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October 2004

Living Positively
Migraine Headaches
New Migraine Research
Caffeine Addiction
Ask Dr. J: Omega-3 Oil Doses
References
In the Health News
Diet and Disease
Recipe of the Month: Potato/Bean/Tomato Casserole

Living Positively

Dear Friends,

A recent article suggested that cancer survivors are often left with a poor quality of life from their experience with the disease itself or from the treatments. However, this does not have to be the case. Regardless of the disease or treatment (and less toxic alternatives are often helpful), lifestyle choices can lead to a vigorous, healthy, and rewarding life. The power of positive feelings, a winning attitude, regular exercise, and supportive nutrition and dietary supplements can all combine to create enduring and enjoyable daily living.

The career of Lance Armstrong is an example of how a person can survive the most intensive treatments and bounce back with a rich, successful life. You don’t have to be in the Tour de France to achieve the benefits of healthy lifestyles, but you do have to take charge of your life and your health.

The recent study suggests that cancer survivors have lower quality of life than age-matched controls who have never had cancer. The survey shows that 31 percent of cancer survivors report having fair or poor health, compared to only 18 percent of the controls. Only 13 percent of the cancer survivors reported having excellent health, but the researchers did not look at how lifestyle and attitude relate to these results.

These healthier choices can clearly contribute to a positive outcome. This is not to glibly pass off the physical and emotional stress of having cancer, or the side effects of the treatments with surgery, radiation, and chemotherapy, but some of my healthiest cancer patients have been those who were determined not to succumb to the emotional trauma of the diagnosis. In Norman Cousins’ books, Anatomy of an Illness, The Healing Heart, and Head First, he describes his own experiences with healing—of himself from a debilitating and life-threatening collagen disease and then heart disease, and of numerous cancer patients in group sessions while he was on the faculty of medicine at UCLA.

Cousins emphasized not only the power of laughter and positive emotions, but the value of nutrition and dietary supplements (he took huge doses of vitamin C orally and intravenously during his first major illness, and unexpectedly recovered—at least it was unexpected by the medical community). During those group sessions, his experience with patients showed him that the patients with cancer who did well were those who accepted the diagnosis (they were not in denial) but did not accept the negative prognosis. They mounted a vigorous defense both emotionally and nutritionally, and survived far longer than expected, with a superior quality of life.

The power of positive feelings, a winning attitude, and positive actions to enhance one’s health may be immeasurable, but it is clearly visible in those who choose to take charge of their health.

Migraine Headaches

Migraines can be debilitating headaches related to vascular spasms followed by dilation of blood vessels. They are often associated with initial warning symptoms (prodrome, or aura) of blurry or double vision, or flashing, bright lights, or localized vision loss prior to the headache and accompanied by nausea, vomiting, irritability, mood changes, and severe light sensitivitiy. Some people just get the visual auras with no real headache, referred to as “optical migraines.” Common migraines (as opposed to "classical") occur without the prodrome.

These are not simple headaches, possibly lasting for hours or days, and localized inflammation of tissues around the brain can make the pain worse. Migraines can be triggered by hormonal changes; weather patterns; bright, flashing, or fluorescent lights; foods, such as chocolate, wine, cheese, caffeine; aspartame; and specific food sensitivities. Abnormal regulation of blood sugar (hypoglycemia) may also trigger migraines.

Dietary changes may make a considerable difference in migraines. Avoiding refined sugar and eating five or six small meals can help stabilize blood sugar levels and may reduce the frequency of migraines. It is best if food selections are high in fiber, which delays absorption of the naturally occuring sugars. Also, avoid food additives.

A number of dietary supplements have been helpful in preventing migraines, but it is much more difficult to treat them once started. Magnesium doses of 300 to 600 mg daily can decrease migraine attacks, especially those related to premenstrual syndrome. Riboflavin (vitamin B2, 400 mg daily) significantly lowers migraine incidence and the number of days of symptoms. In a 1998 controlled study of 55 patients, 60 percent improved on riboflavin compared to only 15 percent who were given a placebo.

Many people benefit from supplements of the herb, feverfew. I recommend standardized extract containing 250 mcg of parthenolide, one of the apparently active components of the herb, although there may also be others. Feverfew has anti-inflammatory properties and inhibits platelet aggregation. You may need to take feverfew for a month or more to see the reduced frequency of migraines.

In addition to these supplements, 5-hydroxy tryptophan (5-HTP) has been shown in a number of studies to reduce symptoms with daily supplements of 200 to 600 mg. This is a derivative of the amino acid tryptophan, and is a precursor of the neurotransmitter serotonin. I and many colleagues have found supplements of ginkgo biloba to help patients with migraines. Ginkgo may help by reducing platelet activating factor, a suspected contributor to migraines.

New Migraine Research

A recent small trial strongly suggested that supplements of melatonin could reduce the frequency, duration, and intensity of migraine headaches. Thirty-four patients were studied for three months, and although the study was short and not double-blind, the results were significant.

In a variety of migraine types, melatonin levels have been found to be abnormal. In this study, the patients were given 3 mg of melatonin 30 minutes before bedtime. At the end of the study, 25 patients had greater than 50 percent reduction in the number of headaches, including eight with no headaches and seven with 75 percent reduction. None of the subjects had any increase in symptoms or side effects. Overall, duration and intensity of the headaches was reduced and medication use declined significantly.

Although most doctors and researchers will caution that this research is not definitive, and may even recommend against taking action based on it, I disagree. While this study was small and not blinded, the value of melatonin as an antioxidant for the brain and other tissues, its value in insomnia and depression, and the lack of side effects make it worth trying.

Some preliminary open trials suggest that coenzyme Q10 can help with migraines also. In a 2002 study, 32 migraine patients were given 150 mg of coQ10 per day, and after three months, the number of days with migraines and the frequency of headaches were reduced by 60 percent.

Another recent study shows that patients have increased migraine intensity if they have high levels of glutamate (not glutamine) in their plasma, platelets, and cerebrospinal fluid. Glutamate is found in MSG (monosodium glutamate), a common food additive that may precipitate migraine headaches.

Caffeine Addiction

Coffee and other caffeinated beverages are ubiquitous, socially accepted stimulants that are taken for granted among our cultural habits. While the occasional consumption of caffeine is likely to be relatively harmless, it is not without some potential problems.

Caffeine is a stimulant and a diuretic causing calcium loss in the urine and an increased risk of osteoporosis. It may also cause acid indigestion. For those not habituated to it, even one cup of coffee can cause anxiety, hyperactivity, rapid heart rate, and arrhythmias. Evidence shows that this amount can lead to signs of addiction, particularly the dependence on the morning cup to prevent withdrawal symptoms of headaches, fatigue, nervousness, irritability, and depression, and even flu-like symptoms. (Even decaf can cause gastric irritation and digestive upset.)

A literature review of over 60 studies, shows that withdrawal was evident in 50 percent of subjects within 12-24 hours after abstaining from caffeine. Symptoms were more severe with higher consumption, but were evident even if subjects drank only one cup of coffee daily (coffee contains 90-150 mg of caffeine; green or black tea has about 30-50 mg, and sodas from 30-55 mg).

The peak of withdrawal symptoms occurs within one to two days, and may last from two to nine days. Habitial coffee consumption is related to a desire (conscious or not) to avoid withdrawal symptoms. Coffee has some health value. It is full of antioxidants and may reduce the risk of diabetes. However, red bush tea (with no caffeine) and green tea (preferably decaf) are even healthier and have fewer associated risks.

Ask Dr. J: Omega-3 Oil Doses

Q. What is the right dose of omega-3 oil, either from fish or flaxseeds?.
—RL, Maryland, via email

The typical recommendation for flaxseed oil (containing alpha-linolenic acid, or ALA) is from 1 to 2 teaspoons, up to 2 to 3 tablespoons, depending on individual needs. I use it on salads and as a garnish for steamed veggies, and I don’t measure it, but as with any oil, it is high in calories. One recent study suggests that although flaxseed oil does not increase the risk of prostate cancer, ALA (from vegetable as well as milk and meat sources) may be associated with more aggressive tumor behavior in men who have those cancers. Most evidence shows that flaxseed oil decreases prostate cancer risk, so I suspect flaxseed oil may not be the cause.

Fish oil supplements have more anti-platelet and anti-inflammatory effects than flaxseed oil, and the usual dose varies depending on why it is being taken. Typical doses range from 2000 mg twice a day, to 12,000 mg per day. Capsules contain varying amounts of omega-3 oils, usually about 300 mg total of the combination of EPA (180 mg) and DHA (120 mg). Some people recommend larger proportions of the DHA, especially for children, and such capsules are also available.

The larger doses are used for inflammation, such as arthritis and auto-immune diseases, and for heart disease, strokes, and asthma. One ounce of wild salmon contains about the same amount of omega-3 oil as one typical capsule.

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References

Living Positively:

Yabroff KR, et al., Burden of illness in cancer survivors: findings from a population-based national sample. J Natl Cancer Inst 2004 Sep 1;96(17):1322-30.

Cousins N, Anatomy of an illness (as perceived by the patient) N Engl J Med 1976 Dec 23;295:1458-1463.

Migraine Headaches:

Millichap JG, Yee MM, The diet factor in pediatric and adolescent migraine. Pediatr Neurol 2003 Jan;28(1):9-15.

Lipton RB, et al., Aspartame as a dietary trigger of headache. Headache 1989 Feb;29(2):90-2.

Bianchi A, Role of magnesium, coenzyme Q10, riboflavin, and vitamin B12 in migraine prophylaxis. Vitam Horm 2004;69:297-312.

Schoenen J, et al., Effectiveness of high-dose riboflavin in migraine prophylaxis. A randomized controlled trial. Neurology 1998 Feb;50(2):466-70.

Boehnke C, High-dose riboflavin treatment is efficacious in migraine prophylaxis: an open study in a tertiary care centre. Eur J Neurol 2004 Jul;11(7):475-7.

Peres MF, et al., Melatonin, 3 mg, is effective for migraine prevention. Neurology 2004 Aug 24;63(4):757.

Rozen TD, et al., Open label trial of coenzyme Q10 as a migraine preventive. Cephalalgia 2002 Mar;22(2):137-41.

Peres MF, et al., Cerebrospinal fluid glutamate levels in chronic migraine. Cephalalgia 2004 Sep;24(9):735-9.

Caffeine Addiction:

Juliano LM, Griffiths RR, A critical review of caffeine withdrawal: empirical validation of symptoms and signs, incidence, severity, and associated features. Psychopharmacology (Berl) 2004 Sep 21.

Elta GH, et al., Comparison of coffee intake and coffee-induced symptoms in patients with duodenal ulcer, nonulcer dyspepsia, and normal controls. Am J Gastroenterol 1990 Oct;85(10):1339-42.

Salazar-Martinez E, et al., Coffee consumption and risk for type 2 diabetes mellitus. Ann Intern Med 2004 Jan 6;140(1):1-8.

Siddiqui IA, et al., Antioxidants of the beverage tea in promotion of human health. Antioxid Redox Signal 2004 Jun;6(3):571-82.

In The Health News

Although antidepressants can relieve serious symptoms, they can also lead to an increased risk of adolescent suicide. The link has been played down by the FDA, accused of blocking a congressional investigation (Reuters, September 9, 2004). Another drug, Vioxx, a treatment for arthritic pain, is associated with an increased risk of heart disease, and has just been recalled by Merck, although they and the FDA knew as early as 1999 about the associated risks (PRWEB Sept 1, 2004).

Diet and Disease

a. Curcumin, a component of turmeric, may prevent childhood leukemia. A report by researchers in Chicago shows that this spice inhibits the white blood cell effects of some of the risk factors for leukemia, such as infections, radiation, chemicals, pesticides, and viruses. In lab studies, this spice blocks replication of leukemia cells and interferes with the effects of cigarette smoke and processed foods. At the same meeting, other researchers reported that eating oranges and bananas helped protect children from leukemia. (Turmeric may protect against leukemia-scientist. Reuters, Sep 9,2004)

b. Red meat consumption, and especially processed meats such as hot dogs and bacon, is associated with a significant increased risk of type 2 diabetes. Results from the Women’s Health Study, evaluating 37,309 participants, showed that the highest meat consumption was associated with a 28 percent increase in diabetes risk, and 43 percent for processed meats (Song Y, et al., A prospective study of red meat consumption and type 2 diabetes...Diabetes Care. 2004 Sep;27(9):2108-15). Cholesterol, animal protein, and meat-source (heme) iron were also associated with greater risk.

Recipe of the Month: Potato, Bean, Tomato Casserole

Harvesting potatoes and tomatoes makes me think of the many ways to use these versatile and tasty foods. Slice some potatoes about 1/4 inch thick, and some tomatoes a bit more thickly, and alternate several layers of each in a baking pan, with a thin layer of cooked pinto beans in between. As you put down each layer, sprinkle some crushed garlic; minced scallion greens; fresh or dried basil, thyme, or chopped cilantro; freshly ground pepper; chili powder; or other spices to taste (this can also be made with a curry flavor), and if you like you can spread a garnish of grated parmesan, feta cheese, or crumbled tofu in one or two of the layers. You can use a small amount of sea salt if you skip the cheese. Make several layers, as it will cook down. Bake this in a preheated oven at 400 degrees, for about 40 minutes, but test regularly to see when the potatoes are soft.

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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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