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March 2002

Children's Eating Habits
Vitamin E: Which is Best
Dietary E and Other Antioxidants
Love, Marriage, Work, and Stress
Raynaud's Disease: Ask Dr. J
In the Health News
Recipe of the Month: Herb-Nut Loaf

Letter from Dr. Janson: Children's Eating Habits

Dear Friends,
When I see parents about their children, they frequently tell me
how difficult it is to get them to eat healthy foods; either they
are fussy eaters, don't like vegetables, won't eat anything that
is smooth, or anything that is lumpy, will eat nothing raw, or
nothing cooked, or dislike many other food characteristics.

I think it must be a cultural phenomenon, because in other
countries it is hard to imagine similar interchanges--a Chinese
child who refuses vegetables, rice, or tofu; a Mexican child who
won't eat tortillas and beans, or mangoes; an Indian child who
won't eat vegetable curry, chick peas, and fruits.

In most cultures,the availability of foods determines the dietary
choices that children make, (of course, we don't want to neglect
the possibility that a child refuses something because of a food
allergy). If junk is not as available, healthy eating becomes the
routine. A recent study showed that parents and family situations
have a great influence on children's eating habits.

The study of 3000 high school students showed that those teens
who had good communication with and close supervision by their
parents were far more likely to have healthy eating habits. The
number eating a healthy breakfast ranged from 12 to 24 to 32
percent among those in foster homes, living with another family
member, or with a single parent, compared to 43 percent of those
living with both parents. Children were more likely to eat
healthy breakfasts and lunches if they spent more time with
family and less unsupervised time. While their healthy breakfast
might not be the same as mine, the point is that parents can
influence what children eat. We need to pay attention to this
because our epidemic of obesity (and diabetes, heart disease,
cancer, and hypertension) starts with childhood eating habits.

Curiously, in the better family situations, the number of
children eating healthy breakfasts was still only 43 percent,
meaning that on average in those families, 57 percent of the
children did not eat healthy breakfasts. Those families with the
highest parental monitoring reported that 80 percent of the
children ate fruits and vegetables at least once a day. As the
recommendations for fruits and vegetables is between 5 and 9
servings a day, this does not strike me as very positive.

Nonetheless, the important point to take away is that parents can
have a great influence on their children's eating habits, and
they don't have to despair. Many years ago I saw a report
suggesting that when children grow up they are much more likely
to eat what their parents ate, even if they had poor eating
habits when they were growing up (if they refuse the asparagus
now, they may like it in their 20's). While you can't completely
control your child's eating habits, you can influence them
through communication, having good foods available in the house,
and through setting a good example.

Vitamin E: Which Is Best?
A large body of evidence shows that the antioxidant vitamin E is
beneficial for prevention of heart disease, cancer, and menstrual
pain, as well as enhancement of immunity, and slowing the aging
process related to oxidative damage.

A lot of the research has been done with synthetic vitamin E,
referred to with the prefix "dl-" before the alpha-tocopherol.
However, it is increasingly clear that natural vitamin E is more
desirable, better absorbed and more biologically active. A plain
"d-" before alpha-tocopherol indicates the natural form.

Even more desirable is a combination that includes not only the
alpha form, but the "mixed tocopherols," containing other isomers
called beta, gamma, and delta. In particular, the
gamma-tocopherol (GT) appears to be valuable in both laboratory
and human studies.

Most vitamin E on the market, even the natural mixed vitamin E,
has very little GT. However, evidence is accumulating that GT is
an important nutritional antioxidant in addition to
alpha-tocopherol (AT). A December report shows that GT is an
effective scavenger of oxidative molecules in lipid tissues, and
both GT and its metabolites inhibit an enzyme called
cyclo-oxygenase, which is a mediator of inflammation. GT provides
an anti-inflammatory activity not seen with AT.

High plasma GT is associated with reduced cardiovascular disease
and a lower incidence of prostate cancer. Evidence also suggests
that high intake of AT can inhibit the accumulation of GT in
tissues and plasma (even though most studies with AT show it is
beneficial). Earlier studies suggest that GT is a more effective
detoxifier of the pollutant nitrogen dioxide. Supplements with 40
to 50 percent GT are available, and may be preferable to those
with little or no GT.

Dietary E and Other Antioxidants
GT is the predominant form of vitamin E in the diet, and it seems
prudent to take a balanced vitamin E with higher levels of the
GT. However, most of the studies that show benefit from
supplements of vitamin E are done with the synthetic form or the
natural AT, with little or no GT. Recent studies that cast some
doubt on the value of antioxidant supplements often use too low a
dose, such as 50 mg of vitamin E, but perhaps they should be
looking at using combinations of effective doses of several
antioxidants, and including GT in the tocopherol mix.

With combinations of antioxidants they support each other
synergistically. These include selenium, vitamin C,
carotenoids--not just beta-carotene, alpha-lipoic acid, coenzyme
Q10, and flavonoids, as well as others. Recent articles show that
alpha-lipoic acid supplements can restore youthfulness to
animals, improve the function of their cells' mitochondria, and
enhance their brain function, especially when combined with a
derivative of the amino acid L-carnitine. These supplements also
help reverse the age-related memory loss in older animals.

My recommendation is to take some vitamin E in a multivitamin,
with the natural d-alpha form, and add some extra mixed
tocopherols with high levels of GT. In addition, get as many
dietary antioxidants as possible, from vegetables, fruits,
legumes, and whole grains, adding complementary antioxidants for
greater aging protection.

Love, Marriage, Work, and Stress
For Valentine's day, the World Heart Federation, a collection of
cardiology societies and heart foundations, came out and said
that love is good for your health. Citing a study of 10,000 men,
they noted that love and support can markedly reduce the
development of angina, even in the face of numerous other risk

It appears that marriage itself is not protective, but a loving,
supportive relationship. In one report, lack of social support
nearly tripled the mortality from coronary disease, while marital
status was unrelated.

On the other hand, marital stress significantly increases
mortality. In other words, if you are in a loving relationship,
married or not, you reduce disease risks, but a stressful
relationship makes things worse. Recent divorce has a significant
negative effect on health risks, but so does staying in a
stressful relationship.

Another study, the MRFIT, or Multiple Risk Factor Intervention
Trial, is a long term study that has led to a report that both
work and marital stress can significantly contribute to mortality
from heart disease. The lesson is not to go out and get married,
but to strive to find satisfying relationships and work, and
combine them with healthy lifestyle choices--exercise, diet, and
stress management.

It has been shown that psychological support and stress reduction
can improve the mortality in people with heart disease. Support
groups and rehabilitation programs can help significantly. In one
study, mortality was reduced from 17 percent to 4 percent over a
nine-year period for heart attack patients in rehab programs. In
addition, the rehab patients had less stress and depression than
controls. I've reported earlier on other studies showing that
yoga and meditation provide similar benefits.

Supportive relationships are usually the result of giving
support, not expecting it or searching for it (D.H. Lawrence
writes "...only the loving find love, and they never have to
search for it."). Satisfying work comes from giving every effort
to whatever job you are doing. If you are in difficult work or
relationship situations, they are likely to have negative effects
on your health, and you should consider what is necessary to
improve them or change them.

Raynaud's Disease: Ask Dr. J
Q. I have Raynaud's syndrome. My hands turn very blue when
exposed to the cold. Can you recommend something? (FK, New York)

A. Raynaud's disease involves spasms of the small arteries in the
hands, and sometimes the feet or face, triggered by cold. The
syndrome is sometimes associated with auto-immune diseases such
as scleroderma, lupus or rheumatoid arthritis (when it is called
Raynaud's phenomenon), and it can be the first sign of such
disorders, but it often occurs alone with no apparent disease
association. It can also be triggered by reaction to some drugs,
including beta-blockers, chemotherapy. It is much more common in
women than men.

The extremities turn white with lack of blood flow, and as it
persists they can turn blue and then bright red as the spasm
abates and blood rushes back in to the tissues. It can cause
numbness and tingling from lack of blood flow, and then pressure
and pain with the last phase.

The obvious recommendation is to keep warm and wear gloves and
scarves in cold weather (not everyone can move to warmer climates
as a solution, but it is a nice idea!) and get regular exercise.
Avoid all tobacco, a cause of arterial spasms.

While medications are sometimes used, a number of dietary
supplements may provide relief. Vitamin B3, as timed-release
niacin (250 mg twice daily) or inositol hexaniacinate (800 to
1600 mg daily) has been successful. Gamma-linolenic acid (GLA,
240 mg from borage oil) relaxes the blood vessel muscles by
rebalancing the prostaglandins that affect smooth muscle
contraction (reducing meat and other animal fat in the diet may
provide similar benefit by reducing arachidonic acid that leads
to increased muscle spasm).

Ginkgo biloba improves blood vessel function and can relieve
Raynaud's symptoms (120 to 240 mg of standardized extract). Other
supplements that help include magnesium as a blood vessel
relaxant (400 to 1000 mg), fish oil (2000 to 10,000 mg), and
L-carnitine (2000 to 3000 mg).

In the Health News
a. Elevated levels of homocysteine in the blood is a known risk
factor for heart disease. Now research shows that it is also a
significant risk for the development of dementia, including
Alzheimer's disease (Seshadri S, et al., Plasma
homocysteine...and Alzheimer's disease. N Engl J Med 2002 Feb
14;346(7):476-83). Information from the Framingham study
indicates that each 5-unit rise in plasma homocysteine leads to a
40 percent increase in dementia incidence. Levels above 14 units
doubled the risk. Homocysteine can be lowered with B vitamins,
including folate, B6, and B12.

b. Non-steroidal anti-inflammatory drugs (NSAIDS) are
contributors to the risk of gastrointestinal bleeding, and now it
appears that in patients with congestive heart failure they can
increase the likelihood of relapse (Feenstra J, et al.,
Association of nonsteroidal anti-inflammatory drugs with...heart
failure. Arch Intern Med. 2002 Feb 11;162(3):265-270). Natural
anti-inflammatory agents curcumin, ginger, vitamin C are free of
this risk.

Diet and Disease
Insulin resistance, most commonly the result of obesity, and a
reflection of poor sugar metabolism, is a risk factor for the
development of heart disease and diabetes. A recent study shows
that caffeine intake, even in moderate amounts, can cause insulin
resistance and thus increase disease risks (Keijzers GB, et al.,
Caffeine can decrease insulin sensitivity in humans. Diabetes
Care 2002 Feb;25(2):364-9). Caffeine increased blood levels of
adrenal stress hormones, and elevated blood fats and blood
pressure. The editorialists noted that this adds another risk
from caffeine, but they cryptically remarked that coffee drinkers
should not panic, because these were experimental conditions with
healthy people! They think you should wait to become sick from
caffeine, then panic.

Recipe of the Month: Herb-Nut Loaf

Nut loaf can be quite tasty, although often ridiculed by
non-vegetarians. In a mixing bowl, combine 1 1/2 cups of walnuts
or almonds ground up in a blender, 2 cups of bread crumbs
(toasted whole wheat sesame bread is good), 1 1/2 cups of minced
tomato, 1 1/2 onions and 4 cloves of garlic minced and lightly
stir-fried in olive oil, 2 beaten eggs, 1 Tbsp of soy sauce, 1
tsp of lemon juice, 2 tsp each of thyme, oregano, and chili
powder, and 8 Tbsp of minced parsley and cilantro. Mix well and
fill into an oiled loaf pan; bake for 35 minutes at 350º F. Slice
and cover with mushroom gravy (mushrooms, onions, garlic and
ground pepper, sauteed in olive oil, with added organic vegetable
broth--you can buy this at a health food store). This is a
delicious main course with steamed veggies and salad.

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Young EM, Fors SW, Factors related to the eating habits of
students in grades 9-12. J Sch Health 2001 Dec;71(10):483-8.

American Heart Association. 2002 Heart and Stroke Statistical
Update. Dallas, Texas: American Heart Association, 2001.

Vitamin E
Cooney RV, Gamma-tocopherol detoxification of nitrogen dioxide:
superiority to alpha-tocopherol. Proc Natl Acad Sci U S A 1993
Mar 1;90(5):1771-5.

Jiang Q, et al., gamma-tocopherol, the major form of vitamin E in
the US diet, deserves more attention. Am J Clin Nutr 2001

Ziaei S, et al., ...placebo-controlled trial...of vitamin E in
treatment of primary dysmenorrhoea. BJOG 2001 Nov;108(11):1181-3.

Hemila H, et al., Vitamin C, vitamin E, ... Beta-carotene in
relation to common cold incidence... Epidemiology 2002

Liu J, et al., Age-associated mitochondrial oxidative
decay...Proc. Natl Acad Sci USA, 2002 Feb 19;99(4):1876-81.

Hagen T, et al., Feeding acetyl-L-carnitine and lipoic acid to
old rats significantly improves metabolic function while
decreasing oxidative stress. Proc Natl Acad Sci, 2002 Feb

Love, Stress, and Mortality
Medalie JH, Goldbourt U, Angina pectoris among 10,000 men.
Psychosocial...risk actors... Am J Med 1976 May 31;60(6):910-21.

Tucker JS, et al., Marital history...: alternative explanations
to the protective effect of marriage. Health Psychol 1996

Welin C, et al., ...importance of psychosocial factors for
prognosis after myocardial infarction. J Intern Med 2000

Orth-Gomér K, et al., Marital Stress Worsens Prognosis in...
Coronary...Disease JAMA. 2000 December 20;284(23):3008-3014.

Matthews KA, et al., Chronic Work Stress...Marital Dissolution
and...Mortality... Arch Intern Med 2002 Feb 11;162(3):309-315.

Denollet J, Brutsaert DL, Reducing emotional distress improves
prognosis in coronary heart disease: 9-year mortality in a
clinical trial of rehabilitation. Circulation 2001 Oct


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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.