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March 2014

Topics:

Magnesium lowers inflammation marker
Cholesterol and Alzheimer’s disease
Cinnamon, insulin, and liver disease
Probiotics help fatty liver disease
Lutein and zeaxanthin and eye disease
Walking prevents hip fractures
General Information

Magnesium lowers inflammation marker

Magnesium is involved in well over 300 enzyme activities. It is important for neurological, renal, and cardiovascular health. Dietary magnesium is often deficient, especially with diets of processed foods (brown rice, for example, has about four times the magnesium that is found in white rice). It is high in almonds, cashews, leafy greens, peanuts, whole wheat, soymilk, and black beans, but low in chicken, meat, broccoli, and apples.

A new scientific review shows that a high amount of magnesium in the diet is associated with lower serum levels of C-reactive protein (CRP). CRP is an indicator of inflammation, and a high level of CRP is a risk factor for cardiovascular disease. The researchers in this meta-analysis reviewed data from seven cross-sectional studies including 32,918 participants. They also reviewed five interventional studies with participants given magnesium supplements. In the cross-sectional studies, those with the lowest magnesium intake had a 49 percent higher likelihood of having an elevated CRP level than those with the highest intake. (Dibaba DT, et al., Dietary magnesium intake is inversely associated with serum C-reactive protein levels: meta-analysis and systematic review. Eur J Clin Nutr. 2014 Feb 12. doi: 10.1038/ejcn.2014.7. [Epub ahead of print])

The review of the intervention studies also showed benefits from magnesium supplements on the level of serum CRP. Regardless of the benefits of magnesium for decreasing CRP, it is important to find out the source of the inflammation and manage it. It is possible to have elevated CRP from chronic gingivitis, which is also associated with an increased risk of cardiovascular disease. Of course, numerous other causes of inflammation might be involved, such as infections, rheumatoid diseases, and other auto-immune disorders. It might also be from exposure to substances in foods called advanced glycation end products (AGEs), (which I mentioned in my last newsletter), and allergies.

Reducing inflammation, as reflected in a lower serum CRP is likely to lower the risks of a variety of chronic diseases, including hypertension, heart attacks, strokes, and kidney diseases, as well as Alzheimer’s disease and diabetes.

Practical guidelines:

Consume the high magnesium foods listed above, aiming for about 400 to 500 mg daily. A more thorough list is available at the NIH Office of Dietary Supplements: http://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/#h3. I take an additional 200 to 400 mg daily for cardiac health. Magnesium aspartate is a well-absorbed form. Magnesium citrate is also well absorbed, but possibly more likely to cause loose bowels. If you have a high CRP, try to find the cause and manage it.

Cholesterol and Alzheimer’s disease

Although not proven to be the cause of Alzheimer’s disease (AD), the deposition of beta-amyloid (also called amyloid beta, or Aβ) seems to be an important initiating process. A new study was designed to evaluate the relationship of serum cholesterol and lipid fractions to the level of cerebral Aβ. Researchers recruited 74 patients from stroke clinics, with an average age of 78 years. Among these subjects, 3 had mild dementia, 33 were normal, and 38 had mild cognitive impairment.

They measured Aβ deposits in the brain using a radioactively labeled compound called PIB and positron emission tomography (PET scans). They were able to determine the PIB retention in areas of the brain cortex prone to amyloidosis. They found independent associations of the PIB index with both LDL-cholesterol and HDL cholesterol. A higher LDL was associated with a higher PIB index, and a higher HDL was associated with a lower PIB index. (Reed B, et al., Associations between serum cholesterol levels and cerebral amyloidosis. JAMA Neurol. 2014 Feb 1;71(2):195-200.

Total cholesterol was not associated with the PIB index, and treatment with statins also did not alter the PIB associations. The authors concluded that the cerebral Aβ was associated with cholesterol in the same pattern as that seen in cardiovascular disease. They noted that their findings are consistent with prior autopsy reports, epidemiologic findings, and both animal and in vitro studies.

Practical guidelines:

Once again, following a healthy diet and exercise program to maintain a healthy lipid profile is more important than drug treatment for cholesterol levels. I am not a proponent of statin treatment as a means to lower cholesterol levels, although they are among the most profitable drugs for pharmaceutical companies. Some combination of Asian-style and/or Mediterranean-style diets and an aerobic fitness program is likely to provide the best chance to keep a healthy lipid profile and prevent a wide variety of chronic diseases, including AD and other degenerative conditions. Curcumin, a component of the spice turmeric, appears to be associated with a lower incidence of AD, and it also has anti-inflammatory effects. I take a supplement of turmeric, standardized to contain 550 mg of curcuminoids per capsule, once or twice per day, and I also eat curry dishes often. In addition, numerous supplements help modify serum lipids (without the side effects or expense of statins). Niacin (vitamin B3) is one of the best, and I take 500 mg twice per day of the timed-release form.

Cinnamon, insulin, and liver disease

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver injury in the world. Most of the time it is related to being overweight or obese, or having diabetes, high cholesterol, or high triglycerides, but it may be unrelated to any of these risk factors. NAFLD may cause the liver to swell, leading to scarring, known as cirrhosis, and possibly cancer as a result. A more severe form is called non-alcoholic steatohepatitis (NASH) and it is related to the same causes. Both conditions may be asymptomatic, but may be associated with fatigue, weakness, nausea, abdominal pain, and loss of appetite.

While no specific medical treatments are known, therapeutic recommendations include controlling diabetes and managing insulin resistance and oxidative stress. New research suggests that cinnamon acts as an insulin sensitizer in patients with NAFLD. In a double-blind, placebo-controlled study of 50 patients, half were given either two capsules containing 750 mg of cinnamon each, or two capsules of placebo, daily for 12 weeks. (Askari F, et al., Cinnamon may have therapeutic benefits on lipid profile, liver enzymes, insulin resistance, and high-sensitivity C-reactive protein in nonalcoholic fatty liver disease patients. Nutr Res. 2014 Feb;34(2):143-8. doi: 10.1016/j.nutres.2013.11.005. Epub 2013 Dec 6.)

Cinnamon has been studied previously for sugar regulation in diabetics. In one of the earlier studies, cinnamon supplements lowered total cholesterol by up to 26 percent. In this study, all patients were given advice on how to implement a balanced diet and incorporate physical activity into their lives. In the treatment group, they found significant decreases in fasting blood sugar levels, total cholesterol, triglycerides, liver enzymes, and CRP levels. In both the treatment and placebo groups, LDL-cholesterol levels decreased significantly, probably as a result of the dietary and exercise advice that they received.

Practical advice:

Cinnamon enhances the activity of insulin, so diabetics have to be aware of dose adjustments they may need to make when taking therapeutic levels of cinnamon. Depending on the fineness of the grind, a teaspoon might contain about 3 grams of cinnamon. The dose in this study was half that, or 1.5 grams. I put cinnamon in almost all my smoothies, and in many fruit desserts, and it can be added to oatmeal, other cereals, or buckwheat porridge (buckwheat is not a true cereal grain, but a “fruit seed” that is similar to a sunflower seed, unrelated to wheat, and contains no gluten).

Probiotics help fatty liver disease

Another study on Non-Alcoholic Fatty Liver Disease was just published in the American Journal of Clinical Nutrition, examining the effects of probiotics on the disease. It was proposed because of the modulating effect of probiotics on gut flora and the gut-liver axis. This was a randomized, double-blind, placebo-controlled trial with 52 patients, half of whom were given probiotic capsules and half given placebo capsules twice per day for 28 weeks. Both groups were advised to follow a lower-calorie diet and physical activity recommendations.

At the end of the study, they found some improvements in both groups, probably related to the diet and physical activity. However, those in the treatment group (taking probiotics) had greater benefits, with a 3 to 5 fold decrease in liver enzymes compared to the placebo group. They also had a 2-fold greater decline in the CRP level and a significantly lower fibrosis score. (Eslamparast T, et al.,  Synbiotic supplementation in nonalcoholic fatty liver disease: a randomized, double-blind, placebo-controlled pilot study. Am J Clin Nutr. 2014 Mar;99(3):535-42.)

Practical guidelines:

Probiotics include a host of friendly bacteria that usually inhabit the intestinal tract (if you count the gut bacteria, there are 10 times as many  non-human cells in the body than human cells) and they play a large role in digestion, metabolism, and disease prevention. The most common probiotics are Lactobacillus acidophilus and Bifidobacterium bifidum (also called Lactobacillus bifidus), but there are also a number of others. I take a capsule twice per day of one supplement with 15 different organisms, and a bacterial count of 35 billion per capsule. These friendly bacteria are found in many yogurts that say on the label that they contain live organisms (not just “made with”), but most flavored yogurts have too much sugar for health, and the bacterial count can vary widely (I use plain, non-fat yogurt on occasion, made at home). Other fermented foods, such as homemade sauerkraut, also contain lactobacilli. Most commercial sauerkraut is pasteurized, which kills the bacteria.

Lutein and zeaxanthin and eye disease

The researchers in the Age Related Eye Disease Study (AREDS) just published a new report on their subjects, which includes information on 4203 participants, aged 50 to 85 years, who were at risk for developing age-related macular degeneration (AMD). Their earlier reports indicated that the formula they studied (vitamins C and E, beta-carotene, zinc, and copper) helped to maintain vision and prevent further deterioration in the macula.

In this new study, they compared the original formula to the same with added lutein/zeaxanthin (10mg/2mg). They also analyzed the use of this combination instead of beta-carotene, because other research showed that, in tobacco smokers, beta-carotene could increase the risk of lung cancer. In addition, they studied adding omega-3 fatty acids to the supplements. They followed the subjects for an average of 4.9 years. (Age-Related Eye Disease Study 2 (AREDS2) Research Group, Secondary analyses of the effects of lutein/zeaxanthin on age-related macular degeneration progression: AREDS2 Report No. 3. JAMA Ophthalmol. 2014 Feb 1;132(2):142-9. doi:10.1001/ jamaophthalmol.2013.7376.

Compared to beta-carotene, the lutein/zeaxanthin supplement led to an 18 percent decline in the development of late stage AMD, and a 22 percent lower risk of developing neovascular AMD. For subjects with bilateral early disease at baseline, the lutein/zeaxanthin combination showed a 24 percent reduction in risk of developing late-stage AMD. These benefits are in addition to the benefits seen with the original AREDS formulation.

Practical guidelines:

Beta-carotene is only one of the carotenoid family of nutrient antioxidants. It is apparent that the others are also important. Lutein and zeaxanthin accumulate in the retina. They are found in kale, spinach, Swiss chard, and collard greens, among other leafy green vegetables. I take a supplement of 10 mg of lutein with 0,5 mg of zeaxanthin, in addition to eating a lot of green vegetables, which are more important than supplements because of their other nutritional benefits.

Walking prevents hip fractures

Exercise is known to help strengthen bones, and evidence from a new study suggests that it also helps prevent hip fractures in men. Researchers analyzed data from the Health Professionals Follow-up Study and reported time spent walking, sitting, and in 10 other activities. They included 35,996 men aged 50 years and older and followed them for 24 years, and evaluated all of these activities every two years.

Over the 24 years, the men reported 490 hip fractures unrelated to accidents or “impact trauma.” More walking time lowered fracture risk by 43 percent for those who walked four hours or more per week, compared to those who walked less than one hour per week. Brisk walking lowered risk by 47 percent, compared to a leisurely pace. (Feskanich D, et al., Physical activity and inactivity and risk of hip fractures in men. Am J Public Health. 2014 Apr;104(4):e75-81.) In this study, strenuous activity added no extra benefit compared to walking briskly. I think that practical guidelines are self-evident from this report.

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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