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October 2002

Reporting Research Statistics
Nutrition and Brain Function
Antioxidant Brain Protection
Ask Dr. J: Peptic Ulcers
Ask Dr. J: Carotid atherosclerosis
In the Health News
Diet and Disease
Recipe of the Month: Guacamole and Gazpacho
References

Reporting Research Statistics

Dear Friends,
If you know how to manipulate statistics, you can appear to prove or disprove almost anything. I am particularly interested in recent articles that appear to show that ginkgo biloba does not work to help improve memory and that vitamin E is dangerous.

In similar articles that I have already discussed, they suggested that vitamin C was either risky for arteries or a cancer promoter (both untrue), or that St. John’s wort did not help depression (but was as good as Prozac relatives!).

There is a fascinating little book by Darrell Huff, first printed in 1953, called How to Lie with Statistics. He notes that the death rate in the Navy during the Spanish American war was 9 per thousand, while in New York it was 16 per thousand. Navy recruiters used the figures to show that it was safer to be in the Navy than in New York.

They neglected to mention that the Navy is made up of young, fit, carefully selected men, while the New York population included the elderly, the infirm, infants, and hospitalized patients, so the two groups were hardly comparable.

Data manipulation still takes place in medical science, when a researcher or a reporter wants to make a point. A study may be too small or too short to reach significance. Researchers can then claim that they found no evidence of effectiveness. Authors may also draw conclusions that are not justified by their own data.

Misleading studies and reporting
The recent study on ginkgo biloba is an example of misleading conclusions. Many studies have shown that as people age, and memory starts to fail, they can restore and maintain their mental function with supplements of ginkgo biloba. Research supports a daily dose of 120 to 240 mg of standardized extract. In this study, the subjects had normal memory function, and in six weeks they had no improvement with 120 mg daily. One can only conclude from this that taking ginkgo at a typical dose (but not high doses) for a short time may not help people with normal memory.

News reporters may mislead readers with their headlines and opening paragraphs, even if later in the article they temper those remarks. Many readers do not venture deeply into the text. When the first scientific article showing benefits from ginkgo appears, that is news. The next nine are not. Then one appears that shows no benefit, and that is news again. Tempting material for reporters. We must draw our conclusions from the weight of evidence, not one study. Right now, the evidence shows that ginkgo biloba, St. John’s wort, vitamin C, vitamin E, and numerous other dietary supplements and herbs are safe and effective in the treatment and prevention of many diseases.

Nutrition and Brain Function
Last month I reported that adequate dietary linoleic acid (an omega-6 polyunsaturated fatty acid, or PUFA), is an essential fatty acid (EFA), found in sunflower, corn, and soy oils that reduces the risk of stroke. However, when consuming PUFA’s, you must take adequate antioxidants.

PUFA’s are highly subject to oxidation. A high intake of omega-6 PUFA is associated with impairment of brain function, perhaps because of oxidation or the production of arachidonic acid, a precursor that can lead to increased inflammation and reduced blood flow.

Other studies point out that the issue is complex. Research shows that a high intake of total fat, saturated fat, and cholesterol can nearly double the risk of dementia, while a high intake of fish with omega-3 EFA’s decreases the risk of developing dementia (flaxseeds and walnuts are other sources of omega-3 fatty acids).

The authors speculate on the mechanisms by which fat consumption might increase the risk of brain degeneration. They include atherosclerosis and thrombosis, inflammation, impaired brain development, abnormal membrane functioning, or an accumulation of beta-amyloid, a protein found in excess in Alzheimer’s disease (AD).

Although the Western diet is rich in omega-6 oils, and relatively deficient in omega-3 oils, much of the omega-6 oil comes from highly processed sources and margarines, of which the former may already be oxidized, and the latter compromised by high levels of trans fatty acids. Trans fatty acids are found in hydrogenated oils, and they interfere with normal fat metabolism, prostaglandin production, and membrane structure.

One study on fat and brain function showed that the risk of AD was doubled for subjects with the highest level of dietary fat compared to those with the lowest. The same relationship was noted between total caloric intake and AD. These are particular problems in the US, where fat consumption and total caloric intake are both high.

In other research, investigators studied the effects of omega-3 oils and saturated fat on cognitive function in animals. They found that if brain blood flow was already low, increased saturated fat led to further cognitive decline. On the other hand, in the same study, omega-3 fish oil improved the brain function in animals. They evaluated the animals by maze testing and other behavioral measurements.

One of my concerns is that many people are choosing low carbohydrate diets for weight loss and other reasons. I agree that refined, simple carbohydrates (especially sugars and white flour) are significant problems in the western diet, and increasingly in other countries, including China and Japan. However, complex carbohydrates from whole, unrefined foods are healthy.

Whole, unrefined foods include whole grains, potatoes, yams or sweet potatoes, winter squashes, beans, and fresh vegetables and fruits. With low carbohydrate diets, the only alternative sources of calories are protein and fats. If calories are restricted, active people will lose weight. High fat intake is not healthy, and loss of brain function is only one of the risks. (The surest and safest way to lose weight is to increase exercise while eating whole, healthy, natural foods.)

Antioxidant Protection of the Brain
Because of the risk of oxidation of dietary fats, high levels of fruits and vegetables, particularly those very rich in antioxidants (such as berries, which I wrote about last month) are apparently protective of brain function (as well as reducing heart disease, cancer, eye disease, and more). Other antioxidant nutrients that protect the brain include coenzyme Q10, acetyl L-carnitine, alpha-lipoic acid, N-acetyl cysteine, ginkgo, bioflavonoids, and proanthocyanidins.

Vitamin E is one antioxidant that helps preserve brain function. Beta-amyloid is toxic in part due to free radical damage, which can be controlled to some extent by vitamin E. In tissue culture, vitamin E protects brain cells.

However, the study I mentioned on page 1 showed that supplements of 200 IU of vitamin E, might prolong respiratory infections or increase symptoms. While such a study is of concern, many other human and animal studies suggest the opposite for influenza, hepatitis, and other infections, and enhancement of immune function.

I suggest a low-fat diet with adequate amounts of the EFA’s, with specific EFA’s added as needed, and nutrient and herb antioxidant supplements.

Ask Dr. J
Q. What is the alternative for the treatment of ulcers? RB, via Email

A. Peptic ulcers are erosions in the stomach or the duodenum, the first part of the small intestine, and the disease is often related to the presence in the stomach of a bacterium called Helicobacter pylori. Treatment includes antacid drugs and antibiotic therapy to eliminate the bacteria. Pepcid, Axid, and Prilosec are examples of antihistamine antacids, but they have side effects, and reducing stomach acid may increase the growth of Helicobacter.

It is important to eliminate the bacteria, but many other lifestyle changes and dietary supplements can also help relieve symptoms and heal the ulcer. Avoid aspirin and other non-steroidal anti-inflammatory drugs, such as ibuprofen (Advil or Motrin), which are stomach irritants.

Stress plays a role in hyperacidity and predisposition to ulcers. Stress reduction, through visualization, breathing exercises, yoga, meditation, or the relaxation response may be helpful.

Dietary changes that help include elimination of caffeine, alcohol, sugar, salt, and white flour foods, as well as fried foods and highly processed fast foods. High dietary fiber helps to absorb stomach acid and reduce damage to the duodenum, and it prevents the recurrence of ulcers.

Dietary supplements are very important. L-glutamine, the main source of energy for intestinal cells, promotes healing of any gastric inflammation (2-4000 mg daily). Arginine, another amino acid, also helps ulcer healing (3-5000 mg).

Heartburn or pain in the upper abdomen or chest can be relieved with a licorice extract called DGL (deglycyrrhinizated licorice), which coats the stomach lining. It also helps relieve acid reflux symptoms. It must be chewed to be effective.

I also recommend vitamins C (2-6000 mg) and E (400 IU), zinc (30 mg), quercetin (800 mg) and other bioflavonoids, plus some vitamin A.

Q. My dad has a blocked carotid. What can he do without surgery? JL, W. Virginia.

A. Symptoms of blocked carotid arteries range from temporary loss of brain function called a transient ischemic attack (TIA, including dizziness, weakness, paralysis, or loss of vision, to a stroke from prolonged lack of brain circulation.

Atherosclerotic carotid arteries require the same lifestyle changes as heart disease. A low-fat, high-fiber vegetarian diet plus fish appears to provide the best nutrition. Typical dietary supplements include vitamins C (4-6000 mg), and E (800 IU), magnesium (1000 mg), coenzyme Q10 (200 mg), and a comprehensive multivitamin (such as UltraVitality from QCI Nutritionals).

For high cholesterol, he can take octacosanol (10 mg plus mixed polycosanols), inositol hexaniacinate (16-2400 mg), gugulipids (500 mg), or red yeast rice (1000 mg), plus garlic, and fish oils (both of which also help circulation).

If he has high blood pressure, coQ10 should help plus hawthorn extract (500 mg), garlic, and gamma-linolenic acid (240 mg). He should also start intravenous chelation therapy with EDTA, shown since the 1950’s to help circulation to the heart, brain, and legs. Find a doctor from the American College for Advancement in Medicine (ACAM), at www.acam.org, or 800-532-3688.

In the Health News
• A new review of women taking hormone replacement therapy confirms the recent reports from the Women’s Health Initiative that they appear to do more harm than good. This review is of 20,000 women in four different studies (Beral V, et al., Evidence from randomised trials on the long-term effects of hormone replacement therapy. Lancet 2002 Sep 21;360(9337):942-44). Again, they showed an increased risk of strokes, breast cancer, and blood clots in women on Premarin with or without medroxyprogesterone. However, it is important to note that none of this information applies to women taking natural (bio-identical) hormones. Human estrogens and progesterone are not the same as the typical prescriptions given to women. Many compounding pharmacies will make these bio-identical hormones with a doctor’s prescription.

Diet and Disease
• Salmonella bacteria are found in significant numbers in sausages, according to British researchers. Even if the sausages appear well cooked, they may still have live bacteria, which can cause diarrhea, vomiting, and fever (Reuters Health, September 10, 2002). The bacteria were found in just under 10 percent of sausages, particularly in cheap brands. In the report, the public health doctors said the message is to be sure to cook your sausages well! Well, that is one possible message!

• A 28-year Finnish study of 10,000 people confirms that an apple a day may keep the doctor at bay (Knekt P, et al., Flavonoid intake and risk of chronic diseases. Am J Clin Nutr 2002 Sep;76(3):560-8.) Many antioxidant flavonoids from fruits and vegetables reduce the incidence of cancer, asthma, diabetes, heart disease, and strokes. Apples, rich in quercetin, appeared to provide the greatest risk reduction, but many other flavonoids, such as kaempferol from onions, and hesperidin were also beneficial.

Recipe of the Month: Garden Guacamole and Gazpacho
I can’t grow avocados or lemons, but I add my own garden harvest to them for a healthy dip. Peel and mash up two ripe avocados, juice one lemon (adjust the amount for your taste), press one or two cloves of garlic, and mince a fresh medium tomato and a handful of fresh cilantro. Add some minced hot pepper if you like it spicy. Serve this with wedges of whole wheat pita bread. While you are at the tomatoes, cilantro, and garlic, (and fresh basil) you can make that cold gazpacho soup I mentioned last month. Add to the above ingredients some diced sweet peppers and cucumber, organic corn, minced onion and fresh basil, and lemon juice, with a small amount of tomato juice for liquid. Add a dash of cumin, pepper, and oregano. Now, plan a larger garden for next year.

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References

Supplement Effectiveness, Statistics, and Reporting
Graat JM, et al., Effect of daily vitamin E and multivitamin-mineral supplementation on acute respiratory tract infections in elderly persons... JAMA 2002 Aug 14;288(6):715-21.
Solomon PR, et al., Ginkgo for memory enhancement: a randomized controlled trial. JAMA 2002 Aug 21;288(7):835-40.
Kirsch I, The Emperor’s New Drugs: An Analysis of Anti-depressant Medication... Prevention & Treatment, 2002 July 15; 5(article 23 online) (American Psychological Association).

Nutrition and The Brain
Kalmijn S, Fatty acid intake and the risk of dementia and cognitive decline: a review of clinical and epidemiological studies. J Nutr Health Aging 2000;4(4):202-7.
Luchsinger JA, et al., Caloric intake and the risk of Alzheimer disease. Arch Neurol 2002 Aug;59(8):1258-63.
de Wilde M, et al., The effect of n-3 polyunsaturated fatty acid-rich diets on cognitive and cerebrovascular parameters in chronic cerebral hypoperfusion. Brain Res 2002 Aug 30;947(2):166.
Yatin SM, et al., Vitamin E Prevents Alzheimer’s Amyloid ...Protein Oxidation... J Alzheimers Dis 2000 Jun;2(2):123-131.
Greenwood CE, Winocur G, Learning and memory impairment in rats...high saturated fat. Behav Neural Biol 1990 Jan;53(1):74-87.
Andreone P, et al., Vitamin E as treatment for chronic hepatitis B: ...a...controlled pilot trial. Antiviral Res 2001 Feb;49(2):75-81.

Peptic Ulcers
Katschinski BD, et al., Duodenal ulcer and refined carbohydrate intake... Gut 1990 September;31(9):993–6.
Rees WD, et al., Effect of deglycyrrhizinated liquorice on gastric mucosal damage... Scand J Gastroenterol 1979;14(5):605-7.
Rydning A, Berstad A, Dietary aspects of peptic ulcer disease. Scand J Gastroenterol Suppl 1985;110:29-33.
Beil W, et al., Effects of flavonoids on...acid secretion... Helicobacter...Arzneimittelforschung 1995 Jun;45(6):697-700.
Tanaka H, et al., Influence of L-glutamine on aspirin-induced gastric lesions... Jpn J Pharmacol 1974 Dec;24(6):903-10.

 


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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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