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November 2002

Hysteria over Listeria
Coenzyme Q10 and Parkinson's Disease
How Coenzyme Q10 Might Work
Other Treatments for PD
Ask Dr. J: Lithium and Mood
In the Health News
Diet and Disease
Recipe of the Month: Wild Rice and Mushrooms
References

Hysteria over Listeria

Dear Friends,
Recent warnings have made people aware of the risk of infection from eating contaminated meat products, and many of them have been recalled because of the presence of E. coli, Listeria monocytogenes, and other infectious agents. Much news was made of the 23 deaths and 120 illnesses from listeriosis this summer in the Northeast.

Since then, another recall of processed meats, this time of 27 million pounds of potentially contaminated poultry products from a factory of Pilgrim’s Pride (Wampler brand) in Pennsylvania, has reignited the concern over the potential for lethal infections.

Listeriosis is a serious disease. Symptoms may include fever, muscle aches, nausea or diarrhea. Spread of the infection to the nervous system may lead to headache, confusion, stiff neck, and loss of balance, and even convulsions and death. Of those infected with the disease, about 25 percent will die.

Listeria is more serious in the elderly, the frail, those who are immune compromised, or people ill with diabetes, cancer, or kidney disease. Pregnant women are much more susceptible to the infection, but the most serious effects are in the newborns of these infected women.

Many Reasons to Avoid Meat and Poultry
With the many other reasons to avoid meat and chicken in the diet (last month I wrote about the salmonella contamination in sausages), and to say nothing of mad cow disease, this is just one further indication that you have to be diligent in your food choices.

It is curious to me that the 23 deaths from listeriosis have created such a stir in the news, when it is possible to relate the consumption of meat and poultry to hundreds of thousands of deaths every year from coronary heart disease, cancer, hypertension, strokes, non-Hodgkins lymphoma, kidney disease, and other conditions, plus increases in rheumatoid disease and gall stones. Without diminishing the importance to public health of acute infections, the real problem with western dietary choices are the chronic, degenerative diseases from foods that are not contaminated with bacteria and parasites.

Although the disease picture in China is changing (as the diet is westernized), when T. Colin Campbell reported in 1998 on the Cornell-China study, it was clear that in rural areas of China consumption of animal protein was about 10 percent of the US intake, and dietary fat was about half of that in the US. Among men, coronary disease was only one-sixteenth(!) that in the US. High intake of plant protein, legumes, and vegetables was associated with lower rates of these diseases. Further benefits accumulated with every increase in the proportion of plant-based foods in the diet.

Coenzyme Q10 and Parkinson’s
Parkinson’s disease (PD) is a disease of neurons in the area of the brain that affects muscle movement. Symptoms include tremors, difficulty with walking and balance, rigidity, and poor coordination. The incidence is greater in people over 50, and increases with age (certain drugs can cause these symptoms in younger people).

PD is a degenerative disease, and the deterioration progresses with time. The cells in one region of the brain, called the substantia nigra, are affected and the production of the neurotransmitter dopamine is reduced. So far, no treatments have been able to slow the progression of the disease. A number of drugs can temporarily reduce the symptoms. The medications that help control PD may have side effects, including excessive episodes of sleepiness (somnolence) or involuntary writhing movements (dyskinesia).

It was widely reported in the news recently that coenzyme Q10 could help delay the development of symptoms in patients with early signs of Parkinson’s disease. The researchers tested unusually high doses of 300, 600, and 1200 mg daily, and compared them to placebo over a period of 16 months.

Although there was some trend toward benefit from doses of 300 and 600 mg daily, the most (and statistically significant) benefits were seen with doses of 1200 mg. This is far more than is usually given for heart disease, cancer, and immune enhancement (common doses being from 100 to 400 mg daily).

How Coenzyme Q10 Might Work
Coenzyme Q10 is normally manufactured in the body, but the amount produced declines with age. It is an essential cofactor for the production of energy in the cell components called mitochondria. These mitochondria make the energy-storage molecule called ATP.

The health of the mitochondria is reflected in the proper function of many organs, including the heart and the brain. PD patients have both poor mitochondrial function and particularly low levels of coQ10.

Now it appears that health of the neurons affected in PD may be maintained longer in people who take coenzyme Q10 supplements. Two years ago, it was shown that neuronal degeneration was related to oxidative damage. In addition to the production of energy and maintaining mitochondrial health, coenzyme Q10 is also a potent antioxidant, so this may be one of the mechanisms by which it helps protect the nervous tissue in patients with PD.

Damage to mitochondria from pesticides has also been linked to PD in animal studies, particularly in the cells that produce dopamine. Coenzyme Q10 may protect the mitochondria from such toxic substances.

This new study only involved 80 subjects, but the results are very provocative because of the authors’ conclusion that there was a reduction in disease progression. Because patients did not improve in the first month, but were better at later evaluations, the authors suggested that this is a sign of prevention of neuronal degeneration, rather than just symptom relief. This study is also important because even administration of these high doses was effective, but caused no significant side effects.

In spite of this, one of the authors of the study suggested that the information was too limited, and it would be “premature” to recommend that patients start taking coenzyme Q10 because it was such a small study. The research team is planning to expand the study and add specific evaluation of neuronal degeneration. Based on previous information, it is likely that the new study will show that the neurons are protected by coQ10. If you or a loved one has PD, is it really wise to wait for the further research? This is a particularly poignant question, considering the safety of the treatment.

Previous studies have shown that high doses of vitamin E can help PD. In 1992, a pilot study showed benefits in delaying symptom progression with 3000 mg of vitamin C and 3200 IU of vitamin E. Lower doses did not work. High doses may be essential for benefits because of the difficulty of getting antioxidants into the brain.

Other nutrients that protect the brain include alpha-lipoic acid, acetyl L-carnitine, and proanthocyanidins, which I have discussed previously. A combination of these nutrients may make a significant difference to PD patients and their families.

Other Treatments for PD
Dietary supplements are not the only natural treatments that can help people with Parkinson’s disease. Exercise has been shown to help reduce depression as well as improve motor skills, and general signs of well being. In the 1999 study, intensive exercise was performed twice a week by patients with moderate PD symptoms.

Diet may also play a role. For patients who respond to the drug Sinemet, very low protein diets improve their response to the drug. The benefits are seen within one week, and it appears to be even better if most of the protein intake is toward the end of the day. It appears that protein interferes with the absorption of the medication.

To prevent PD, reduce your exposure to pesticides by eating organic foods, eat a wide variety of foods with antioxidants (vegetables, fruits, and legumes), and take brain-protecting antioxidant supplements, including coQ10. For treatment, take high doses of coenzyme Q10 and other antioxidants, get regular exercise, and eat a low protein diet, with most of the protein in the evening.

Ask Dr. J
Q. I have been having problems with mood swings and a Dr. suggested lithium carbonate. He said it’s a natural mineral and may help. Is this safe?  JY, New Jersey, via Internet

A. Although lithium is a natural mineral, it is not free of side effects when used to treat “bipolar disorder” or manic-depressive illness. The amounts in the diet (and it is not clearly essential) are in the range of 100 mcg per day, and doses for treatment are 500 mg daily.

Side effects include drowsiness, weakness, tremors, blurry vision, ringing in the ears, loss of appetite, heart arrhythmias, low blood pressure, abnormal kidney function, headaches, and others. Also, they can occur close to the therapeutic level of the drug, but it can help some patients.

If you need treatment for mood swings, you may benefit from some nutritional alternatives to lithium. One is to try a diet for blood sugar regulation as hypoglycemia can also cause mood swings. I recommend small meals spread through the day, with a high fiber content. Avoid sugar and white flour, caffeine, alcohol, and hydrogenated oils.

Regular exercise can help stabilize mood and relieve depression. Aerobic exercise, such as brisk walking, jogging, cycling, or swimming may be effective. Some evidence also supports the value of resistance exercise (weights).

A number of supplements can help. St. John’s wort is as effective as antidepressant medications for mild to moderate depression. You can try 300 mg of standardized extract 3 times a day for 6 to 8 weeks. Be careful to avoid excessive sun exposure while taking St. John’s wort, as it can cause sun sensitivity.

Omega-3 oils (9 gms a day, equal to 9 oz of oily fish) can also help manic depression. Other supplements that may be beneficial include 5-HTP, a precursor to the neurotransmitter serotonin (100 to 200 mg daily), and melatonin, the hormone from the pineal gland that regulates the body clock ( 3 mg at bedtime). In my clinical experience, vitamin B3 (I usually recommend inositol hexaniacinate, 800 to 1200 mg daily) and vitamin C (3000 to 4000 mg) can also help.

In the Health News

• You only need to look around to see it, but scientific data now shows obesity in adults and children has increased in recent years. Two recent studies published in the Journal of the AMA show about a 50 percent increase in overweight children, from 10 percent among teens in 1994, to 15 percent in 2000, and in adults from 22 to 30 percent in the same time period. (Flegal KM, et al., Prevalence and Trends in Obesity Among US Adults, 1999-2000. JAMA 2002 Oct 9;288(14):1723-7, and Ogden CL, et al., Prevalence and Trends in Overweight Among US Children and Adolescents, 1999-2000. JAMA 2002 Oct 9;288(14):1728-32.) The authors point out the serious public health problems that this presents.

• Last year, I reported on the anti-inflammatory and antioxidant effects of curcumin (the yellow pigment in turmeric), and its apparent benefit in preventing Alzheimer’s disease (but neglected to mention it again last month in the brain article). Earlier studies also showed that it could decrease tumors. New information confirms that curcumin is valuable for reducing pancreatic cancer cell growth in cell cultures (Hidaka H, et al., Curcumin inhibits...human pancreatic carcinoma cell growth by autocrine regulation. Cancer 2002 Sep 15;95(6):1206-14). The Japanese researchers conclude that curcumin is a potent anticancer agent.

Diet and Disease
• A study of low-carbohydrate diets showed more weight loss compared to a diet with 30 percent fat (erroneously called a low fat diet), and cardiac risk factors were not increased. However, this is a six-month study, the controls were not on a real low-fat diet (15 percent). The weight loss itself, not the diet, could explain the normal blood pressures and blood sugars, but risks of cancer, heart disease, and more make this an unhealthy long-term diet plan. (Reuters Health, October 21, 2002.)

Recipe of the Month: Wild Rice and Mushrooms
I buy real wild rice from Minnesota Native Americans in a land recovery project (Native Harvest at 888-779-3577, or www.nativeharvest.com). Add one cup of wild rice to two cups of organic brown rice and rinse three times, then cook in 6 cups water. Sauté onions and garlic with marjoram, thyme, and sage for a savory flavor. Add some diced mushrooms (I like to mix a variety of wild mushrooms) and a small amount of soy sauce, umeboshi plum vinegar, or lemon juice, and cook lightly, adding enough water to make a sauce (option: add some diced tofu to the onions). Serve this over the rice. Variations: add different spices, such as curry, cumin, and cayenne pepper, or simply cumin, turmeric (for extra color and antioxidants), and crushed black and white pepper.

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References

Hysteria over Listeria
Pilgrim’s Pride Begins Record Meat Recall (Reuters) Oct 14, 2002.
Campbell TC, et al., Diet, lifestyle, and the etiology of coronary artery disease... Am J Cardiol 1998 Nov 26;82(10B):18T-21T.
Sinha R, Rothman N, Role of...meat...in the etiology of human cancer. Cancer Lett 1999 Sep 1;143(2):189-94.

Coenzyme Q10 and Parkinson’s Disease
Shults CW, et al., Effects of coenzyme q10 in early Parkinson disease: evidence of slowing of the functional decline. Arch Neurol 2002 Oct;59(10):1541-50.
Fahn S, A pilot trial of high-dose alpha-tocopherol and ascorbate in early Parkinson’s disease. Ann Neurol 1992;32 Suppl:S128-32.
Fleming L, et al., Parkinson’s disease and brain levels of organochlorine pesticides. Ann Neurol 1994 Jul;36(1):100-3.
Betarbet R, et al., Chronic systemic pesticide exposure reproduces features of Parkinson’s disease. Nat Neurosci 2000Dec;3(12):1301-6.
Giasson BI, et al., Oxidative damage linked to neurodegeneration ...Science 2000 Nov 3;290(5493):985-9.
Reuter I, et al., Therapeutic value of exercise training in Parkinson’s disease. Med Sci Sports Exerc 1999 Nov;31(11):1544-9.
Pincus JH, Barry K, Influence of dietary protein on...Parkinson’s disease. Arch Neurol 1987 Mar;44(3):270-2.
Riley D, Lang AE, Practical application of a low-protein diet for Parkinson’s disease. Neurology 1988 Jul;38(7):1026-31.

Lithium and Mood
Ahmadi J, et al., Various types of exercise and scores on the Beck Depression Inventory. Psychol Rep 2002 Jun;90(3 Pt 1):821-2.
Mather AS, et al., Effects of exercise on depressive symptoms in older adults ... Br J Psychiatry 2002 May;180:411-5.
Stoll AL, et al., Omega-3 fatty acids and bipolar... Prostaglandins Leukot Essent Fatty Acids 1999 May-Jun;60(5-6):329-37.
van Praag HM, de Haan S, ...An attempt to compare lithium with 5-[HTP]. Acta Psychiatr Scand Suppl 1981;290:191-201.
Angst J, et al., The treatment of depression with L-5-HTP] versus imipramine... Arch Psychiatr Nervenkr 1977 Oct 11;224(2):175-86

 


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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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