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September 2007

Coffee and hypertension
Exercise helps heart patients
Green tea and cancer protection
Antacids damage mental function
Low-normal weight is better
Extra virgin olive oil reduces clotting
Food additives and hyperactivity

Coffee and hypertension

Coffee consumption of more than one cup per day appears to increase the risk of hypertension, according to a new study from Finland. Researchers evaluated 24,710 subjects from 25 to 64 years old. Over 13 years, 2505 participants were prescribed medication to treat high blood pressure. (Hu G, et al.,Coffee consumption and the incidence of antihypertensive drug treatment in Finnish men and women. Am J Clin Nutr. 2007 Aug;86(2):457-64.)

The number of patients who had to take blood pressure medication was 25 percent higher among those who drank more than 1 cup of coffee per day. (Among those who drank more than 8 cups per day, the increased risk was not quite as high, but it is not clear why.) Other studies also suggest cardiovascular risks from excessive coffee consumption. The lower risk of diabetes among coffee drinkers in an earlier study was virtually all related to decaffeinated coffee.

Exercise helps heart patients

Exercise has many benefits, including prevention and treatment of cardiovascular disease. A new study shows that regular exercise for patients with congestive heart failure actually builds new blood vessels and improves function. (Hollriegel R, et al., Regular physical exercise training promotes neovascularization in the skeletal muscle in patients with end-stage chronic heart failure. Eur Heart J (2007) 28 (Abstract Supplement) 745.)

The researchers evaluated 37 patients, half of whom were put on three months of exercise training, 30 minutes per day on an exercise bicycle, and half who were sedentary serving as the controls.

Using muscle biopsies, they found that new blood vessels appeared in the exercising muscles during the three months. They also found a 47 percent increase of circulating stem cells in the blood, adding to the potential for tissue repair and blood vessel generation.

Rather than being afraid to exercise, patients with heart failure (decreased function of the heart muscle) should be encouraged to do physical activity. While they need to stay generally within the limit of their capacity, shortness of breath should not be the limiting factor. A little shortness of breath seems to be the stimulus for the repair process and stem cell formation. Repair and regeneration is the body’s response to the stress.

The lining cells of the arteries are called endothelial cells, and new cells from which the endothelial cells are formed were 130 percent more active in the exercising group compared to both the controls and the activity at the start of the study.

Green tea and cancer protection

Green tea consumption is associated with a decreased risk of cancer. A new study suggests one possible reason for its benefits. Glutathione S-transferase (GST) is a cancer fighting enzyme produced in the body that helps to detoxify carcinogens.

Researchers administered a standardized extract of green tea containing a specific amount of a polyphenol called epigallocatechin gallate (EGCG; 800 mg daily) to 42 subjects for four weeks. At the end, they found that the subjects with the lowest level of GST had an 89 percent increase in their blood level. (Chow HH, et al., Modulation of human glutathione s-transferases by polyphenon e intervention. Cancer Epidemiol Biomarkers Prev. 2007 Aug;16(8):1662-6.)

While those with the highest levels showed a slight decrease in GST, they were still well protected. The authors concluded that green tea extract supplements (the product they used in their research was decaffeinated) had a beneficial effect in those subjects who had low levels of protection at the start of the study.

Antacids damage mental function

Drug companies are particularly fond of drugs that have to be taken regularly for the rest of your life. They make more money on diabetes and hypertension drugs than they do on antibiotics and acute care medications. However, chronic use of many medications leads to problems that are often missed in the shorter term drug-approval process. Thus, many drugs are removed from the market after approval and widespread usage when these effects are discovered (remember Vioxx – an anti-inflammatory found to increase heart problems?).

A new study shows that the use of antacid medications called histamine blockers (H2 antagonists such as Zantac, or ranitidine, and Pepcid, or famotidine) can also have unintended consequences. Researchers studied 1558 African American subjects over 65 years old taking these medications and evaluated them for mental function using an assessment tool called the Community Screening Instrument for Dementia. (Boustani M, et al., The association between cognition and histamine-2 receptor antagonists in African Americans. J Am Geriatr Soc. 2007 Aug;55(8): 1248-53.)

After controlling for a number of variables, they found that those who regularly used antacids such as the ones above had a risk of cognitive impairment that was 2.4 times greater than in those who did not use the drugs. With all the other problems faced by the elderly, if they can manage their symptoms without risky drugs they will be better off.

I often recommend simple dietary changes (more fiber, less fat and sugar, elimination of processed foods, caffeine, and alcohol) and some supplements to manage acid indigestion. The supplements that help include the amino acid L-glutamine, vitamins C and E, aloe vera, and a licorice extract called DGL (chewing tablets of DGL mixes it with saliva and creates a protective coating for the esophagus and stomach).

Low-normal weight is better

Among normal weight people who exercise there is an advantage to being in the “low-normal” category of body weight. For 8 years researchers studied 29,139 men and 11,985 women runners, almost all within the limits of normal weight.

Even among these reasonably fit participants, those with higher body mass index (BMI) had a significantly higher risk of developing chronic health problems, such as diabetes, high cholesterol, and high blood pressure. (Williams PT, et al., Weight-related increases in hypertension, hypercholesterolemia, and diabetes risk in normal weight male and female runners. Arterioscler Thromb Vasc Biol. 2007 Aug;27(8):1811-9.)

The lowest risks were associated with BMI between 18.5-20, which is the low end of normal. (Subjects who were excessively thin had somewhat higher risks.) Those men who had a BMI in the 22.5 to 25 range had more than double the risk of diabetes compared to those whose BMI was lower than 20. For women it was a 64 percent increase. The best way to maintain a healthy BMI, in addition to exercise, is to eat a whole, unprocessed diet that is low fat and mostly vegetarian, with a focus on vegetables, fruits, whole grains, beans, seeds, and nuts.

Extra virgin olive oil reduces clotting

Researchers in Spain evaluated the effects of extra virgin olive oil that is rich in phenols on clotting factors in the blood to see if this might explain its beneficial effects on heart disease. They gave 21 volunteers with high cholesterol one of two breakfasts containing either olive oil with 400 parts per million (ppm) of phenols or an oil with only 80 ppm.

They then measured three different clotting factors and blood lipids two hours after the meal. The high phenol olive oil reduced the excessive clotting risk while the low phenol oil did not. This may explain why some studies of olive oil do not show benefits for heart disease although others do, as olive oils differ markedly in their phenol content. (Ruano J, et al., Intake of phenol-rich virgin olive oil improves the postprandial prothrombotic profile in hypercholesterolemic patients. Am J Clin Nutr. 2007 Aug;86(2):341-6.)

Age, atherosclerosis, and high animal fat in the diet shift the balance of clotting and clot-dissolving factors in the blood to make it more prone to blood clots in the vessels. In this study, factor VII antigen and plasminogen activator inhibitor, both of which promote blood clots, were lowered by the high phenol oil.

Normally, it is better to eat whole foods, and olive oil is an extracted food component. The problem is that olives themselves are cured in brine, and thus they are high in salt, which is too much for many people. In this case, olive flavor is best achieved by using extra virgin olive oil that is high in phenol content.

Food additives and hyperactivity

Over 30 years ago, Dr. Ben Feingold showed that hyperactive children improved when they were put on diets free of artificial flavors, colors, and preservatives. While these substances are not the only contributors to attention deficit hyperactivity disorder (ADHD), it is often a significant part of the problem.

A new study in Britain showed that artificial flavors, colors preservatives (such as sodium benzoate) do indeed contribute to ADHD. (McCann D, et al., Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial. Lancet 2006 September 6.)

Researchers studied 297 children, either 3 years old or 8/9 years old, and gave half a juice drink with food additives and half the same juice drink without the additives as a placebo.

The additives increased ADHD symptoms significantly in both groups. Even children who did not have ADHD were affected adversely – the additives reduced their attention spans. It is also often helpful to avoid sugar added to foods.


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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.