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November 2013

Topics:

Polyphenols lower mortality
Lycopene lowers systolic blood pressure
High dietary magnesium lowers mortality
Physical activity lowers heart risks
Nuts lower mortality and pancreatic cancer
Garlic lowers blood pressure
General Information

Polyphenols lower mortality

Dietary questionnaires are not always accurate, depending on recall and honesty, among other variables, such as self-deception (people may report on the person they would like to be (exercising a lot and eating fruits and vegetables) rather than the person they actually are (sedentary and eating junk)). The questionnaires are commonly used in large population studies of diet and disease, and larger studies with validated questionnaires may decrease the influence of these variables.

Polyphenols are dietary antioxidants that influence a number of diseases. An Italian research group was trying to assess polyphenol intake and mortality, and they decided to evaluate the difference in mortality linked to total dietary polyphenol (TDP, based on questionnaires) compared to the association of mortality rates with total urinary polyphenol (TUP) concentration, which might be a better indicator of polyphenol intake. Over a 12-year period, they followed 807 men and women aged 65 years and older in the Chianti region of Tuscany, Italy.

During the 12-year follow-up, 274 participants died. TUP excretion at enrolment, adjusted for age and sex, was greater in participants who survived than in those who died. However, the data showed no association of TDP with mortality. Those subjects in the highest third of TUP had a 30 percent lower risk of mortality than those in the lowest third of TUP. (Zamora-Ros R, et al., High concentrations of a urinary biomarker of polyphenol intake are associated with decreased mortality in older adults. J Nutr. 2013 Sep;143(9):1445-50. doi: 10.3945/jn.113.177121. Epub 2013 Jun 26.)

Practical guidelines:

A wide variety of foods are full of polyphenols. Some of the best sources are fruits (apples, berries, apricots mangoes, pomegranates, and rhubarb), vegetables (broccoli, celery, eggplant, garlic, leeks, spinach, cabbage, and sweet potatoes), nuts and beans (almonds, cashews, chick peas, black beans, pinto beans, hazelnuts, lentils, peanuts, and sunflower seeds), and many herbs and spices. You can find the foods richest in polyphenols at this source: http://www.nature.com/ejcn/journal/v64/n3s/fig_tab/ejcn2010221t1.html

All of these foods provide a complex collection of flavors and recipe possibilities and they are also nutritious in many other ways (see the article on nuts later in this newsletter).

Lycopene lowers systolic blood pressure

Lycopene is a carotenoid antioxidant commonly known to be found in tomatoes, but also present in red grapefruits, red navel oranges, guavas, and papayas, and in watermelon in even higher amounts than in raw tomatoes (two to three times as much per gram). Sun-dried tomatoes have the most per cup, because the removal of the water from tomatoes concentrates the lycopene, which has been associated with a lower risk of prostate cancer and other health benefits.

New research evaluating results from earlier studies shows a correlation of dietary lycopene and supplementation with a reduction of systolic blood pressure in hypertensive subjects. They included six studies that met the criteria for inclusion in the analysis. Higher lycopene intake led to an average 5 mmHg reduction in systolic blood pressure. Supplements greater than 12 mg per day led to even greater reductions in blood pressure in subjects with elevated blood pressure. (Li X, Xu J, Lycopene supplement and blood pressure: an updated meta-analysis of intervention trials. Nutrients. 2013 Sep 18;5(9):3696-712. doi: 10.3390/nu5093696.)

In these studies, lycopene had no apparent influence on diastolic blood pressure or on systolic pressures in healthy subjects. It is possible that lycopene, an antioxidant that is a potent free radical blocker, might help protect the vascular endothelium that produces nitric oxide, a relaxant.

Practical guidelines:

At one time, tomatoes were considered poisonous in America, and people avoided them for 200 years, even though they were eaten elsewhere with no ill effects. Consuming foods and supplements that provide lycopene helps to prevent second heart attacks, strokes, and inflammation, as well as cancer. When tomatoes are not in season, I buy jars or BPA-free cans of organic tomatoes. However, I also eat a lot of watermelon whenever it is in season, as well as red grapefruit and red navel oranges. Blood oranges do not get color from lycopene, but from anthocyanins (which are also quite healthful).

High dietary magnesium lowers mortality

Magnesium is associated with over 300 enzyme functions in the body, and it is commonly deficient in the American diet. It is particularly abundant in green vegetables, as it is the central atom in chlorophyll and gives it the deep green color. (Chlorophyll is chemically like the heme part of the hemoglobin molecule in blood, but the central atom in heme is iron, making it red, not green.) Low magnesium levels are very difficult to detect with ordinary laboratory testing, making it important to get enough from diet and supplements. Marginal intake levels have a long-term detrimental effect on cardiovascular and neurological health.

In a new study of Mediterranean subjects, researchers evaluated 7216 men and women aged 55-80 years at the start of the study. They were randomized to two groups – one on the Mediterranean diet supplemented with nuts or olive oil, and the other on a low-fat control diet. They assessed magnesium intake, placing subjects in low, middle, or high consumption groups, adjusted for calorie intake. They followed the subjects for 4.8 years. (Guasch-Ferré M, et al., Dietary magnesium intake is inversely associated with mortality in adults at high cardiovascular risk. J Nutr. 2013 Nov 20. [Epub ahead of print])

At the end of follow-up, 323 total deaths, 81 cardiac deaths, 130 cancer deaths, and 277 total cardiac events occurred. The subjects in the highest third of magnesium intake had a 34 percent lower mortality compared to those in the lowest third of magnesium intake. Overall, they found an inverse relationship of magnesium intake with cardiovascular, cancer, and all-cause mortality. Heart death risk was 59 percent lower and cancer mortality was 37 percent lower for the highest intake compared to the lowest intake.

Practical guidelines:

It is wise to eat a diet high in magnesium. This means dark, leafy greens such as spinach, chard, and kale; nuts and seeds, such as pumpkin seeds, sesame seeds, almonds, cashews, and peanuts; beans, such as navy beans, black-eyed peas, kidney beans, and chick peas: whole grains, such as quinoa, millet, and buckwheat (not a true grain); and fish, if you choose to include it, such as salmon.

In terms of magnesium level per calorie, leafy greens are the best bet, as you derive very few calories per 100 grams of spinach or kale. One cup of cooked spinach is 180 grams, and contains only 41 calories, while one ounce of pumpkin seeds has about the same amount of magnesium, but 153 calories. High magnesium intake might also help eliminate leg cramps and restless leg syndrome. Supplements are helpful for those with higher needs than the diet supplies.

Physical activity lowers heart risks

We all know that exercise is beneficial, but not everyone manages to participate in a formal exercise program. This does not mean there is no hope for them! In Stockholm, Sweden, 4232 individuals participated in a study of non-exercise physical activity (NEPA) and its relationship to cardiovascular health. They were followed for 12.5 years and assessed for cardiovascular disease events as well as mortality.

Independent of regular exercise, higher levels of NEPA were associated with lower waist circumference, better HDL-cholesterol levels, and lower triglycerides in both sexes, and lower insulin, glucose, and fibrinogen levels in men (fibrinogen is a blood clotting factor associated with heart risks). (Ekblom-Bak E, et al., The importance of non-exercise physical activity for cardiovascular health and longevity. Br J Sports Med. 2013 Oct 28. doi: 10.1136/bjsports-2012-092038. [Epub ahead of print])

Compared with reporting a low NEPA level, reporting a high level was associated with a 27-percent lower risk of a first cardiovascular event and a 30-percent lower all-cause mortality. The occurrence of metabolic syndrome (syndrome X) was significantly lower among those with higher NEPA in both non-exercising and regularly-exercising individuals. Metabolic syndrome includes high blood pressure, high blood sugar, excess abdominal fat, and abnormal cholesterol levels, which, taken as a group (or even individually), increase the risk of heart disease, stroke, and diabetes.

Practical guidelines:

Exercise is valuable, but additional activity as part of daily life is also important. This might include housework, gardening, walking for errands, mowing the lawn, raking leaves, taking out the trash, and even just standing up from your normal sitting activity (such as when I spend time writing this newsletter) are all beneficial. The lowest risk profile was among those who had a lot of NEPA and also regular, more-vigorous exercise. An earlier study showed that people who gardened had a lowered risk of stroke and heart attack.

Nuts lower mortality and pancreatic cancer

New research indicates that eating nuts regularly can lower total and cause-specific mortality. Earlier studies have shown that nuts could decrease major chronic diseases, such as heart disease and diabetes. Data was collected as part of two studies on 76,464 women in the Nurses’ Health Study and 42,498 men in the Health Professionals Follow-up Study. They were followed for 25 to 30 years and had data updated every 2 to 4 years.

Overall, the study had 3,038,853 person-years of follow-up, during which time 16,200 women and 11,229 men died. Nut consumption was inversely associated with mortality for both men and women. Compared to those who never ate nuts, those who ate them less than once per week had a 7 percent risk reduction, those eating them once per week had an 11 percent reduction, and 2-4 times per week led to a 13 percent reduction. For those who ate nuts 5-6 times per week the mortality risk was 15 percent lower, and for those consuming them daily or more, the overall risk was 20 percent lower. (Bao Y, et al., Association of nut consumption with total and cause-specific mortality. N Engl J Med. 2013 Nov 21;369(21):2001-11. doi: 10.1056/NEJMoa1307352.)

The researchers also observed inverse associations between nut consumption and deaths due to cancer, heart disease, and respiratory diseases. The associations were similar whether the consumption was of tree nuts (almonds, walnuts, pecans, cashews, etc), or peanuts, which are really beans but with many nutritional similarities to other nuts. In another study, the same research team found that higher nut consumption led to a reduced risk of pancreatic cancer in women. (Bao Y, et al., Nut consumption and risk of pancreatic cancer in women. Br J Cancer. 2013 Nov 26;109(11):2911-6. doi: 10.1038/bjc.2013.665. Epub 2013 Oct 22.)

They evaluated data on 75,680 women in the Nurses’ Health Study and found that those who consumed 1 oz of nuts twice per week had a 35 percent reduction in relative risk of pancreatic cancer. Because pancreatic cancer is uncommon, the absolute risk reduction is low, from 6 cases per 1000 subjects to 4 cases per 1000. However, because eating nuts is not harmful (if you are not allergic) and has many other health benefits, it is unlike many drugs, where a small absolute risk reduction does not justify widespread treatment (such as with the most recent hype about cholesterol drugs).

Practical guidelines:

Eat some nuts, unless you are allergic. I put walnuts in banana bread, cashews in my fruit salad, and always travel with almonds, either roasted or raw. They go very well with bananas. I also eat peanuts and peanut butter (often on whole grain bread with mashed banana or applesauce instead of jam). I only eat organic nuts, which are almost always available, and I keep them in the fridge or sometimes in the freezer if I am keeping them for longer times.

Garlic lowers blood pressure

Garlic has a long traditional history of being used to help lower blood pressure (among its many other health benefits and culinary delights). Recent research confirms beneficial effects of garlic on both systolic and diastolic blood pressure. In this study, 210 subjects with essential hypertension (“essential” means with no known metabolic, physiological, or cardiovascular cause) were divided into seven groups of 30 patients. The first five groups received garlic tablets in doses of 300, 600, 900, 1200, or 1500 mg per day. The sixth group received the blood pressure drug atenolol, and the last group received a placebo. (Ashraf R, et al., Effects of Allium sativum (garlic) on systolic and diastolic blood pressure in patients with essential hypertension. Pak J Pharm Sci. 2013 Sep;26(5):859-63.)

The subjects were then followed for 24 weeks, with initial blood pressure readings and again at 12 and 24 weeks. Each garlic group had a significant reduction in both systolic and diastolic blood pressures, and the effects were dose and duration dependent. Those on each higher dose had a greater blood pressure reduction than those on the lower doses, but all were significant compared to both atenolol and placebo. The results were better at 24 weeks than at 12 weeks. The highest dose of garlic led to an average drop in systolic blood pressure of 8 points, and an average drop in diastolic pressure of 5 points. Atenolol led to a 9 point systolic drop and a 9 point drop in diastolic, but in the atenolol group the initial pressure was slightly higher than in the garlic groups.

Practical guidelines:

Garlic is a wonderful culinary addition, and it has numerous health benefits. Supplements might be better if you do not eat it consistently, and most information that I have seen suggests that the differences between brands are not significant. I use garlic in virtually every soup and stir fry that I make, and it is an essential component of pesto (basil, garlic, and olive oil, with or without pine nuts – I do not use parmesan in my pesto, even though it is traditional), hummus (chick peas, tahini, lemon, garlic, and cumin), and baba ghanouj (roasted eggplant replacing the chick peas).

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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