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June 2004

Supesize the USA, et al.
Protecting Your Skin
Lifestyle/Supplements for Skin
Topical Skin Treatments
Ask Dr. J: Bursitis
References
In the Health News
Diet and Disease
Recipe of the Month: Mexican Bean-Stuffed Tortilla

Supesize the USA, et al.

Dear Friends,

Dear Friends,

The success of the recent film “Supersize Me” has brought wide attention to the problem of fast foods and obesity. Although McDonald’s claims that their nearly simultaneous elimination of supersize portions had nothing to do with the film, the timing would make this a “supersize” coincidence. The rise of obesity in the US and in other countries was revealied as parallel to the increase in fast food outlets in the book, Fast Food Nation, just a couple of years ago.

Now, Congress is reviewing legislation to control what kinds of foods are served in schools as an effort to stem the tide of obesity, diabetes, and degenerative diseases that are increasingly seen in young people. In fact, by the time kids are 15 to 19 years old, they already have atherosclerotic plaque in their arteries (50 percent of their right coronaries and 100 percent of their aortas). This is not genetic. It is the result of lifestyle, particularly sedentary lives in cars and in front of televisions and computer games, combined with high-calorie junk in the diet instead of food.

Even though the government and many health organizations have been sounding the alarm in the past decade about the serious problem posed by rampant obesity, the government has contributed to the problem through the school lunch program. They have done little in the way of education or financing to promote healthier eating or to limit the amount of fat, sugar, and other junk that dominate the caloric intake of kids.

The only way to prevent this accelerating decline in health, and consequent increase in health care costs, is through education. As long as people choose harmful products from the marketplace, the companies who make them will continue to do so. It is encouraging that organic foods are the fastest growing segment of the grocery industry. However, this is not enough when dietary junk is also growing and infiltrating other countries. (As these western habits invade other countries, it becomes apparent that one of the most successful exports from the US is disease.)

We can help by choosing whole, natural foods in our own diets and setting the example for others. Choosing lots of vegetables, fresh fruits, and other high fiber foods is a good start. The more we choose better foods, the more the industry will provide them for us. We can also help by being active in schools to promote the availability of healthier foods in the school meals and limiting the vending machine junk and soft drinks that are little more than “liquid candy.”

It is also important to encourage increased physical activity in children. That way they will not wake up at 30 years old realizing that they are 30 to 50 pounds or more overweight and having the difficult task of starting so late on the path to health. It is easier to start early, but it is never too late.

Protecting Your Skin

The skin is a remarkable organ and the largest in the body. It provides a protective barrier from the elements, helps to regulate body temperature, and blocks infectious organisms. It also eliminates toxins, acts as a sensory organ, and very importantly, allows exposure of cholesterol derivatives to ultraviolet for the manufacture of vitamin D (cholecalciferol).

Each square inch of skin has up to 650 sweat glands, sebaceous glands, numerous nerves and blood vessels, 65 hair follicles, and melanocytes– the pigment cells. It also contains fat and connective tissue that is both structural and elastic, allowing the skin to stretch. Men tend to have somewhat thicker skin than women.

Because the skin is highly exposed, it is also subject to numerous degenerative problems. This is partly because in acting as the defense barrier for our internal organs the skin itself is readily affected by toxins and radiant energy. In addition, the skin is a rapidly growing tissue, so it is particularly vulnerable to some toxins, such as chemotherapy drugs.

With aging and exposure to the elements, the skin is less able to retain water and is damaged by oxidation and ultraviolet light, becoming wrinkled and dry. It also loses elasticity due to poor nutrition, such as lack of zinc and adequate vitamin C, which may lead to poor collagen and elastin production.

The leathery skin of people who have spent their lives outdoors, and the dry, wrinkled appearance of those who smoke is evidence of the damage of ultraviolet and free radical exposure. Other sources of free radicals damage the skin as well as internal organs, so the skin is only the most visible evidence of the aging process.

Lifestyle and Supplements for Skin

Maintaining a strong, elastic, and youthful skin is valuable for both cosmetic and health reasons. Everyone wants to look their best, but in this case, appearance is the result of maintaining the integrity of the connective tissue and protecting ourselves from free radical damage.

While we need sun exposure, it is all too easy to overdo it. Excessive sun exposure causes sunburn, photodamage, and skin cancers, as well as an aged appearance. If you plan to be outdoors for extended times, protect yourself with clothing, a hat, and sunscreen with protection from both UVB and UVA (such as oxybenzone, avobenzone, zinc oxide, and titanium dioxide). It is important to have some sun exposure in order to make vitamin D. It is easy to be overly assiduous in avoiding the sun or wearing sunblock, leading to inadequate vitamin D production.

Diet also plays a role in protecting the skin. Actinic keratosis (AK) is a skin cancer precursor related to sun overexposure. In people who are prone to develop AK, switching to a low-fat diet can markedly reduce the recurrence rate. In two studies, those who changed to 20 percent fat had less than one third the recurrences compared to those who stayed on their 40 percent fat diet.

Vegetables and fruits are high in antioxidants that help protect the skin from free radical damage and aging. Vitamins C and E, bioflavonoids, and omega-3 fatty acids, selenium, and carotenoids all provide such protection. Beta-carotene, lycopene, tocopherol, and selenium administered for seven weeks improved epidermal defenses and reduced the evidence of skin damage from ultraviolet exposure, including redness, sunburn, and peroxide formation.

Dietary sugar leads to sugar-protein complexes, or advanced glycation endproducts (AGE), and cross-linking of collagen, contributing to skin wrinkling. Reduction of sugar and refined carbohydrates is important to protect the skin and other organs. Fiber in the diet slows the conversion of carbohydrates to sugar. L-carnosine supplements reduce the production of AGEs.

L-carnosine also has antioxidant and free-radical scavenging properties that protect DNA. Other antioxidants likely to be helpful in preserving healthy skin include proanthocyanidins, coenzyme Q10, and alpha-lipoic acid.

Topical Skin Treatments

Advertising for skin care products is full of hyperbolic and unjustified claims for restoring youthful looks, and you should be wary of these products. However, some products do help preserve healthy skin and prevent cancer. Topical preparations that contain antioxidants penetrate the skin and protect deeper layers. Products containing both vitamins C and E, as well as N-acetyl cysteine, offer enhanced antioxidant protection compared to any of them alone.

Topical coenzyme Q10 has been shown to reverse photodamage, decrease epidermal oxidation by UV, and reduce wrinkle depth. It protects against the damage from UVA and suppresses the enzyme that breaks down collagen. Some studies also suggest benefits from topical application of alpha-lipoic acid, green tea extract, silymarin from milk thistle, and ginger. These ingredients are found in a variety of skin care products, including some sunscreens, but they need more than token amounts to be effective.

Controversy surrounds sun protection for several reasons. As noted above, sun is essential for vitamin D production, and vitamin D appears to prevent some cancers, such as breast, prostate, ovarian, and colon. Sunscreens may not protect against melanoma and basal cell cancers. Vitamin D appears to be important to prevent basal cell and squamous cell cancer. Depending somewhat on sun exposure, I advise taking supplements of 400 to 1000 IU of vitamin D.

If a sunscreen blocks only UVB, it allows people to stay in the sun longer without burning, but it allows the UVA rays to penetrate the skin for a longer time. UVA will cause skin aging, wrinkling, and skin cancer. Even without burning, excessive sun exposure is dangerous.

In summary, wear appropriate clothing for protection, wear UVB and UVA sunscreen for extended sun exposure, eat a high-antioxidant, low-fat diet, take supplements, and apply topical antioxidants to the skin.

Ask Dr. J: Bursitis

Q. I have hip bursitis, which is painful and limits my activitiy. I prefer not to take steroid injections, and I don’t want to take Vioxx. Do you have any suggestions?
—RB, Florida, via Internet

A. A bursa is a fluid-filled sac between a tendon and a bone or a tendon and skin that helps to reduce friction and aid movement. Trochanteric bursitis is inflammation of the bursa of the hip.

Bursitis can be painful and debilitating, restricting motion of the involved joint, with tenderness and swelling. It can be brought on by injury from falls or contact sports, overuse, as in tennis elbow, by infection, or rheumatiod arthritis. It can be acute, or can persist as chronic bursitis.

In hip bursitis, the pain can radiate down the thigh and it can also interfere with sleep. Typical treatments include rest, caution when getting up or down in chairs, and anti-inflammatory drugs or steroid injections. I prefer to start with natural anti-inflammatories, such as standardized curcumin, (300 to 600 mg twice a day), standardized ginger (250 to 500 mg), and bromelain enzyme (10,000 mcu 2 to 3 times daily).

Fish oil, as a source of omega-3 EPA and DHA, is also an effective anti-inflammatory. Capsules with 300 mg of omega-3 (from 1000 mg of fish oil) are commonly available. Typical doses range from 2 to 4 capsules, 2 to 3 times per day. GLA from borage oil may also help. I also recommend high doses of vitamin C (4000 to 8000 mg per day). You mentioned heartburn from some of your supplements, so I suggest taking L-glutamine (1000 to 2000 mg) along with your herbs and vitamins, and being careful to avoid sugar, caffeine, and alcohol.

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References

Supersize the USA, et al.:

Strong JP, et al., Prevalence and extent of atherosclerosis in adolescents and young adults.. JAMA. 1999 Feb 24;281(8):727-35.

Skin Protection:

Sies H, Stahl W, Nutritional protection against skin damage from sunlight. Annu Rev Nutr. 2004;24:173-200.

Black HS, et al., Effect of a low-fat diet on the incidence of actinic keratosis. N Engl J Med. 1994 May 5;330(18):1272-5.

Black HS, Influence of dietary factors on actinically-induced skin cancer. Mutat Res. 1998 Nov 9;422(1):185-90.

Eberlein-Konig B, et al, Protective effect against sunburn of combined systemic ascorbic acid (vitamin C) and d-alpha-tocopherol (vitamin E). J Am Acad Dermatol. 1998 Jan;38(1):45-8.

Cesarini JP, et al., Immediate effects of UV radiation on the skin: modification by an antioxidant complex containing carotenoids. Photodermatol Photoimmunol Photomed. 2003 Aug;19(4):182-9.

Bellei E, et al., Effect of alpha-tocopherol and N-acetylcysteine on benzoyl peroxide toxicity in human keratinocytes. J Biochem Mol Toxicol. 2004;18(2):107-14.

Hoppe U, et al., Coenzyme Q10, a cutaneous antioxidant and energizer. Biofactors. 1999;9(2-4):371-8.

Sime S, Reeve VE, Protection from ... UV radiation in mice by topical Pycnogenol. Photochem Photobiol. 2004 Feb;79(2):193-8.

Chen TC, Holick MF, Vitamin D and prostate cancer prevention and treatment. Trends Endocrinol Metab. 2003 Nov;14(9):423-30.

Kamradt J, et al., Analysis of the vitamin D system in cutaneous malignancies. Recent Results Cancer Res. 2003;164:259-69.

Bursitis:

Calder PC, N-3 polyunsaturated fatty acids and inflammation: from molecular biology to the clinic. Lipids. 2003 Apr;38(4):343-52.

Leventhal LJ, et al., Treatment of rheumatoid arthritis with gammalinolenic acid. Ann Intern Med. 1993 Nov 1;119(9):867-73.

Satoskar RR, et al., Evaluation of anti-inflammatory property of curcumin... Int J Clin Pharmacol Ther Toxicol 1986 Dec;24(12):651-4.

Protective Effects of Curcumin against Oxidative Damage on Skin .... J Trauma 2001 Nov;51(5):927-931.

In The Health News

Metabolic syndrome consists of insulin resistance with abdominal obesity, high blood pressure, elevated blood sugar, and high cholesterol, and contributes to an increased risk of diabetes,heart disease, and early death. Regular exercise reduces this mortality. In a sample of 19,223 men, all-cause and cardiac mortality was much higher among those with metabolic syndrome. However, high fitness levels eliminated the difference. (Katzmarzyk PT, et al., Cardiorespiratory fitness attenuates the effects of the metabolic syndrome on all-cause and cardiovascular disease mortality in men. Arch Intern Med. 2004 May 24;164(10):1092-7.) This indicates that exercise can overcome the effects of insulin resistance.

Diet and Disease

a. Age-related macular degeneration is a leading cause of blindness in the elderly. The risk of macular degeneration is greatly reduced by increasing fruit consumption. In two large studies of over 100,000 subjects followed for 12 to 18 years, researchers found that those who consumed three or more fruits per day had a 36 percent lower incidence of neovascular macular degeneration compared to those who consumed less than 1.5 fruits per day. (Cho E, et al., Prospective study of intake of fruits, vegetables, vitamins, and carotenoids and risk of age-related maculopathy. Arch Ophthalmol. 2004 Jun;122(6):883-92).

b. A recent analysis of the overall (lipophilic and hydrophilic) antioxidant capacity of foods shows a very high value for blueberries, other berries, pears, plums, and apples. Nuts (pecans and walnuts), beans (kidney, pinto, and red), and spices were also very high. Somewhat surprisingly, perhaps due to vitamin C, russet potatoes are rich in antioxidant activity, diminished only a little by cooking. (Wu X, et al., Lipophilic and hydrophilic antioxidant capacities of common foods in the United States. J Agric Food Chem. 2004 Jun 16;52(12):4026-37.)

Recipe of the Month: Mexican Bean-Stuffed Tortilla

Pressure-cook some red, kidney, or pinto beans (with that high antioxidant activity) for 20 minutes, and then sauté them until well mixed with garlic and onions, chili powder, cayenne pepper to taste, olive oil, soy sauce, and some crushed tomatoes. (Alternatively, you can buy cans of organic refried beans.) Make some guacamole with mashed ripe avocado, blending in some fresh crushed garlic, fresh lemon or lime juice, and minced onion and tomato. Spread some of the beans and guacamole on a warmed whole-wheat or corn tortilla, and then add some shredded lettuce, minced cilantro, diced fresh bell peppers, and tomatoes. (If you like, you can top this with a sprinkle of organic grated cheddar cheese.) Fold it over and enjoy a Mexican “sandwich.” The last time I made this, I had some freshly cooked brown and wild rice that I added to the filling.

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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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