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December 2006 - January 2007

Coenzyme Q10 and migraine
Low-carb/high protein diets
Low protein reduces cancer risks
Exercise lowers breast cancer risk
Diet reduces prostate cancer risk
Benefits of lignans and soy isoflavones
Ask Dr. J: Healthy Weight Gain

Coenzyme Q10 and migraine

Supplements of Coenzyme Q10 help migraine headaches. In a double-blind, placebo controlled study of 42 migraine patients, subjects received either 300 mg of coenzyme Q10 per day or a placebo. Within three months, treatment led to a reduction in the frequency of headaches, the number of days with nausea, and the number of headache days. Treatment produced no side effects. Half of the subjects in the treatment group had fewer headaches, compared with only 14 percent in the placebo group (Sandor PS, et al., Efficacy of coenzyme Q10 in migraine prophylaxis: a randomized controlled trial. Neurology. 2005 Feb 22;64(4):713-5.)

Low-carb/high protein diets

A new study of diet suggests that low-carbohydrate diets do not raise the risk of heart disease. The Nurses’ Health Study examined the effects of different nutritional combinations among 82,202 women over a period of 20 years. The researchers did find that the quality of the carbohydrate and the source of the protein and fat were significant. (Halton TL, et al., Low-carbohydrate-diet score and the risk of coronary heart disease in women. N Engl J Med. 2006 Nov 9;355(19):1991-2002.)

This study compared those subjects with the lowest carbohydrate intake (bottom 10 percent) with those who had the highest intake (top 10 percent) and evaluated the incidence of heart disease. One problem with this method is that the researchers used total caloric intake as carbohydrate without distinguishing the amounts of sugar and white flour versus the intake of whole grains, beans, and fruits, and other high-fiber sources of carbohydrate.

As a result, any purported benefits from consuming “low carbohydrates” could be totally due to the reduced intake of sugar and white flour and other refined grains or sweeteners. One effect of this would be to conceal the dangers of high-protein diets when compared to high-carbohydrate diets rich in whole grains, beans, vegetables and fruits.

Numerous studies have shown reduced disease and mortality when adding whole grains and other unrefined carbohydrate sources to the diet. (Lang R, Jebb SA, Proc Nutr Soc. 2003 Feb; 62(1): 123-7; Steffen LM, et al. Am J Clin Nutr. 2003 Sep;78(3):383-90; Jacobs DR Jr, et al., Am J Public Health. 1999 Mar;89(3):322-9; Liu S, J Am Coll Nutr 2002 Aug;21(4):298-306; Liu S, A J Clin Nutr 1999;70:307-308,412-419; Cotterchio M, et al., J Nutr. 2006 Dec; 136(12):3046-53; and others.) These studies show that the rate of heart disease, diabetes, and a variety of cancers are reduced by whole grains, legumes, fruits and vegetables.

It appears from this and other research that fiber, flavonoids, antioxidants, and other phytochemicals found in unrefined carbohydrate foods are protective. Another finding in the current study was that all of the apparent benefit of the lower-carbohydrate diets resulted if the sources of the protein and fat in the diet were vegetarian.

Low protein reduces cancer risks

A new study suggests mechanisms by which a low protein diet might reduce the risk of cancer. (Fontana L, et al., Long-term low-protein, low-calorie diet and endurance exercise modulate metabolic factors associated with cancer risk. Am J Clin Nutr. 2006 Dec;84(6): 1456-62.) The researchers noted that long-term, low-protein or low-calorie diets, as well as endurance exercise, are associated with a lower incidence of cancer.

The researchers found that those on low protein or low calorie intake, or exercisers had lower levels of insulin, inflammatory markers such as CRP, and sex hormones. In the low-protein and low-calorie groups, growth factors such as IGF-1 (insulin-like growth factor) were lower, but these were not influenced by exercise. These plasma markers are all associated with increased cancer risk. Only the dietary changes influenced all the markers.

Exercise lowers breast cancer risk

In the Iowa Women’s Health Study of 41,836 post-menopausal women, a new analysis shows that recreational exercise lowers the risk of breast cancer. (Bardia A, et al., Recreational Physical Activity and Risk of Postmenopausal Breast Cancer Based on Hormone Receptor Status. Arch Intern Med. 2006 Dec 11;166(22):2478-83.) Those women who did the most exercise had a 15 percent lower risk of breast cancer than those who did the least exercise, and the risk of estrogen receptor positive tumors was similarly reduced. These are the riskiest tumors. Some estrogen sensitive tumors had a 44 percent lower risk.

Diet reduces prostate cancer risk

A review article in a German scientific journal concluded that dietary choices and dietary supplements could reduce the risk of prostate cancer. (Theobald S. Nutrition and prostate cancer--what is the scientific evidence? Med Monatsschr Pharm. 2006 Oct;29(10):371-7.) The author noted that a high intake of total fat, saturated fats, meat, dairy, and calcium were associated with an increased risk of prostate cancer.

Conversely, lower risk was seen with a high intake of tomato products, soy, lycopene (a carotenoid found in tomato, watermelon, red grapefruit and red navel oranges), selenium, omega-3 oils from fish, and vitamin E (in smokers). Also, supplements of tomato derivatives and selenium could slow the progression of tumor growth. The author also noted that selenium supplements could reduce the toxicity of chemotherapy and enhance its effectiveness.

Benefits of lignans and soy isoflavones

Plant compounds that have mild estrogen-like activity include isoflavones, present in a variety of beans, especially soybeans, and lignans found in grains, fruits, nuts, some vegetables, and seeds (especially flaxseeds). These substances have a variety of health benefits.

New research on 2985 subjects shows that those with the highest lignan intake had a 27 percent lower risk of colo-rectal cancer, while those with the highest isoflavone intake had a 29 percent lower risk, compared to those with the lowest intake of the two substances. (Cotterchio M, et al., Dietary phytoestrogen intake is associated with reduced colorectal cancer risk. J Nutr. 2006 Dec;136(12):3046-53.) Other research shows a lowered risk of breast and prostate cancers.

While some writers have expressed concerns about the possible “dangers” of soy intake, the evidence continues to accumulate that typical dietary amounts of minimally processed soy products (such as tofu, soymilk, and tempeh) have a variety of health benefits. Setchell evaluated the risks and benefits of soy intake in 2001 (Setchell KD, Soy isoflavones--benefits and risks from nature's selective estrogen receptor modulators (SERMs). J Am Coll Nutr. 2001 Oct;20(5 Suppl):354S-362S). He estimated that soy food intake among Asian adults ranges from 2 to 4 ounces per day, providing 7 to 14 grams of soy protein, and 15 to 70 mg of isoflavones daily.

Isoflavones contribute to lowered cholesterol, reduced atherosclerosis, and improved blood vessel reactivity (greater relaxation and dilation of the arteries leading to improved blood flow: Honore EK, et al., Fertil Steril. 1997 Jan;67(1):148-54.). Other studies indicate that soy isoflavones limit bone turnover and reduce post-menopausal bone loss. They are also antioxidant and anti-inflammatory.

Some animal studies suggesting problems with soy ignored the species differences in metabolism of isoflavones (the cat family, for example, lacks an enzyme to help metabolize the phytoestrogens so these have much greater hormonal effects in cats than in humans). Other problems are due to the ingestion of extremely high amounts of phytoestrogens that go far beyond the typical human dietary intake.

The concern about thyroid inhibition is based on test-tube studies of the blockage of an enzyme that is required for thyroid hormone production (thyroid peroxidase), but the levels of isoflavones required to show this negative effect are extremely high, and again unrelated to typical soy food consumption in humans. (This enzyme is also inhibited by other flavonoids commonly present in many fruits and vegetables, but they do not have adverse effects either).

While breast milk is the ideal food for infants, those who are fed soy formula do not have evidence of thyroid problems (retardation of growth and development). This suggests that isoflavones do not lead to significant thyroid inhibition. Still, it is best for brain development if infants are breast fed so they would get the omega-3 fatty acids present in breast milk.

Finally, some writers and medical colleagues have suggested that Asians do not eat as much soy food as has been thought. The numbers noted above are one indication that for adults in Asia soy intake is moderately high (and very high compared to typical Western diets). During my visits to Japan for consulting, I have found that soy foods are readily available in grocery stores and served in most restaurants. I have eaten at restaurants that specialize in numerous ways to prepare soy foods.

Soy consumption in Asia now has a lot of competition with more abundant and affordable supplies of meat and dairy, and the transition to more animal products and less soy is associated with an increase of some diseases, such as heart disease as well as increasing average body weight. I am not a proponent of texturized soy protein or any other highly processed and adulterated foods, but minimally processed soy, such as tofu, tempeh, and soy milk are healthful.

Ask Dr. J: Healthy Weight Gain

Q: How can I gain weight in a healthful way, without having to eat lots of ice cream and overloading the diet with excessive amounts of fat?

KK, Netherlands, via Internet

A: It is not often that I have questions on how to gain weight, as overweight and obesity are far more common problems in industrialized cultures. However, a significant number of people do have problems with being underweight.

It is important first to make sure there is no underlying health issue, such as malabsorption, infectious diseases, hyperthyroidism, liver problems, or malignancies. If none of these is the issue, you can gain weight healthfully by some dietary choices and a combination of regular exercises.

Include extra oily foods that contain healthful essential fatty acids. These include avocados (added to salads or as guacamole), sesame tahini (in salad dressings, vegetable dips, or in hummus – a chick pea dip, and baba ghanouj – an eggplant dip), and seeds and nuts. Peanuts and soybeans are the highest legumes in fat content, so tofu and peanut butter might help. Also, coconut is healthful and relatively high in calories. Add it to smoothies or use some coconut milk in sautéed vegetables with brown rice.

You can also include olive oil and flaxseed oil in your diet as part of salad dressings or drizzled over vegetables and potatoes. It is helpful to eat frequently, with nutritious between meal snacks, and it may help to take pancreatic digestive enzymes.

Regular exercise and weight lifting to build muscle will help make sure that you are putting on muscle as well as gaining some fat weight. Increasing muscle mass is important for general health, longevity, and blood sugar control.

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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.