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October 2013

Topics:

Colon cancer and Pan-Asian medicine+vitamins
Fish oils lower rheumatoid arthritis risk
Changing diet lowers heart attack mortality
Dietary fiber lowers heart risks
Black currant anthocyanins and glaucoma
General Information

Colon cancer, Pan-Asian medicine+vitamins

After surgery, colon cancer is commonly treated with chemotherapy and radiation. Some patients choose to have the post-op treatment combined with complementary and alternative medicine (CAM). One form of CAM is a combination of Pan-Asian Medicine (PAM) with vitamin supplements (PAM+V). The PAM included Chinese herbs, energy therapies, acupuncture, exercises (yoga, jogging, Tai Chi), relaxation techniques, and an organic, natural diet recommendation. A wide variety of nutrients and herbs were part of the program, in relatively high doses. These included vitamins C and E, curcumin, fish oil, coenzyme Q10, beta-carotene, B-complex, vitamin D, selenium, zinc, melatonin, and others.

Researchers conducted a consecutive case series with 10-year follow-up of all colon cancer patients presenting at a San Francisco Bay-Area center for Chinese medicine. This included 193 colon cancer patients. Some of them chose to have the PAM+V for the duration of the chemotherapy-radiation, and others continued the PAM+V for a longer term. They also compared the survival of their subjects with that of concurrent external controls from Northern California Cancer Registries. (McCulloch M, et al., Colon cancer survival with herbal medicine and vitamins combined with standard therapy in a whole-systems approach: ten-year follow-up data analyzed with marginal structural models and propensity score methods. Integr Cancer Ther. 2011 Sep;10(3):240-59.)

During the 10-year follow-up, compared with conventional therapy alone, PAM+V combined with conventional therapy reduced the risk of death for patients in stage I by 95 percent. The reduction in stage II was 64 percent, in stage III it was 29 percent, and in stage IV the risk of death was reduced by 75 percent. Whether the patients chose short-term therapy with PAM+V or continued after the conventional treatment was finished apparently made no significant difference in survival rates.

Practical guidelines:

Although many doctors suggest that patients stop their antioxidants before they receive chemotherapy, the evidence strongly suggests that herbs and supplements, including antioxidants, actually enhance the success of conventional treatment and reduce the side effects.

If you must have treatment for colon cancer, consider a comprehensive program including numerous alternatives with supplements and herbs. The same authors also published an article on this approach to lung cancer, combining conventional and alternative treatments, and they found similar benefits with even better results for longer term treatment with PAM+V.

Fish oils lower rheumatoid arthritis risk

Last month I discussed rheumatoid arthritis (RA) and the benefits provided by curcumin supplements as a treatment. This is apparently due to the anti-inflammatory properties of curcumin. Omega-3 oils from fish also have anti-inflammatory properties, and have been shown to be helpful in ailments that are associated with inflammation.

A new large study confirms this benefit for RA patients.
Researchers collected data in 1987 and 1997 on diet and RA among 32,232 women, born from 1914 to 1948, using food-frequency questionnaires. The average follow-up was 7.5 years, during which time they identified 205 new cases of RA. (Di Giuseppe D, et al., Long-term intake of dietary long-chain n-3 polyunsaturated fatty acids and risk of rheumatoid arthritis: a prospective cohort study of women. Ann Rheum Dis. 2013 Aug 12. doi: 10.1136/annrheumdis-2013-203338. [Epub ahead of print])

Consistent intake of omega-3 oils from fish averaging 210 mg/day was associated with a 35 percent reduction in the risk of developing RA. An intake consistently greater than 210 mg/day was associated with a 52 percent decreased risk. One serving of fatty fish per week (such as salmon) provides an average daily consumption of omega-3 oil of 210 mg. With consumption of larger quantities of fish, the benefits taper off, so more is not better.

Practical guidelines:

A number of studies show benefits from omega-3 oil consumption. It appears that fish is the most likely source to provide anti-inflammatory benefits, but you can also get omega-3 oils from flaxseeds or flaxseed oil, and walnuts, and you can get 200-1000 mg from tofu, navy beans or kidney beans. The non-fish sources have to be converted in the body to EPA and DHA to have their anti-inflammatory effects. (I always recommend organic soy products because the non-organic are highly likely to be genetically modified.) You can also take fish oil supplements that have concentrated levels of omega-3 oils. Capsules range from 200 to 600 mg of EPA/DHA combined.

Changing diet lowers heart attack mortality

The Alternative Healthy Eating Index 2010 (AHEI2010) was developed to recognize eating patterns based on scientific data about foods and nutrients associated with a lowered risk of chronic disease. A new study from Harvard suggests that changes in diet from before to after a heart attack (myocardial infarction, or MI) can lead to lowered mortality. Researchers examined the association of post-MI dietary quality and changes from pre- to post-MI with all-cause and cardiovascular mortality.

They included 2258 women MI survivors from the Nurses’ Health Study and 1840 men MI survivors from the Health Professionals Follow-up Study. They completed pre-and post-MI food frequency questionnaires, which were then measured using the AHEI2010. They adjusted the results for medical history, medication use, lifestyle risk factors (tobacco, alcohol, exercise), and other confounding variables. (Li S, Better diet quality and decreased mortality among myocardial infarction survivors. JAMA Intern Med. 2013 Oct 28;173(19):1808-1819.)

During follow-up, they confirmed 682 all-cause deaths for women, and 451 for men. The median survival time after the initial MI was 8.7 years for women and 9.0 years for men. Comparing those adhering most closely to the AHEI2010 and those adhering the least, they found a 24 percent reduction in all-cause mortality and a 27 percent reduction in cardiovascular mortality. For those who changed their diets the most from before to after their MI, the reduction in mortality was 29 percent overall, and 40 percent for cardiovascular death.

Practical guidelines:

The AHEI2010 is quite simple. It emphasizes lots of vegetables, fresh fruits of all varieties, lots of whole grains, and plenty of water. Among proteins, it suggests fish, beans, nuts, and poultry. It recommends limiting red meat and cheese, and completely avoiding processed meats. This is close to my recommendations, although I do not recommend poultry because it is unnecessary, and if you watch the documentary movie Food, Inc, you would probably want to avoid chicken. You can find the details of the AHEI here: http://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/pyramid/

I also avoid red meat because of the association with heart disease and cancer, stroke, and even diabetes. I would include seeds in the diet, and they are not mentioned in the AHEI. The oils they mention, in small quantities, are olive and canola, and I would add flaxseed oil to that.

Dietary fiber lowers heart risks

Dietary fiber is often neglected, partly because it is not digested or absorbed, so is not considered a nutrient. However, it is an important component of the diet. High fiber intake has long been associated with lowered risks of heart disease, colo-rectal cancer, diabetes, diverticulitis, appendicitis, stroke, and hypertension. It is possible that this association is partly related to the sources of the fiber, as it is found in fruits, vegetables, whole grains, beans, seeds, and nuts: all healthy foods, but it might also be due to the fiber itself.

A new study links a low fiber intake with an increased risk of heart disease. It is common for much of the US population to consume far too little fiber. Five to 15 grams of fiber intake has been the average until recently, and many experts suggest an intake of at least 20 to 40 grams per day. When Denis Burkett, MD, studied African native diets in the 1950s, he found that they commonly consumed 100 grams of fiber (the staples of their diet were potatoes, bananas, cornmeal, and beans). They had almost no incidence of the diseases mentioned above.

In the new study, based on the 1999-2010 National Health and Nutrition Examination Survey, researchers evaluated 23,168 men and women over 20 years old. Fiber intake was consistently below recommended levels, with a mean of 15 to 17 grams per day. Compared to those with the lowest intake, those with the highest intake had a 22 percent lower risk of metabolic syndrome, a 44 percent lower risk of inflammation, and a 23 percent lower risk of obesity. These are all cardiovascular disease risk factors. (Grooms KN, et al., Dietary fiber intake and cardiometabolic risks among US adults, NHANES 1999-2010. Am J Med. 2013 Oct 9. pii: S0002-9343(13)00631-1. doi: 10.1016/j.amjmed.2013.07.023. [Epub ahead of print])

Practical guidelines:

Remember that these benefits are among people whose fiber intake is still mostly below recommended amounts. Higher levels of fiber are likely to provide even more benefits. The bulk of the diet should be composed of vegetables, fruits, whole grains, and legumes, plus seeds and nuts (flaxseeds are particularly rich in fiber; it is best to grind them up fresh at the time of consumption to get the full benefits). Fiber comes only from plant products, not animal products (meats, fish, dairy, and eggs).

Fiber can be either soluble or insoluble, and each type has its benefits for bowel function and overall health. I suggest a diet with a lot of high-fiber foods with both soluble and insoluble fiber. I include oats, barley, whole wheat, brown rice, millet, and quinoa, among the grains, as well as lentils, chick peas, kidney, and navy beans, seeds, nuts, vegetables, and fruits. For the small number of people who have either gluten sensitivity or celiac disease, avoiding wheat, barley, rye, kamut, and spelt is important, but gluten sensitivity is much less common than the commercial hype of gluten-free products would suggest. Celiac disease (an autoimmune disorder) occurs in only 0.75 percent of the population (1 of 133 people). Other types of gluten intolerance have less severe symptoms.

Black currant anthocyanins and glaucoma

People with glaucoma have an elevated fluid pressure inside the eye. This can lead to damage to the optic nerve (although it does not always do so) and result in blindness. In the more common form, no symptoms appear until the loss of vision is advanced. An ophthalmologist will always check for elevated eye pressures to detect the disease in its early stages and prevent loss of vision. The pressure is usually treated with medication if it is significantly elevated.

In a Japanese study researchers administered black currant anthocyanins (BCAC) to both healthy subjects and those with glaucoma. They had 12 healthy and 21 glaucoma subjects. They gave them 50 mg of BCAC once per day or a placebo for a total of 4 weeks. They then followed the changes in intraocular pressure in both groups. (Ohguro H, et al., Effects of black currant anthocyanins on intraocular pressure in healthy volunteers and patients with glaucoma. J Ocul Pharmacol Ther. 2013 Feb;29(1):61-7.)

Compared to baseline levels, at both 2 and 4 weeks, the treated subjects, whether healthy or glaucoma patients, had a significant drop in their intraocular pressures, while the placebo group had no change in pressures. At 24 months after baseline, the glaucoma patients taking BCACs had significantly lower intraocular pressures. The researchers also evaluated changes in visual fields that deteriorate as a result of glaucoma. In the glaucoma patients, visual field defects were significantly less at 12 and 18 months after baseline for those treated with BCACs compared with the placebo group.

Practical guidelines:

Numerous plants are rich in anthocyanins, especially blueberries, bilberries, blackberries, blackcurrant, cherry, and eggplant peels, and acai (Amazonian palmberry). They are reddish blue to blue or purple. Autumn foliage colors are from anthocyanins in the leaves that are produced at the end of summer. It is likely that these other sources would have the same benefits.

Consuming a selection of the foods that contain anthocyanins has many benefits, and now a new one for the eyes. I make blueberry-banana smoothies frequently, or cherry-banana smoothies. Organic blueberries and cherries are usually available in the frozen food section of health food stores. Blackcurrant supplements are readily available so you can easily take them when the fresh fruits are not available. The dose in this study, 50 mg daily, is a relatively low dose, but seemingly effective. Higher doses would be quite safe.

General Information

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CONSULTATIONS:

PLEASE NOTE THE CHANGE IN MY SUMMER SCHEDULE

From September to May or June, I see patients in New Smyrna Beach, Florida. Call 386-409-7747, or send an email to mjansonmd@gmail.com to make arrangements.

For part of the summer, I see patients in offices at the Rothfeld Center in Waltham, Massachusetts. My schedule has changed, so I will only be in Massachusetts for specific weeks. Please be sure to inquire well in advance if you wish to see me in person. For appointments, send an email to mjansonmd@gmail.com, or call my Florida number, which is portable and travels with me: 386-409-7747.

I also do phone, Instant Messaging, and Email consults year round. Contact: mjansonmd@gmail.com
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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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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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