. This suggests that the condition is more complicated than just too much acid. In that study, the researchers used an antioxidant mixture, an antihistamine drug, and a placebo. They found that the incidence of esophageal ulcerations was 80 percent in the placebo group, 60 percent in the drug group, and only 27 percent in the antioxidant group.

The researchers suggested that oxygen free radical damage was the major cause of ulcerations in the esophagus, rather than gastric acid. You should be aware that the same symptoms can be caused by a gastric or duodenal ulcer, so you should have a check-up if the symptoms are severe or persistent.

Managing Heartburn
My first recommendation is to eat a whole foods diet, with lots of fiber, and lots of vitamins and bioflavonoids for their antioxidant value. Avoid salty foods, as salt can increase the growth of H. pylori. In addition, drink at least 6 to 8 glasses of water a day. Be sure to drink either spring water or filtered water rather than typical tap water (I recommend the MultiPure solid carbon block filter system, available from QCI Nutritionals at 888-922-4848, or www.qcinutritionals.com).

Avoid caffeine, sugar, alcohol, and the vast array of highly processed junk with hydrogenated and reheated oils, artificial flavors, colors, preservatives, and sweeteners. These are the least nutritious components of the western diet. Avoid sodas, which contain sugar and caffeine. Try not to eat just before bedtime, and eat smaller meals, as overeating can increase pressure on the esophageal sphincter, leading to reflux.

Try to minimize the use of anti-inflammatory drugs, such as aspirin and NSAIDS (including Advil, Ibuprofen, Naprosyn, Celebrex). These are common contributors to ulcers and bleeding. Unless you have an ulcer diagnosed, it is probably best not to take any antacid drugs.

Stressful lifestyles contribute to heartburn. It has long been accepted that stress can lead to ulcers, although it is not usually the only cause. Do some form of meditation, relaxation, yoga, or breathing exercises. While exercise is an important part of overall health, do not do aerobic exercise immediately after meals, as that can worsen symptoms.

Supplements that can help
My first supplement recommendation for acute heartburn and ulcer symptoms is a licorice extract called DGL (deglycyrrhizinated licorice). Chewing mixes it with saliva, forming a protective coating of mucin for the lining tissues of the esophagus and stomach. Chew 1 or 2 DGL tablets before each meal, and at bedtime, or take them as needed to relieve symptoms between meals.

The next important supplement is the amino acid L-glutamine, the most abundant free amino acid in the body. This is essential for the health of the intestinal lining cells, and has been shown to help heal ulcers and other bowel inflammatory diseases. Typical doses are 1000 to 2000 mg twice a day, although sometimes higher doses are beneficial.

Glutamine acts as an anti-inflammatory, but it is also a precursor for the antioxidant glutathione. As I mentioned, antioxidants protect against free radical damage to the esophagus. Other antioxidants that might help include vitamins C and E, and bioflavonoids. N-acetyl cysteine (NAC) contributes to glutathione production and free radical control, and it can help heal ulcers. The usual dose is 500 to 1000 mg twice a day.

Additional valuable supplements include zinc, which promotes healing, and carotenoids for their antioxidant effects and benefits in healing gastric erosions. Curcumin (from turmeric) is an anti-inflammatory herb that also has excellent antioxidant properties. Typical doses are 500 mg of standardized extract, 2 to 3 times a day.


Ask Dr. J
Q. I have been developing varicose veins as I get older. Is there anything natural I can do about them? I don’t want surgery.
A. Veins contain valves that control the direction of blood flow, and with time they often get damaged, leading to pooling of blood and bulging veins. This can result from lack of exercise (exercise helps propel the blood from the legs back to the heart), and obesity, constipation, long term standing or sitting, and pregnancy, all of which put extra pressure on the valves.

It is important to do something for varicose veins, because chronic venous insufficiency with bulging veins can lead to blood clotting (thrombosis) and inflammation. The calves and feet can become swollen and painful.

Eating a high-fiber diet can relieve constipation and bowel pressure, reducing stress on the venous valves. This means lots of fresh vegetables, fruits, whole grains (whole wheat, oatmeal, brown rice, millet, and others), and legumes, and avoidance of white flour, white rice, and sugar. This diet is also rich in vitamins, minerals and flavonoids.

Strengthening the connective tissue with vitamin C and mixed bioflavonoids (1000 to 2000 mg daily) is beneficial in preventing further damage to the veins. Proanthocyanidins (100 mg), found in grape seed and pine bark, are other flavonoids that increase small blood vessel strength.

In addition, various herbs have been helpful in managing vein problems. Horse chestnut extract with 20 percent aescin relieves edema and improves venous blood flow. The typical dose is 250 mg twice a day of a standardized extract.

Another herb, butcher’s broom (100 mg per day of a standardized extract), is also effective in relieving symptoms of varicose veins. As with horse chestnut, the active components appear to be saponins, and the standardized extracts contain known amounts of these substances. Combinations of these herbs are available with flavonoids, and often with gotu kola (Centella asiatica), which helps restore venous connective tissue.

In the Health News
•While obesity is related to the risk of type II diabetes, it was thought that only very obese people were at increased risk. However, new research shows that diabetes is more common in direct proportion to increased body mass, meaning that at each level of increasing obesity there is a higher incidence of diabetes. (Hillier TA, Pedula KL.Characteristics of an Adult Population With Newly Diagnosed Type 2 Diabetes. Diabetes Care 2001 Sep;24(9):1522-7) Previously it was thought that you had to reach a certain threshold of weight to increase your risk, but that appears not to be the case. What this means is that any weight you lose will be helpful in lowering your risk.


•With age, genes change in their expression, reflecting the deterioration associated with the aging process. Restriction of caloric intake in mice (and in other animals in previous studies) can reverse or delay many of these genetic changes. (Cao SX, Genomic profiling of short- and long-term caloric restriction... Proc Natl Acad Sci U S A 2001 Sep 11;98(19):10630-5) Lower calorie intake reduces the expression of genes associated with inflammation, stress proteins, and cancer formation. In addition, calorie restriction enhanced the ability of the liver to detoxify harmful chemicals. Healthy diets are filling because of the high fiber content, but they also have a low caloric density.

Diet and Disease
•Breast feeding for at least six months appears to help cognitive function in infants at 13 months and at 5 years old. (Angelsen NK, et al., Breast feeding and cognitive development Arch Dis Child 2001 Sep;85(3):183-8) DHA (docosahexaenoic acid), an essential fatty acid, is important for neurological development. DHA from fish oil can be added to an infant’s diet. (DHA is also valuable for adults’ brain and heart function.)

Recipe of the Month: Lentil-Lemon Soup
One of my favorite ethnic dishes is a simple tasty soup. Sauté chopped onions and celery (with some leaves for extra flavor) in a small amount of olive oil and some added cumin. Add green lentils with at least 4 times as much water as beans, and make sure there is always adequate water to make a soup (although if it gets thick you can call it a stew). Add chopped green chard or another green and simmer until the lentils are done, which is usually about 45 minutes, but check them regularly, and stir to avoid burning. Before serving, add fresh-squeezed lemon juice to taste. Serve this with some whole wheat bread or rice cakes, and a side of salad, and you have a delicious, healthy meal.

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References

Editorial
Moore TJ, et al., DASH...diet is effective treatment for stage 1
isolated systolic hypertension. Hypertension 2001
Aug;38(2):155-8.

Friedenreich CM, et al., Case-control study...physical activity
and breast cancer risk. Am J Epidemiol 2001 Aug 15;154(4):336-47.

Tice JA, et al., Cost-effectiveness of vitamin therapy...for...
coronary heart disease:... JAMA 2001 Aug 22-29;286(8):936-43.

Heartburn and GERD
Reimann HJ, Lewin J.Gastric mucosal reactions in patients with
food allergy. Am J Gastroenterol 1988 Nov;83(11):1212-9.

Goso Y, et al., Effects of traditional herbal medicine on gastric
mucin against ethanol-induced gastric injury in rats. Comp
Biochem Physiol C Pharmacol Toxicol Endocrinol 1996
Jan;113(1):17-21.

Rees WD, et al., Effect of deglycyrrhizinated liquorice on
gastric mucosal damage by aspirin. Scand J Gastroenterol
1979;14(5):605-7.

Souba WW, et al., The role of glutamine in maintaining a
healthy gut... J Surg Res 1990 Apr;48(4):383-91.

Denno R, et al., Glutamine-enriched total parenteral nutrition
enhances plasma glutathione... J Surg Res 1996 Feb 15;61(1):35-8.

Tsugane S, et al. Salty food intake and risk of Helicobacter
pylori infection. Jpn J Cancer Res 1994;85(5):474-8.

Thamlikitkul V, et al. Randomized double-blind study of Curcuma
domestica Val for dyspepsia. J Med Assoc Thai 1989;72:613-20.

Varicose Veins
Unkauf M, et al., Investigation of the efficacy of oxerutins...
chronic venous insufficiency treated with compression stockings.
Arzneimittelforschung 1996 May;46(5):478-82.

Rehn D, et al., Comparative clinical efficacy and tolerability of
oxerutins and horse chestnut extract in..
chronic venous insufficiency. Arzneimittelforschung
1996 May;46(5):483-7.

Diehm C, et al., ...leg compression andhorse-chestnut extract...
chronic venous insufficiency. Lancet 1996 Feb 3;347(8997):292-4.

Diehm C, et al., Medical edema protection...A placebo controlled
double blind study. Vasa 1992;21(2):188-92.

Cappelli R, et al., Use of extract of Ruscus aculeatus in venous
disease in the lower limbs. Drugs Exp Clin Res 1988;14(4):277-83.

 


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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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