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December 2008

Irritable bowel, peppermint, and fiber
Ubiquinol form of coenzyme Q10
Testosterone for muscles and more
High fruit, veggie, fiber, and low-fat diets reduce breast cancer recurrence
Exercise reduces headaches

Irritable bowel, peppermint, and fiber

Irritable bowel syndrome (sometimes called spastic colon) is associated with gas, bloating, cramps, alternating diarrhea and constipation, and abdominal pain. It is commonly treated with antispasmodic drugs, and patients have often been told to avoid potentially irritating foods, including fiber (or roughage). However, it appears that fiber is actually helpful for the condition.

In a new review of studies (a meta-analysis), covering a total of 3622 patients, treatment with antispasmodic drugs was not as good a helpful as supplements of peppermint oil. (Ford AC, et al., Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. BMJ. 2008 Nov 13;337:a2313. doi: 10.1136/ bmj.a2313.) Treatment with fiber supplements was also helpful.

The peppermint oil was most effective, reducing the risk of persistent symptoms by 57 percent, while drugs were only 32-45 percent effective. These are the older, safer, and less expensive drugs that have fewer side effects than the newer drugs that have become available. No side effects were seen with the peppermint oil.
High levels of dietary fiber (psyllium husk powder) reduced the risk of persistent symptoms by 22 percent. Psyllium contains a lot of soluble fiber, unlike bran that is insoluble and was not effective. The psyllium has the added benefit of lowering total cholesterol, triglycerides, and LDL, and raising the good HDL almost as much as statin drugs.

Combining these treatments with an overall healthier diet, avoidance of food allergens, exercise, and stress management can often alleviate the symptoms. Supplements of gamma-linolenic acid (GLA from primrose or borage oil) may help relax the intestinal muscles, and treating overgrowth of intestinal yeast (Candida) is a benefit in many people.

Ubiquinol form of coenzyme Q10

Recently, a new form of coenzyme Q10 has become available. Coenzyme Q10 is essential for mitochondrial energy production, and while it is produced in the body, the amount that is made declines with age and various illnesses. It has been shown to be helpful with high blood pressure and congestive heart failure, and much higher doses are effective in preserving brain function in patients with Alzheimer’s disease and Parkinson’s disease.

The commonly used form of coenzyme Q10 is called ubiquinone, which is converted after absorption in to the blood stream into the reduced form, ubiquinol, the form that is responsible for its effects. Although the conversion readily takes place, it is now possible to take the ubiquinol form in supplements (it is produced by the Japanese company Kaneka that makes the best coenzyme Q10 on the market).

Ubiquinol is apparently better absorbed and better utilized than ubiquinone, and blood levels are higher and more persistent after taking ubiquinol. In one study, after a 90 mg, 150 mg, or 300 mg daily dose for 14 days, the lowest blood levels between doses were 2.61 mcg/ml, 3.66 mcg/ml, and 6.53 mcg/ml, respectively. They continued to increase for the remaining two weeks of the study. (Hosoe K, et al., Study on safety and bioavailability of ubiquinol (Kaneka QH) after single and 4-week multiple oral administration to healthy volunteers. Regul Toxicol Pharmacol. 2007 Feb;47(1):19-28.)

In a presentation by Peter Langsjoen, MD, at the April, 2008 conference of the American College for Advancement in Medicine, he reported that a dose of 360 mg of ubiquinone in patients with severe congestive heart failure led to an average blood level of 1.4 mcg/ml, while a dose of 514 mg of ubiquinol produced an average blood level of 5.6 mcg/ml. This suggests that the ubiquinol is about three times as effective in raising blood levels of coenzyme Q10 as the ubiquinone.

In Langsjoen’s patients, the left ventricular ejection fraction (EF, a measure of heart failure) improved to 22 percent with the ubiquinone (still quite severe heart failure) while the ubiquinol led to an improvement to 41 percent EF. This shows that a 42 percent higher dose almost doubled the clinical benefit of the supplement. (ACAM Meeting, Integrative Approaches to Cardiovascular Disease, April 2008, Orlando, FL).

In congestive heart failure, coenzyme Q10 improves heart muscle contractility, endothelial function, and overall functional capacity. It is also of value in patients with diabetes, macular degeneration, and migraines. In healthy volunteers, both 100 mg and 300 mg of coenzyme Q10 supplements reduced fatigue and improved stamina during an endurance exercise test on a bicycle ergometer. (Mizuno K, et al., Antifatigue effects of coenzyme Q10 during physical fatigue. Nutrition. 2008 Apr;24(4):293-9.)

Testosterone for muscles and more

Men’s testosterone levels decline with age, and low testosterone can lead to reduced muscle mass, lowered physical functional capacity, and sexual dysfunction. A study of testosterone supplements (by injection in this case) showed that in healthy men aged 60 to 75 years the treatment increased muscle mass and maximal strength, but in these subjects, muscle fatigability was not affected. (Storer TW, et al., Changes in muscle mass, muscle strength, and power but not physical function are related to testosterone dose in healthy older men. J Am Geriatr Soc. 2008 Nov;56(11):1991-9.)

They studied 44 men treated with 25, 50, 125, or 300 mg per week of injectable testosterone and followed them for 20 weeks. The improvements in muscle bulk and strength were highly significant, and would likely help these men to retain normal function for extra years.

The misleading news headlines proclaimed that “extra testosterone won’t boost physical function”. However, this is not an accurate assessment of the study results. The improved muscle strength and bulk are signs of better physical function.

In addition, as the authors noted, and as could be found buried in the text of the news article, the failure to show improved scores on fatigability and physical function was likely due to the fact that these men were already high-functioning at the start of the study, and had little room to improve stamina, even though their strength was greater.

Testosterone is also valuable for improving the strength of the heart muscle, and may lower the risk of heart disease and diabetes while reducing metabolic syndrome and maintaining cognitive function. Bio-identical supplements are available in topical creams and gels. Taking testosterone to raise older men’s levels up to those of younger men does not, as many doctors believe, increase the risk of prostate cancer (in fact, it appears that low testosterone leads to increased risk). (Morgentaler A, Schulman C, Testosterone and prostate safety. Front Horm Res. 2009;37:197-203).

It also appears that testosterone supplements do not increase the urinary obstruction symptoms of benign prostatic hyperplasia, or BPH. Menopausal women can also benefit from small doses of testosterone as part of a balanced hormone treatment program. If you are considering testosterone therapy, it is important to have regular prostate exams and blood levels done both prior to treatment and as a way of monitoring the therapy.

High fruit, veggie, fiber, and low-fat diets reduce breast cancer recurrence

A new study sheds some light on previous contradictory studies of diet and breast cancer. A diet that is very high in fruits, vegetables, and fiber and low in fat can markedly reduce the risk of breast cancer recurrence in women who do not have hot flashes. It does not appear to have an effect in women who do have hot flashes. This suggests that the diet changes work by inhibiting estrogen activity.

The researchers evaluated 2967 breast cancer survivors who were 18 to 70 years old at the start of the study. The control diet was the usual “five-a-day” recommendation for fruits and vegetables. The intervention diet included 10 servings per day of fruits and vegetables (compared to 6.5 servings in the controls), had 25 gms of fiber per day (19 in controls), and 26.9 percent fat (31.3% in controls). (Gold E, et al., Dietary pattern influences breast cancer prognosis in women without hot flashes: The Women's Healthy Eating and Living Trial. Published online ahead of print Dec 15 2008. J Clin Oncology, 10.1200/JCO.2008.16.1067).

Estrogen dependent tumors are the most common kind, and earlier studies of diet and breast cancer did not consider the estrogen status of the participants. Women with hot flashes had lower recurrence rates in both study groups, so the diet did not show as much benefit. The very healthy intervention diet in this study is also beneficial in preventing breast cancer.

Exercise reduces headaches

New information shows that exercise can reduce the frequency of both migraine and non-migraine type headaches. A study of 22,397 participants in one part of the study and 46,648 in another part showed that physical inactivity was directly related to headache prevalence.

Non-exercisers were 14 percent more likely to have headaches at the 11 year follow-up evaluation. (Varkey E, et al., Physical activity and headache: results from the Nord-Trøndelag Health Study (HUNT). Cephalalgia. 2008 Dec;28(12):1292-7.) It appears that fitness training can have benefits that go beyond those for the heart, brain, and lungs. (Note that vigorous physical activity might trigger migraines in some sufferers.)

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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.