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September 2013


Curcumin eases arthritis pain
Fish oil helps arteries heal
Red meat and colon cancer deaths
Whole fruits lower diabetes risk
Supplements help mood
[Practical guidelines are now included at the end of each article]

Curcumin eases arthritis pain

Rheumatoid arthritis is an auto-immune inflammatory disease. Anti-inflammatory medications are commonly used to control symptoms, but do little to stall the progress of the disease, and they often have side effects. In more severe cases, physicians may administer immunity inhibiting drugs like methotrexate (a cancer chemotherapeutic drug), which can help, but have more serious side effects than the anti-inflammatories. Nutrition and dietary supplements can be very helpful, and they are unlikely to have any side effects.

In 2012, a pilot study showed that curcumin, a component of the spice turmeric that is known to have anti-inflammatory effects, can help patients with rheumatoid arthritis. In this study, curcumin was compared to a non-steroidal anti-inflammatory drug (NSAID) called diclofenac, marketed in the USA as Voltaren. In this study, 45 patients were randomized into three groups and given curcumin (500 mg), diclofenac (50 mg), or both together. They were treated for eight weeks and evaluated for changes in the Disease Activity Score (DAS), and criteria for joint tenderness and swelling. (Chandran B, Goel A, A randomized, pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis. Phytother Res. 2012 Nov;26(11):1719-25.)

At the end of the study, all treatment groups showed statistically significant improvement in their DAS. The group treated with curcumin showed the highest percentage of improvement in overall DAS and in the swelling and tenderness scores. Although the differences were small, the curcumin was statistically significantly better than the medication. Also, the curcumin was not related to any side effects. Diclofenac, on the other hand, often has numerous side effects, including abdominal pain, gastrointestinal bleeding, fatigue, nausea, and dizziness, among others.

Practical guidelines:

I recommend supplements of curcumin in addition to eating curry dishes frequently, and not only for rheumatoid arthritis. Studies suggest that curcumin might be the substance responsible for the low rate of Alzheimer’s disease in India. This study used 500 mg of curcumin, but I take a supplement that contains 550 mg twice a day. It also contains black pepper, which is supposed to increase the absorption of the curcumin. For arthritis, one capsule might be enough, but it is possible that the higher dose might help even more. I also enjoy a variety of vegetable curry dishes.

Fish oil helps arteries heal

Fish oils are known to help reduce inflammation, because of the omega-3 unsaturated fatty acids that they contain (EPA and DHA). These compounds are precursors to prostaglandins that reduce inflammation. However, chemicals called D-series resolvins (RvD) are derived from omega-3 fatty acids and influence vascular smooth muscle cells and vascular injury.

Vascular treatments such as balloon angioplasty, arterial stents, and bypass surgery can create high levels of inflammation and consequent vascular injury. In a new study of human arterial muscle cells and rabbit arteries that were injured by angioplasty, researchers evaluated the effect of treatment with RvD1 and RvD2 on signs of vascular injury. (Miyahara T, et al., D-series resolvin attenuates vascular smooth muscle cell activation and neointimal hyperplasia following vascular injury. FASEB J. 2013 Jun;27(6):2220-32.)

 After treatment with these fish oil derivatives, they found a dose-dependent decrease of vascular smooth muscle cell proliferation, cell migration, monocyte adhesion, superoxide production, and proinflammatory gene expression, all signs of inflammation or vascular damage. Some measures were decreased by 40 to 50 percent, and overgrowth of arterial lining cells was decreased by 29 percent. This suggests that omega-3 oils can help heal arteries after injuries.

Practical guidelines:

The data suggest the value of fish oils, but you can also get omega-3 fatty acids from flaxseeds and flaxseed oil. However, they need to be metabolically converted to EPA and DHA. The conversion of the alpha-linolenic acid to EPA and DHA may not be sufficient, so you might consider taking some capsules of fish oil, if you must have a cardiovascular procedure. Typically, the dose of total EPA/DHA combined that is helpful is 1000 to 3000 mg per day.

Red meat and colon cancer deaths

Many articles have shown increased health risks from eating red meat (and other meats except wild fish), so reasons to avoid consuming it are numerous. A new study shows a link between red and processed meat consumption before and after the diagnosis of colorectal cancer and mortality from the disease. However, this study does not make clear that red meat without processed meat is a contributor. In addition, cooking methods may make a difference in the risks.
In this study, those subjects with the highest consumption of red and processed meat before and after diagnosis of colorectal cancer had a 79 percent higher risk of mortality compared with those with consistently low intakes. (McCullough ML, et al., Association between red and processed meat intake and mortality among colorectal cancer survivors. J Clin Oncol. 2013 Aug 1;31(22):2773-82.)

Another study suggested that it is the type of meat that makes a difference. This Danish study evaluated 53,988 participants for 13.4 years. Colon cancer occurred in 644 cases, and rectal cancer in 345 cases. The risks were highest for pork and lamb, while substituting fish for red meat was associated with a lower risk of colon cancer (but not rectal cancer). (Egeberg R, et al., Associations between red meat and risks for colon and rectal cancer depend on the type of red meat consumed. J Nutr. 2013 Apr;143(4):464-72.)

Yet another study showed that red meat, processed meat, and heme iron (derived from blood) were all associated with colorectal polyps (cancer precursors), especially grilled meat and well-done meat. On the other hand, iron from supplements and other foods was associated with fewer colorectal polyps. (Ferrucci LM, Meat consumption and the risk of incident distal colon and rectal adenoma. Br J Cancer. 2012 Jan 31;106(3):608-16.)

Finally, a Japanese study showed that in a population with relatively low meat consumption, higher meat consumption was associated with a higher risk of colon and rectal cancers. This was a study of 80,658 men and women from 1995 to 2006. They found a 48 percent higher colon cancer risk in the women with the highest red meat intake, and a 44 percent increase in men with the highest total meat intake. In this study, processed meat was not associated with colon or rectal cancer (possibly due to the relatively low intake of processed meats in this population). The authors noted that the highest level of meat consumption in their study would be considered moderate by Western standards. (Takachi R, et al., Red meat intake may increase the risk of colon cancer in Japanese, a population with relatively low red meat consumption. Asia Pac J Clin Nutr. 2011;20(4):603-12.)

Practical guidelines:

All important decisions are made with inadequate information. However, the weight of the evidence is useful in making choices, especially when it comes to diets. I haven’t eaten meat or chicken since 1975, based on the evidence of health risks. I don’t know if total avoidance is essential for health, but the science so far suggests that reducing or eliminating meat from the diet helps to prevent cancer and other diseases. A study of Chinese herbal medicine and vitamins combined with conventional therapy showed that the combination improved survival in colon cancer compared with conventional therapy alone.

Whole fruits lower diabetes risk

Although fruits contain sugars, the evidence suggests that a high consumption of a number of whole fruits lowers the risk of type 2 diabetes. In three studies including a total of 187,382 participants followed from 1984 to 2009, researchers found that for every 3 servings per week of whole fruit consumption, diabetes risk was significantly lowered.

For blueberries, the risk was reduced by 26 percent, for grapes and raisins, prunes, apples and pears, bananas, and grapefruit, the risk reductions were 12, 11, 5, 5, and 3 percent, respectively. As servings per week increased, the benefits improved. The recommended five to nine servings of fruits and vegetables per day could mean as much as 25 to 30 servings of fruit per week, perhaps lowering the risk of diabetes up to 10 times as much as shown in this study. (Muraki I, et al., Fruit consumption and risk of type 2 diabetes: results from three prospective longitudinal cohort studies. BMJ. 2013 Aug 28;347:f5001.)

Interestingly, fruit juices increased the risk of diabetes. The USDA guidelines for fruits includes juices, but these are not as good for you as consuming whole fruits. The sugar content of juices is high and it is just too readily absorbed, and the fiber is usually removed, further reducing the health value. For each increase of 3 servings per week of fruit juice, the diabetes risk increased by 8 percent. This could be why earlier studies of fruit consumption and diabetes gave mixed results, as they often looked just at total fruit consumption and did not always separate out whole fruits from fruit juices.

Practical guidelines:

I recommend a large amount of fruits and vegetables in the diet, including a wide variety. Although many people think of juicing as a healthy dietary habit, most juices contain far too much sugar, particularly carrot, apple, and beet juices, and most juicers extract the fiber. These might be fine as occasional treats. The best way to include fruit is to eat whole pieces of fruit, or bowls of whole blueberries. When I do have fruit juice, I dilute it with about 70 to 80 percent water.

Supplements help mood

Biochemistry influences brain function and mood. In a meta-analysis of eight studies on vitamin supplements and subjective symptoms related to mood, researchers evaluated studies that lasted for at least 28 days and included multivitamin/mineral supplements with placebo controls. The studies covered 1292 healthy men and women. The symptoms studied included perceived stress, mild psychiatric symptoms, fatigue, anxiety, and confusion.

The analysis indicated that supplements had a beneficial effect on all of these symptoms, but not on depression. Perceived stress was reduced by 65 percent, mild psychiatric symptoms by 70 percent, anxiety by 68 percent, and fatigue by 73 percent. The authors noted that supplements that contained high doses of B vitamins appeared more effective in improving mood states. (Long SJ, Benton D, Effects of vitamin and mineral supplementation on stress, mild psychiatric symptoms, and mood in nonclinical samples: a meta-analysis. Psychosom Med. 2013 Feb;75(2):144-53.)

Practical guidelines:

A good quality multivitamin and mineral supplement is inexpensive, easy to take, and readily available. Try to find one that is rich in B complex vitamins, but also has zinc and magnesium, as well as vitamins C and E and natural carotenoids. More severe psychiatric symptoms may need more targeted specific nutritional treatments, such as high-dose niacin and SAMe, and herbs, such as St. John’s wort and valerian, among others.

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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.