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July 2005

Health Care Business
Folic Acid Update
Macular Degeneration Update
Pesticides and Parkinson’s Disease
Ask Dr. J: Sulfa and Sulfate
References
In The Health News
Diet and Disease
Recipe of the Month: Yams and Black Bean Salsa

Health Care Business

Dear Friends,

I was recently listening to some business analysis regarding the state of the economy in the United States and predictions for its future. Prominent in the report were the comments that one of the “stellar performers” in the economy was the business of health care, with the implication that this was a positive contributor to national economic growth, and therefore good.

My mind immediately jumped to the economist Henry Hazlitt who noted that it is a common belief that destruction, such as a vandal throwing a brick through a shop window, is a good business stimulant. After all, he points out, the shopkeeper then has to spend money to clean up the mess, buy plywood to cover the opening until he can hire the glazier to replace the glass, the plasterer to repair the wall, and the painter to finish the job. This flurry of business puts money into the hands of each contractor that they then spend on other things and the economy grows.

The fallacy is in ignoring that the shopkeeper would have spent that money on other things–a new suit, a home improvement, a bicycle for his child–which would have been just as good for the economy, without the destruction of resources (and the associated headaches and lost time). I am all for innovation, research, the development of new devices, procedures, and safe, effective medications. However, in the overall picture, expansion of health care as a business is an indication that the health of the population is worsening, which can’t be desirable. In addition to the strain on resources, from hospital beds, nursing care, physician time, and medical supplies, as well as the side effects of expensive and often unnecessary drugs, this economic and resource loss in no way reflects the human tragedy of illness.

The medical-pharmaceutical complex in the United States is already a more than 1.5 trillion dollar industry, making up a far greater percentage of overall business activity (GDP) than in any other country, but neither health nor health care is better here than in many other developed nations that spend less. High health care costs result in part from the high cost of drugs, doctors practicing defensive medicine (ordering extra tests, visits, and expert consultations to protect themselves from lawsuits), and the high expense of end-of-life care. However, for the most part, the expansion of health as a business reflects the unhealthy lifestyles that people follow, resulting in obesity, diabetes, heart disease, cancer, and other chronic, degenerative diseases, as well as accelerated aging.

Controlling health care costs through health education and lifestyle change would not be harmful to the economy, even though the medical industry would contract. On the contrary, we would see a more productive work force and a redirection of resources toward life-enhancing activities.

Folic Acid Update

Folic acid (or folate) at doses that are above what is found in the typical diet (from greens, beans and citrus fruits) has many health benefits, reducing birth defects, cancer, heart disease, and other atherosclerotic circulatory disorders, such as strokes. New research shows that folate is also valuable for preserving brain function in elderly people, and at a dose that is most likely to come from supplements rather than food alone.

Folic acid supplements lower serum homocysteine levels. Homocysteine has been associated with an increased risk of atherosclerosis, strokes, and congestive heart failure. In addition, in patients who have had balloon angioplasty, the likelihood of those vessels closing up again (restenosis) is much greater if homocysteine levels are high, and this risk is reduced by folate supplements (along with B6 and B12, which also help to lower serum homocysteine levels). Other research shows that low folate is associated with arterial damage independent of homocysteine.

Earlier studies have shown an association of low levels of folate with an increased incidence of Alzheimer’s disease (AD). These patients have a higher level of homocysteine (a neurotoxin), indicating that this is a risk factor for AD as well as heart disease. One study showed that patients with the lowest folate levels had triple the risk of AD compared to those with the highest levels, and low levels were associated with faster progression of the disease. The researchers suggested that people take 500 to 5000 mcg (5 mg) of folate supplementation. (Vitamin B12, which also lowers homocysteine levels, showed a similar association with AD.)

Research also suggests that folate can prevent and treat depression. People with low folate levels are more likely to have clinical depression. Depressed patients treated with Prozac respond sooner and they are less likely to have relapses if they have adequate folate levels. A study of 123 patients with acute psychiatric disorders, including depression and schizophrenia showed a significant response if they were given high dose supplements (15 mg) of a form of folate.

The new study shows that folate supplements can enhance memory and slow the decline seen with aging. Researchers studied 818 people with normal brain function, aged 50 to 75 years old, and gave them either a placebo or 800 mcg of folate for three years. Those on the supplements, (well above the usual recommended amount) had better memory scores, comparable to people 5.5 years younger. (To prevent memory decline, it also helps to keep the brain active, do regular physical exercise, and maintain social interactions.) Some high-potency multivitamin formulas contain 800 mcg of folate. Doses of 5 to 20 mg of folate may have additional benefits.

Macular Degeneration Update

Macular degeneration, an age-related deterioration of the retina with declining visual function, can be reduced with better nutrition and dietary supplements, such as the carotenoid lutein, trace minerals, and vitamins C and E and beta-carotene. It may also be beneficial to take supplements that help small vessel circulation, such as ginkgo biloba.

New research shows that in combination even small doses of coenzyme Q10, acetyl L-carnitine, and omega-3 oils can reverse some early signs of macular degeneration and prevent progression. These nutrients all influence mitochondrial function and enhance cellular energy production. Also, macular degeneration might result from compromised circulation to the retina, and these supplements may help circulation.

In this double-blind study of 106 patients, half were given the supplement combination and half a placebo and they were followed for one year. The subjects given the supplement improved in every parameter that was evaluated, including changes in visual field defects, visual acuity, sensitivity of the retina in the most sensitive area, and the anatomical appearance of the retina.

In the supplement group, only one patient had disease progression, while nine patients in the placebo group worsened. An earlier pilot study had suggested these benefits, but this was the first controlled study to show these results.

These nutrients have a number of other health benefits, including benefits for the heart, the brain, circulation, and immune function. Combining them with other antioxidants and trace minerals as part of a total health program will help to preserve and restore eyesight.

Pesticides and Parkinson’s Disease

Pesticides are not confined to commercial farms and gardens. They are commonly used in and around the home, and particularly in both flower and vegetable gardens. However, you don’t have to be a farmer to be damaged by exposure to these toxic compounds. A team of researchers studying 2756 people in five European countries published their findings in New Scientist (www.newscientist.com/channel/health/mg18625014.900). They found that exposure to pesticides was directly related to the risk of developing Parkinson’s disease.

The researchers suggested that people using pesticides should wear protective clothing, but a far better choice would be to practice organic gardening, eliminating the use of toxic pesticides entirely. These substances are neurotoxins and likely carcinogens, and they also damage the soil and the beneficial organisms in the soil that help to control pests. In addition, residues of pesticides get into the food supply, poisoning consumers, and children playing in the garden are even more likely to be exposed to high levels.

People concerned about Parkinson’s disease, especially those with a family history of the condition, should consider eating organic foods and especially legumes, which are protective. They should also take supplements of vitamins C and E, and particularly high doses of coenzyme Q10, which have been shown to protect the brain.

Ask Dr. J: Sulfa and Sulfate

Q. I am beginning to have osteoarthritis, but I am allergic to sulfa drugs. Can I still take glucosamine sulfate?
—TW, via email

This is a common confusion. Sulfa drugs (a class of antibiotics more properly called sulfonamides) contain sulfur deeply embedded in a complex structure that also contains nitrogen, carbon and other elements. They are effective for many bacterial urinary tract and other infections, but many bacteria are now resistant to these medications. They are also often used to treat inflammatory bowel disease.

Sulfa drugs do have side effects though, and many people are allergic to them. However, it is not the sulfur itself that causes allergies to these drugs but the entire complex molecule to which some people react.

Sulfur is a required nutrient present in many foods, such as beans, eggs, dairy products, fish, garlic, and onions, and it is essential for protein production (hair, skin, muscles, collagen), bone formation, and bile production to aid digestion. It is a component of many important nutrients, such as glutathione, taurine, cysteine, and alpha-lipoic acid with its antioxidant activity and support in detoxifying heavy metals.

Glucosamine sulfate is unrelated to sulfa drugs other than having sulfur as one component. You should still be able to take it safely for arthritis (typically 1500 to 2000 mg daily). Some people report hypersensitivity to this and other dietary supplements. If that is your situation, try any combination of alternatives such as vitamin B3 (niacinamide, 1500 to 3000 mg), SAMe (200 to 800 mg), fish oil containing omega-3 oil (1200 to 2400 mg of EPA/DHA), and MSM, another sulfur source (1500 to 3000 mg) that helps arthritis.

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References

Health Care Business:

Hazlitt, Henry, Economics in One Lesson, Harper & Brothers, 1946

President Bill Clinton Interview, Talk of The Nation Science Friday, National Public Radio, June 3, 2005

Folic Acid:

Study: Folic Acid May Aid Seniors’ Memory, Alzheimer’s Association International Conference on Prevention of Dementia, Washington, D.C., June 18-21, 2005, as reported in WebMD Health

Durga J, Low concentrations of folate, not hyperhomocysteinemia, are associated with carotid intima-media thickness. Atherosclerosis. 2005 Apr;179(2):285-92.

Seshadri S, et al., Plasma homocysteine as a risk factor for dementia and Alzheimer’s disease. N Engl J Med. 2002 Feb 14;346(7):476-83.

Wang HX, et al., Vitamin B(12) and folate in relation to...Alzheimer’s disease. Neurology. 2001 May 8;56(9):1188-94.

Snowdon DA, et al., Serum folate and the severity of atrophy of the neocortex in Alzheimer disease: findings from the Nun study. Am J Clin Nutr. 2000 Apr;71(4):993-8.

Clarke R, et al., Folate, vitamin B12, and serum total homocysteine levels in confirmed Alzheimer disease. Arch Neurol. 1998 Nov;55(11):1449-55.

Godfrey PS, et al., Enhancement of recovery from psychiatric illness by methylfolate. Lancet. 1990 Aug 18;336(8712):392-5.

Papakostas GI, et al., The relationship between serum folate, vitamin B12, and homocysteine levels in major depressive disorder... Int J Neuropsychopharmacol. 2005 May 9;1-6 [Epub ahead of print]

Papakostas GI, et al., Serum folate, vitamin B12, and homocysteine in major depressive disorder... J Clin Psychiatry. 2004 Aug;65(8):1096-8.

Macular Degeneration Update:

Feher J, et al., Improvement of visual functions and fundus alterations in early age-related macular degeneration treated with a combination of acetyl-L-carnitine, n-3 fatty acids, and coenzyme Q10. Ophthalmologica. 2005 May-Jun;219(3):154-66.

Age-Related Eye Disease Study Research Group. A...trial of high-dose supplementation...for age-related macular degeneration and vision loss: Arch Ophthalmol. 2001 Oct;119(10):1417-36.

In The Health News

Weight loss of even moderate amounts reduces the likelihood of developing high blood pressure. Obese middle aged subjects who lost 15 pounds decreased the risk by 21 percent, while older subjects fared even better, with a 29 percent risk reduction. (Moore LL, et al., Weight loss in overweight adults and the long-term risk of hypertension: the Framingham study. Arch Intern Med. 2005 Jun 13;165(11):1298-303.) Even as little as 4 pounds reduction in weight made a significant difference. The data were derived from the Framingham study, and evaluated 1228 overweight adults.

Hypertension increases heart and kidney disease and strokes and shortens life. It reduces lifespan by five years, and adds seven years of heart disease. Researchers followed 3128 subjects for 28 years. (Franco OH, et al., Blood Pressure in Adulthood and Life Expectancy With Cardiovascular Disease...Hypertension 2005 August; online 27 June.) These effects were much greater than previously thought. Blood pressure rises with poor diet, obesity, and lack of exercise, and is helped with many dietary supplements, including coQ10, vitamins C and E, and magnesium, among others.

Diet and Disease

Eating more than 5 to 6 ounces of red meat per day increases the risk of developing bowel cancer, according to a large study of 478,040 men and women from 10 European countries followed for five years. Fish consumption in the same group was associated with a reduction in risk. The researchers estimated that the risk was about 40 percent increased in the meat eaters and 30 percent reduced in the fish eaters. Processed meat consumption was associated with an even higher risk. (Norat T, et al., Meat, fish, and colorectal cancer risk: the European Prospective Investigation into cancer and nutrition. J Natl Cancer Inst. 2005 Jun 15;97(12):906-16.)

Recipe of the Month: Yams and Black Bean Salsa

After cutting into 1-inch cubes, steam some sweet potatoes or garnet yams until soft. Make salsa with diced tomatoes, organic fresh or frozen sweet corn, chopped onions, crushed garlic, minced fresh cilantro, cumin, fresh diced hot peppers or powdered cayenne, chili powder, and a small amount of olive oil, lemon or lime juice (or cider vinegar), and a pinch of salt if you choose. Add a small amount of cooked black beans (pressure cook them for 20-25 minutes to save hours of cooking time; or you can use organic canned beans). You can vary any of the amounts to taste. (In a pinch, you can buy jars of organic black bean and corn salsa.) Mix the salsa and yams and let it sit in the refrigerator for a while to infuse the flavors. This can be served chilled with some organic whole wheat or corn tacos, or as a side dish for those summer cookouts.

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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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