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February 2012

Aspirin as good as Plavix
Fried foods increase stroke risk
BPA linked to heart disease
Fiber helps gum health
Soy helps manage cholesterol

Aspirin as good as Plavix

Peripheral vascular disease, or intermittent claudication, is pain in the legs on walking due to hardening of the arteries that results in decreased blood supply to the muscles. Smoking is the most common contributor to the development of claudication. With muscular activity, lactic acid builds up in the tissues causing pain. If adequate oxygen is supplied through better circulation, the lactic acid is metabolized and the pain diminished. Without that oxygen, stopping or at least slowing down is the only way to relieve the pain.

Part of the rehabilitation program for intermittent claudication (IC) is walking, which increases collateral blood flow through newly developing small vessels. Patients with vascular disease are at risk for heart attacks and strokes, so, in addition to walking programs, patients with IC are often treated with aspirin or Plavix (clopidogrel) to reduce platelet stickiness and prevent arterial clots. (Many natural substances also reduce platelet stickiness and could substitute for the drugs. These include vitamin E, fish oil, ginkgo biloba, garlic, onion, curcumin (turmeric), and policosanol, among others.)

In some animal studies, aspirin appeared to inhibit the generation of new vessels due to its anti-inflammatory effects, so doctors often prefer prescribing clopidogrel. In a recent study comparing aspirin and clopidogrel, they were found equally effective in improving walking distance and exercise duration before pain in IC patients on a walking treatment program. (Singer E, et al., Effect of aspirin versus clopidogrel on walking exercise performance in intermittent claudication: a double-blind randomized multicenter trial. JAHA.111. 2012; 1:51-56000067 doi: 10.1161/.)

In this research, 229 patients from 21 centers in Switzerland and Germany were randomized to receive either low-dose aspirin or clopidogrel in addition to a one-hour per day walking program for 3 months. At the end of the study, the improvement in both groups was about the same, although the aspirin group did slightly better in the distance walked before pain was incapacitating. Aspirin is far cheaper than clopidogrel and readily available without a prescription.

The nutrients and herbs that I mentioned above are also relatively inexpensive and virtually free of side effects. Chelation therapy is another safe and effective treatment for claudication. It is the intravenous administration of EDTA, a synthetic amino acid that binds with lead and other heavy metals and removes them from the body. I have written about it in previous newsletters.

Fried foods increase stroke risk

Consumption of fatty foods in excess is associated with a number of health problems, not the least of which is obesity. A new study shows that a higher intake of trans fats is also related to an increased risk of stroke. Trans fats are commonly found in fried foods, bakery products, and other packaged foods because they often use partially hydrogenated oils as the cooking medium. Most of these shortenings and margarines are rich in trans fats.

Researchers evaluated 87,025 post-menopausal women as part of the Women’s Health Initiative. The age range was 50 to 79 years and diets were evaluated using validated food-frequency questionnaires. They were followed for an average of about eight years. During that time they documented 1049 cases of ischemic stroke. Women with the highest trans fat intake had a 39 percent increased risk of stroke compared to those with the lowest intake.

Taking aspirin appeared to eliminate the increased risk. Women with high intake of trans fats who did not take aspirin had a 66 percent increased risk, while those who took aspirin had no increased risk. (Yaemsiri S, et al., Trans fat, aspirin, and ischemic stroke in postmenopausal women online: Ann Neurol 1 MAR 2012 DOI: 10.1002/ana.23555.) However, stroke is only one of the negative effects of trans fat intake, and we do not know if aspirin can protect against the other risks. Also, other anti-platelet and anti-inflammatory substances might do just as good a job. Just because the study was done in women does not mean that men are off the hook. It is likely that these effects would translate to men also.

BPA linked to heart disease

Bisphenol A (BPA) is a chemical used to make plastics. It is widely used in food and beverage packaging and migrates into the contained foods. It is a known endocrine disruptor, interfering with normal hormone activity. A new study shows that exposure that is sufficient to lead to higher urinary levels of BPA is associated with an increased risk of coronary disease. (Melzer D, et al., Urinary Bisphenol A concentration and risk of future coronary artery disease in apparently healthy men and women. Circulation 2012 February 21. [Epub ahead of print])

Researchers followed 758 patients who were initially free of coronary artery disease (CAD) but later developed it, and 861 controls who remained free of CAD for 10.8 years. The subjects were part of the European Prospective Investigation of Cancer (EPIC). They took urine samples at baseline and measured the BPA concentration. For each increase of BPA they found a corresponding increased risk of CAD, but they can’t be certain that the BPA was the cause of the CAD. However, this information corresponds to similar results from studies in the USA, where the correlation was even stronger than in the EPIC study.

It appears to be important to avoid plastic wrapped foods as much as possible and to use BPA-free containers to store food. In addition to food and beverage containers, BPA exposure also comes from water, dental sealants, and household dust. BPA is one of the most highly produced chemicals in the world. It is used to make polycarbonate polymers and epoxy resins.

BPA use in baby bottles is banned in Canada and the European Union, but it is still used as a liner in food and beverage cans, although that use has been replaced in Japan with a different film coating. Some organic food producers use BPA free cans, but not all. Interestingly BPA is also found in thermal point-of-sale receipts and carbonless copy paper. Most household plastic food storage containers are made with BPA, so changing to glass is desirable, or at least plastics that do not have BPA (Rubbermaid has a line of BPA-free containers, and both Glad and Ziploc brand food storage containers are also BPA free).

Fiber helps gum health

Gum disease (periodontal disease) is a serious health issue affecting 10 percent of US adults and about 20 percent of those over 75 years old. It includes bleeding gums, receding gums, tartar build up, bone degeneration, and tooth loss. Tooth loss makes it much more difficult to eat a healthful diet. In a recent study, researchers followed 625 men in the Boston area for an average of 15 years, measuring bone loss, gingival pocket depth, and tooth loss as indicators of periodontal disease. (Schwartz N, et al., High-fiber foods reduce periodontal disease progression in men aged 65 and older: The Veterans Affairs Normative Aging Study/Dental Longitudinal Study. J Am Geriatr Soc. 2012 Feb 8. doi: 10.1111/j.1532-5415.2011.03866.x. [Epub ahead of print])

In men over 65 years old, higher fiber intake was associated with 24 percent less bone loss and 28 percent less tooth loss. Each serving of high-fiber fruit was associated with 14 percent less bone loss and 12 percent less tooth loss. Bananas and apples were the fruits most associated with these benefits.

Even though this study does not prove that fiber was the source of the benefit, high fiber foods of all sorts have numerous health benefits, even though the fiber itself is considered the “non-nutritive” part of the food because it is not metabolized or absorbed. They help to control blood sugar, lower cholesterol, and help with weight loss. They also aid normal bowel function.

Soy helps manage cholesterol

Soy foods can lower cholesterol, possibly through conversion of the soy isoflavones into compounds with estrogen-like activity, including one called equol. Equol is not a steroid hormone, but may have beneficial effects on the incidence of prostate cancer, bone health, skin health, and menopausal symptoms. Some people are more efficient producers of equol than others, and some research suggested that the equol conversion was important to the cholesterol-lowering effect of soy. This appears not to be the case, as research shows that soy is beneficial independent of equol production.

In a recent Canadian study, 85 subjects with high cholesterol levels were divided into those who produced equol efficiently (30 subjects) and those who did not (55 subjects). They were fed one to two ounces of soy foods in three different ways: high or low isoflavone content; with or without a prebiotic to enhance fermentation that produces equol; or soy combined with a low carbohydrate diet. (Wong JM, et al., Equol status and blood lipid profile in hyperlipidemia after consumption of diets containing soy foods. Am J Clin Nutr. 2012 Mar;95(3):564-71.)

In all groups, LDL-cholesterol (the undesirable form) was reduced by 9.3 percent. In those who produced equol, the HDL-cholesterol (the protective form) was maintained, while it dropped slightly in those who did not produce equol. This suggests that soy foods are beneficial for all groups but somewhat better among those who produce equol. In humans, soy does not have negative effects in the amounts that are consumed in societies where it is a staple in the diet. It does have some negative effects in rodents, as they metabolize it differently than humans do.

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CONSULTATIONS:

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.

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