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September 2009

Salt reduction preserves health
Whole grains help weight control
Whole grains reduce hypertension risk
Coenzyme Q10 protects skin
Lead increases heart disease
Exercise lowers prostate cancer risk
Brainy leisure activity lowers dementia

Salt reduction preserves health

Researchers recently calculated the potential health care cost savings through reduction of salt consumption in the United States diet. They based their conclusions on the savings from a reduction in hypertension and heart disease as well as the costs of the medications used to treat them.

Human needs for salt are about 500-1000 mg per day, but in the US people consume an average of 3500 to 5000 mg daily. The US government recommendations are to restrict salt consumption to 2300 mg, but in other countries the guidelines suggest only 1600 mg (already generous unless you sweat a lot by exercising in hot weather).

The new study predicts that a reduction of sodium intake to 2300 mg per day would lower hypertension cases by 11 million, and save $18 billion in health care costs. It would also add 312,000 “quality-adjusted life years” worth $32 billion dollars annually. (Palar K, Sturm R, Potential societal savings from reduced sodium consumption in the U.S. adult population. Am J Health Promot. 2009 Sep-Oct;24(1):49-57.) A further reduction to healthier levels would likely be even more valuable.

This kind of study, using readily available data, cannot account for the emotional toll of strokes and heart attacks on individuals as well as their families and friends (imagine having to wheel someone around after a stroke). What it can do is help understand that the financial burden of health care costs is strongly related to lifestyle choices, and the health insurance crisis could be readily addressed by incentives that promoted healthier habits, such as more exercise, better diets (less salt, sugar, and fat), less smoking, and taking some basic dietary supplements.

Whole grains help weight control

Increasing whole grain intake appears to help with weight control, lowering body mass index (BMI)and abdominal fat in adults. Researchers evaluated 434 men and women 60 to 80 years old. They used a 126-item food frequency questionnaire to evaluate whole grain, refined grain, and fiber intake and compared those levels with various body fat measurements (McKeown NM, et al., Whole-grain intake and cereal fiber are associated with lower abdominal adiposity in older adults. J Nutr. 2009 Oct;139(10):1950-5).

They found that whole grain intake was inversely related to BMI, percent body fat, and abdominal fat mass. The BMI averaged 2 points lower in the high whole-grain group, body fat was lower by 3 percent, and abdominal fat was 5 percent less. The whole grains studied included whole wheat bread, brown rice, popcorn, and others.

Unfortunately, even those in the relatively high whole grain group still had lower than ideal intake of only 1.5 servings per day, and averaged only 18 grams of fiber per day, including that from fruits and vegetables. When Denis Burkitt studied native diets in Africa in the 1950s and 1960s, they consumed about 100 grams of fiber per day, while the current US guidelines recommend a mere 25 grams per day (still far more than the average consumption of 10 grams).

The staples of the diets of Burkitt’s subjects included potatoes, bananas, corn meal, and beans, and they were almost totally free of hypertension, diabetes, heart disease, colon cancer, diverticulitis, appendicitis, varicose veins, and hemorrhoids. Burkitt attributed this to the fiber in their diets, although the high amounts of fruits and vegetables might also have been part of the answer.

Whole grains reduce hypertension risk

Another study suggests a further benefit from whole grains. Researchers followed 31,684 men in the Health Professionals Follow-Up Study for 18 years. Over that time, 9227 men developed hypertension. Those with the highest whole grain intake had a 20 percent lower risk of developing high blood pressure than those with the lowest intake. (Flint AJ, et al., Whole grains and incident hypertension in men. Am J Clin Nutr. 2009 Sep;90(3):493-8.)

Total bran intake was associated with a 15 percent reduction in risk of hypertension. The difference might well be that those who ate added bran (bran flakes, for example), did not have as much benefit as those who at the entire grain, because other nutrients in the grains (fatty acids, vitamins, minerals, flavonoids) account for a significant portion of the benefit.

Coenzyme Q10 protects skin

A laboratory study shows that coenzyme Q10 protects skin cells from the effects of aging, in addition to its anti-oxidant activity and promotion of cellular energy production. In cells from the outer layer (epidermis) and middle layer (dermis) of skin, CoQ10 promoted the growth of connective tissue cells (fibroblasts), but not the keratinocytes (those cells that produce the toughening outer protection). (Muta-Takada K, et al., Coenzyme Q(10) protects against oxidative stress-induced cell death and enhances the synthesis of basement membrane components in dermal and epidermal cells. Biofactors. 2009 Sep 14. [Epub ahead of print]).

Coenzyme Q10 treatment also promoted production of cellular membrane components. In addition, pretreatment with CoQ10 in tissue culture protected against cell death induced by several oxidative stresses. This suggests that it is important to take enough coenzyme Q10 to keep the skin cells well supplied. For the best absorption, I now recommend the ubiquinol form of CoQ10.

Lead increases heart disease

New research confirms that a high level of lead in the body increases the risk of dying from heart disease and other causes. While lead exposure is often monitored by blood lead levels, this is inadequate because lead is cleared from the blood fairly quickly and deposited in tissues, particularly bone, brain, and liver. However, in this study, using non-invasive methods with X-ray fluorescence, researchers examined lead levels in the patella and tibia as well as in the blood.

They evaluated 868 men over an average of 9 years. Those men with the highest bone lead were 2.5 times more likely to die of any cause, and 5.6 times more likely to die of heart disease than those with the lowest bone levels. Blood levels were not related, and therefore are not reliable indicators of risk. (Weisskopf MG, et al., A prospective study of bone lead concentration and death from all causes, cardiovascular diseases, and cancer in the Department of Veterans Affairs Normative Aging Study. Circulation. 2009 Sep 22;120(12):1056-64.)

After adjusting for other risks, those with the highest bone lead had 8.4 times the risk of cardiovascular mortality compared with men in the lowest category of tissue lead. This data suggests that cumulative lead exposure is a serious risk factor. This may be one reason that chelation therapy, which removes lead and other heavy metals, is helpful with vascular disease.

Exercise lowers prostate cancer risk

Exercise appears to lower the risk of prostate cancer, and among those who do get prostate cancer, exercisers have less aggressive tumors. Researchers evaluated 190 men who had prostate biopsies and analyzed their exercise habits. (Antonelli JA, et al., Exercise and Prostate Cancer Risk in a Cohort of Veterans Undergoing Prostate Needle Biopsy. J Urol. 2009 Sep 14. [Epub ahead of print]).

Those men who had higher levels of exercise (9 or more metabolic equivalent (MET) task hours per week) had only one third the risk of cancer on biopsy. Among the men who had cancer on biopsy, those who reported moderate exercise (3 to 8.9 MET task hours per week) had significantly less aggressive tumors.

A MET is a measure of intensity of physical activity. For examples, moderate activity is 3 to 6 METs, such as walking, hiking, yoga, or gymnastics. Vigorous activity is 6 METs or more, including jogging, roller skating, bicycling more than 10 mph, or high-impact aerobic dancing. The higher levels of activity can burn 7 calories per minute.

Brainy leisure activity lowers dementia

A study of 5698 participants over 65 years old shows that brain-stimulating leisure activities reduce the risk of Alzheimer’s dementia. The activities that were found to be helpful included crossword puzzles, card games, artistic activities, going to the theater, and organizational activities. (Akbaraly TN, et al., Leisure activities and the risk of dementia in the elderly: results from the Three-City Study. Neurology. 2009 Sep 15;73(11):854-61.)

The cognitive stimulation provided by these activities appears to cut the risk of dementia in half, after accounting for other potential risks, such as vascular disease, depression, and reduced physical capacity. Other leisure activities that were not cognitively stimulating were not associated with any reduction in risk. I hope that writing my newsletter (among many other cognitive activities, diet, and exercise) will help protect me (if it isn’t already too late!).

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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.