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August 2003

False Claims (Pro and Con)
Black Cohosh Tea or Capsules
Vitamin C for Heart Disease
Breast Cancer Risk and Diet
Ask Dr. J: Iron Supplements
In the Health News
Diet and Disease
Recipe of the Month: Fruit Desserts

False Claims (Pro and Con)

Dear Friends,

I am pleased that the Federal Trade Commission is finally taking action against a repeating infomercial making unjustified claims for the supposed benefits of “coral calcium.” Calcium is an important nutrient, but there is no reason to believe that coral calcium (calcium carbonate) is superior in any way to other sources. In fact, it is relatively poorly absorbed, and potentially contaminated with heavy metals that are common in animal-derived calcium.

While most supplement manufacturers are reliable and honest, a few bad apples can taint the whole industry, so it is important that we not be seduced by false claims and unjustified hopes, and that abuses through advertising be exposed. The proponents of coral calcium have been making misleading claims that their product cures almost everything. This is totally unjustified.

On the other hand, I have seen proponents of nutrition, dietary supplements, and alternative medicine make unjustified claims, in bold headlines, that dietary supplements are harmful–until you read the fine print and realize that they are not against all supplements, only brands other than their own.

While I agree that many of the commercial supplements on the shelves of some drug stores and supermarkets are made with artificial colors, preservatives, and low doses of important ingredients, it is not true in general that supplements are harmful. In fact, even those conventional supplements are unlikely to do harm (it is just that they often contain doses that are below therapeutic levels).

I lament both forms of misinformation through advertising, infomercials, newsletters, radio shows and other media. It is so important for companies and professionals involved with health care and complementary/alternative medicine to stay close to the documented evidence, and to have reasonable justification for their claims (for both benefit and harm).

Reliable companies may make justifiable claims for the benefits of their products. The laws have recently been updated to allow more claims, as long as they are scientifically supported. Even the FDA is taking a more reasonable position toward more and better public information about dietary supplements and the health value of foods. The most likely place the public will get information about the health value of broccoli, berries, and beans, or vitamin C, folic acid, and coenzyme Q10 is at the point of sale, and more specifically on the label or signs accompanying the food.

I favor providing as much reliable information as possible so consumers can make wise choices. If a few companies abuse their trust and make false claims, it jeopardizes the future availability of reliable health information for all of us.

Black Cohosh Tea or Capsules

I have been asked by a reader about the relationship between black cohosh tea and the capsules that I usually recommend. The reader notes that her black cohosh herb tea says each bag contains 40 mg, while I recommend 40-mg capsules twice a day, and she wonders if she can take the tea instead of the capsules.

These amounts are not comparable. The amount in the tea is simply the amount of ground up rhizome (a root-like structure) that is put in the teabag. Not all of this will get into the tea after infusion, and it is not a standardized extract. While fresh and dried herbs and herb teas are often valuable in management of health problems, most of the recent research on herbs is done with standardized extracts, containing specific levels of known active compounds in addition to other components of the herb.

Black cohosh is valuable not only for hot flashes, but also for irritability, nervousness, and night sweats, as well as insomnia, all of which may accompany menopause. The usual dose is 40 mg of standardized extract twice a day. This contains 4 mg of 27-deoxyactein, one of the active substances called triterpene glycosides. Numerous studies have shown the value of black cohosh for treatment of menopausal symptoms.

Recently some researchers have expressed concerns because of a study in mice suggesting that black cohosh might be a problem for women who have undetected breast cancers. While the herb does not cause breast cancer, this study indicated that existing breast cancers spread more readily in treated mice. Their concern was that tumors in women might metastasize before they were detected.

It is not yet clear what the mechanism might be for this effect in mice, and the study has not yet been analyzed completely. Herbal influences on hormones might be quite different in mice, and so far in humans there has been no indication of significant side effects from black cohosh, including cancer risk. Another recent study, from the University of Illinois, showed that black cohosh did not have estrogenic effects, and did not stimulate the growth of estrogen-dependent tumors in mice. Previous studies showed similar results, so it is not yet appropriate to draw conclusions from just one study when it is contrary to other data.

In addition, for prevention of breast cancer and other tumors, I always recommend dietary guidelines and supplements that are protective (low-animal-fat vegetarian diets, lots of fruits and vegetables, soyfoods, such as tofu and miso, decaffeinated green tea, plus selenium, vitamins C and E, folic acid, coenzyme Q10, and omega-3 fatty acids from flaxseeds or fish). These additional health practices would lessen any potential negative effect of any other treatment, so the mouse study should not be viewed in isolation.

Vitamin C for Heart Disease

Once again, vitamin C is in the news because it has been shown to protect against heart disease. As an antioxidant and anti-inflammatory, vitamin C has a theoretical basis for protecting the heart and blood vessels, and much information in the past has suggested that it does. However, not all studies have confirmed this.

A new report from the Nurses’ Health Study shows that diet alone is not enough to provide protection, but that supplements significantly reduce the incidence of heart disease. The dietary intake of vitamin C in the study ranged from 61 to 209 mg daily, enough to prevent scurvy, but apparently not enough to fully benefit the heart.

In women who consumed 360 mg of vitamin C, in diet and supplements, the risk of heart disease was lowered by 28 percent . By itself, supplement use was associated with reduced risk, probably because to achieve these high levels, most people require supplements.

Vitamin C supplements protect the heart, blood vessels, and other tissues. For example, high plasma vitamin C levels reduce mortality from heart disease, cancer, and all causes. In cardiomyopathy, 3 gms of intravenous vitamin C reverses arterial endothelial dysfunction. Vitamin C also lowers blood pressure.

An intake of 360 mg reduces the risk of cataract by 57 percent, and long-term intake of supplements is associated with a 60 percent reduction of cataract formation. Thus, for many reasons, vitamin C supplements are beneficial.

Breast Cancer Risk and Diet

Two new studies show that high saturated fat consumption increases breast cancer, while some past studies have dismissed this connection. (Reducing saturated fat is risk free.)

The Nurses’ Health Study of over 90,000 women, using food frequency questionnaires, shows that in premenopausal women, 26 to 46 years old, high dietary fat from red meat and high-fat dairy products led to a 35 to 50 percent increase in breast cancer. Fat from vegetable sources, including olive oil, does not increase the risk.

Research from England, using food diaries, confirms this information. The relationship has been overlooked by some researchers, but it cannot be ignored. In this study women who consumed 90 gms of fat had double the risk of those who ate just 37 gms daily.

Weight-loss diets that depend heavily on protein and fat, and aim for short-term benefits in weight control, ignore the many long-term risks of high-fat and high-animal-product diets. In addition, the supposed benefits in weight loss have never been documented. Why take such a risk? High saturated fat intake is associated with Alzheimer’s disease, dementia, prostate cancer, arthritis, hypertension, and other ills. High meat diets are also associated with more heart disease and cancer, independent of fat content, perhaps based on iron levels. On the other hand, fruits, vegetables, soy foods, tea, whole grains, and fiber are all protective against cancers.

Ask Dr. J: Iron Supplements

Q. Is there any reason that you do not routinely recommend taking iron in a multivitamin? SR, via Internet

A. Iron is a very important nutrient, necessary for red blood cell formation as the central mineral in hemoglobin. Low iron leads to anemia, but even without anemia, it can cause fatigue due to poor cellular energy production. Iron is also important for muscle cells, as part of myoglobin, essential for the storage of oxygen.

With iron deficiency, I definitely do recommend iron supplements. This may be the result of poor diet, excessive menstrual bleeding, internal bleeding (perhaps from ulcers or intestinal inflammation), or malabsorption. A healthy vegetarian diet, and normal menstrual bleeding are not likely to cause iron deficiency.

Excess iron promotes oxidative damage. As a transition metal, it exists in different electron states, and can lead to free radical generation. The risk is particularly associated with heme iron found in meats, associated with increased cancer and heart disease, but I am somewhat cautious with all iron supplements, unless testing shows a need.

Common iron supplements contain ferrous sulfate, which often causes gastrointestinal upset and constipation. When I recommend extra iron, I usually suggest iron carbonyl (Ferronyl) because it is safest and is well absorbed with few intestinal side effects.

Other forms of iron that are better than ferrous sulfate are ferrous gluconate, ferrous fumarate, and chelated iron. In addition to a multi with iron, for significant deficiency it is usually essential that extra iron be added to the treatment program (50 to 100 mg of iron carbonyl).

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Black Cohosh:

Bodinet C, Freudenstein J, Influence of Cimicifuga racemosa on the proliferation of estrogen receptor-positive human breast cancer cells. Breast Cancer Res Treat. 2002 Nov;76(1):1-10.

Mahady GB, Is black cohosh estrogenic? Nutr Rev. 2003 May;61(5 Pt 1):183-6.

Mahady GB, et al., Black cohosh: an alternative therapy for menopause? Nutr Clin Care. 2002 Nov-Dec;5(6):283-9.

Amato P, et al., Estrogenic activity of herbs commonly used as remedies for menopausal symptoms. Menopause. 2002 Mar-Apr;9(2):145-50.

Huntley A, Ernst E, A systematic review of the safety of black cohosh. Menopause. 2003 Jan-Feb;10(1):58-64.

Vitamin C and Heart Disease:

Osganian SK, et al., Dietary carotenoids and risk of coronary artery disease in women. Am J Clin Nutr 2003 Jun;77(6):1390-9.

Khaw KT, et al., Relation between plasma ascorbic acid and mortality in men and women...Lancet 2001 Mar 3;357(9257):657-63.

Richartz BM, Reversibility of...endothelial vasomotor dysfunction ...acute effects of vitamin C. Am J Cardiol 2001 Nov 1;88(9):1001-5.

Bates CJ, et al., Does vitamin C reduce blood pressure? Results of a large study of people aged 65 or older. J Hypertens 1998 Jul;16(7):925-32.

Taylor A, et al., Long-term intake of vitamins and carotenoids and ...[cataract]. Am J Clin Nutr 2002 Mar;75(3):540-9.

Valero MP, et al., Vitamin C is associated with reduced risk of cataract... J Nutr 2002 Jun;132(6):1299-306.

Breast Cancer Risk and Diet:

Cho, E, et al., Premenopausal fat intake and risk of breast cancer. J Natl Cancer Inst, 2003, July 16;95(14):1079-1085.

Bingham S, et al., Are imprecise methods obscuring a relation between fat and breast cancer? Lancet 2003 July 19;362(9379)

Kalmijn S, et al., Dietary fat intake and the risk of incident dementia in the Rotterdam Study. Ann Neurol 1997 Nov;42(5):776-82.

Luchsinger JA, et al., Caloric intake and the risk of Alzheimer disease. Arch Neurol 2002 Aug;59(8):1258-63.

Hayes RB, et al., Dietary factors and risks for prostate cancer... Cancer Epidemiol Biomarkers Prev 1999 Jan;8(1):25-34.

Roberts CK, et al., Enhanced NO inactivation and hypertension induced by a high-fat, refined-carbohydrate diet. Hypertension 2000 Sep;36(3):423-9.

Adam O, Nutrition as adjuvant therapy in chronic polyarthritis. Z Rheumatol 1993 Sep-Oct;52(5):275-80.

Ask Dr. J: Iron Supplements:

Klipstein-Grobusch K, et al., High dietary iron associated with increased MI risk in elderly. Am J Epidemiol 1999;149:421-8.

Cross AJ, et al., Haem, not protein or inorganic iron, is responsible for endogenous intestinal N-nitrosation arising from red meat. Cancer Res 2003 May 15;63(10):2358-60.

In the Health News

Obesity increases the risk of Alzheimer’s disease (Gustafson D, et al., An 18-year follow-up of overweight and risk of Alzheimer disease. Arch Intern Med. 2003 Jul 14;163(13):1524-8). Researchers in Sweden followed 392 women who were not demented from the time they were 70 until 88 years old. Alzheimer’s developed more frequently in those whose body mass index (BMI) was higher. For every one point increase in BMI, the risk increased by 36 percent. Those who were overweight at 70 had a higher risk than those who became overweight during those years. This is one more of many reasons to try to control weight through diet and exercise.

Vitamin E supplements reduce the risk of bladder cancer, but in this report, it was only effective if taken for 10 years or more. (Jacobs EJ, et al., Vitamin C and vitamin E supplement use and bladder cancer... Am J Epidemiol 2002 Dec 1;156(11):1002-10.) This may be due to antioxidant activity, inactivation of some carcinogens, or other actions of vitamin E. This confirms previous studies. It is important to take supplements for the long term. Regarding supplements and other health practices, it is never too soon and never too late to start taking care of yourself.

Diet and Disease

Although the soft drink companies deny that their beverages are related to any health problems or obesity, it is now clear that such high sugar drinks cause children to get fat (Mrdjenovic G, Levitsky DA, Nutritional and energetic consequences of sweetened drink consumption... J Pediatr. 2003 Jun;142(6):604-10). The children who consumed soft drinks failed to reduce their food consumption. As a result they ate 244 more calories per day, and in 8 weeks gained 0.8 pound more than their peers with lower sugar drink consumption.

Recipe of the Month: Fruit Desserts

Occasionally I like to cook fruits for some variety and to make a healthy dessert. Here are three easy and delicious desserts that will surprise your guests.

  1. Take a barely ripe banana, slice the skin open along its inside curve. Cut slightly across the skin on the bottom, so it will standup on the flat surface. Put this in the oven at 350 degrees, and cook until the skin is brown-black. Wear gloves to squeeze it open like a baked potato, add some freshly ground nutmeg and a touch of vanilla inside and serve hot.
  2. Core an apple, sprinkle in some cinnamon, and bake it at 350 until soft.
  3. Slice pears in half, remove the seeds, drizzle on some cherry juice (organic is available) and add some cinnamon. Bake these or microwave them until soft, and serve them hot or cold.

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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.