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August 2005

Healthier Health Foods
Hypertension Update
Hypertension and Lifestyle
Digestion and Food Allergies
Ask Dr. J: Combining Cholesterol Agents
References
In The Health News
Diet and Disease
Recipe of the Month: Curry Carotene Soup

Healthier Health Foods

Dear Friends,

I recently went to two health restaurants, serving organic foods with vegetarian choices. While I was pleased that healthier organic foods are increasingly available, I was somewhat disappointed that neither of these establishments served any foods containing whole grains. Although their wheat was organic, it was made from white flour, devoid of the healthiest parts of the grain–the nutritious germ and fibery bran.

I have been so encouraged to see the growth of the health food industry in the past twenty-five years, but it has come with some compromise of the ideals that were present when it started. Until the late 1960s, a health food store contained a collection of dry goods, canned foods, and boxes of dietary supplements. The packaged breads that they sold were mostly heavy, dry, and dense, although they were made from whole wheat.

It was about that time that the interest in healthier and more tasty foods became part of the revolution of the sixties. Perhaps all that European travel contributed to the interest in fresher and tastier foods, but it was the macrobiotic movement that gave the largest push to healthier foods, including organic produce, organic whole grains, and the elimination of refined sugars and artificial ingredients. At that time, Michio and Aveline Kushi, macrobiotic teachers, developed a following, and they opened grocery stores to supply them with their organic, whole foods, including whole wheat and brown rice.

Although only one store is left, in Los Angeles, the influence that the Kushi’s and macrobiotics had on the health food industry was dramatic. Organic food is now the fastest growing segment of the entire grocery business. It is taking off across the country and in Europe and Japan (where the dietary choices that macrobiotics encouraged had their start). Health food stores are proliferating.

Unfortunately though, white flour and sugar (taboos in the earlier health food stores) have become pervasive throughout health stores and restaurants. At one time, as the stores and restaurants grew and prospered, they added a small amount of white flour and natural sweeteners to appeal to a wider audience. Then organically produced sugar became available, and these two ingredients came to dominate the market, with the assumption that the larger audience for health foods no longer cared about the health benefits of whole grains and fiber. Organic, whole-grain breads are hard to find.

I applaud the healthier, organic foods restaurants. I have been to many around the world (recently to O’Naturals and Flatbread in New England). I would like it even more if they and health food stores would make a commitment to less sugar and healthier whole grains, which have consistently been shown to be associated with improved health and lower risks.

Hypertension Update

I noted last month that conventionally defined hypertension shortens lifespan by five years and adds seven years of heart disease. New information confirms earlier evidence that even modest elevations of blood pressure, not enough to be considered hypertension, can have a negative influence on heart health. Normal blood pressure is below 120 (systolic) over 80 (diastolic), but mild elevations (diastolic pressure between 80 and 90, for example) have long been considered of little significance.

Recently, “prehypertension” has been considered a risk factor, with blood pressures from 120-140 systolic and 80-90 diastolic. In this current report, researchers reviewed data on 8986 participants in the National Health and Nutrition Examination Survey followed for 18 years. They found that prehypertension (levels above 130 systolic and 85 diastolic) significantly increased the risk of heart disease by 32 percent, and heart attacks by 42 percent.

These blood pressures have also been associated with an increased risk of strokes and other illness. In a 2004 report, researchers estimated the effects of prehypertension on health. Their projections estimated that the condition accounted for 3.4 percent of hospital admissions, 6.5 percent of nursing home stays, and 9.1 percent of deaths. Drug companies seized on this information to promote increased use of pharmaceuticals to control blood pressure.

However, while this information shows that it is important to control blood pressures even if elevations are modest, most of the time medications are unnecessary. Moderately high blood pressure can be controlled more safely by following a healthy low-salt, low-animal-fat diet, controlling weight, exercising, learning to relax, and taking dietary supplements.

Salt in the diet is a contributor to increased blood pressure. Although some reports (particularly reviews from the salt industry) suggest that only some sensitive individuals show increased blood pressure in response to dietary salt, some thorough reviews suggest that the relationship is common and consistent. Research in the journal Hypertension indicates that excessive salt intake may be a problem for most people.

The International Study of Salt and Blood Pressure (INTERSALT study) evaluated more than 10,000 people in 52 population groups from 32 countries and salt was clearly shown to influence blood pressure in both normal and hypertensive groups. It also appears that salt sensitivity increases with age, and if someone develops a habit of eating salty foods when they are younger, they may find it difficult to change if they develop health problems later in life. Typical daily salt consumption is from 5-13 gms, while our needs are only 1/2 to 1 gm per day (1/5th teaspoon).

Hypertension and Lifestyle

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

Digestion and Food Allergies

Food allergies have recently been shown to be related to irritable bowel syndrome (IBS). Typical symptoms of IBS are gas, bloating, cramps, diarrhea alternating with constipation, and general abdominal discomfort. Most of the medical profession has been skeptical that food sensitivities might play any role in the condition, other than recognizing that lactose intolerance might be one contributor, as most adults lack the enzyme that digests milk sugar (lactase).

While some studies have shown that elimination of specific foods often helps to reduce symptoms of IBS, now, researchers have found that people with IBS have high levels of antibodies to common foods, including wheat, beef, pork, lamb, soy, and eggs. While the researchers were unable to correlate the level of antibodies with the severity or frequency of symptoms, but symptoms might be more related to quantity and frequency of consuming the offending foods.

Food sensitivities that are not allergies will not show up in antibody tests. IBS may also be related to stress, abnormal intestinal bacteria, caffeine, alcohol, low dietary fiber, overgrowth of intestinal yeasts, and excessive dietary sugars.

Treatment options include avoiding offending foods, taking supplements of probiotics such as acidophilus and bifidus bacteria, and eating a high fiber diet. Fiber tends to absorb water, which helps to increase the bulk of the stool and improve elimination. Supplements of L-glutamine (2000-8000 mg), gamma linolenic acid (240-480 mg), and enteric-coated peppermint can all be helpful, as can fiber supplements, such as freshly ground flaxseeds or psyllium powder.

Ask Dr. J: Combining Cholesterol Agents

Q. To lower cholesterol, can I safely take policosanol, guggulipids, and niacin together?
—TT, via Internet

Natural substances tend to be much safer than the drugs that lower cholesterol, and they can be just as effective. Policosanol (labeled as from Saccharum officanarum or sugar cane), has been well studied in comparison with the statin drugs, and it appears to be of equal benefit for the cholesterol level and protection of the arterial lining cells (endothelium). It is a mixture of waxy alcohols, including octacosanol, but the specific mixture seems to make a difference in its effect. However, sometimes additional cholesterol-lowering supplements are helpful.

Niacin, guggulipids, and red yeast rice may all contribute to maintaining a normal cholesterol level, and they are unlikely to have any negative interactions with each other or with policosanol. For most of my patients, a combination of policosanol and red yeast rice has been very effective, but I have also recommended these with guggulipids, niacin, or garlic in various combinations, as well as soy protein.

The usual doses: policosanol, 20 mg per day; red yeast rice, 1000-2000 mg; guggulipid, 500-1500 mg; garlic (deodorized), 1000-2000 mg; and niacin, 2000-3000 mg. You will probably not need to take more than one or two of these to be effective. You might also benefit from fish oil supplements (EPA/DHA, 1000-2000 mg), and soy protein (30 gms, or 20 gms if replacing meat protein), with its isoflavones and other beneficial components.

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References

Healthier Health Foods:

Gary Hirshberg, How Business Can Save the World, Monadnock Summer Lyceum, June 26, 2005

Hypertension:

Liszka HA, et al., Prehypertension and cardiovascular morbidity. Ann Fam Med. 2005 Jul-Aug;3(4):294-9.

Russell LB, Effects of prehypertension on admissions and deaths: a simulation. Arch Intern Med. 2004 Oct 25;164(19):2119-24.

Chobanian AV, Hill M, National Heart, Lung, and Blood Institute Workshop on Sodium and Blood Pressure: a critical review of current scientific evidence. Hypertension. 2000 Apr;35(4):858-63.

Appel LJ, et al., Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. JAMA. 2003 Apr 23-30;289(16):2083-93.

Miller ER 3rd, et al., Results of the Diet, Exercise, and Weight Loss Intervention Trial (DEW-IT). Hypertension. 2002 Nov;40(5):612-8.

Keenan JM, et al., Oat ingestion reduces systolic and diastolic blood pressure... J Fam Pract. 2002 Apr;51(4):369.

Pins JJ, Do whole-grain oat cereals reduce the need for antihyper-tensive medications...? J Fam Pract. 2002 Apr;51(4):353-9.

Fujita H, Yoshikawa M.LKPNM: a prodrug-type ACE-inhibitory peptide derived from fish protein. Immunopharmacology. 1999 Oct 15;44(1-2):123-7.

Marczak ED, et al., New antihypertensive peptides isolated from rapeseed. Peptides. 2003 Jun;24(6):791-8.

He J, et al., Effect of soybean protein on blood pressure: a randomized, controlled trial. Ann Intern Med. 2005 Jul 5;143(1):1-9.

Irritable Bowel Syndrome:

Zar S, et al., Food-Specific Serum IgG4 and IgE Titers to Common Food Antigens in Irritable Bowel Syndrome. Am J Gastroenterol. 2005 Jul;100(7):1550-7.

Santelmann H, Howard JM, Yeast metabolic products, yeast antigens and yeasts as possible triggers for irritable bowel syndrome. Eur J Gastroenterol Hepatol. 2005 Jan;17(1):21-6.

Malhotra S, et al., Dietary fiber assessment of patients with irritable bowel... Indian J Gastroenterol. 2004 Nov-Dec;23(6):217-8.

In The Health News

Just after writing about folic acid last month, a new article appeared showing that folate lowers the risk of hemorrhagic strokes. In an evaluation of 396 patients, folate levels were inversely related to the risk of hemorrhagic strokes (Van Guelpen B, et al., Folate, vitamin B12, and risk of ischemic and hemorrhagic stroke...Stroke. 2005 Jul;36(7):1426-31). The researchers were surprised that no association was seen with ischemic strokes (clots), but noted that folate levels in Sweden are possibly too low to find such a link (foods are not fortified and vegetable intake is relatively low).

Chromium is essential for fat and carbohydrate metabolism, and has been associated with improved diabetic sugar control and better management of hypoglycemia. New research in a nine-country case-control study of 1408 men shows that subjects with the highest levels of chromium had a 40 percent reduction in the risk of a heart attack compared to men with the lowest levels (Guallar E, et al., Low toenail chromium concentration and increased risk of nonfatal myocardial infarction. Am J Epidemiol. 2005 Jul 15;162(2):157-64.)

Diet and Disease

A Japanese study evaluated 42,000 adults on a Western-style diet, with high amounts of red meat, poultry, cheese, white flour, and butter, a Japanese diet, high in some traditional foods, such as pickled vegetables and salted fish, and a healthy diet, high in fruits, vegetables, soy, and beans. Colon cancer was double in both the Western diet and the Japanese traditional diet compared with the healthy diet. (Kim MK, et al., Dietary patterns and subsequent colorectal cancer risk by subsite: a prospective cohort study. Int J Cancer. 2005 Jul 10;115(5):790-8.) Meat and saturated fats have often been linked to increased colon cancer risk.

Recipe of the Month: Curry Carotene Soup

Peel and seed about 3 pounds of butternut squash, and steam with 3 yams or sweet potatoes until they are all soft. In olive oil, sauté 2 diced onions, 3 diced large carrots, a minced, thumb-sized piece of peeled fresh ginger, 4 minced cloves of garlic, and 1-3 Tbsp of curry powder, depending on your taste. After browning, add the juice of a half lemon, 1 cup of organic coconut milk (a creamy blend of coconut pulp, available canned), and a cup of shredded coconut, and lightly cook these together. Mash the steamed vegetables in the cooking water, adding extra water as needed, and add the other mixture to the pot. Simmer this until everything is blended and the flavors are well mixed. You can add some sea salt to taste (or just extra lemon if you want to avoid the sodium). You can use the food processor or blender to make it smoother, and serve it hot or cold.

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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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