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September 2011

Lifestyle lowers heart failure risk
White fruits and veggies lower strokes
Dietary fiber reduces colon polyps
Vitamin D reduces colon cancer
Chores (!) help prevent dementia
Vitamins help breast cancer patients

Lifestyle lowers heart failure risk

Congestive heart failure is a progressive decline in heart muscle function resulting in shortness of breath with physical activity and fluid accumulation outside the blood vessels (primarily the legs or the lungs or both) and eventual death from inadequate blood and oxygen supply to the tissues. The most common cause of heart failure is hardening of the arteries to the heart muscle, but it is also caused by inflammation of the heart muscle (from viruses or chemical insults), or cardiomyopathy from other causes, including hypertension, thyroid disease, diabetes, or excessive alcohol use. However, the cause of cardiomyopathy is often unknown.

A new study suggests that lifestyle changes could prevent many cases of heart failure. A large Finnish study of 18,346 men and 19,729 women analyzed smoking, body mass index (BMI), physical activity, and vegetable, fruit, and alcohol consumption and the relationship to heart failure. They followed the subjects for 6 to 21 years. During that time, 638 men and 445 women developed heart failure. When other variables were eliminated (such as heart attacks, valve disease, diabetes, and hypertension), four lifestyle factors made a large difference in the risk of heart failure. (Wang Y, et al., Lifestyle factors in relation to heart failure among Finnish men and women. Circ Heart Fail. 2011 Sep 1;4(5):607-12.)

Those four were not smoking, BMI, physical activity, and vegetable consumption, while eating fruit and drinking alcohol were not related (it is likely that alcohol and fruit consumption was not high enough in this study group to make a difference). For subjects engaging in 1 to 4 of these lifestyle choices, the rates of heart failure were lowered by 31 percent, 55 percent, 66 percent, and 69 percent, respectively, compared to those subjects with none of those healthy choices.

Smoking led to an 86 percent increase in heart failure in men and a 109 percent increase in women. Being overweight led to a modest increase of 15 percent in men and 21 percent in women, but obesity led to a 75 percent increase in men and a 106 percent increase in women. Heart failure was lower in both men and women who exercised moderately, but declined by one third in those with higher levels of exercise.

White fruits and veggies lower strokes

Contrary to “conventional wisdom,” white-fleshed fruits and vegetables have a lot of health benefits. When it comes to the risk of strokes, they are even better than more colorful fruits and vegetables (which have many other benefits, so don’t leave them out of your diet). The white fruits and vegetables that were most helpful were apples, pears, bananas, cauliflower, cucumber, and mushrooms. In a Dutch study, researchers followed 20,069 men and women for 10 years. (Oude Griep LM,  et al., Colors of fruit and vegetables and 10-year incidence of stroke. Stroke. 2011 Sep 15. [Epub ahead of print])

During the 10 years, they documented 233 cases of stroke. They then classified the fruits and vegetables into four color groups – green, orange/yellow, red/purple, and white. In this study, only the white-fleshed fruits and vegetables were associated with stroke reduction. Those subjects with the highest intake of those foods had half the risk of stroke compared to those with the lowest intake. They calculated that each 25 gram increase of intake was associated with a 9 percent lower stroke risk (an apple weighs about 100-150 grams).

White fruits and vegetables contain lots of fiber, flavonoids, and other phytochemicals, but just different ones than are common in more colorful foods. Apples, pears, and yellow onions, for examples, are particularly good sources of quercetin, a yellow flavonoid that is a good antioxidant. In this study from Holland, apples and pears were the most commonly consumed white-fleshed foods.

Dietary fiber reduces colon polyps

Dietary fiber is important for lowering cholesterol, cleansing the bowel, and preventing obesity by providing a sense of fullness with a lower intake of calories. A new study shows that eating a lot of fiber can lower the incidence of colon polyps, which are cancer precursors. Researchers evaluated 2,818 subjects who had had colonoscopy as part of the Adventist Health Study in 1976 (AHS-1) and the AHS-2 from 2002-2005. A total of 441 cases of colon polyps were identified. (Tantamango YM, et al., Foods and food groups associated with the incidence of colorectal polyps: the Adventist Health Study. Nutr Cancer. 2011 May;63(4):565-72.)

Consumption of cooked green vegetables at least once per day compared to less than five times per week led to a 24 percent reduction of risk, and it was the same reduction for consumption of dried fruits more than three times per week compared to less than once per week. Eating legumes (peas and beans) at least three times per week reduced risk by 33 percent, and eating brown rice at least once per week led to a 40 percent reduction in risk. They found that the amount of consumption of these high-fiber foods (that are also high in protective phytochemicals) was directly proportional to the risk reduction. Once again, whole grains, beans, fruits, and vegetables are proving to be the staples of a healthy diet.

Vitamin D reduces colon cancer

In a review of studies (a meta-analysis), researchers have confirmed the value of vitamin D for protection against colon cancer. They included in their review nine studies of vitamin D intake and nine studies of blood levels of 25(OH)D – the typical test for adequate vitamin D. The studies had a total of about 1,000,000 participants from several coutries. (Ma Y, et al., Association between vitamin D and risk of colorectal cancer: a systematic review of prospective studies. J Clin Oncol. 2011 Aug 29. [Epub ahead of print])

Those participants with the highest vitamin D intake from foods and supplements had a 12 percent reduction of colorectal cancer risk, compared to those with the lowest intake. Those with the highest blood levels had a 33 percent risk reduction compared to those with the lowest blood levels. The discrepancy in benefit between intake and blood levels might be explained by absorption differences, skin production of vitamin D from sun exposure, or different metabolic utilization of vitamin D.

In a further analysis, the researchers estimated that each 10ng/ml increase of vitamin D in the blood conferred a 24 percent reduction in the risk of colorectal cancer. Vitamin D supplements are particularly important for people living farthest from the equator, where even in summer they might not get enough vitamin D. Even in areas that have more sun, such as the southern half of the US, spending time indoors or covered with clothing or sun block would make supplements just as important.

Chores (!) help prevent dementia

I hate to admit it, but it appears from recent research that chores around the house help to prevent dementia (I can’t really avoid them, much as I might like to; “nature abhors a vacuum”— and so do I). In a study of 197 men and women averaging 74.8 years old, subjects were followed for up to five years and evaluated for activity energy expenditure and the Modified Mini-Mental State Examination (MMMSE). At the end of the study, cognitive impairment was defined as a decline of at least 9 points on the MMMSE.

Subjects who were the most active with daily activities (mowing the lawn, folding laundry, unloading the dishwasher, taking out the trash) burned about 1,000 calories per day with such activities. This group, compared to the most sedentary subjects, had a 91 percent reduction in the incidence of memory decline, concentration, and communication skills based on the MMMSE. (Middleton LE, et al., Activity energy expenditure and incident cognitive impairment in older adults. Arch Intern Med. 2011 Jul 25;171(14):1251-7)

Of course, chores are not the only way to get exercise, and they might not take the place of some more formal program of physical activity. Muscle building activity and aerobics still have their place, and one advantage of a formal exercise program is consistency (to say nothing of the fun of playing physical games like basketball, racquetball, and tennis, or bicycling and kayaking). I still try to reuse, recycle, and compost everything so there is little trash to take out.

Vitamins help breast cancer patients

Oncologists commonly tell their patients that taking vitamin supplements will interfere with their cancer treatment and that they should specifically avoid antioxidant supplements. This advice is inappropriate and potentially dangerous, as the medical literature does not support such claims. In fact, it appears that the opposite is true. Vitamin supplements actually reduce the recurrence and mortality associated with cancer (and the treatments themselves). In a prospective study of 4,877 women aged 20 to 75 diagnosed with invasive breast cancer, subjects were evaluated for dietary supplement use during the six months after the diagnosis and then followed for an average of 4.1 years. (Nechuta S, et al., Vitamin supplement use during breast cancer treatment and survival: a prospective cohort study. Cancer Epidemiol Biomarkers Prev. 2011 Feb;20(2):262-71.)

In the four years of follow-up, 444 women died and there were 532 cancer recurrences. After adjusting the statistics for multiple lifestyle factors, clinical prognostic factors, and sociodemographics, those women who took antioxidants (vitamins C and E) and multivitamins had an 18 percent lower mortality and a 22 percent reduced risk of tumor recurrence. This association was found whether the patients took their supplements concurrently with their chemotherapy or not.

The authors concluded that the results do not support the recommendation that breast cancer patients should avoid the use of vitamin supplements. I can only hope that patients do not follow the misguided advice to avoid supplements. The same conclusions are almost certainly true for other cancers as well.

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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.