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May 2002

Healthy Diet Costs
St. John's Wort Research
Other Treatment Options
Vitamin E Protects Muscles
Allergies: Ask Dr. J
In the Health News
Recipe of the Month: Mashed Sweet Potato with Lime
References

Healthy Diet Costs

Dear Friends,
I recently saw a TV discussion group on healthy diets, and one of
the commentators was saying that shopping at the health food
store was expensive, and several others nodded in almost
automatic agreement, as though this were a well-known fact.

It is true that some foods at the health food store, particularly
organic foods, are somewhat more expensive than their
conventional counterparts. However, it is not true that eating a
healthy diet has to be expensive, even if you shop at a health
food store. This is a myth, because it totally depends on what
you choose.

A healthy diet based on unprocessed fresh vegetables, fruits,
whole grains, and legumes is generally quite inexpensive. For
example, a nutritious breakfast of oatmeal, banana or shredded
apple, and raisins, cooked in dilute soymilk, with sunflower
seeds and some cinnamon and nutmeg, usually costs under a dollar
(a little more if you use almonds instead of sunflower seeds). It
provides a lots of fiber, phytonutrients, and essential fatty
acids, and helps to control blood sugar and appetite for a long
time.

Similar choices of basic foods as I describe in my recipes for
lunch and dinner are just as cost effective. Costs are higher
when you buy prepared foods (rice cakes, for example, cost far
more than brown rice that you cook; granola is more expensive
than oatmeal).

I was recently reducing clutter in my home office (an action that
is as therapeutic as any that I recommend in my newsletter!), and
while clearing up a pile of papers, I came across a Boston Globe
article from 1996. The headline said, "Poor people's diets
winning the hearts of the affluent." The winning diet consisted
of basic foods, mostly vegetarian, minimally processed, and with
varied nutritional content, such as they eat in most of the
economically emerging countries. They might eat this way for
religious or economic reasons, and sometimes for health reasons,
but the fact is they can afford to eat this way, and people in
developed countries can't afford not to.

I realize that even when that article was written the costs of
eating three meals a day at the fast junk joints (formerly called
fast food restaurants) could be quite cheap (in every sense),
although that was not the comparison I envisioned. However, the
direct costs of the diet are only one consideration. The costs of
illness, degenerative diseases, and accelerated aging must be
added to the price of the food. And these costs go beyond the
monetary to the emotional and spiritual drain on individuals,
families, and friends. It is unfortunate that unhealthy diets are
now so widely exported to other countries.

In choosing a healthy diet for yourself, you will not only
protect your health without straining your pocketbook, but you
will set an example for others, and you will add to their health
while supporting increased availability of healthy food, and
promoting a healthier environment.

St. John's Wort Research
Recent headlines repeating previous negative claims about St.
John's wort (SJW) are apparently designed to discredit natural
remedies in general, and particularly SJW in this case. So I have
to repeat myself in criticizing these reports. The study in
question suggested that SJW appears useless in the treatment of
moderately severe depression. This is not news and it is not
relevant.

No one so far has claimed that SJW is useful for severe
depression, only mild to moderate depression, although in the
right dose with the right combination of other supplements, it
might still help more serious psychiatric illness.

To do a study such as this, and make the claim that SJW is no
better than placebo, leaves the reader thinking it is useless.
This is misleading at best, and deceitful at worst, and many
people may miss out on this beneficial treatment, because other
research shows that it is very useful for treatment of other
levels of depression.

Interestingly, in this study, published in the Journal of the
American Medical Association, Sertraline (Zoloft), a "serious"
treatment for depression, and one that generates billions of
dollars in sales each year, was also no better than placebo, and
for the most part no better than SJW. The report says "On the 2
primary outcome measures, neither sertraline nor H perforatum was
significantly different from placebo."

Another study a week later drew the same negative conclusion, in
spite of the authors' statement that "The number reaching
remission of illness was significantly higher with St John's wort
than with placebo."

The newspaper headlines blared the supposed ineffectiveness of
SJW, but little mention was made of the uselessness of Zoloft.
Perhaps they should have read "Zoloft no better than placebo for
severe depression." SJW has been shown to help with mild to
moderate depression.

Studies Support St. John's Wort:

For example, a German study published in the British Medical
Journal showed that SJW was equivalent to imipramine (Tofranil)
in treatment of mild to moderate depression, but with fewer side
effects. A 2001 German study showed significant benefit compared
to placebo after just 4 weeks on SJW, and the benefits started to
appear after just one week.

Another placebo-controlled, double blind study in 1998 showed
similar results using standardized extract containing hyperforin,
one of the components of SJW. A 1995 study showed similar
benefits compared to placebo, and a 70 percent response rate,
which is as much as you can see with the drugs. In addition, the
SJW also relieved anxiety, and had no side effects in this study.

This does not mean that SJW has no side effects. It can cause sun
sensitivity, which is lessened if you divide the dose to three
times per day. Interference with some medications is possible,
and occasional digestive upset.

It is interesting to note that the lead authors of the JAMA study
hold stock in, have received grant money from, and been paid
consultants to Pfizer, the manufacturer of Zoloft, and have been
paid speakers for this and other drug companies. They note that
all the previous studies have flaws (as all studies do), implying
that their study corrects all prior research. I don't believe it.

Other Treatment Options
In addition to SJW for depression (the usual dose is 300 mg of
standardized extract taken three times a day), I also recommend a
number of other treatments. Not surprisingly, regular aerobic
exercise frequently helps relieve depression. It is not uncommon
to see poor regulation of blood sugar contributing to mood
abnormalities, so a diet free of sugar and refined foods can
help. Food allergens often play a role, and avoiding them may be
an essential part of treatment.

Other supplements that help include 5-hydroxy tryptophan (5-HTP
100 to 200 mg daily), which is a precursor of serotonin, one of
the neurotransmitters. The SSRI medications (Zoloft, Paxil,
Prozac) increase the available serotonin in the junction between
nerves, but increasing the production of serotonin can help also.

I have found that B vitamins, zinc, magnesium, and vitamin C are
helpful. S-adenosyl methionine (SAMe, 400 to 800 mg) is another
valuable treatment. For the elderly, B12 and ginkgo biloba can
relieve depression, and finally, melatonin (3 mg at night) can
elevate mood.

Vitamin E Protects Muscles
The antioxidant activity of vitamin E is well known, and as a
result, it appears to reduce damage to muscles related to oxygen
free radicals. A report at the Experimental Biology 2002
conference in San Diego showed that vitamin E can reduce muscle
soreness, inflammation, and fatigue that occur after strenuous
exercise.

Vitamin E mops up these harmful chemicals, reducing symptoms and
aiding recovery. The researchers used 1000 IU of vitamin E in
both younger and older age groups. The younger group responded
better, but both groups were helped by the supplements. The
researchers noted that this is a high dose, and suggested that
lower doses might also be effective, although this appears to be
purely speculative.

Earlier studies have shown that vitamin E can protect the heart
muscle in congestive heart failure, in which the muscle is weak
and cannot pump blood as effectively as in healthy people. A
study in animals revealed that antioxidant supplements reduced
oxidative stress on heart muscles and improved cardiac function.

They used either a combination of vitamins C and E and
beta-carotene, or vitamin E alone, and found good results with
both regimens, but the combination was better than the single
vitamin. The researchers suggested that these antioxidants would
help congestive heart failure in humans. I would suggest adding
coenzyme Q10.

Allergies: Ask Dr. J
Q. It seems to be a terrible allergy season this year. Any
suggestions? (J.R., Connecticut)

A. Probably because of the warm winter, especially in the
northeast, allergies do seem to be more prevalent this year than
most. Symptoms of hay fever or pollen allergies include runny
nose, watery eyes, sneezing, conjunctivitis, sinus congestion, or
even cough, and asthmatic breathing.

Staying away from food allergens is a good start, particularly
milk products, which always seem to exacerbate the congestion
from other allergens. Other foods may be allergens also, but this
is individual, so you may need to do some self testing to find
out which ones may be causing your sensitivity.

Environmental controls that reduce exposure to allergens, such as
a home air filter, hypoallergenic bedding, and air conditioning
on hot, humid days, play a large role in reducing symptoms.

Supplements can also help a lot with both allergies and asthma.
Vitamin C (2 to 6 gms daily) reduces the histamine response, and
has anti-inflammatory benefits. Vitamin B6 (50 to 200 mg) and
magnesium (500 to 1000 mg) both relax the airways and are useful
treatments, especially if asthma is part of the allergic
response.

Quercetin is a bioflavonoid that reduces the histamine release
from the tissue mast cells and blood basophils. It works by
stabilizing the cell membranes and making them less sensitive to
the allergic trigger for histamine release. The usual dose is 800
to 1200 mg daily.

Nettle (250 to 1000 mg of standardized extract) is an herb with a
long history of use for inflammation and allergies. It works
fairly quickly to reduce symptoms such as runny nose, sinus
congestion, and watery eyes.

In the Health News
a. Antioxidant vitamins are associated with protection of the
heart from atherosclerosis. A new study shows that heart
transplant patients, 70 percent of whom develop atherosclerosis
within 3 years, are protected by supplements of vitamins C and E
(Fang JC, et al., Effect of vitamins C and E on progression of
transplant-associated arteriosclerosis: a randomised trial.
Lancet 2002 Mar 30;359(9312):1108-13). It is suspected that the
transplant operation itself leads to oxidative stress that
increases the risk of atherosclerosis. The researchers gave
supplements of 500 mg of vitamin C and 400 IU of vitamin E twice
a day and compared this to a placebo. They measured damage to the
lining cells in the arteries, and found significant protection in
those subjects receiving the vitamin supplements.

b. Antibiotics in animal feed and overuse in humans is an
increasingly serious problem. About 50 percent of all antibiotics
in the US are put into animal feed as a growth enhancer. The
European Union has just banned such use of antibiotics in animal
feed (Reuters Health, March 25, 2002). In the US, overuse of
antibiotic prescriptions has led to increasing resistance of
group A Strep to erythromycin and azithromycin (Martin JM, et
al., N Engl J Med 2002 Apr 18;346(16):1200-6). Reducing
unnecessary prescriptions can reverese this trend.

Diet and Disease
Eating oatmeal daily can reduce blood pressure and allow
hypertensive patients to reduce their medications. Oatmeal also
reduced their total cholesterol, triglyceride levels, and fasting
glucose (Pins JJ, et al., J Fam Pract, 2002 April;51(4):353-9).
The same researchers also found that all whole grains reduce
insulin resistance, a risk factor for diabetes and heart disease
(Pereira, MA, et al., Am J Clin Nutr. 2002 May;75(5):848-55.)

Recipe of the Month: Mashed Sweet Potato with Lime
For those of you who want a side dish rich in natural carotenoids
and the vitamin C and other beneficial phytochemicals found in
lime juice, this one is delicious and simple. Wash, trim, and cut
two or three medium sweet potatoes (with or without the peel,
your choice, but I usually leave it on), and put them in a
steamer until they are quite soft. Squeeze the juice of one or
two limes and mash together with the sweet potatoes, into a
creamy blend. You can add a pinch of sea salt if you choose. I
serve this with a salad and either a piece of wild salmon, or the
grilled tofu or grilled portobello mushroom from previous
newsletters. You can also make the same dish with butternut
squash, or a pumpkin, although these are not usually as rich as
the sweet potatoes (or as easy to prepare).

Click here to receive the Healthy Living newsletter free.

References

Editorial:
Boston Globe, September 5, 1996, Poor people's diets winning
hearts of affluent.

St. John's Wort and Depression:
Hypericum Depression Trial Study Group, Effect of Hypericum
perforatum (St John's Wort) in Major Depressive Disorder. JAMA
2002 Apr 10;287(14):1807-14.

Shelton RC, et al., Effectiveness of St John's wort in major
depression: a randomized controlled trial. JAMA 2001 Apr
18;285(15):1978-86.

Kalb R, et al., Efficacy and tolerability of hypericum extract WS
5572 versus placebo in mildly to moderately depressed patients.
Pharmacopsychiatry 2001 May;34(3):96-103.

Laakmann G, et al., St. John's wort in mild to moderate
depression: the relevance of hyperforin for the clinical
efficacy. Pharmacopsychiatry 1998 Jun;31 Suppl 1:54-9.

Witte B, et al., Treatment of depressive symptoms with a high
concentration hypericum preparation. Fortschr Med 1995 Oct
10;113(28):404-8.

Philipp M, et al., Hypericum extract versus imipramine or placebo
in patients with moderate depression... BMJ 1999 Dec
11;319(7224):1534-8.

Penninx BW, et al., Exercise and depressive symptoms... J
Gerontol B Psychol Sci Soc Sci 2002 Mar;57(2):P124-32.

Vitamin E and Muscles:
Vitamin E May Lessen Post-Workout Muscle Soreness, Reuters
Health, April 23, 2002.

Shite J, et al., Antioxidant vitamins attenuate oxidative stress
and cardiac dysfunction in tachycardia-induced cardiomyopathy. J
Am Coll Cardiol 2001 Nov 15;38(6):1734-40.

Allergies
Middleton E, Effect of flavonoids on basophil histamine release
and other secretory systems. Prog Clin Biol Res 1986;213:493-506.

Mittman P, Randomized, double-blind study of freeze-dried Urtica
dioica in...allergic rhinitis. Planta Med 1990 Feb;56(1):44-7

 


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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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