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January 2009

Alkali may help maintain bones
Olive oil polyphenols and cancer
Home exercise for diabetics
Vitamin K and diabetes
Vitamin C and blood pressure in youth
Vitamin D for statin myalgia
Caring touch lowers stress

Alkali may help maintain bones

High dietary protein intake increases the excretion of nitrogen in the urine. As a result of this, acid excretion is increased, leading to a higher urinary loss of calcium. The result is a greater risk of bone loss and fractures, especially in older individuals. A new study shows that if you add an alkalinizing agent, such as potassium bicarbonate, to the diet, you can reduce these negative effects. (Ceglia L, et al., Potassium bicarbonate attenuates the urinary nitrogen excretion that accompanies an increase in dietary protein and may promote calcium absorption. J Clin Endocrinol Metab. 2008 Dec 2 [Epub ahead of print]).

In this study, 19 healthy subjects aged 54 to 82 were put on either a low- or high-protein diet and then received either a potassium bicarbonate supplement or a placebo. They were followed for 41 days. The supplement improved calcium absorption on the low-protein diet more than on the high-protein diet. In addition, potassium bicarbonate reduced the rise in urinary nitrogen seen on the high protein diet.

A diet high in fruits and vegetables also increases alkalinity of the diet and is often associated with lower protein intake, providing two benefits related to maintaining bone density. Of course, consuming lots of fruits and vegetables has many other benefits, including reducing the risks of cancer, heart disease, hypertension, strokes, and other serious chronic conditions.

Olive oil polyphenols and cancer

Extra virgin olive oil (EVOO) contains a number of phytochemicals, including polyphenols, that have a variety of health benefits. New information shows that specific components of this unprocessed olive oil can inhibit the expression of certain breast cancer genes and block the activity of certain enzymes that lead to tumor protein production.

In a complex laboratory experiment on modified breast cancer cells, the polyphenol lignans and secoiridoids not only reduced these enzymes, but they also enhanced apoptosis (programmed cell death) of tumor cells. (Menendez JA, et al., Extra-virgin olive oil polyphenols inhibit HER2 (erbB-2)-induced malignant transformation in human breast epithelial cells: Relationship between the chemical structures of extra-virgin olive oil secoiridoids and lignans and their inhibitory activities on the tyrosine kinase activity of HER2. Int J Oncol. 2009 Jan;34(1):43-51.)

The beneficial compounds are removed in the refining process, so most commercial olive oil will not be effective in reducing such gene activity. Regions of the world where EVOO is consumed have a low rate of breast cancer, and this may provide part of the explanation. However, this Mediterranean diet pattern is also rich in fruits and vegetables and low in animal fat, which may also contribute to these benefits. In Japan, where olive oil is not consumed as much as in the Mediterranean, they have a very low rate of breast cancer, so it is clear that other factors play a role.

The researchers were quick to point out that the levels of polyphenols that are beneficial are unlikely to be reached with typical amounts of olive oil consumption. They noted, however, that this information would be a good starting point for the development of new genetically targeted drugs to mimic these effects. I would suggest that it is better to consume the healthy EVOO and combine this with the rest of the protective diet and lifestyle to avoid the need for such expensive drugs.

Home exercise for diabetics

Diabetics benefit from a home-based exercise program with low-tech equipment as much as from more expensive and high-tech gymnasium-based fitness training. Researchers studied 121 subjects with risk factors for diabetes, including 37 percent with either abnormal glucose tolerance or fasting glucose. They were all put on a self-management program, then a 12-week home- or gymnasium-based resistance training program, followed by 34 weeks of maintenance. (Payne WR, et al., Effect of a low-resource-intensive lifestyle modification program incorporating gymnasium-based and home-based resistance training on type 2 diabetes risk in Australian adults. Diabetes Care. 2008 Dec;31(12):2244-50.)

Although the group on the gymnasium program had a significantly better drop in systolic blood pressure over the 52 weeks of the study, the diabetes risk measurements were improved almost identically in both groups. Participants also lost an average of about 9 pounds during the study. The number with glucose abnormalities dropped from the 37 percent initial level to only 23 percent at the end of the study. The low tech devices included cans of food as substitutes for weights. I use exercise rubber tubing (Lifeline Gym) for my muscle-building program, but there are a number of other inexpensive elastic bands available.

Vitamin K and diabetes

Another way to help with diabetes prevention is to take supplements of vitamin K. In a recent study of 355 men and women 60 to 80 years old, they were given either 500 mcg of vitamin K or a placebo for three years in a randomized, controlled trial. (Yoshida M, et al., Effect of vitamin K supplementation on insulin resistance in older men and women. Diabetes Care. 2008 Nov;31(11):2092-6.)

In this study, only men showed the benefits from the vitamin K. This may partly be explained by the greater frequency of obese and overweight subjects among the women, so they may have needed a higher dose of vitamin K (a fat-soluble vitamin) for enough to be available to the cells. Vitamin K is found in dark, leafy, green vegetables, and in broccoli. Supplements are readily available.

Vitamin C and blood pressure in youth

Vitamin C from food and supplements has been shown to help lower blood pressure in adults. Elevated blood pressure in children has not usually been a problem, but this is changing with modern poor dietary habits and lack of exercise, as increasing numbers of children are overweight.

A new report shows that in girls and young women, vitamin C levels are related to blood pressure. The study followed 242 black and white women from 18 to 21 years old who had been enrolled in the study since they were 10 or 11. During the 10th year of following them, blood pressures were evaluated at the beginning of the year and at the end. (Block G, et al., Vitamin C in plasma is inversely related to blood pressure and change in blood pressure during the previous year in young black and white women. Nutr J. 2008 Dec 17;7:35.)

Subjects with the highest plasma level of vitamin C had a 4.66 mmHg lower level of systolic blood pressure and a 6 mmHg lower level of diastolic pressure than those with the lowest plasma vitamin C levels. The researchers reported these results after adjusting for race, body mass index (BMI), education, and intake of dietary fat and sodium. (If their diets were similar, I wonder if the difference in vitamin C blood levels was related to vitamin C supplements.) The results were due to a gradual rise in blood pressure in the low vitamin C group, while the high vitamin C group maintained the same blood pressures. Lower blood pressure in young adults may translate to a lower incidence of age-related vascular disease as they get older.

Vitamin D for statin myalgia

Patients who are prescribed statin drugs to lower cholesterol (and take them) often develop muscle pain (myalgia) or muscle inflammation (myositis) as side effects of the drugs. In rare but severe cases, they can develop advanced muscle breakdown called rhabdomyolysis, and this can be fatal. (One such drug, Baycol, was removed from the market after it caused a higher-than-expected frequency of this side effect.)

New research suggests that patients with myositis or myalgia usually have low serum levels of vitamin D. Among 621 patients on statins, 128 had myalgia and these patients had about 20 percent less vitamin D in the blood. Of the 82 myalgia patients who were low in vitamin D, 38 were treated with 50,000 IU per week for 12 weeks. In 35 of these patients, the vitamin D treatment eliminated the myalgia. (Ahmed W, et al., Low serum 25 (OH) vitamin D levels (<32 ng/mL) are associated with reversible myositis-myalgia in statin-treated patients. Transl Res. 2009 Jan;153(1):11-6.)

If you plan to continue to take statin drugs, it is wise to make sure you are getting enough vitamin D (which also has many other benefits). On the other hand, you might want to consider stopping the statins and changing your diet, getting more exercise, and taking niacin, beta-sitosterol, red yeast rice, policosanol, and/or garlic, The “dietary portfolio” that is as effective as statins includes psyllium or flaxseed powder, soy foods, oatmeal, eggplant, and okra, and eating less animal fat.

Caring touch lowers stress

Touching in a caring fashion lowers physical indicators of stress. A program called “warm touch enhancement” provides more than just social and emotional support. (Holt-Lunstad J, et al., Influence of a "warm touch" support enhancement intervention among married couples on ambulatory blood pressure, oxytocin, alpha amylase, and cortisol. Psychosom Med. 2008 Nov;70(9):976-85.)

Among 34 healthy couples, those who were instructed to touch and massage each other on the neck, shoulder, and hands several times a week had increased production of oxytocin (a hormone associated with love and cuddling) and decreased levels of alpha-amylase, an indicator of stress. The men in the intervention group also had significantly lower systolic blood pressure than the controls, who were just monitored, not instructed in the “warm touch” techniques.

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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.