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
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.
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
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.
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
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.
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.
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
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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human breast cancer cells. Breast Cancer Res Treat. 2002 Nov;76(1):1-10.
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Osganian SK, et al., Dietary carotenoids
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Khaw KT, et al., Relation between plasma
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Richartz BM, Reversibility of...endothelial
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Bates CJ, et al., Does vitamin C reduce
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Valero MP, et al., Vitamin C is associated
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Cho, E, et al., Premenopausal fat intake
and risk of breast cancer. J Natl Cancer Inst, 2003, July
Bingham S, et al., Are imprecise methods
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Kalmijn S, et al., Dietary fat intake and
the risk of incident dementia in the Rotterdam Study. Ann
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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
Roberts CK, et al., Enhanced NO inactivation
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Klipstein-Grobusch K, et al., High dietary
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Cross AJ, et al., Haem, not protein or
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arising from red meat. Cancer Res 2003 May 15;63(10):2358-60.
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.
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.
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.
- 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.
- Core an apple, sprinkle in some cinnamon, and bake it
at 350 until soft.
- 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.