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March 2013

Topics:

Soy foods and lung cancer
Coenzyme Q10 and heart failure
Gestational folate and autism
Chelation reduces cardiac events
Dietary fiber reduces stroke risk
Vitamin D and Parkinson’s disease
New Feature: Practical Guidelines

Soy foods and lung cancer

Recent articles have shown that consuming soy foods, such as tofu, soymilk, tempeh, and soybeans, both dried and fresh (edamame), can reduce the lung cancer risk among non-smoking women. Lung cancer among non-smokers is rare in the United States, but in China it is far more common. This could be due to the high levels of pollution in China, in the cities and increasingly in other areas. Data from the Shanghai Women’s Health Study, including 71,550 women, show that soy consumption can reduce the risk of developing lung cancer. Of the 370 cases of lung cancer, 340 of the women had never smoked.

Those women with the highest intake of soy foods had a 37 percent lower risk than those with the lowest soy intake. When the authors analyzed seven other studies of non-smokers, they found that the risk reduction was 41 percent lower for those with the highest intake of soy isoflavones compared to those with the lowest intake. The benefits were greatest for prevention of the most aggressive lung cancers. (Yang G, et al., Soy food intake and risk of lung cancer: evidence from the Shanghai Women's Health Study and a meta-analysis. Am J Epidemiol. 2012 Nov 15;176(10):846-55. doi: 10.1093/aje/kws168.)

More recently, the same authors reported on improved survival among lung cancer patients if they consumed larger amounts of soy foods. This analysis reported on 444 women with lung cancer, of whom 318 died during the follow-up period. Those with the highest intake of soy foods prior to their diagnoses had better overall survival compared to those with the lowest or middle levels of intake. (Yang G, et al., Prediagnosis soy food consumption and lung cancer survival in women. J Clin Oncol. March 25, 2013, doi: 10.1200/JCO.2012.43.0942. (Epub before print)

Subjects with the lowest level of soy consumption had an 81 percent higher risk of death than those with the middle level of dietary soy. On the other hand, those with the highest level of soy consumption had a 12 percent lower risk of mortality during the study period. It appears that for survival, it is important to have a high soy intake prior to diagnosis, rather than wait for a problem to develop and then start adding soy to the diet.

It is important to note that those with the lowest soy intake averaged 0 to 2 ounces of soy food intake, while those with the highest intake consumed about 4 ounces on average per day. Apparently there was no further benefit in terms of lung-cancer survival from consumption above 4 ounces per day (although there might be other benefits). Soy may work through its selective estrogen receptor modulation effects, as lung cancer cells have estrogen receptors.

In the United States soy foods are most commonly made from genetically modified soybeans. No studies have shown these to be safe for long-term human consumption (the lack of studies showing specific risks is simply a reflection of the absence of studies). In addition, be aware that highly processed soybeans, such as texturized vegetable protein, are mostly unhealthy, and it is best to avoid them. Eating organic soy foods is the only way to be sure you are not getting GMO soybeans, as they are not allowed in organic foods. (In numerous countries, including the European Union, GMO foods are not permitted.)

Coenzyme Q10 and heart failure

Numerous studies over many years have strongly suggested that coenzyme Q10 (ubiquinone or ubiquinol) is valuable for heart health, and particularly for congestive heart failure. It is an antioxidant that is an essential component of the energy production cycle in the mitochondria (the little organelles inside cells that product ATP, the energy storage molecule). Coenzyme Q10 is most concentrated in the heart. A recent meta-analysis confirms the benefits of coenzyme Q10, although the effects were smaller than in some previous studies. (Fotino AD, Effect of coenzyme Q?? supplementation on heart failure: a meta-analysis. Am J Clin Nutr. 2013 Feb;97(2):268-75.)

The studies selected for this analysis included those that examined ejection fraction (EF), a reflection of heart muscle function, and the New York Heart Association (NYHA) functional class, a common standard for evaluating congestive heart failure. Normal EF is 55-65 percent, and patients with heart failure might have EF from 10 to 40. In these reports, the baseline EF ranged from 22 to 46 percent. The researchers included 13 studies that met their inclusion criteria. The doses of coenzyme Q10 in these studies ranged from 60 mg to 300 mg per day, with most of them being less than 100 mg per day. More recent trials are using larger doses, ranging from 200 to 450 mg per day.

Coenzyme Q10 supplements led to an average improvement in EF of 3.67 percent. While this may not seem like much, it was a significant improvement, and it included all of the different doses, even those that were too low to have much effect. In 2008, Langsjoen reported on benefits using 450 to 900 mg per day, leading to an increase of EF from 22 to 39 percent, and a reduction in NYHA classification from IV (the worst level) down to an average of II (slightly worse than normal). (Langsjoen PH, Langsjoen AM, Supplemental ubiquinol in patients with advanced congestive heart failure. Biofactors. 2008;32(1-4):119-28.)

Gestational folate and autism

Folic acid (or folate) has been known to prevent neural tube defects in newborns when taken in adequate doses, typically over 800 mcg (or over 1000 mcg, equal to 1 mg). For many years, the maximum dose of folate was restricted by the FDA, and manufacturers were prohibited from informing potential customers of this value of folate supplements. Neural tube defects include spina bifida and anencephaly (inadequate brain formation). When I testified at the Senate hearings on the Dietary Supplement Health and Education Act (DSHEA), the FDA representative was still saying, incorrectly, that high amounts of folate could cause a B12 deficiency.

A new study shows that prenatal consumption of folate supplements from four weeks before until eight weeks after conception can help prevent later childhood autism spectrum disorders (ASD). Researchers evaluated data on 85,176 children (as part of the prospective Norwegian Mother and Child Cohort Study) born between 2002 and 2008. Follow-up ended in March of 2012, by which time the children were aged 3 through 10 years old. (Surén P, et al., Association between maternal use of folic acid supplements and risk of autism spectrum disorders in children. JAMA. 2013 Feb 13;309(6):570-7.)

At the end of follow-up, 270 children had been diagnosed with ASD, including 114 with autism, 56 with Asperger syndrome, and 100 with pervasive developmental disorder. The percentage of children with ASD was twice as high in children whose mothers did not take folate as in those children whose mothers did take the supplements (0.21 percent versus 0.1 percent). Folate has a number of other benefits, such as lowering  serum levels homocysteine (a risk factor for heart disease).

Chelation reduces cardiac events

Chelation therapy as used for the treatment of vascular disease is the intravenous administration of a synthetic amino acid called EDTA, used conventionally for the treatment of lead toxicity. It has been used for heart and other vascular disorders since the early 1950s, when it was found that those lead toxic patients who also had heart disease and were treated with EDTA were incidentally getting relief from their angina symptoms. Since then, this treatment has been quite controversial in the medical community, especially since the advent of coronary artery bypass surgery (a far more lucrative treatment).

Some years ago, Gervasio A. Lamas, MD, a cardiologist and the chief of the Columbia University Division of Cardiology at Mount Sinai Medical Center in Miami Beach, Florida, helped design a study of chelation therapy, and he was its principal investigator. The study, supported by the National Institutes of Health, was designated the Trial to Assess Chelation Therapy (TACT). Many conventional physicians, antagonists to any complementary and alternative medicine, opposed even doing this study, and they railed against even the suggestion that chelation needed study.

This TACT study has produced its first results, recently published in the Journal of the American Medical Association. (Lamas GA, et al., Effect of disodium EDTA chelation regimen on cardiovascular events in patients with previous myocardial infarction: the TACT randomized trial. JAMA. 2013 Mar 27;309(12):1241-50.) The investigators enrolled 1708 patients from 2003 until 2011. Patients received a total of 40 treatments over about a one-year period. The study was too small to evaluate effects on mortality, but other end points were recurrent heart attack, stroke, angioplasty, or hospitalization for angina.

Overall, the chelation therapy reduced the recurrence of cardiovascular events by 18 percent compared with placebo. This is a smaller benefit than I would have expected based on my experience administering chelation therapy since 1983. However, because of the small size of the study compared to the number of people who choose to receive chelation therapy, a number of clinical and statistical issues, and study design may be involved. At the very least, this study shows that chelation is safe, provides a modest but statistically significant benefit, and is worthy of further study in larger clinical trials. The supposed dangers that opponents touted were not evident in this study. In the last 20 years, I have had at least 140 chelation treatments myself, primarily for prevention and removal of toxic heavy metals, to which we are inevitably exposed.

Dietary fiber reduces stroke risk

Dietary fiber is usually ignored because it is not absorbed or metabolized, but it is a very important component of the diet. In Denis Burkitt’s studies of the native African diet, he found that very high fiber intake was associated with a very low incidence of hypertension, diabetes, heart disease, colon cancer, diverticulitis, appendicitis, and other conditions. Dietary fiber can be either soluble (such as found in flax seeds, psyllium husks, barley, oats, and eggplant), and insoluble (such as wheat bran, rice bran, and most fruits and vegetables. Most foods have a combination of fibers.

A new meta-analysis of eight studies shows a relationship between higher fiber intake and a reduced risk of strokes, both hemorrhagic (from bleeding) and ischemic (from atherosclerosis and clots). (Threapleton DE, et al., Dietary fiber intake and risk of first stroke: a systematic review and meta-analysis. Stroke. 2013 Mar 28. [Epub ahead of print] Subjects who consumed a higher level of fiber by just 7 grams per day had a 7 percent reduction in stroke risk. In the U.S. typical fiber intake is 10 to 15 grams per day although 25 to 30 grams is recommended. In the studies by Burkitt, individuals would typically consume 100 grams of fiber per day. The staples of their diets included potatoes, bananas, corn meal, and beans.

A 7 gram increase should be easy to achieve. For example, a half-cup of cooked lentils (or other beans) has 8 grams. A baked potato, sweet potato, or an apple has about 4.5 grams of fiber. A cup of raspberries has about 8 grams. Including any of these foods in the diet could help health in a variety of ways, not only from the fiber, but also from the many phytonutrients that these foods contain.

Vitamin D and Parkinson’s disease

Vitamin D has been a hot topic in the past few years, and I have reported on its many benefits when taken as a supplement, which provides more than you can get from food sources or sunlight. A new study shows that a supplement of 1200 IU per day inhibited the progression of Parkinson’s disease (PD) in patients with certain genetic characteristics.

In this study of 114 subjects, 56 were given vitamin D3, and 58 were given a placebo for 12 months in a double-blind setting. They evaluated the changes from baseline with two different rating scales. In one scale, the vitamin D3 patients deteriorated by 0.02 points while the placebo group deteriorated by 0.33 points. (Suzuki M, et al., Randomized, double-blind, placebo-controlled trial of vitamin D supplement in Parkinson's disease. Am J Clin Nutr. 2013 Mar 13. [Epub ahead of print])

New Feature: Practical Guidelines

One of my readers asked me to include some practical advice based on the information presented in my newsletters. It may seem simple to me to draw conclusions from the data, but maybe it is not quite as easy for others.

Based on the articles in this newsletter, I would suggest a diet that includes soy foods, such as tofu, tempeh, and soymilk, but be sure that the source is GMO free (which mostly means organic). Consume a high-fiber diet based on plant foods such as vegetables, fruits, legumes, whole grains, seeds, and nuts that have been minimally processed if at all. A healthy choice would be this high-fiber recipe, including tofu, vegetables, and whole grains:

Dice tofu into 1/2 inch cubes, then sauté (stir-fry) some diced onions, crushed garlic and ginger, and a touch of cayenne in a small amount of olive oil. When sizzling, add the tofu and sauté for one or two minutes, then add a mix of some cut up broccoli, spinach, cabbage, and/or bok choy. A touch of soy sauce (careful of its high salt content) or a bit of cider or balsamic vinegar brightens it up. Mix in some cooked brown rice, and stir in for one or two minutes. Turn off the flame, and add a garnish of cut up scallions, cilantro, and a few drops of toasted sesame oil.

If you have heart disease, or are at risk because of lifestyle or family history, you can alter the lifestyle (more exercise, better diet), and take supplements of coenzyme Q10. If you are over 40, this may be a good idea in any case, as our own production of coenzyme Q10 declines with age. I recommend 200 mg of ubiquinol, a well-absorbed form of Q10, but you might need more, depending on your condition.

Get your level of vitamin D checked with a simple blood test, and consider taking 1000 to 5000 IU of vitamin D3 (the natural form), not D2.

If you are considering pregnancy (or might be surprised by it), take supplements of folic acid. It is found in leafy green vegetables, so eating lots of them can also help. A supplement containing 1000 mcg is readily available and perfectly safe.

Finally, if you have cardiovascular disease, in addition to coenzyme Q10 supplements, consider EDTA chelation therapy. It is an intravenous therapy administered in a doctor’s office, and each treatment takes about 3 hours. You would likely need 20 to 40 treatments to see benefits. To find a local doctor who administers EDTA chelation therapy, contact the American College for Advancement in Medicine (www.acam.org)

Last month, I wrote about resveratrol, and I recommend it as an anti-aging supplement. Typical supplements may contain 37.5 mg of resveratrol, derived from Japanese knotweed (Polygonum cuspidatum) rather than red wine, which would be a much more expensive source. I take 2 capsules per day of this supplement.

I also noted the value of curcumin and vitamin D for Alzheimer’s disease, to prevent it or slow its progression. The study was a laboratory analysis, rather than a clinical one, so it does not suggest a dose. I often recommend 500 mg of curcumin once or twice a day, or cooking regularly with curry or turmeric. Again, the typical doses of vitamin D are 1000 to 5000 IU per day, but testing for blood levels is still important.

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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.

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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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