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February 2014


B vitamins may reduce stroke risk
Meat-derived AGEs and Alzheimer’s risk
Vegetarian diet lowers blood pressure/stroke
Vitamin C helps cancer patients
Multivitamins reduce cataract risk
General Information

B vitamins may reduce stroke risk

Homocysteine is a non-protein amino acid metabolized with the enzymatic cofactor support of B vitamins. High blood levels of homocysteine have been associated with blood clots, heart attacks, strokes, damage to endothelial cells, and inflammation. Researchers recently did a meta-analysis (a review of previous studies) on the effect of lowering homocysteine levels by supplementing with B vitamins and the risk of strokes. They used clinical trials published prior to 2012, including 14 randomized, controlled studies with a total of 54,913 participants. (Ji Y, et al., Vitamin B supplementation, homocysteine levels, and the risk of cerebrovascular disease: a meta-analysis. Neurology. 2013 Oct 8;81(15):1298-307.)

Overall, the relative risk of stroke was reduced by 7 percent, which was statistically significant. However, a number of variables influenced the effects. For examples, individual absorption rates, the resulting concentration of the nutrients in the blood, and whether a patient had high blood pressure or renal disease. Typically, B6, B12, and folic acid (folate) are given therapeutically to lower homocysteine levels. Earlier studies have shown that folate alone could reduce homocysteine by 25 percent. In a review published in the Journal of the American Medical Association, adding B12 supplements to the folate lowered it another 7 percent.

Some studies have not shown an association between lowering homocysteine and either stroke or heart attacks, and this may be due to those variables mentioned above. Larger controlled trials might help clarify the relationship between homocysteine and vascular disease. However, these vitamin supplements are inexpensive and quite safe, so for anyone at risk it is probably a good idea to take some B complex supplements until further studies are published.

Practical guidelines:

Typical doses of these nutrients are 1000 to 5000 mcg (1 to 5 mg) of folic acid, 1000 to 5000 mcg of B12 as methyl cobalamin in a sublingual tablet (but any form of cobalamin might help), and 50 to 100 mg of B6 (pyridoxine). It is not necessary to take the more expensive coenzyme forms of these vitamins (such as pyridoxal-5-phosphate) for lowering homocysteine.

Meat-derived AGEs and Alzheimer’s risk

Chemicals produced during cooking of certain foods, particularly meat products, but also almost any fried foods, may increase the risk of Alzheimer’s disease (AD). Advanced glycation end-products (AGEs) have been implicated in the development or progression of chronic degenerative diseases, such as diabetes, heart disease, strokes, and renal failure. Glycation refers to the addition of a sugar molecule to a protein. It happens in the course of normal metabolism in small amounts, but adding significant amounts from foods poses problems, making cells less flexible and more prone to chronic disease and premature aging.

In a new study in mice, one group (MG+) fed a diet high in an AGE called methyl-glyoxal (MG) were compared to others fed regular chow (REG) and a group (MG-) fed a chow specifically lower in MG than the other diets. The MG+ mice developed metabolic syndrome and increased brain amyloid-beta, as well as cognitive deficits. These are the changes seen in Alzheimer’s disease. A particularly protective survival factor called SIRT1, is suppressed in AD, and this suppression is made worse by ingestion of AGEs. (Cai W. et al., Oral glycotoxins are a modifiable cause of dementia and the metabolic syndrome in mice and humans. PNAS 24 February 2014, online doi: 10.1073/pnas.1316013111.) The authors also noted the correlation between high AGE levels and impaired cognition in older humans. Otherwise, mouse data may not always translate to humans, but this seems unlikely, given all the supportive data from other sources.

In addition, AGEs contribute to increased oxidant stress and inflammation. In an earlier study, dietary AGEs were linked to diabetes and cardiovascular disease. The authors noted an increase in dietary AGEs of 10 to 100 times in heated foods compared to uncooked foods. They also indicated that animal foods high in fat and protein are rich in AGEs, and they are prone to further AGE formation during cooking. In contrast, carbohydrate-rich foods, such as vegetables, whole grains, and fruits contain relatively few AGEs, even after cooking. (Uribarri J, et al., Advanced glycation end products in foods and a practical guide to their reduction in the diet. J Am Diet Assoc. 2010 Jun;110(6):911-16.e12. doi: 10.1016/j.jada.2010.03.018.)

AGEs are present even in uncooked foods, particularly meat and full-fat and aged cheeses. After beef and cheese, AGE levels were highest in poultry, pork, fish, and eggs. Frying and dry-heat cooking (such as roasting or toasting) increase those levels, as reflected by the “browning” of those foods (including bread crusts). Butter, cream cheese, margarine, and mayonnaise are also high in AGEs, while nuts are further down the list. Whole grains, including whole grain breads, vegetables, fruits, and milk were among the lowest sources of AGEs, unless they were prepared with added fats.

Practical guidelines:

If you do not avoid meats altogether (which is my recommendation), then prepare them by poaching or steaming (moist heat dramatically reduces the increase of the AGEs, although not the baseline level). When cooking vegetarian foods, try to avoid preparing them with added fats, such as butter or oils. Having a low-sugar diet is helpful in avoiding the consequences of exposure to AGEs, and taking antioxidant supplements can also help. When I attend craft fairs, I lament when I see the vendors who sell fried dough and funnel cakes, and I watch in dismay as people consume those along with their grilled or fried meats (the food vendors make far more money at these shows than the artists!).

Vegetarian diet lowers hypertension/stroke

Vegetarian diets have other advantages besides potentially lowering the risk of Alzheimer’s disease. A new meta-analysis shows that vegetarian diets are associated with lower blood pressures (BP). Analyzing 258 studies, researchers found 32 observational studies and 7 clinical trials that met their criteria for inclusion. The controlled trials had a total of 311 participants. The 32 observational studies had a total of 21,604 participants. (Yokoyama Y, et al., Vegetarian diets and blood pressure: a meta-analysis. JAMA Intern Med. 2014 Feb 24. doi: 10.1001/jamainternmed.2013.14547. [Epub ahead of print])

In the controlled trials, consumption of vegetarian diets was associated with a mean reduction in systolic BP of 4.8 points and in diastolic BP of 2.2 points. In the observational studies, vegetarian diets were associated with a mean 6.9 point reduction in systolic BP and a mean 4.7 point reduction in diastolic BP. All of these results were in comparison to an omnivorous diet. If sustained over a long time, these reductions could reduce heart attack risks by 10 percent and stroke risk by 14 percent.

These changes will not be adequate for treatment of very high blood pressure, but they will contribute to the management without additional drug treatments. If combined with exercise, relaxation techniques, weight control, and supplements, it is very possible for patients to avoid drugs altogether.

Practical guidelines:

This is just one further reason to lean to a plant-based diet, which also helps weight control, a further benefit for blood pressure control. It may also be critical to severely curtail your consumption of added salt in the diet. For more serious blood pressure problems, I recommend supplements of vitamin C (1000 to 5000 mg per day), magnesium (400 to 600 mg/d), coenzyme Q10 (200 mg of ubiquinol/d), garlic (deodorized, 500 to 1500 mg/d), hawthorn (standardized extract, 250 to 500 mg twice/d), and vitamin E (200 to 400 IU, plus gamma tocopherol).

Vitamin C helps cancer patients

The studies by Linus Pauling on treating cancer with vitamin C showed some significant benefits and prolongation of life in patients with advanced cancer. Although the authors of the follow-up studies suggested that he was incorrect, they did not follow the protocol that he outlined in his study, and their blanket dismissal of his conclusions was not justified. More recent research has shown benefits from vitamin C in many cancer patients, but the doses in these new protocols are far higher than were originally used, and very likely they work by a completely different mechanism.

Doctors commonly caution cancer patients undergoing chemotherapy not to take their antioxidant vitamin supplements. The theory is that many of the cancer chemotherapy drugs work as powerful oxidants, so taking antioxidants might interfere with their anti-cancer effects. In theory, this seems reasonable, but the research shows that antioxidant vitamins do not interfere with chemotherapy. Instead, they enhance the cancer-killing effects while at the same time reducing side effects (which can be debilitating and more than unpleasant).

Antioxidant supplements also appear to enhance survival and reduce cancer recurrence. (Nechuta S, et al., Vitamin supplement use during breast cancer treatment and survival: a prospective cohort study. Cancer Epidemiol Biomarkers Prev. 2011 Feb;20(2):262-71). In this study, they evaluated the use of vitamins C and E and a multivitamin in 4877 women and found an overall 18 percent reduction in mortality and a 22 percent reduced recurrence risk compared to those who never took vitamins. For vitamin C use of greater than 3 months, they found a 44 percent reduction in mortality and a 38 percent reduction in recurrence rates. For vitamin E use of greater than 3 months they found a 48 percent reduction in mortality and a 43 percent reduction in recurrences. For any antioxidant use greater than 3 months, they found a 40 percent mortality reduction and a 33 percent recurrence reduction.

In earlier reports, vitamin C (ascorbate, or simply C) was administered intravenously to advanced cancer patients. At the high doses of 35 to 100 grams per infusion, red blood cells and local tissues are saturated with C, and at these high levels it acts as a local pro-oxidant, rather than an antioxidant. It increases the local production of peroxide, which is toxic to cancer cells. Normal cells produce an enzyme called catalase, which detoxifies the peroxide, so they are not as affected by peroxide as cancer cells, which are deficient in catalase. (Oral vitamin C cannot be absorbed adequately to produce such tissue saturation.)

My colleague, Dr. Jeanne Drisko, at the  University of Kansas Medical Center, has been using this high dose intravenous C for years (and I have as well), and finding excellent results even with patients who have metastatic cancer. She reported several case histories of advanced ovarian cancer in which the patients survived far longer than expected. In this latest report, she and her colleagues delivered C directly to human and mouse ovarian cancer cells. At these concentrations, C induced cell death through DNA damage and cell energy depletion. When combined with chemotherapeutic agents (carboplatin and paclitaxel) in mice, it acted synergistically to inhibit ovarian cancer and reduce chemotherapy-associated toxicity. (Ma Y, et al., High-dose parenteral ascorbate enhanced chemosensitivity of ovarian cancer and reduced toxicity of chemotherapy. Sci Transl Med. 2014 Feb 5;6(222):222ra18. doi: 10.1126/scitranslmed.3007154.)

Practical guidelines:

I have seen good results in cancer patients given intravenous vitamin C both with and without conventional treatments. Combined with a healthy diet and other supplements, it can dramatically reduce side effects of chemotherapy. Doses are based on the level required to saturate tissues, and therefore vary from patient to patient, but the doses typically range from 35 to 120 grams, and are usually administered once or twice a week at first and then tapered in frequency depending on patient response.

Multivitamins reduce cataract risk

A cataract is a clouding of the lens of the eye that can obscure vision. The clouding results in part from sugar-protein combinations (glycoproteins) that deposit in the lens. Cataract risk is increased by smoking, diabetes, excessive alcohol consumption, excessive dietary sugar, and ultraviolet light exposure (too much sun without UV-blocking glasses). A new study shows that taking multivitamins can reduce the risk of cataract formation.

Researchers followed 14,641 male physicians over 50 years old for 11.2 years of treatment and follow-up. They were given either a daily multivitamin or a placebo. By the end of the study, they identified 1817 cases of cataract. In the multivitamin group there were 872 cataracts, and in the placebo group there were 945 cataracts. This was a statistically significant 9 percent reduction in cataract risk. They noted no difference in the rate of age-related macular degeneration (AMD). (Christen WG, et al., Effects of multivitamin supplement on cataract and age-related macular degeneration in a randomized trial of male physicians. Ophthalmology. 2014 Feb;121(2):525-34. doi: 10.1016/j.ophtha.2013.09.038. Epub 2013 Nov 20.)

Some nutrients that help with prevention of AMD are not present in adequate doses in most multivitamins. They include zinc, vitamins C and E, beta-carotene, and copper. These can reduce AMD by 25 percent. Lutein and zeaxanthin may be even better than beta-carotene. An earlier randomized trial of B vitamins showed a beneficial effect for AMD.

Practical guidelines:

To preserve vision, avoid added dietary sugar, and eat a diet rich in fruits and vegetables. The flavonoid quercetin can help prevent the formation of sugar-protein complexes, and I recommend supplements of 400 to 1200 mg daily (this nutrient can also help with allergies by lowering cellular histamine release). I recommend a daily high-quality multivitamin/mineral. Regular exercise helps to maintain circulation to the eyes. Wear eye protection with ultraviolet-blocking coatings for extended sun exposure.

General Information

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From September to May or June, I see patients in New Smyrna Beach, Florida. Call 386-409-7747, or send an email to 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, or call my Florida number, which is portable and travels with me: 386-409-7747.

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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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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.