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June 2006

Organic Vegetarian Travel
Too Many Vitamins??
Multivitamins-Multi-Benefits
Tap Water & Bladder Cancer
Ask Dr. J: Melatonin & Diabetes
References
In the Health News
Diet and Disease
Recipe of The Month: Noodles, Greens, and Beans

Organic Vegetarian Travel

Dear Friends,

On a recent trip to England to see friends in London and attend a wedding in Bath, I was pleasantly surprised at how easy it was to eat according to the healthy principles that I have followed for the past 31 years. I always make special efforts when traveling, taking my own food on the plane, for example, but I know it can be difficult to eat healthfully in some circumstances.

Before I left, I learned that Whole Foods Market had taken over seven health stores in England, including six in London. Also in London, I found a large health store called Planet Organic (with three stores in London). At their deli they served prepared foods, from salads and soups to entrées, all made with whole, organic ingredients. (Unfortunately, Whole Foods Markets deli foods are usually not whole, as they are often made with white rice and white flour, and organic foods are unusual.) At Planet Organic, I was able to sit down to eat some delicious foods and take some home to share with the friends at whose house I was staying.

I also found some healthy food at Neal’s Yard, a quaint little shopping area in Covent Garden. Two restaurants served whole, vegetarian fare, including a selection of salads, and one also had a variety of wheat-free baked goods for food-allergic people. The food was not organic, but this is a compromise that travel sometimes requires. An occasional compromise is not my concern, but rather the everyday practices that are with us all the time. The food was delicious and healthful; I never recommend giving up pleasure for health, as I know people won’t do it, and they don’t have to.

It is interesting that in England even many of the supermarkets carry a variety of organic foods, and one department store (Marks and Spencer’s) has a food section with both fresh, organic produce and a selection of prepared salads (on my last day, I stopped at a gas station that carried these fresh salads in their food section, an experience that would shock me here).

Bath is a beautiful city, with Roman baths, elegant architecture, a magnificent cathedral, and the wonderful meandering Avon river. It also has a good health food store, two supermarkets with organic foods, and a superb organic vegetarian restaurant (Demuth’s), in business since 1970 (they do serve white rice, but will serve brown rice if you call a day ahead and request it). On a day trip to Stonehenge, the tour stopped in Avebury, and a small village called Lacock (voted the prettiest village in England), where we stopped at a pub for lunch. Having prepared for the trip by making food, I was delighted to find that the pub had three different vegetarian selections (it seems that the demand for this is strong in England), and they offered at least part whole wheat in one of the meals. I was able to save the food I had made for dinner that evening. While staying healthy during travel can be difficult, it is by no means impossible with a little effort—less effort in England than I have found elsewhere.

Too Many Vitamins??

According to a report released by the Institute of Medicine, Americans may be taking too many vitamins. A panel of 13 “experts” suggested that while over half of Americans take vitamins, hoping to live longer, healthier lives, “we don’t know for sure that they’re benefiting from them.” This is part of a recent spate of journal articles and journalistic reports criticizing many common supplements that have good data supporting their use for various conditions.

The data supporting the value of many supplements is quite clear, whether for treating disease, preventing disease, or simply feeling better. The report noted that the most likely vitamin consumers were better nourished, in a higher socio-economic group, and better educated, and thus less likely to need the supplements. More poorly nourished people are least likely to take supplements. Of course, the fact that people who are more likely to need supplements are less likely to take them is due in part to misleading reports like this one.

The report says that “there are no good studies showing people who take multivitamin or mineral supplements can prevent chronic diseases such as cancer and heart disease.” This is simply untrue. The large Nurses’ Health Study showed that subjects who consumed the most vitamin E (primarily from supplements) had a 34 percent lower heart disease mortality than those with the lowest intake, and for those who took vitamin E supplements for more than two years, mortality was reduced by 41 percent.

A 2004 journal article suggested that certain nutrients protect the heart from stress and age-associated decline in function. These include coenzyme Q10, alpha-lipoic acid, magnesium, and omega-3 fatty acids. A previous report by these same researchers showed protection of the heart with supplements of coenzyme Q10.

Other research shows benefits from taking multivitamins and multiminerals. For example, a study of 178 patients with small-cell lung cancer, a very aggressive tumor, showed that those who took multivitamin-mineral supplements survived 40 percent longer than those who did not. This tumor has 99 percent mortality at one year. This does not mean that supplements were a cure, but that they prolonged survival. In other tumors and with other dietary supplements, cures may be possible, as I noted last month.

A previous study of patients with the same tumor showed that if they were given high-dose antioxidants, trace minerals, and essential fatty acids that survival was dramatically increased. The expected survival was one percent at the end of one year, but 8 of these 18 patients were alive when the study concluded at almost 3 years. Maybe the evidence is not conclusive (it rarely is for almost any treatment), but it is so strongly suggestive, and supplements are so safe and relatively cheap, that it is sufficient evidence for those “educated and better nourished” people who have decided to take supplements.

Multivitamins-Multi-Benefits

A prospective study of over a million adult Americans showed that those who took a combination of multivitamins and vitamins A, C, or E had a 15 percent reduction in mortality among non-smoking men. Supplements of L-carnitine can dramatically help patients with heart attacks. In a study of 101 heart attack patients, the group given 2 gms of L-carnitine per day had half as many deaths and half as many recurrent heart attacks as those given a placebo, and they had far less heart failure and fewer arrhythmias.

Research showed that in patients with AIDS supplements of multivitamins slowed the progression of the disease and delayed the need for anti-retroviral drugs. Among 1078 women in this double-blind, placebo-controlled study, multivitamins improved T-cell counts and lowered levels of viruses. Other research has also showed benefits in AIDS patients from taking multivitamins. In pregnant women, fetal death was 2/3 higher among those not taking supplements.

A study of age-related eye disorders (AREDS) showed that supplements of vitamins C, E, zinc, and beta-carotene prevent or delay the progression of macular degeneration (ARMD). Another study showed that people with the highest levels of lycopene (a carotenoid antioxidant) have the lowest rate of ARMD. No conventional medical treatment is available for macular degeneration. In addition, those with ARMD have a higher mortality than those without the disease. Loss of vision is the most feared disability, so anything that might help would be of great value. Telling people that they may be taking “too many” vitamins may deprive large numbers of people of the benefits that are likely with virtually no risk.

In recent months, medical and news reports have made it appear that many supplements are ineffective. Policosanol for cholesterol, St. John’s wort for depression, ginkgo for memory, vitamin E for the heart, glucosamine sulfate for arthritis, saw palmetto for the prostate, and antioxidants have all come under attack. It is hard to avoid the thought that these are all competing with expensive, highly touted drugs, and that this has something to do with the reports. Now even multivitamin-mineral supplements have been assailed.

While it is true that not all studies support extensive benefits of multivitamin supplements, the evidence of benefit is significant, and they are incredibly safe. Most people would benefit by taking a variety of supplements, and it is unwise to wait for the government to say it is OK.

Tap Water and Bladder Cancer

A new review shows that consumption of tap water increases the risk of bladder cancer. People who consumed more than two liters of tap water had a 46 percent higher risk of bladder cancer than those who consumed less than a half liter per day (and it was even higher among men). Chlorine in tap water combines with organic matter to create harmful substances, including trihalomethane (THM).

Researchers evaluated 2729 patients with bladder cancer and 5150 controls. The researchers found that total fluid intake was not associated with any increase in risk, including other sources of water, such as filtered or bottled waters. In this study, THM exposure was independent of the increased risk of bladder cancer, so other contaminants that are carcinogenic must be present.

As in some other studies, this research showed a greater risk of bladder cancer associated with coffee consumption. More than five cups a day significantly increased the risk.

Previous studies have shown that THM is an independent risk for bladder cancer. The level of THM in tap waters of developed countries is directly related to chlorination, and cumulative exposure increases the risk. Bottled and filtered waters are better choices.

Ask Dr. J: Melatonin & Diabetes

Q. Can I take melatonin if I am being treated for adult-onset diabetes? Can I use it to help sleep?

MH, California, via internet

A. Melatonin is the pineal gland hormone that regulates the body clock, promotes sleep, prevents jet lag, and helps mood. As an antioxidant, it also protects the brain and other tissues. While one small study suggests a possible negative effect of melatonin on insulin activity, the bulk of the evidence indicates that melatonin is actually helpful for diabetics. It protects the beta cells in the pancreas by reducing oxidative stress.

Typical doses of melatonin range from 1 to 3 mg just before bedtime, using timed release tablets if you fall asleep easily and wake up too early. You can monitor your blood sugar to make sure it does not cause problems for you. Other natural sleep aids include magnesium (300-800 mg), valerian (200-400 mg of standardized extract), 5-hydroxy tryptophan (5-HTP, 50-100 mg), and possibly passion flower, hops, or skullcap.

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References

Too Many Vitamins??

Stampfer MJ, et al., Vitamin E consumption and the risk of coronary disease in women. N Engl J Med. 1993 May 20;328(20):1444-9.

Rosenfeldt FL, et al., Coenzyme Q10 protects the aging heart against stress: studies in rats, human tissues, and patients. Ann N Y Acad Sci. 2002 Apr;959:355-9; discussion 463-5.

Rosenfeldt F, et al., Response of the senescent heart to stress: clinical therapeutic strategies and quest for mitochondrial predictors of biological age. Ann N Y Acad Sci. 2004 Jun;1019:78-84.

Singh RB, et al., A randomised, double-blind, placebo-controlled trial of L-carnitine in suspected acute myocardial infarction. Postgrad Med J. 1996 Jan;72(843):45-50.

Jatoi A, et al., Exploring vitamin and mineral supplementation and purported clinical effects in patients with small cell lung cancer... Nutr Cancer. 2005;51(1):7-12.

Jaakkola K, Treatment with antioxidant and other nutrients in combination with chemotherapy and irradiation in patients with small-cell lung cancer. Anticancer Res. 1992 May-Jun;12(3):599-606.

Watkins ML, Multivitamin use and mortality in a large prospective study. Am J Epidemiol. 2000 Jul 15;152(2):149-62.

Fawzi WW, et al., A randomized trial of multivitamin supplements and HIV disease progression and mortality. N Engl J Med. 2004 Jul 1;351(1):23-32.

Fawzi WW, et al., Randomised trial of effects of vitamin supplements on pregnancy outcomes and T cell counts in HIV-1-infected women in Tanzania. Lancet. 1998 May 16;351(9114):1477-82.

Mares-Perlman JA, et al., Serum antioxidants and age-related macular degeneration. Arch Ophthalmol 1995 Dec;113(12):1518-23.

Bladder Cancer Risks

Villanueva CM, Total and specific fluid consumption as determinants of bladder cancer risk. Int J Cancer. 2006 Apr 15;118(8):2040-7.

Villanueva CM, et al., Disinfection byproducts and bladder cancer: a pooled analysis. Epidemiology. 2004 May;15(3):357-67.

Kunze E, et al., Life style and occupational risk factors for bladder cancer in Germany. A case-control study. Cancer. 1992 Apr 1;69(7):1776-90.

In The Health News

a. Some medications used to control blood pressure appear to increase the risk of developing adult onset diabetes. In three studies with 75,000 subjects, beta-blockers and diuretic drugs (thiazides), led to a 20 to 45 percent higher incidence of diabetes (Taylor EN, et al., Antihypertensive medications and the risk of incident type 2 diabetes. Diabetes Care. 2006 May;29(5):1065-70). Calcium channel blockers and ACE inhibitors were not associated with this risk. Moderate hypertension can usually be controlled with diet, exercise, weight loss, and a number of supplements, including magnesium, coenzyme Q10, vitamin C, fish oil, and garlic, among others. Unless the blood pressure is at crisis levels, it is better to try natural treatments first. Diabetes increases cardiac risks and speeds aging.

b. School lunches in England are taking a turn for the better. The government announced that, starting this year, they will serve no sodas, or chocolate, and no “low-quality” meats, and they will provide at least two servings of fruits and vegetables. They will also limit deep fried foods, such as potato chips, to no more than twice a week. Schools will no longer have vending machines selling junk. This is a good start, and sets a good example for other countries. (Chips only twice a week for English school kids. Reuters, May 19, 2006.)

Diet and Disease

High sugar consumption increases the risk of breast cancer. Women with the highest levels of sugar intake had 1.19 times the risk of breast cancer. The relative risk increase is small, but the problem is that risks are additive, and people who eat high sugar diets usually also have other dietary habits that increase their risks through chemical and animal fat exposure. (Tavani A, et al., Consumption of sweet foods and breast cancer risk in Italy. Ann Oncol. 2006 Feb;17(2):341-5.)

Noodles, Greens, and Beans

Soak chick peas for 4-8 hours, discard the soaking water, and pressure cook them in fresh water for 22 minutes, letting them cool while still under pressure. Boil water in a noodle pot and cook soba (buckwheat) or whole wheat noodles until just tender (soba takes about 8 minutes). In a wok or skillet, sauté onions, garlic, shredded carrots, and diced bell peppers in olive oil with fresh or dried thyme, oregano, minced parsley, and cayenne to taste. When the onions soften, add the juice from one lemon and a small amount of soy sauce. Stir in, then add chopped fresh chard, spinach, or kale leaves (not stems), or a mixture of any of them. Next, add the chick peas, noodles, diced fresh tomatoes (or fire-roasted canned tomatoes), and a garnish of grated Romano cheese. Cook until the flavors are mixed or put in a casserole dish and bake covered in the oven at 350° for 20 minutes.Continue simmering to wilt the greens. Turn off the heat and fold in a bunch of minced cilantro and garnish with a few drops of toasted sesame oil.

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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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