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July 2011

Green tea lowers cholesterol
Nutrients lower macular degeneration
Omega-3 oils reduce stent clotting
Best exercises for weight and heart
Olive oil may lower stroke risk
Vitamin D and diabetes

Green tea lowers cholesterol

Green tea contains very healthful phytochemicals called catechins. These substances (epigallocatechin, or EGC, and epigallocatechin gallate, or EGCG) have been widely researched over recent years. A new study shows that consuming green tea or green tea extract containing EGC and EGCG can lower total cholesterol without lowering the good HDL cholesterol. This is important as some cholesterol lowering agents lower all levels, thus reducing their benefits. Remember that green tea does contain some caffeine.

Researchers reviewed the results of 14 controlled trials of green tea consumption with a total of 1136 subjects. Some of the studies evaluated green tea consumption and some used green tea extracts. They controlled for a variety of possible confounding variables (although no study can account for all possible differences between groups).

Overall, they found a significant reduction of total cholesterol averaging 7.2 mg/dL, and an average reduction of LDL cholesterol of 2.19 mg/dL. (Zheng XX, et al., Green tea intake lowers fasting serum total and LDL cholesterol in adults: a meta-analysis of 14 randomized controlled trials. Am J Clin Nutr. 2011 Jun 29. [Epub ahead of print])

While these average reductions are small, it suggests that some patients do very well with green tea compared to others. Also, any natural approach to lowering cholesterol is best if it combines approaches, such as diet, exercise, weight loss, and supplements. The specifically helpful foods that have been studied as the “portfolio diet,” include eggplant, okra, oats, almonds, soy foods, and certain gummy fibers, such as psyllium seed husks or flax seeds (ground up freshly for each use).

This diet has been shown to be virtually identical in benefits to the statin drugs, but without their cost and side effects. Supplements that help include niacin (B3), garlic, red yeast rice, pantethine (B5), and chromium. Some combination of these foods and supplements (with weight control and exercise) can help most people completely avoid cholesterol drugs.

Nutrients lower macular degeneration

Macular degeneration is a deterioration of the function of the most sensitive part of the retina. It is commonly called age-related macular degeneration (ARMD) as it develops gradually after the age of 55 and is much more common after 70. The central area of vision (the sharpest area) is lost over time. The risk of ARMD is increased by smoking, obesity, and high blood pressure, as well as a poor diet with few fruits and vegetables, or a high cholesterol level. There is also a genetic component to the ARMD risk.

A number of studies have shown a relationship of dietary components and dietary supplements to preventing and treating macular degeneration. One highly publicized study (age-related eye disease study, or AREDS), showed slowing of progression of ARMD and visual preservation with supplements containing zinc, copper, vitamins C and E, and beta carotene.

A new study shows similar benefits from zinc, antioxidants, and omega-3 fatty acids in patients with a high genetic risk for ARMD. They studied 2167 participants over 55 years old and assessed their diets with a standard food frequency questionnaire. They were followed for an average of 8.6 years, during which time, 517 participants developed ARMD.

Those with the highest intake of zinc had about half the risk of ARMD compared to those with the lowest intake. For beta-carotene, the highest-intake group had a 44 percent lower risk compared to those with the lowest intake. For lutein (another carotenoid) the risk was 35 percent lower in the high-intake group, and for EPA/DHA (the omega-3 fatty acids from fish) the risk was 34 percent lower for those with the highest intake. (Ho L, et al., Reducing the genetic risk of age-related macular degeneration with dietary antioxidants, zinc, and {omega}-3 fatty acids: The Rotterdam Study. Arch Ophthalmol. 2011 Jun;129(6):758-66.) For people who do not have access to genetic testing to see what their risks are, it is wise to assume that these nutrients are valuable assets in the effort to maintain vision.

You can find many valuable nutrients by eating a wide variety of dark green leafy vegetables and other colorful fruits and vegetables. It also helps to avoid excessive exposure to ultraviolet light by wearing glasses that block UV. In addition, supplements of ginkgo biloba, bilberry (or blueberry), omega-3 oils, and taurine are helpful.

Omega-3 oils reduce stent clotting

Patients with coronary artery blockages are often treated with balloon angioplasty with stents placed in the vessel to keep it open (whether they need the procedure or not is another subject). Often the stents close up with clots after too short a time, so many of them are impregnated with anti-clotting drugs. How much these help is still controversial, but patients can favorably influence the likelihood of clots by lifestyle changes.

A study of 54 patients evaluated clotting factors to show the risk of developing a clot after the procedure. All of the patients were on the typical treatment of aspirin and clopidogrel (Plavix). Of these patients, 24 were placed on the usual treatment plus a placebo, and 30 were given 1000 mg of combined EPA/DHA (omega-3 oil) per day. The factors studied were related to thrombin, prothrombin, and fibrin, and the time to breakdown clots that have formed.

Evaluation was done at the start of the study, again 3 to 5 days later, and at the end of the study at 30 days. (Gajos G, et al., Reduced thrombin formation and altered fibrin clot properties induced by polyunsaturated omega-3 fatty acids on top of dual antiplatelet therapy in patients undergoing percutaneous coronary intervention (OMEGA-PCI Clot). Arterioscler Thromb Vasc Biol. 2011 May 26. [Epub ahead of print])

Those patients on the EPA/DHA had less clot formation and changes in the clot structure indicating that the clots were easier to dissolve. Other supplements also influence clotting by different mechanisms. While aspirin has anti-platelet effects, many supplements have anticlotting and anti-platelet effects, including ginkgo biloba, vitamin E, grape seed and skin extracts, garlic, curcumin, and niacin, among others.

Best exercises for weight and heart

Exercise is essential for prevention of chronic disease, but what kind of exercise is best for weight control and prevention of diabetes and heart disease, or their precursor known as metabolic syndrome? A study from Duke University aimed to answer that question. Researchers compared aerobic exercise versus resistance training (muscle building) in relation to the development of metabolic syndrome (a combination of abdominal obesity, high blood sugar, high blood pressure, low HDL cholesterol, and insulin resistance).

They evaluated 196 men and women subjects, 18 to 70 years old, with obesity and abnormal blood lipids. After four months of observation, they were divided into three exercise groups for eight months: resistance training (RT) 3 days/week, aerobics (AT) for 120 minutes per week, and a combination of AT and RT at the same levels as the other groups. They were given a score representing the level of metabolic syndrome.

After 8 months of RT alone, the score did not change. AT showed a trend toward an improving score. The combined exercise program led to a significant improvement in the metabolic syndrome score, but not significantly better than AT alone. (Bateman LA, et al., Comparison of aerobic versus resistance exercise training effects on metabolic syndrome (from the Studies of a Targeted Risk Reduction Intervention Through Defined Exercise - STRRIDE-AT/RT). Am J Cardiol. 2011 Jul 7. [Epub ahead of print])

Subjects in the RT group gained an average of 1.5 pounds and had a slight increase in waistline. Those in the AT group lost an average of 3 pounds and lost a half inch from their waistlines. Those who did both AT and RT lost an average of 4 pounds and 1 inch from their waistlines. These differences in the combined exercise group could easily be based on the extra time burning calories, rather than the type of exercise.

It seems that it is best to do a combination of aerobics and weight training, but if you lack the time to do both, then aerobics would be the most important one to include.

Olive oil may lower stroke risk

Olive oil contains mono-unsaturated oil (oleic acid) that appears to be a beneficial part of the Mediterranean diet. Researchers studied 7625 participants for olive oil consumption and the incidence of strokes, following them for 5.25 years. Those who used the most olive oil had a 41 percent lower risk of stroke than those who never consumed olive oil. (Samieri C, et al., Olive oil consumption, plasma oleic acid, and stroke incidence: The Three-City Study. Neurology. 2011 Jun 15. [Epub ahead of print])

In a secondary evaluation of 1245 subjects, those with the highest plasma level of oleic acid had a 73 percent reduction of stroke risk compared to those with the lowest plasma level. It is possible that those with low olive oil intake derived oleic acid from other sources (peanuts, avocados, canola and grape seed oils, ) so the plasma level might be a more accurate reflection of stroke risk.

Vitamin D and diabetes

Two more studies show the benefits of vitamin D for lowering the risk of diabetes. A meta-analysis of 8 observational studies and 11 controlled trials showed that those with vitamin D intake more than 500 IU per day had a 13 percent lower risk of diabetes than those with intake less than 200 IU per day. (Mitri J, et al., Vitamin D and type 2 diabetes: a systematic review. Eur J Clin Nutr. 2011 Jul 6. doi: 10.1038/ejcn. 2011.118. [Epub ahead of print])

In another study, researchers gave 92 pre-diabetic subjects either vitamin D3 supplements (2000 IU per day), calcium (400 mg twice per day), both, or placebo. They tested the blood for hemoglobin A1C (a blood sugar indicator) and the function of the pancreatic beta cells (those that produce insulin). (Mitri J, et al., Effects of vitamin D and calcium supplementation on pancreatic {beta} cell function, insulin sensitivity, and glycemia in adults at high risk of diabetes: the Calcium and Vitamin D for Diabetes Mellitus (CaDDM) randomized controlled trial. Am J Clin Nutr. 2011 Aug;94(2):486-94. Epub 2011 Jun 29.)

At the end of the 4-month study, they found that higher vitamin D intake improved beta-cell function by 15 to 30 percent, and increased insulin secretion. Glucose tolerance tests were also better in the vitamin D group. Calcium did not have any effect, with or without the vitamin D.

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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.