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March 2009

Vitamin C helps gout
Chondroitin sulfate helps osteoarthritis
Broccoli may help asthma and allergy
Weight loss relates to calories, not diet
Vitamin D lowers respiratory infections
Elderly often poorly nourished
Mushrooms, green tea, breast cancer

Vitamin C helps gout

Gout is an arthritic condition due to deposits of uric acid in the joints, often, but not exclusively, in the big toe. It is related to alcohol abuse and diets high in meat and cheese. Vitamin C intake is related to uric acid levels and gout. Researchers examined the vitamin C intake among 46,994 men over a 20-year period with re-evaluations every four years. During this time, they documented 1317 cases of gout and correlated the incidence of gout with their vitamin C intake. (Choi HK, et al., Vitamin C intake and the risk of gout in men: a prospective study. Arch Intern Med 2009 March 9;169(5):502-507.)

Increasing vitamin C intake over 250 mg per day lowered the risk of gout significantly (note that 250 mg is already higher than the officially recommended levels). Men with intake of 500 to 999 mg per day had a 17 percent lower risk than those with the lowest intake levels. For those men with vitamin C intake of 1000 to 1499 mg/d, the risk reduction was 34 percent, and for those with intake above 1500 mg/d, the risk was 45 percent lower.

They also evaluated the risk of gout among supplement takers compared to those who did not take supplements. They found that men who took supplements of 1000 to 1499 mg, the risk reduction was 34 percent, and above 1500 mg, the risk was lowered by 55 percent. (They did not study whether higher intakes could eliminate the risk of gout.) I do not know if rheumatologists are now routinely recommending vitamin C supplements for men at risk of gout.

A related earlier study showed that increasing vitamin C intake could lower serum uric acid levels. With increasing vitamin C intake, serum uric acid levels dropped from 6.4 to 6.1 to 6.0 and then 5.7. Levels above 6 are considered high, and the odds of having a high level are reduced by 66 percent in those with the highest vitamin C intake compared to those with the lowest. (Gao X, et al., Vitamin C intake and serum uric acid concentration in men. J Rheumatol. 2008 Sep;35(9):1853-8.) It is difficult to get these vitamin C levels without supplements (for example, an orange contains about 50 to 70 mg).

Chondroitin sulfate helps osteoarthritis

Osteoarthritis (OA), or degenerative arthritis, is a joint condition with cartilage deterioration associated with age and injury leading to pain, stiffness and loss of mobility. It most often affects the hips, knees, spine, and hands, but other joints may be involved. Drugs that treat the symptoms have significant side effects, including gastrointestinal bleeding that is sometimes fatal.

A new study shows that supplements of chondroitin sulfate (CS), a component of cartilage, can reduce the symptoms and may help cartilage regeneration. Researchers studied 622 patients with OA of the knee in a double-blind, placebo-controlled trial for two years. Half received 800 mg of CS and half placebo, and they were evaluated at 12, 18, and 24 months with X-rays and symptom questionnaires.

In the treatment group, the risk of disease progression as evaluated by X-rays was reduced by 33 percent compared to the placebo group. The CS group also had significantly less pain than the controls. (Kahan A, et al., Long-term effects of chondroitins 4 and 6 sulfate on knee osteoarthritis: The study on osteoarthritis progression prevention, a two-year, randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2009 Feb;60(2):524-33.)

Glucosamine sulfate is similar in effect to CS, and both need to be taken for several months to notice significant symptom improvement. The typical dose for either of them is 1200 mg. It is not clear that taking both is necessary or that the benefits are greater with both than with either one taken alone, and the glucosamine is usually less expensive.

Other supplements that help include niacinamide, MSM, boswellia, SAMe, and ginger, and cayenne pepper applied topically to the affected joints in the form of a cream.

Broccoli may help asthma and allergy

It is common knowledge that broccoli is a healthful vegetable for a variety of reasons, with high levels of vitamin C, minerals, carotenoids, folic acid, and fiber. It also contains phytochemicals that are important as antioxidants and for cancer protection. These include indole-3 carbinol, phenethyliso-thiocyanate (PEITC), and sulforaphane, a glucosinolate.

Sulforaphane is helpful in respiratory inflammation according to a new study. (Riedl MA, et al., Oral sulforaphane increases Phase II antioxidant enzymes in the human upper airway. Clin Immunol. 2009 Mar;130(3):244-51.) This would be helpful for people with allergic rhinitis, asthma, and chronic obstructive pulmonary disease, as well as pollution effects from ozone and particulates that cause inflammation.

In this study subjects consumed sulforaphane doses that were standardized from broccoli sprouts. The researchers then measured inflammatory markers and Phase II enzymes that are anti-inflammatory and antioxidant substances found in mucous membranes. While this was not a clinical study of a specific disease, it was very suggestive that broccoli could help with these conditions. Subjects who were given alfalfa sprouts as a control had no such beneficial effects.

Weight loss relates to calories, not diet

Weight loss is becoming increasingly important because of the rising trend of obesity and diabetes that are placing a great burden on individuals and society as a whole. As a result of the difficulty people have in losing weight, numerous authors and speakers have claimed that their particular dietary approach is best (in an effort to sell more books, no doubt). The great hope people place in these fads is unjustified.

A new study suggested that for weight loss what really matters is the calories that you consume, rather than the particular percentage of major nutrients. Subjects were placed on four different diets – low or high fat combined with low or high protein and 35, 45, 55, or 65 percent carbohydrates. (Sacks FM, et al., Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med. 2009 Feb 26;360(9):859-73.)

All 811 overweight subjects were offered group and individual instruction and they were evaluated at 6 months, 12 months, and 2 years, at the end of the study. Independent of the diet composition, participants lost an average of 8.8 pounds over the two years, and 15 percent of them lost at least 10 percent of their body weight. (Success with weight loss was strongly associated with attendance at the instructional meetings.)

Interestingly, all of the diets were low in saturated fat and cholesterol, and were meant to include at least 20 grams of fiber per day. This is quite different from the typical American diet, which usually contains only about 10 to 15 grams of fiber per day. This is important, because the higher fiber level in all of these diets may well have contributed to their moderate success with weight loss.

Vitamin D lowers respiratory infections

Once again vitamin D is in the medical news, this time for its benefits in supporting immune function. In a study of 18,883 participants over six years, low serum vitamin D levels were associated with a higher rate of upper respiratory tract infections. (Ginde AA, et al., Association between serum 25-hydroxyvitamin D level and upper respiratory tract infection in the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2009 Feb 23;169(4):384-90.)

Compared to those participants with serum vitamin D levels above 30 ng/mL, those with vitamin D levels from 10 to 30 ng/mL had a 24 percent higher incidence of respiratory infections. Those whose vitamin D level was lower than 10 ng/mL had a 36 percent higher incidence of infections. Among those with asthma, low levels of vitamin D increased the infection risk by five fold, and with chronic obstructive pulmonary disease the risk was 2.25 times higher.

Taking vitamin D supplements is the best way to achieve the higher levels.

Elderly often poorly nourished

A new study shows that the elderly are often poorly nourished, and many of them who do meet their needs do so by taking supplements. Among 6237 multi-ethnic subjects, many did not meet their needs for calcium, magnesium, and vitamin C. (Burnett-Hartman AN, et al., Supplement use contributes to meeting recommended dietary intakes for calcium, magnesium, and vitamin C in four ethnicities of middle-aged and older Americans: the Multi-Ethnic Study of Atherosclerosis. J Am Diet Assoc. 2009 Mar;109(3):422-9.)

The authors noted that those taking individual supplements often “exceeded the Tolerable Upper Intake Levels” known as “UL”. It is not clear how the UL is established, because it is not related to safety, and the UL for magnesium is lower than the recommended amount.

Mushrooms, green tea and breast cancer

Breast cancer rates are relatively low in China, but they do vary with diet. A new report shows that consuming mushrooms and green tea significantly lowers the risk. A case control study compared 1009 patients with breast cancer and 1009 age-matched controls. (Zhang M, et al., Dietary intakes of mushrooms and green tea combine to reduce the risk of breast cancer in Chinese women. Int J Cancer. 2009 Mar 15;124(6):1404-8.)

The research shows that consumers of either mushrooms or green tea had a 50 to 65 percent lower risk than non-consumers. Those who consumed both mushrooms and green tea had an 80 to 90 percent reduction in the risk of breast cancer.

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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.