Letter from Dr. Janson: Real and Imagined
L-Arginine for the Heart
Exercise as Medicine
Ask Dr. J.
In the Health News
Diet and Disease
Recipe of the Month: Mushroom and Eggplant
I recently saw two news articles that made me think of the
"What's wrong with this picture?" Each one was interesting
itself, but seeing them in the same week started me thinking.
The first headline had to do with the presence of salmonella
processed meat. The USDA had tried to remove its inspection
endorsement from one meat processor that had repeatedly produced
salmonella-contaminated meat (a very common problem); the
appeals court prevented the USDA from taking such action.
The end result was that salmonella could more easily get
food supply, and consumers would be responsible for proper
handling and cooking to make sure they were not eating
contaminated food. The implication is that the government
less able to warn consumers of potential food hazards (although
the USDA maintains that they are still doing their job, while
they are very disappointed that they have lost this case).
The second article was a warning to seniors from the General
Accounting Office (GAO) that they may be "risking their
(and wasting money) by taking dietary supplements. The Associated
Press article says that supplements can have "serious
consequences" for the elderly, and that they can "aggravate
medical conditions." The GAO report also warned about
side effects from herbal supplements, or that the products
not work at all.
The juxtaposition of these two articles shows some misguided
governmental priorities. The Centers for Disease Control
estimates that "76 million people get sick, more than
hospitalized, and 5,000 Americans die each year from foodborne
illness," much of it from contaminated meat. In one study
percent of meat, chicken, turkey, and pork samples were
contaminated with Salmonella (of which 84 percent were antibiotic
resistant). Estimates based on a German study suggest that
Americans get hemorrhagic E. coli infections from meat
contaminated with fecal material during slaughtering and
processing, yet the courts are restricting the government
warning people about this specific risk, even though research
shows that people are not knowledgeable about how to handle
to prevent these risks. If dietary supplements led to one-tenth
this level of risk, you can be sure the government would be
trying to ban them altogether.
On the other hand, dietary supplements are helping millions
people to prevent and treat chronic degenerative diseases
as everyday health problems. Side effects from nutritional
products and herbs are few, and serious side effects are very
rare, while deaths are virtually non-existent. If we spend
and resources warning people about unlikely risks, they become
inured to warnings about real risks, and we waste the energy
need to focus on serious problems.
Recent research shows that the amino acid L-arginine is valuable
as part of a supplement program for people with angina. In
combination with soy isoflavones and vitamins C, E, and
B-complex, supplements of L-arginine enhanced exercise tolerance
in patients with coronary artery disease.
These subjects had a 20 percent improvement in their time
treadmill compared to the control group. In addition, their
vessel function improved, as measured by the relaxation of
brachial artery, and they had a better quality of life, based
a valid health questionnaire.
L-arginine is a non-essential amino acid, but as with a number
other nutrients and physiological substances, it is necessary
certain conditions, and is therefore considered "conditionally
essential." In physical trauma, surgery, burns, and wounds,
L-arginine supplements promote healing and shorter hospital
(of course, the less time you stay in the hospital, the lower
your chance of developing an infection). L-arginine is also
important for restoring immune function and promoting hormone
release, including insulin and growth hormone.
Previous studies had shown that L-arginine helps with angina
congestive heart failure. In one, the effects of L-arginine
exercise were better for arterial function in heart failure
patients than either intervention alone. In that study, the
researchers used 8 grams of L-arginine, but the study ranges
from 2 g to 20 g per day.
L-arginine is a precursor to nitric oxide, a blood vessel
relaxing factor. This helps to open up the flow of blood to
organs. Improving blood flow and lowering resistance not only
improves the function of most organs, but it specifically lowers
blood pressure. In research on animals and humans, L-arginine
supplements significantly improve hypertension, with a 5 to
drop in both systolic and diastolic pressures, and supplements
were better than increasing L-arginine from food sources.
These same studies also showed that supplements can reduce
cholesterol, increase the level of the good HDL-cholesterol,
reduce triglycerides, and improve regulation of blood sugar.
Subjects on supplements also showed enhanced kidney function
measured by the ability of the kidneys to clear creatinine
the blood. L-arginine reduces the aggregation of platelets,
cells that initiate blood clots. Excessive aggregation of
platelets can initiate clots inside blood vessels that lead
heart attacks and strokes.
L-arginine improves the ability of patients with hardening
arteries in the legs to walk without pain (intermittent
claudication), and to increase the total distance they can
Because of its blood vessel effects, L-arginine can also help
with male sexual dysfunction. Erectile dysfunction may result
from reduced penile blood flow, and nitric oxide, which relaxes
the penile blood vessels, is a prerequisite for normal erections.
The clinical studies are equivocal, however, as not all of
show benefits in sexual functioning from taking L-arginine
supplements. Perhaps it is the dose used or the timing of
supplements that creates the disparity. In one study, measures
function improved, but the researchers were not able to
demonstrate the physiological causes for the improvement.
Nonetheless, some people refer to L-arginine as "natural
and it has no apparent side effects.
If you are taking L-arginine for its circulatory benefits,
also need to attend to your diet and recognize that the
supplement is synergistic with exercise. A regular exercise
program is important even for patients with heart failure.
supportive supplements include L-carnitine, vitamins C and
magnesium, garlic, hawthorn berry, and ginkgo biloba. N-acetyl
cysteine (NAC) significantly reduces the recurrence of heart
attacks in patients on nitroglycerin, but may increase the
headaches that nitro can cause.
Regular exercise is known to enhance brain function in the
elderly. A new study shows that regular exercise also improves
brain function in younger people. Seven healthy young people
put on a regular jogging program for three months. They then
complex computer tests to evaluate memory and other measures
cognitive function. Their scores were compared to the values
the start of the study. At the end, not only were their scores
increased, but the reaction times were measurably better and
completed the tasks faster than in the initial testing. However,
if they stopped exercising, their scores began to fall,
indicating that for long term preservation of brain function
is essential to continue physical activity.
A number of earlier studies have shown that exercise helps
elderly people improve their brain function. Not only does
general cognitive ability improve, but they lower their risk
Alzheimer's disease and dementia of all kinds.
It is not clear why exercise is beneficial, but improved
circulation and oxygen availability to the brain is one possible
mechanism. Exercise also enhances the production of natural
antioxidant molecules in the body called superoxide dismutase
(SOD), and these are protective against functional decline
Other studies report that exercising reduces the risk of
heart disease and lowers mortality from all causes. Another
benefit is that exercise can improve mood in elderly people
are frail, and they needn't worry about pain or discomfort,
even those with arthritis did not develop pain from the exercise.
Q. Do you have any advice for treatment of hemorrhoids? I
pressure on my veins from liver disease and colon problems.
A. Hemorrhoids are enlarged, varicose veins in the rectum
anus (internal and external). They are usually the result
excessive pressure on the vessels, and may be due to constipation
or diarrhea and straining on the toilet, and they often develop
during pregnancy. The valves that control the direction of
flow become damaged, and then the veins bulge out and the
get thin. This is the same mechanism that leads to varicose
in the legs.
These veins are very close to the surface, so when the are
bulging and thin they may bleed during a bowel movement. Just
as leg veins may develop phlebitis, hemorrhoids can become
inflamed, causing discomfort, burning, and itching.
Hemorrhoids are associated with low-fiber diets. Populations
a high fiber intake have a very low incidence of hemorrhoids.
If hemorrhoids are severe, they may require surgery or laser
treatment to remove them or tie them off. However, even with
advanced hemorrhoids, surgery may not be needed if symptoms
be controlled with diet and supplements, especially flavonoids
(Br J Surg 2000 Jul; 87(7):868-72).
I recommend a high-fiber diet, with plenty of vegetables,
whole grains, and legumes, and reduction of animal products
(which have no fiber). I also suggest drinking 6 to 8 glasses
water a day, because the combination of fiber and water promotes
easy bowel movements.
Bioflavonoids are anti-inflammatory and help strengthen vessel
walls. I usually suggest mixed bioflavonoids (2000 mg per
as well as vitamins C and E, proanthocyanidins (100 mg), and
mixture called Varitonin (from QCI Nutritionals at
or 888-922-4848) with horse chestnut (250 mg), butcher's broom
(50 mg), gotu kola (60 mg) and the flavonoid hesperidin (125
mg), taken twice a day.
a. Alcohol has been recommended to reduce heart disease,
new review suggests that it has little if any protective effect.
Alcohol did not reduce the risk of having a fatal heart attack,
and it increased the risk of dying from other causes (Wannamethee
SG, Shaper AG, Heart 2002 87: 32-36). Long-term drinkers appear
to have some benefit, but starting to drink for health does
improve heart risk, and overall mortality increases. Non-drinkers
might abstain because they are already in poor health, and
could slant the data. If you are not a drinker, the present
evidence does not indicate that you should start.
b. Tai Chi, the Chinese art of movement, appears to give
from osteoarthritis. Women in a treatment group had less pain,
easier movement, and better balance than controls (Reuters
Health, December 25, 2001). Earlier studies show that Tai
also lowers blood pressure.
Breast cancer is related to diet and environmental factors.
analysis of population data shows that mortality from breast
cancer is increased by animal fat in the diet, and decreased
exposure to sunlight, which is essential for the formation
vitamin D in the skin (Grant WB, Cancer 2002 Jan 2;94(1):272-81).
(Excessive sunlight, however, increases the risk of skin cancer.)
Vegetables, fruits, whole grains, and fish all reduce breast
cancer mortality. The author speculated that antioxidants,
phytochemicals, phytoestrogens, and omega-3 oils are protective.
In addition to animal fat, alcohol increases breast cancer
(Other studies show that high levels of meat and milk consumption
can double and triple the risk of stomach and esophageal cancer,
respectively. Chen H, et al., Am J Clin Nutr 2002
I use a covered non-stick electric skillet to make an easy
healthy lunch. Wash several portabello mushrooms, and slice
eggplant and an onion to about the same thickness. Coat the
mushrooms in a mixture of olive oil and balsamic vinegar (or
lemon juice) with some ground pepper. Place them all on the
electric skillet (or a large stovetop skillet--some cover
burners) set at 375 or medium high on the stove. Cover them
5-10 minutes (depending on the size), flip them over and
re-cover. Give them another few minutes and test to see if
are done. They should all be soft, and the onions browned
glassy. Layer them on whole-wheat toast with mustard or tofu
mayonnaise a tomato slice and lettuce. You can use just eggplant
or mushrooms if one is unavailable.
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CDC Website: www.cdc.gov/foodsafety.
Seniors warned about dietary supplements,
Boston Globe Sep 14, 01
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