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February 2002

Letter from Dr. Janson: Real and Imagined Risks
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 Skillet Sandwich

Real and Imagined Risks

Dear Friends,
I recently saw two news articles that made me think of the line
"What's wrong with this picture?" Each one was interesting in
itself, but seeing them in the same week started me thinking.

The first headline had to do with the presence of salmonella in
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 into the
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 was
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 health"
(and wasting money) by taking dietary supplements. The Associated
Press article says that supplements can have "serious health
consequences" for the elderly, and that they can "aggravate
medical conditions." The GAO report also warned about possible
side effects from herbal supplements, or that the products might
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 300,000 are
hospitalized, and 5,000 Americans die each year from foodborne
illness," much of it from contaminated meat. In one study 20
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 30,000
Americans get hemorrhagic E. coli infections from meat
contaminated with fecal material during slaughtering and
processing, yet the courts are restricting the government from
warning people about this specific risk, even though research
shows that people are not knowledgeable about how to handle foods
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 of
people to prevent and treat chronic degenerative diseases as well
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 time
and resources warning people about unlikely risks, they become
inured to warnings about real risks, and we waste the energy we
need to focus on serious problems.

L-Arginine for the Heart
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 on the
treadmill compared to the control group. In addition, their blood
vessel function improved, as measured by the relaxation of the
brachial artery, and they had a better quality of life, based on
a valid health questionnaire.

L-arginine is a non-essential amino acid, but as with a number of
other nutrients and physiological substances, it is necessary in
certain conditions, and is therefore considered "conditionally
essential." In physical trauma, surgery, burns, and wounds,
L-arginine supplements promote healing and shorter hospital stays
(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 and
congestive heart failure. In one, the effects of L-arginine and
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 vary
from 2 g to 20 g per day.

Other benefits of L-arginine
L-arginine is a precursor to nitric oxide, a blood vessel
relaxing factor. This helps to open up the flow of blood to the
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 7 mm
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 total
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 as
measured by the ability of the kidneys to clear creatinine from
the blood. L-arginine reduces the aggregation of platelets, the
cells that initiate blood clots. Excessive aggregation of
platelets can initiate clots inside blood vessels that lead to
heart attacks and strokes.

L-arginine improves the ability of patients with hardening of the
arteries in the legs to walk without pain (intermittent
claudication), and to increase the total distance they can go.
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 them
show benefits in sexual functioning from taking L-arginine
supplements. Perhaps it is the dose used or the timing of the
supplements that creates the disparity. In one study, measures of
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 Viagra,"
and it has no apparent side effects.

If you are taking L-arginine for its circulatory benefits, you
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. Other
supportive supplements include L-carnitine, vitamins C and E,
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.

Exercise as Medicine
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 were
put on a regular jogging program for three months. They then took
complex computer tests to evaluate memory and other measures of
cognitive function. Their scores were compared to the values at
the start of the study. At the end, not only were their scores
increased, but the reaction times were measurably better and they
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 it
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 their
general cognitive ability improve, but they lower their risk of
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 from
free-radical damage.

Other studies report that exercising reduces the risk of dying of
heart disease and lowers mortality from all causes. Another
benefit is that exercise can improve mood in elderly people who
are frail, and they needn't worry about pain or discomfort, as
even those with arthritis did not develop pain from the exercise.

Ask Dr. J.
Q. Do you have any advice for treatment of hemorrhoids? I have
pressure on my veins from liver disease and colon problems.
(A.N., Internet)

A. Hemorrhoids are enlarged, varicose veins in the rectum and
anus (internal and external). They are usually the result of
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 blood
flow become damaged, and then the veins bulge out and the walls
get thin. This is the same mechanism that leads to varicose veins
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 with
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 can
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, fruits,
whole grains, and legumes, and reduction of animal products
(which have no fiber). I also suggest drinking 6 to 8 glasses of
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 day),
as well as vitamins C and E, proanthocyanidins (100 mg), and a
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.

In the Health News
a. Alcohol has been recommended to reduce heart disease, but a
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 not
improve heart risk, and overall mortality increases. Non-drinkers
might abstain because they are already in poor health, and that
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 relief
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 Chi
also lowers blood pressure.

Diet and Disease
Breast cancer is related to diet and environmental factors. A new
analysis of population data shows that mortality from breast
cancer is increased by animal fat in the diet, and decreased by
exposure to sunlight, which is essential for the formation of
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 risk.
(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

Recipe of the Month: Mushroom Eggplant Skillet Sandwich
I use a covered non-stick electric skillet to make an easy
healthy lunch. Wash several portabello mushrooms, and slice an
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 two
burners) set at 375 or medium high on the stove. Cover them for
5-10 minutes (depending on the size), flip them over and
re-cover. Give them another few minutes and test to see if they
are done. They should all be soft, and the onions browned and
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:

Seniors warned about dietary supplements, Boston Globe Sep 14, 01

Baljer G, Wieler LH, Animals as a source of infections
humans...EHEC. Dtsch Tierarztl Wochenschr 1999 Aug;106(8):339-43.

Altekruse SF, et al., Consumer knowledge of foodborne microbial
hazards and food-handling... J Food Prot 1996 Mar;59(3):287-94.

Maxwell AJ, et al., Randomized trial of a medical food for the
dietary management of chronic, stable angina. J Am Coll Cardiol
2002 Jan 2;39(1):37-45.

Maxwell AJ, et al., Nutritional therapy for peripheral arterial
disease... Vasc Med 2000;5(1):11-9.

Hurson M, et al., Metabolic effects of arginine in a healthy
elderly population. J Parenter Enteral Nutr 1995

Hambrecht R, et al., Correction of endothelial dysfunction in...
heart failure: ... effects of exercise training and oral
L-arginine supplementation. J Am Coll Cardiol 2000 Mar

Rector TS, et al., ...supplemental oral L-arginine in patients
with heart failure. Circulation 1996 Jun 15;93(12):2135-41.

Susic D, ...Systolic Hypertension...Reversed With L-Arginine and
ACE Inhibition. Hypertension 2001 Dec 1;38(6):1422-6.

Siani A, et al., Blood pressure...changes during...L-arginine
supplementation. Am J Hypertens 2000 May;13(5 Pt 1):547-51.

Chen J, et al., Effect of oral administration of ... L-arginine
in men with organic erectile dysfunction... BJU Int 1999

Ardissino D, et al., Effect of...nitroglycerin or
N-acetylcysteine, or both, in... angina pectoris. J Am Coll
Cardiol 1997 Apr;29(5):941-7.

Laurin D, et al., Physical activity and risk of cognitive
impairment and dementia in elderly... Arch Neurol 2001

Society for Neuroscience Meeting, December 2001, Reuters Health,
December 28, 2001.

Schechtman KB, Ory MG, The effects of excercise on the quality of
life of frail older adults: Ann Behav Med 2001 23(3):186-97.



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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.