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February 2006

Health Foods in Supermarkets
Skin Protection Update
Oral Supplements for Skin
Exercise Helps the Brain
Ask Dr. J: Gastritis and Drugs
In the Health News
Diet and Disease
Recipe of the Month: Millet-Yam-Veg Patties

Health Foods in Supermarkets

Dear Friends,

Our local supermarket carries a selection of natural and organic foods in a separate shelf area of each department, so their customers have an opportunity to make healthier choices. Just the availability of these foods in a conventional market increases health awareness among people who would not otherwise be exposed to better foods. This is a significant change from just a few years ago, when it was difficult or impossible to find whole grains and organic products in a supermarket.

I was pleased to see a flyer published by the market promoting these foods, and providing educational articles that were formerly only found in health food stores. This pamphlet covered a variety of topics, including the antibiotic properties of goldenseal, the nutritional value of sweet potatoes, cancer protection from lycopene (in tomatoes and watermelon), the importance of organic foods (and why they are more expensive), and why you should avoid tap water (using bottled or filtered water instead).

While not all of the information in this pamphlet was accurate (they cautioned against taking vitamin C in doses above 2000 mg per day, which is perfectly safe, recommended cheese pizza and ice cream as alternative sources of calcium, and sugary ketchup for lycopene), it is certainly a step in the right direction, and is one more piece of evidence that healthier foods are becoming more mainstream. At the same time, health food stores are growing rapidly and becoming more like supermarkets, slightly beginning to blur the distinction between the two. Unfortunately, some of this “blurring” has come through large health food stores starting to carry more commercial products with lots of white flour and refined sugar (even though some of these are organic, they are still not healthful).

I also recently met a colleague in conventional medicine at a brunch, and he pointed out how “alternative” medicine is becoming more accepted in mainstream circles. We both noted the use of glucosamine sulfate and fish oil by rheumatologists to treat arthritis (he was aware that vets have been using glucosamine for a long time for horses, and taking it themselves), and he knew that niacin (vitamin B3) is effective to lower cholesterol and raise the HDL (good) cholesterol. While this is encouraging, I still see that there is a long way to go. Much of the food marketplace (both markets and restaurants) is still filled with junk masquerading as food, and most of the medical community has negative feelings about complementary/alternative/integrative medicine, even when it is documented in the medical literature.

Unlike my thoughts on these issues 30 years ago, I am now hopeful that the merging of the best of these worlds will happen in my lifetime (although that could still mean it is a long way off).

Skin Protection Update

The skin is our first layer of protection from the elements, but it needs protection itself from damaging environmental exposures. I reviewed skin health in July, 2004, but new research continues to provide information that may further help to reduce aging and skin disease (important not only for cosmetic benefits but also for cancer prevention and improved general health).

Topical application of niacinamide (vitamin B3) to facial skin can increase elasticity and reduce fine lines, hyperpigmentation, redness, and poor texture of the skin, which are all signs of photoaging (ultraviolet damage). In a study on 50 subjects, researchers applied 5% niacinamide to one side of the face and a placebo cream to the other to serve as the control.

After 12 weeks of treatment, all of the improvements above were noted by both observation and instrumental measurements on the treatment side, but not on the control half of the face. A 5% cream would have approximately 1500 mg in one ounce. Adding 3000 mg (the contents of six 500-mg capsules) to a 2-oz tub of natural face cream would provide this concentration.

Earlier studies have shown that topical vitamin C protects the skin against ultraviolet damage (from both UVA and UVB). It has now also been shown to help treat photoaging of the skin. Vitamin C promotes collagen formation, lightens hyperpigmentation, and reduces inflammation, in addition to its antioxidant protection.

In one six-month, double-blind study, a cream with 5% vitamin C was applied to skin of the lower neck and arms (areas with evidence of photoaging) in otherwise healthy female volunteers. In addition to observation of the skin by both the subjects and by dermatologists, the researchers did biopsies to determine the effects of the treatment. The biopsied tissues showed increased density of the skin, reduced wrinkling, and evidence of repair of the elastic tissue.

Oral Supplements for Skin

Green tea extracts containing EGCG (epigallo-catechin gallate) have antioxidant and anti-inflammatory properties. They have become popular as components of skin creams and as oral supplements. In a study combining treatment with a cream containing 10% green tea extract and oral supplements of 300 mg twice a day, skin biopsies showed improved elastic tissue content. The study lasted only eight weeks, during which time the benefits were not visible other than on biopsy. The authors speculated that longer studies would be needed to show observable benefits.

Another double-blind study last year showed similar results in reversing skin aging with oral supplements. In 40 subjects, 20 were treated with supplements of alpha-lipoic acid, proantho-cyanidins, and a mixture of vitamins and minerals, while the other 20 were treated with placebo. Objective measurements of skin thickness and elasticity showed improvement with active treatment compared to placebo. Skin roughness and both fine and coarse wrinkles were also better, based on clinical assessment. In subjective evaluation by participants, the active treatment was significantly better.

In a study of a combination of orally administered nutrients, 62 women from 45 to 73 years old were given either the supplements or a placebo for a total of 12 weeks. Their skin elasticity was improved after six weeks with the treatment as measured by optical equipment, and skin roughness was lessened significantly after 12 weeks. The nutrients included vitamins C and E, carotenoids, selenium, and zinc, as well as blueberry extract and proanthocyanidins.

Lycopene is a red carotenoid found in tomatoes, watermelon, red grapefruit, and red navel oranges (watermelon and red grapefruit have more lycopene than fresh tomatoes). Oral and topical lycopene protects against UV damage to skin. In a study of topical application, lycopene reduced skin wrinkling, redness, and inflammation, and the effect was greater with higher doses. In a study of oral lycopene, volunteers ingested 10-mg supplements daily, and were tested for redness following UV irradiation. By week 12, they had a significantly reduced response to UV light.

Finally, the hormone progesterone helps to reduce skin wrinkling associated with aging. A controlled study on 40 subjects using 2% progesterone cream showed increased elasticity and firmness of the skin, and reduced wrinkling around the eyes, nose, and mouth. Blood levels of the hormone increased during treatment.

Exercise Helps the Brain

Regular exercise, even if only a very modest amount, appears to help preserve brain function in elderly people. Researchers recruited 1740 subjects who had normal cognitive function at 65 years old and followed them for over 6 years, testing them every two years.

Those subjects who exercised three or more times per week, had a 38 percent lower risk of developing any form of dementia (including Alzheimer’s disease and others) compared to those who exercised fewer than three times per week.

Even walking for just 15 minutes more than three times per week provides significant benefit. One value of exercise is the improvement in circulation to the brain (and other tissues), but it also has other benefits that might play a role in prevention of brain degeneration. Physical activity helps to control blood sugar, and this also reduces age-related tissue deterioration. High sugar levels lead to advanced glycation end products (AGEs), toxic substances that interfere with blood vessel and membrane function.

An earlier study showed that physical activity at least twice a week was protective, reducing non-Alzheimer’s dementia by 50 percent and Alzheimer’s disease by 60 percent. This study followed subjects for 21 years, and this level of benefit is remarkable for such a small change in physical activity. Of course, higher levels of physical activity have other benefits, and brain function is also preserved by good nutrition and dietary supplements (acetyl L-carnitine, alpha-lipoic acid, coenzyme Q10, vitamin E, N-acetyl cysteine, and ginkgo biloba among others).

Ask Dr. J: Gastritis and Drugs

Q. I’m taking Tagamet for gastritis caused by another medication. Can I do anything instead of the drug to manage this problem?

ES, via Internet

A. A number of medications can cause gastric upset, including aspirin and other non-steroidal anti-inflammatory drugs (NSAIDS such as Motrin, Advil, and Naprosyn). It can also worsen with exposure to alcohol and caffeine, and the symptoms are often increased by sugary, fatty fast foods. Gastritis can be associated with the bacterium, Helicobacter pylori, which causes a majority of gastric ulcers, so treatment is very important. If Helicobacter testing is positive, antibiotics are prescribed to eliminate the bacteria and help prevent ulcers and gastric cancer.

Tagamet reduces stomach acid production, but it may cause some side effects. Newer antacid drugs, such as Prilosec (the precursor to Nexium, which is not really any better), Protonix, and Prevacid work differently, but they also have side effects (headaches, diarrhea, dry mouth, cough, and abdominal pain).

You can reduce symptoms by improving your diet–-eliminating junk and eating foods that are low in sugar and fat, and taking some dietary supplements. For immediate relief, you can chew tablets of deglycyrrhizinated licorice, or DGL. Mixed with saliva, this coats the lining of the stomach and esophagus, protecting it from acid and relieving heartburn. L-glutamine (1000-6000 mg daily), vitamins C (4000-6000 mg) and E (400-800 IU), N-acetyl cysteine (1000-2000 mg), and zinc (30-50 mg) also help gastric healing.

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Skin Protection Update

Bissett DL, et al., Niacinamide: A B vitamin that improves aging facial skin appearance. Dermatol Surg. 2005 Jul;31(7 Pt 2):860-5.

Humbert PG, et al., Topical ascorbic acid on photoaged skin. Clinical, topographical and ultrastructural evaluation: double-blind study vs. placebo. Exp Dermatol. 2003 Jun;12(3):237-44.

Farris PK, Topical vitamin C: a useful agent for treating photoaging and other dermatologic conditions. Dermatol Surg. 2005 Jul;31(7 Pt 2):814-7.

Segger D, Schonlau F, Supplementation with Evelle improves skin smoothness and elasticity in a double-blind, placebo-controlled study with 62 women. J Dermatolog Treat. 2004 Jul;15(4):222-6.

Thom E, A randomized, double-blind, placebo-controlled study on the clinical efficacy of oral treatment with DermaVite on ageing symptoms of the skin. J Int Med Res. 2005 May-Jun;33(3):267-72.

Chiu AE, et al., Double-blinded, placebo-controlled trial of green tea extracts in the clinical and histologic appearance of photoaging skin. Dermatol Surg. 2005 Jul;31(7 Pt 2):855-60.

Fazekas Z, et al., Protective effects of lycopene against ultraviolet B-induced photodamage. Nutr Cancer. 2003;47(2):181-7.

Aust O, et al., Supplementation with tomato-based products increases lycopene...[and] protects against UV-light-induced erythema. Int J Vitam Nutr Res. 2005 Jan;75(1):54-60.

Holzer G, et al., Effects and side-effects of 2% progesterone cream on the skin of peri- and postmenopausal women...Br J Dermatol. 2005 Sep;153(3):626-34.

Exercise and The Brain

Larson EB, et al., Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older. Ann Intern Med. 2006 Jan 17;144(2):73-81.

Rovio S, et al., Leisure-time physical activity at midlife and the risk of dementia and Alzheimer’s disease. Lancet Neurol. 2005 Nov;4(11):705-11.

Virmani A, et al., Effects of Metabolic Modifiers Such as Carnitines, Coenzyme Q10, and PUFAs against Different Forms of Neurotoxic Insults.... Ann N Y Acad Sci. 2005 Aug;1053:183-91.

In The Health News

a. High cholesterol levels are associated with an increased risk of developing hypertension. In a study of 3110 men with no heart disease or hypertension for 14 years, compared to subjects with the lowest cholesterol, those with the highest total cholesterol had a 23 percent higher chance of developing hypertension, and those with the highest cholesterol relative to the HDL had a 54 percent increased risk. Men with the highest HDL had a 32 percent lower risk compared to those with the lowest HDL. (Halperin RO, et al., Dyslipidemia and the risk of incident hypertension in men. Hypertension. 2006 Jan;47(1):45-50.) A previous study showed the same association in women.

b. In a study of 64 subjects with chronic, obstructive lung disease, omega-3 oil supplements (about 3 Tbsp) reduced inflammatory markers and improved both walking distance and oxygen saturation. This condition is otherwise difficult to treat. Those given omega-6 oils showed no change. (Matsuyama W, et al., Effects of omega-3 polyunsaturated fatty acids on inflammatory markers in COPD. Chest. 2005 Dec;128(6):3817-27.)

Diet and Disease

Eating fish helps to preserve brain function. Researchers evaluating 3718 subjects over 6 years found that those who ate fish once a week had a 10 percent slower cognitive decline (gaining about 3 years of brain preservation) while those who ate fish twice or more per week gained about 4 years (13 percent slower decline). It was not clear whether it was from the omega-3 oils in fish or because eating fish reduced consumption of meat and saturated fat. However, based on other data, the researchers speculated that the result was likely due to the essential fatty acids. (Morris MC, et al., Fish consumption and cognitive decline with age in a large community study. Arch Neurol. 2005 Dec;62(12):1849-53.

Millet-Yam-Veg Patties

Bake a medium yam until tender (about 1 hour). Mix 1 cup of millet in 3 cups of water in a saucepan and bring to a boil, add 1 Tbsp of tamari soy sauce, then simmer until the water is absorbed (about 25 minutes). Finely mince 1 large onion and 2 cloves of garlic, and sauté in olive oil with freshly ground black pepper and 1/2 tsp of thyme. Mince a green, such as arugula or spinach, add 1 cup to the onions when they are brown, and mix well. Mash this all together with the millet and the yam until they are well mixed. Form patties that are about 1/2 to 3/4 inch thick. It should make about six patties. Place them in a skillet with a small amount of olive oil, and pan fry them until the surfaces are just crisp. You can vary this by using curry powder and cumin, or you can use oregano for a different flavor. They can be served as a side dish or as a main dish with a salad.



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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.