International Foods and Farms
Arthritis and Heart Disease
Arthritis and Heart Protection
Vitamin D, Calcium, and Bones
Ask Dr. J: Cholesterol Treatment
In The Health News
Diet and Disease
Recipe of the Month: Eggplant Zucchini Casserole
For my recent lecture trip to Japan, I prepared material
on the negative health effects of processed food diets. My
Japanese nutritionist colleagues pointed out that the dietary
habits of the Japanese were also changing toward this “industrialized”
They noted the high salt intake in Japan (12 grams per day),
which is not really new. However they also informed me of
the increase of white flour products, the decrease in vegetable
consumption (particularly green vegetables), and the increase
in fast foods, such as burgers, fries, sweets, ice cream,
buns, (white) noodles, and beef on white rice (at fast food
outlets not seen in the U.S.) I can see the results in the
skin of many Japanese youths.
All of this is very disappointing to me, especially as I
go to Japan partly to teach healthier eating habits. However,
I am pleased to report that the news is not all bad. I was
amazed at the number of restaurants in both Tokyo and Kyoto
that serve organic foods, and the variety of restaurants that
serve brown rice and vegetarian fare (and, of course, tofu
and other soy products are widely available, including “yuba”
– a tasty, ribbon-like soy curd).
I was able to eat at different restaurants almost every day
without compromising my dietary habits. (My colleagues who
found all these restaurants did a great job in helping me
to stay healthy on the trip.) At the end, I realized that
I had not even visited two of the restaurants where I dined
two years earlier. At all of these restaurants, the food was
not only tasty and healthy, but also elegantly prepared and
artfully presented. I also found a number of healthy, small,
“fast food” shops for a quick organic, vegetarian
lunch to go (and in my case to carry out for my long plane
The interest in healthy and organic foods is growing rapidly
in Japan (and organic foods are the fastest growing segment
of the grocery industry in the U.S.). A major Japanese food
import-export company is increasingly committed to providing
organic foods, and they import large amounts of organic bananas
and whole-grain, organic cereals among other products. In
speaking with the head of this company, I was pleased to learn
of his goal to expand the organic food segment of his business
to meet the growing consumer demand and because of his concern
Another positive note is the rise in organic cotton growing,
particularly in India, where cotton makes up only five percent
of India’s crops but uses 50 percent of the pesticides,
harming the soil and the farmers, and not controlling the
pests! Pesticide-laden cottonseed oil is used in many processed
foods. Now organic farming is becoming more popular, not only
to reduce costs, but also to make the fields safer for the
farmers and foods safer for them and their children. The organic
farmers also have no need for genetically modified seeds.
Internationally, in many ways, I see encouraging changes.
Rheumatoid arthritis and cardiovascular disease are both
common conditions, but cardiovascular disease differs from
arthritis in that it is the number one cause of death, while
rheumatoid arthritis is not lethal. However, it appears that
arthritis and other inflammatory conditions contribute to
an increased risk of dying from heart disease. Inflammation
is indicated by an increase in the serum level of C-reactive
protein (CRP), an inflammatory marker.
In a population study, patients with rheumatoid arthritis
(RA) were evaluated for the likelihood of their dying of heart
disease. Researchers looked at 603 patients over 18 years
old at the start of the study and followed them for 15 years.
After controlling for other risk factors, they found that
the risk of death from heart disease was more than doubled
for those with greater evidence of chronic rheumatoid inflammation.
The same researchers did an earlier study comparing the rates
of heart failure in 1158 subjects with and without RA. They
found that the patients with RA were 70 percent more likely
to develop congestive heart failure than the subjects without
arthritis. Over 30 years, they found that the risk of heart
failure was double in RA patients compared to non-arthritis
subjects. The same relationship does not appear to be true
for patients with osteoarthritis.
These studies add to the growing body of evidence that inflammatory
conditions such as arthritis contribute to damage to the arteries
resulting in cardiac disease and mortality.
Arterial damage in diabetic women is related to higher levels
of inflammatory markers, including CRP and interleukin-6.
Stiffness of the arteries, an early sign of atherosclerosis,
appears to result from asymptomatic inflammation in these
It is not clear why inflammation causes an increase in heart
disease mortality, but among other effects it appears to increase
the fragility of arterial plaque, which contains high amounts
of inflammatory cells and molecules. This leads to increased
vulnerability of the plaque to rupture, precipitating heart
Although infection within the arterial wall (viruses, bacteria,
chlamydia) may contribute to local inflammation and result
in initiation and faster progression of coronary disease,
inflammation at other sites is an additional concern. The
very process of inflammation seems to trigger the cellular
changes that lead to plaque formation and infiltration of
fat, oxidized cholesterol, and eventually calcium into the
arterial wall, all characteristics of atherosclerosis.
Therapies that treat RA or with proven vascular anti-inflammatory
effects are likely to help with prevention of cardiac mortality.
These include a diet low in animal fat and trans fats, junk,
and sugar, as well as exercise and smoking cessation. Conventional
drug therapies with aspirin and statins also have anti-inflammatory
effects, but healthier options make them unnecessary.
Diet plays a large role in reduction of symptoms and objective
measures of rheumatoid arthritis. A short fast followed by
a vegan or vegetarian diet leads to improvement in many measures
of RA as well as inflammatory indicators. A vegan diet is
high in both antioxidants and anti-inflammatory substances.
Arachidonic acid, found in land animal fats, is a non-essential
fatty acid that increases inflammation.
Fish oil, on the other hand, is high in omega-3 fatty acids
that reduce inflammation. In one study, a diet low in animal
fat enhanced the benefits of fish oil. Patients on a western
diet (WD) and those on an anti-inflammatory diet (AID) were
given either fish oil or placebo. Even the placebo group on
the AID had fewer tender joints, and with fish oil the AID
group had less than half as many tender joints as the WD group.
They also had a reduction of one inflammatory marker (LTB4)
from 34 percent to 8 percent.
Some studies show that high doses of vitamin E can reduce
RA symptoms and inflammation. Zinc, selenium, and copper may
also help. Bromelain, a pineapple enzyme, has anti-inflammatory
effects and helps reduce symptoms of RA. High doses of gamma-linolenic
acid (GLA, 1000 mg), fish oil (EPA/DHA, 1200-2400 mg), and
curcumin (1200 mg) can reduce arthritic inflammation. The
herbs boswellia, nettle, and feverfew also have anti-inflammatory
effects. Combine supplements, diet changes, and regular exercise
to achieve the most benefits.
Two recent studies reportedly suggested that vitamin D and
calcium supplements were not helpful in treating osteoporosis.
One study in the Lancet evaluated supplements of calcium carbonate
(1000 mg) and vitamin D (800 IU) in 5292 patients over 70
years old who had already had one fracture. They found no
difference between those on active treatment compared to placebo.
The problems are that these results cannot be extrapolated
to younger age groups, higher doses of vitamin D are needed
to see results, and calcium carbonate is not the best absorbed
form of calcium. Increasing bone density is a very slow process,
and may take longer for improvement to result in reduced fractures
(for patients, fracture rates are more important than bone
density). Another problem was that fewer than half of the
participants in the study took their supplements.
The second study in the British Medical Journal evaluated
3314 post-menopausal women who had already had a fracture.
They used the same doses of calcium and vitamin D, and followed
the participants for an average of two years. The problems
with drawing conclusions from this study are basically the
same as the first, but these research problems do not mean
that calcium and vitamin D are cures for osteoporosis.
In addition to these supplements at the right doses, fracture
prevention requires regular weight-bearing exercise, a healthy
diet, and other supplements such as ipriflavone and boron,
as well as proper hormone balance, with bio-identical hormone
treatment if needed.
Q. Can I take my prescription cholesterol
medication (cholestyramine) along with natural treatments
like policosanol and garlic?
—RM, New Hampshire
This medication binds with bile acids in the intestinal tract
and diverts cholesterol to production of more bile acids,
lowering the level in the blood. It may have some side effects,
such as constipation, gas, bloating, and heartburn. It is
recommended less frequently than statin drugs.
Natural cholesterol-lowering supplements are unlikely to
have any negative interaction with cholestyramine (brand name
Questran) or with any of the cholesterol drugs, including
the statins. Policosanol may have some similar actions to
the statins, but no side effects have been reported, and it
has been shown to be almost as effective as the best statin
drug, in addition to providing similar vascular protection.
If you do decide to take both, you should be sure to inform
your doctor. Most of the time I have found it unnecessary
to use the prescriptions when patients take the natural substances.
Other natural treatments that control cholesterol include
red yeast rice (2000 mg daily), garlic (1000-2000 mg), chromium
(200-600 mcg), vitamin E (400-800 IU of mixed tocopherols),
niacin (vitamin B3, 2000-3000 mg), vitamin C (2000-4000 mg),
and fish oils (600-1200 mg of EPA/DHA).
A diet rich in soy foods, almonds, oats, barley, psyllium,
and specific vegetables that are high in viscous fibers (eggplant
and okra) can effectively lower cholesterol. Combining some
supplements with this diet may eliminate your need for drugs.
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Stepping off the pesticides treadmill.
Maradit-Kremers H, et al., Cardiovascular
death in rheumatoid arthritis:... Arthritis Rheum. 2005 Mar;52(3):722-32.
Nicola PJ, et al., The risk of congestive
heart failure in rheumatoid arthritis:.... Arthritis Rheum.
del Rincon ID, et al., High incidence of
cardiovascular events in a rheumatoid arthritis cohort not
explained by traditional cardiac risk factors. Arthritis Rheum.
Dessein PH, et al., Cardiovascular risk
in rheumatoid arthritis versus osteoarthritis... Arthritis
Heitritter SM, et al., Subclinical Inflammation
and Vascular dysfunction... J Clin Endocrinol Metab. 2005
Apr 19 [Epub ahead of print]
Willerson JT, Systemic and local inflammation
in patients with unstable atherosclerotic plaques. Prog Cardiovasc
Dis. 2002 May-Jun;44(6):469-78.
Shishehbor MH, Bhatt DL, Inflammation and
atherosclerosis. Curr Atheroscler Rep. 2004 Mar;6(2):131-9.
Adam O, et al., Anti-inflammatory effects
of a low arachidonic acid diet and fish oil in patients with
rheumatoid arthritis. Rheumatol Int. 2003 Jan;23(1):27-36.
Hanninen, et al., Antioxidants in vegan
diet and rheumatic disorders. Toxicology. 2000 Nov 30;155(1-3):45-53.
Wittenborg A, et al., Effectiveness of
vitamin E in...chronic polyarthritis. Z Rheumatol. 1998 Aug;57(4):215-21.
Belch JJ, Hill A, Evening primrose oil
and borage oil in rheumatologic conditions. Am J Clin Nutr.
2000 Jan;71(1 Suppl):352S-6S.
Grant AM, et al., Oral vitamin D3 and calcium
for secondary prevention of low-trauma fractures in elderly
people...Lancet 2005 Apr 28, Lancet Early Online Publication
Porthouse J, et al., Randomised controlled
trial of calcium and ...(vitamin D3)...BMJ;330:1003, doi:10.1136/bmj.330.7498.1003
Resveratrol, a substance found in red wine, grape skins,
and peanuts, has antioxidant, anti-inflammatory, and anti-cancer
effects. A recent cellular study showed that resveratrol can
induce cancer cell death in human brain tumors (glioma), and
found that it works by multiple mechanisms (Jiang H, et al.,
Resveratrol-induced apoptotic death in...glioma cells. Mol
Cancer Ther 2005 Apr;4(4):554-61). Other reports indicate
that resveratrol inhibits the initiation, promotion, and progression
of tumors (Alarcon de la Lastra C, Villegas I, Resveratrol
as an anti-inflammatory and anti-aging agent...Mol Nutr Food
Res. 2005 Apr 14; [Epub ahead of print]) and increases the
lifespan of yeasts and fruit flies.
In a study of 7504 men from 45 to 68 years old followed
for 30 years, those with the highest milk consumption had
more than double the risk of developing Parkinson’s
disease, compared to those who drank no milk. This was apparently
not related to the total intake of calcium in either group.
(Park M, et al., Consumption of milk and calcium in midlife
and the future risk of Parkinson disease. Neurology. 2005
Mar 22;64(6):1047-51.) It is not clear whether this is due
to a neurotoxic substance in milk or other causes.
Pancreatic cancer is aggressive and difficult to treat, making
prevention especially important. A new case-control study
of 585 pancreatic cancer patients compared their diets with
4779 adults without the disease. The researchers found that
a diet high in fresh fruits and vegetables (particularly cruciferous
vegetables such as broccoli and cabbage) was associated with
a 49 percent reduction in the risk of developing pancreatic
cancer. (Nkondjock A, et al., Dietary patterns and risk of
pancreatic cancer. Int J Cancer 2005 May 1;114(5):817-23.)
A separate report from the same group shows that lycopene
also cuts pancreatic cancer risk.
Put a layer of tomato sauce or diced tomatoes on the bottom
of a casserole dish (I use fire-roasted tomatoes from Muir
Glen). Thinly slice eggplant and zucchini (about 1/4 to 1/2
inch thick), and lightly sauté them in olive oil on
a griddle with chopped onion and crushed garlic (you can skip
this step if you cook it longer in the oven). Next, cover
the tomato sauce with a layer of the vegetables, a thick layer
of cooked brown rice, and a sprinkle of oregano, thyme, and
freshly ground black pepper or a pinch of cayenne (depending
on how hot you like it). Crumble some tofu (either soft or
firm) in the next layer, and cover that with some more of
the tomato sauce. Add another layer of the vegetables and
onion, and top the entire dish with more tomato sauce. Bake
this in the oven at 375° for about forty minutes (depending
on how much you cooked the vegetables earlier).
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