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October 2006

Letting Go of Habits
Peptic Ulcer Management
Safer Natural Remedies
Arthritis and Food Allergy
Ask Dr. J: Strontium for Bones
References
In the Health News
Diet and Disease
Recipe of the Month: Broccoli Raab (Rapini)

Letting Go of Habits

Dear Friends,

Letting go of certain food attachments can be difficult, but not as difficult as it might seem at first. Whether or not we ate nutritious foods as part of our diets while growing up, many of us also consumed a variety of foods that were (and remain) unhealthful, including cakes, pies, candies, cookies, ice cream, Jell-O, fried foods, meats (particularly deep fried or grilled), and drinks such as milkshakes, sodas, and Kool-Aid. These foods might still be associated with memories of good times and comfort.

I remember the pleasures of a cookout with the extended family, or the offer of an evening milk-shake as a treat (before I realized that lactose intolerance was causing subsequent digestive symptoms), or the summer outings to the clam shack for steamers and fried clams. When confronted with suggestions for improving the diet, people with these associations might hang on to foods for their memories rather than for the actual taste pleasures.

I am not saying that the taste pleasures are not real, but that our tastes are mostly learned, and these can change, especially if we make an effort to create new associations (the smell of fast-food joints always makes me think of the nauseating aroma of overcooked and rancid oils or shortening, which is guaranteed to repel me). I remember creating just such a negative association when I began learning about health and was told that chocolate factories have a serious problem with cockroaches, and as a result they have a certain maximum allowable level of cockroach parts in their products. Whether or not this is true, it altered my interest in chocolate from that day forward, and makes me think twice before even the occasional organic chocolate treat.

I was recently talking with a patient about the habits that are hard to let go, one of which was a fried food. I pointed out that the processed food industry advertises cooking oils in commercial restaurant journals (that the public never sees) claiming that their particular oil can be reused for thirty days without changing it (at the end of the day they skim off the surface crud then top it up and reheat the oil the next day). This information may not lead to an immediate habit change, but at least he is thinking differently with a new motivation (in addition to avoiding future heart surgery).

Years ago I participated in discussions on a network health forum, and one of the participants was talking about her changing to a strict low-fat, low-sugar, vegetarian diet to reverse her heart disease (she had had a coronary bypass after a heart attack in her early forties). Another participant asked her if the diet was not difficult, as she had given up so many foods that are common in the western diet, and to which she had been accustomed before her heart attack. Her response remains with me to this day. She said that after a short transition she found many delicious foods that fit into her new dietary practices, and besides, she said, “there is absolutely nothing edible worth dying for.”

Peptic Ulcer Management

Acid indigestion or heartburn is often the result of poor diet and stress, but it may also be a symptom of a peptic ulcer, an erosion in the lining of the stomach or first part of the small intestine called the duodenum. In some cases the ulcer breaks through a blood vessel and causes serious bleeding, and more rarely it can actually perforate the wall of the stomach or duodenum creating a medical emergency. (“Peptic” refers to pepsin, a digestive enzyme produced in the stomach.)

The typical picture that most people have of someone with an ulcer is a highly stressed, overworked, type-A individual, but this is not necessarily the case. In fact, most ulcers are the result of an infection with a bacterium called Helicobacter pylori (H. pylori), although other influences may contribute to ulcer development. The presence of H. pylori does not necessarily lead to an ulcer.

While stomach acid (hydrochloric acid) is highly corrosive, the lining of the stomach is usually protected from its effects. Only when this protection breaks down does an ulcer develop. Smoking, alcohol, coffee (even decaf), sugar, salt, and fat, and anti-inflammatory drugs, such as aspirin and ibuprofen, are all associated with a breakdown of these defenses, leading to peptic ulcer disease. Interestingly, excessive everyday stress is not clearly associated with development of ulcers (although it is undesirable in many ways).

Although heartburn is a common symptom of ulcer disease (or simply acid indigestion), it is also common to have other symptoms. Abdominal pain may or may not be present, and it may masquerade as chest pain or a gnawing ache in the upper abdomen. The pain usually comes and goes, often happens at night, and is usually relieved by eating (but sometimes eating can make the symptoms worse). It is also possible to have an ulcer with no symptoms at all.

A test that is positive for blood in the stool may suggest a bleeding ulcer. Several tests can reveal the presence of H. pylori, including blood tests, but blood tests are less specific than stool or breath antigen testing. If the diagnosis is not clear, a barium X-ray may reveal an ulcer. Gastroscopy is also helpful in establishing the presence of an ulcer, and although it is a more invasive test, it may be necessary.

Typical medical treatments are mainly efforts to counteract stomach acids with antacid drugs and drug therapies to eradicate H. pylori. While antacids may relieve the symptoms temporarily, they will not by themselves eliminate an infection. Drug treatments are combinations, usually including two antibiotics, such as amoxicillin and clarithromycin, and a gastric acid reducer such as omeprazole (Prilosec). Bismuth subsalicylate (Pepto-Bismol) is sometimes added. Combining the first three is over 80 to 90 percent effective, with fewer side effects than other treatments, but it is not free of side effects, and H. pylori may develop antibiotic resistance.

Safer Natural Remedies

Natural substances are effective against H. pylori and also help to heal and protect the gastric and duodenal lining cells. Fiber in the diet is helpful as a long-term treatment because it absorbs and buffers stomach acid. Avoiding the previously-mentioned irritant substances is an important part of the overall treatment plan. In addition, taking supplements may reduce or eliminate the need for any drugs, but this is something you should consider with professional advice.

Turmeric, cumin, ginger, and licorice are all effective in laboratory studies in killing H. pylori, as is Japanese wasabi horseradish. In addition to killing the bacteria, turmeric inhibits the adhesion of bacteria to the stomach lining, further enhancing its benefits. Using such plant extracts can overcome the resistance associated with antibiotic use. Recent studies in animals have shown that turmeric can inhibit gastric acid secretion, and reduce ulcer formation. A clinical trial showed that turmeric (3000 mg) healed 76 percent of gastric ulcers within 3 months.

A study in 2002 showed that licorice extracts contain a variety of flavonoids and isoflavones that can block the growth of H. pylori in laboratory cultures. These compounds were effective against both strains that were resistant to antibiotics and strains that were sensitive to the drugs. Other components of licorice help to relieve heartburn symptoms by coating the esophagus and stomach with a protective substance produced when the extract is chewed and mixed with saliva.

Mastic gum, a resinous substance from the Pistacia lentiscus tree, is a traditional medicine that has been shown to kill H. pylori and relieve ulcer symptoms. At the right concentration, it can kill over 90 percent of the bacteria. Typical doses of mastic gum range from 500 to 2000 mg daily for two to three months. Other research shows that mastic gum is preventive and therapeutic for leukemic and colon cancer cell growth, induces apoptosis (programmed cell death), and it inhibits tumor angiogenesis.

Other supplements that may be helpful for ulcers include L-glutamine (2000 to 6000 mg daily), garlic, grapefruit seed extract, vitamin C, vitamin A, and zinc. Lactobacillus acidophilus (a probiotic supplement) is also beneficial in reducing H. pylori infection in an animal model. A typical supplement would be 10-20 billion organisms.

L-glutamine is a non-essential amino acid that is needed for reproduction and healing of intestinal lining cells, as well as maintenance of cellular energy. A recent study in rats showed that grapefruit seed extract reduced gastric acidity, improved blood flow to ulcer sites, and decreased ulcer size. Combining supplements with a high-fiber diet that is low in fat, sugar, and salt may reduce or eliminate the need for medication.

Arthritis and Food Allergy

Foods may play a role in making rheumatoid arthritis (RA) worse. Many patients report such an association, and a new study supports this claim. Researchers evaluated 14 RA patients and compared them with 20 controls. Intestinal secretions showed remarkably higher levels of food antibodies in the subjects than in the controls.

The most common offending foods were milk, eggs, pork, and codfish. Because antibodies to multiple foods were found in each subject, the researchers suggested that many small effects could add up to major symptoms. (Hvatum M, et al., The gut-joint axis: cross reactive food antibodies in rheumatoid arthritis. Gut. 2006 Sep;55(9):1240-7.)

Avoid suspect foods and take supplements to help symptoms, such as vitamins C and E, SAMe, fish oil, borage oil, curcumin, and boswellia.

Ask Dr. J: Strontium for Bones

Q. Is strontium (for osteoporosis) dangerous, as some people have told me?

DH, via Internet

A. Strontum is a chemical elemental mineral in the same atomic family as calcium and magnesium. Strontium ranelate and strontium citrate are used as supplements to enhance bone density and reverse osteoporosis. A New England Journal of Medicine study showed a 14 percent increase in bone density of the spine in 3 years, an 8 percent increase in the hip, and a 50 percent reduciton of spinal fracture risk in one year. This is better than risky and expensive medications.

Strontium is not dangerous, and has no side effects. The typical dose of elemental strontium for osteoporosis is about 700 mg per day, taken separately from supplements containing calcium, with which it will compete for absorption.

Some people have a mistaken notion about strontium because in the 1950s atomic testing created a dangerous radioactive form called strontium-90, which deposited in bones and led to bone cancer and leukemia. This is not found in any supplements, so there is no danger. You will still need calcium, vitamin D, ipriflavone, progesterone and other supplements for osteoporosis.

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References

Peptic Ulcer Disease

Peptic Ulcer Disease, Drug Digest, http://www.drugdigest.org.

O’Mahony R, et al., Bactericidal and anti-adhesive properties of culinary and medicinal plants against Helicobacter pylori. World J Gastroenterol. 2005 Dec 21;11(47):7499-507.

Kim DC, et al., Curcuma longa extract protects against gastric ulcers ... Biol Pharm Bull. 2005 Dec;28(12):2220-4.

Mahady GB, et al., In vitro susceptibility of Helicobacter pylori to botanical extracts... Phytother Res. 2005 Nov;19(11):988-91.

Prucksunand C, et al., Phase II clinical trial on effect of the long turmeric (Curcuma longa Linn) on healing of peptic ulcer. Southeast Asian J Trop Med Public Health. 2001 Mar;32(1):208-15.

Shin IS, et al., Bactericidal activity of wasabi... against Helicobacter pylori. Int J Food Microbiol. 2004 Aug 1;94(3):255-61.

Fukai T, et al., Anti-Helicobacter pylori flavonoids from licorice extract. Life Sci. 2002 Aug 9;71(12):1449-63.

Marone P, et al., Bactericidal activity of Pistacia lentiscus mastic gum against Helicobacter pylori. J Chemother. 2001 Dec;13(6):611-4.

Koutsoudaki C, et al., Chemical composition and antibacterial activity of the essential oil and the gum of Pistacia lentiscus Var. chia. J Agric Food Chem. 2005 Oct 5;53(20):7681-5.

Loutrari H, Mastic Oil from Pistacia lentiscus var. chia Inhibits Growth and Survival of Human K562 Leukemia Cells and Attenuates Angiogenesis. Nutr Cancer. 2006;55(1):86-93.

Balan KV, et al., Antiproliferative activity and induction of apoptosis in human colon cancer cells [by] Pistacia lentiscus L. var. chia. Phytomedicine. 2006 May 16.

Cvetnic Z, Vladimir-Knezevic S, Antimicrobial activity of grapefruit seed and pulp ethanolic extract. Acta Pharm. 2004 Sep;54(3):243-50.

Brzozowski T, et al., Grapefruit-seed extract attenuates ethanol-and stress-induced gastric lesions... World J Gastroenterol. 2005 Nov 7;11(41):6450-8.

Zayachkivska OS, et al., Gastroprotective effects of flavonoids in plant extracts. J Physiol Pharmacol. 2005 Mar;56 Suppl 1:219-31.

Brzozowski T, et al., Effect of probiotics ...in Helicobacter pylori-infected Mongolian gerbils. Helicobacter. 2006 Feb;11(1):10-20.

In The Health News

a. Acupuncture provides effective relief for back pain and improves function according to a large study of 11,630 patients. At three months, twice as many acupuncture patients (52 percent) as controls responded to the treatments (up to 15 sessions). When the controls were then switched to treatment, they also responded at the higher rate (Witt CM, et al., Pragmatic randomized trial evaluating the clinical and economic effectiveness of acupuncture for chronic low back pain. Am J Epidemiol. 2006 Sep 1;164(5):487-96.) The researchers noted that the treatments were also relatively cost effective.

b. Supplements of vitamin D can cut the risk of pancreatic cancer almost in half, according to two large studies with a total of 122,198 subjects. Participants who took 300-450 IU of vitamin D per day had a 43 percent lower risk of pancreatic cancer than those with the lowest intake; those who took 150-299 IU had a 23 percent reduced risk). (Skinner HG, et al., Vitamin D intake and the risk for pancreatic cancer in two cohort studies. Cancer Epidemiol Biomarkers Prev. 2006 Sep;15(9):1688-95.) Pancreatic cancer is particularly deadly. Vitamin D also has known benefits in reducing the risk of other cancers, such as colon and prostate.

Diet and Disease

A computer simulation study suggests that increasing the amount of omega-3 oils from fish in the diet could save far more lives from heart disease than cardiac defibrillators. The dietary change could reduce deaths by over 6 percent, an 8-fold greater effect than the estimate for wide distribution of defibrillators. (Kottke TE, et al., Preventing Sudden Death with n-3 (Omega-3) Fatty Acids and Defibrillators. Am J Prev Med. 2006 Oct;31(4):316-323.) High-tech solutions are often recommended in situations where simple lifestyle changes would be better and cheaper.

Broccoli Raab (Rapini)

I love this vegetable partly because it is so easy to grow in both of my gardens, but I also love the slightly bitter, mustardy taste of the leaves. It is usually sold with many buds that look like broccoli (although it is not related to broccoli and never forms a head). The buds will open to bright yellow flowers if left growing in the garden. If you grow your own, simply cut the larger leaves at the base and the smaller central leaves will keep producing. It is simple to cook by lightly steaming (especially the thicker stems of bunches that you buy) and then stir-frying in olive oil and garlic until tender. You can skip the steaming and stir-fry a bit longer. You can add freshly ground pepper or cayenne, fresh lemon juice, and cooked white beans, or make a mixed stir-fry with onions, garlic, tofu chunks, ginger, and diluted soy sauce and vinegar. Serve either recipe over brown rice or millet.

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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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