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April 2014

Topics:

Curcumin reduces inflammation
Salt reduction decreases mortality
Statin use and higher fat intake
Fatty diet raises breast cancer risk
Exercise reduces COPD complications
General Information

Curcumin reduces inflammation

Curcumin is a component of turmeric, a common spice in south Asian foods, and an ingredient in curry. Turmeric is part of the ginger family. It known for helping to reduce inflammation, and recent studies suggest that it may be helpful in preventing Alzheimer’s disease or delaying its progression. A new study suggests that curcumin has a specific benefit for obese individuals.

Obesity is associated with an increase of inflammation and immuno-activation. The inflammatory protein PAR2 is increased when there is an excessive amount of abdominal fatty tissue in both humans and rats. Fatty cells are also endocrine organs, producing hormones such as leptin and adiponectin. Larger fat cells in obese individuals also produce a range of substances that promote insulin resistance. Curcumin influences serum levels of inflammatory markers, such as the cytokines IL-1ß, VEGF, and IL-4, reducing them significantly, while not reducing the levels of anti-inflammatory cytokines. In this recent study, 30 obese individuals received either 500 mg of curcumin twice per day or a matching placebo. The treatment lasted for four weeks, then they had a two-week washout period and the groups were reversed for another four weeks.

Curcumin therapy significantly reduced the pro-inflammatory markers, while not affecting some others or the anti-inflammatory markers. (Ganjali S, et al., Investigation of the effects of curcumin on serum cytokines in obese individuals: a randomized controlled trial. ScientificWorldJournal. 2014 Feb 11;2014:898361. doi: 10.1155/2014/898361.) Earlier reports have suggested numerous benefits from taking curcumin in the diet or as a supplement. A good review of these benefits for a variety of diseases is found here: Aggarwal BB, Harikumar KB, Potential therapeutic effects of curcumin, the anti-inflammatory agent, against neurodegenerative, cardiovascular, pulmonary, metabolic, autoimmune and neoplastic diseases. Int J Biochem Cell Biol. 2009 Jan;41(1):40-59.

Practical guidelines:

Weight control is an important part of a complete health program. Weight loss programs are notoriously unsuccessful. There are no gimmicks for this, just a healthy diet (as I have written about numerous times – lots of fresh vegetables and fruits, whole grains, legumes, seeds, and nuts and avoidance of sugary, fatty, processed foods and most meats and full-fat dairy products), and moderate amounts of exercise.

If you are overweight or obese, then it is a good idea to take curcumin (standardized extract of turmeric), 500 mg twice per day, and normal weight people can benefit also.

Salt reduction decreases mortality

Dietary salt gets mixed reviews, but the overall picture suggests that it is a good idea to avoid excessive amounts that are added to processed foods and most restaurant foods. Some reports indicate that it is only significant for people who are particularly sensitive, but this is not clear. For one thing, in typical amounts added to food it obscures the real taste of a fresh whole food. It also increases the need for water intake to dilute the sodium in the blood (and as a result leads to increased urination and loss of minerals, such as potassium and magnesium, through the kidneys).

A 2009 meta-analysis showed a clear relationship of increased salt intake to an increased risk of stroke and cardiovascular disease. (Strazzullo P, et al., Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies. BMJ. 2009 Nov 24;339:b4567. doi: 10.1136/bmj.b4567.)

The daily need for sodium is less than 500 mg per day (and in temperate climates, without intense exercise, the need might be as low as 115 mg daily). It is easy to consume this level of sodium without adding any to what is present in whole, unprocessed foods. The typical sodium consumption in the United States is between 3000 and 13000 mg daily. The requirements might be higher for someone who exercises in warm weather and sweats profusely, but they would still be lower than the average consumption (and requirements for other minerals, such as potassium and magnesium would also be higher).

A new study using data from the Health Survey for England shows a relationship of salt intake to blood pressure and mortality from stroke, and ischemic heart disease (IHD). From 2003 to 2011 mortality from stroke decreased by 42 percent and from IHD by 40 percent. Blood pressure also showed a significant drop over that time. The analysis included data on 31,692 participants. At the start of the study, the UK implemented programs to reduce salt consumption.

During the study period, smoking prevalence declined from 19 percent to 14 percent, fruit and vegetable consumption increased slightly, and cholesterol dropped a small amount. However, the most significant change associated with the mortality decline was a 15 percent drop in salt consumption in the general population. This was related to the corresponding drop in blood pressure. (He FJ, et al., Salt reduction in England from 2003 to 2011: its relationship to blood pressure, stroke and ischaemic heart disease mortality. BMJ Open. 2014 Apr 14;4(4):e004549. doi: 10.1136/bmjopen-2013-004549.)

Practical guidelines:

I think it is best to consume unprocessed foods as much as possible. The ratio of potassium to sodium in fruits and vegetables ranges from 75:1 up to over 400:1, but in the typical North American diet the ratio is reversed so people get more sodium than potassium (at least a 2:1 ratio), compared to a 10:1 ratio of potassium to sodium on a natural, unprocessed, whole-foods diet. Instead of salt, use lots of herbs and spices (ginger, curry, oregano, thyme, cumin, and many others) and lemon or lime juice to brighten up a home-cooked meal. Eat a lot of salads, but without the commercial dressings (I use garlic, flaxseed oil, lime juice, oregano, and cumin as my dressing).

Statin use and higher fat intake

Statins have become among the most profitable drugs ever sold. They do lower cholesterol, but they also have side effects, such as muscle aches and mild to severe muscle inflammation, and an increased risk of diabetes. Treatment with statins can lower the risk of heart disease and stroke, according to some, but not all, studies, although this may be due partly to the anti-inflammatory effects of the drugs (and there are better ways to reduce cholesterol, cardiovascular disease, and inflammation without the expense and risks of statins). However, it appears that many people would rather take statins than change their diets.

In a new study, researchers correlated statin use with caloric intake relative to caloric intake in nonusers of the drugs. Using data from the United States National Health and Nutrition Examination Survey (NHANES), researchers evaluated a representative sample of 27,886 adults aged 20 years or older, using 24-hour dietary recall to measure calorie and fat intake. In the initial 1999 to 2000 period, caloric intake was significantly less for statin users compared with nonusers. By the years 2009-2010, fat and calorie intake among statin users had climbed about 10 percent. (Sugiyama T, et al., Different time trends of caloric and fat intake between statin users and nonusers among US adults: gluttony in the time of statins? JAMA Intern Med. 2014 Apr 24. doi: 10.1001/jamainternmed.2014.1927. [Epub ahead of print])

This suggests that people taking statins feel they have a certain “license” to consume less-healthy foods because they are “protected” by the drugs. However, there are many other problems with poor dietary choices than serum cholesterol elevations. The disease risks associated with salt intake and weight gain (in this study, for statin users body mass index, or BMI, went up 1.3 points during the same decade) are not addressed by statins.

The official guidelines for physicians to recommend taking statins (or not) are controversial. The New England Journal of Medicine presented a case history, with doctors recommending for or against prescribing statins for a patient. One physician comment after the article was telling, from Dr. Jeffrey Bloom:

The acknowledged conflicts of interest are directly proportional to whether statins are advised. Dr. Ansell lists far fewer disclosures than Drs. Mora and Krumholz. Dr. Ansell does not advise statins; the other doctors do. Most physicians have not reviewed how the most recent national cholesterol education program guidelines were sponsored by the pharmaceutical industry (BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f6989). The previous guidelines use of statins did not reduce mortality (OR 1.01) (Lancet 2007;369:168-9). The new guidelines are no better and may lead to over treatment, which necessitates careful re-analysis before these guidelines go into effect. (Lancet 2013;382 (9906):1680.) The guidelines battle on starting statins. Comments. N Engl J Med 2014; 370:1652-1658 April 24, 2014DOI: 10.1056/NEJMclde1314766.)

One study author, Dr. Sugiyama, was quoted in a news source: “…eating more fat, especially saturated fat, will lead to higher cholesterol levels…Being overweight also increases the risk of diabetes and [high blood pressure]…the goal is to decrease patients’ cardiovascular risks…, not to empower them to put butter on steaks.”

Practical guidelines:

Preventing vascular disease is mostly a matter of choosing the right diet (as noted above), exercising, reducing stress, avoiding smoking, and taking some dietary supplements. For populations, as opposed to some individuals, vascular disease is almost certainly NOT genetic. Genetics have not changed that much since western dietary habits have increased the rates of hypertension, heart disease, strokes, diabetes, and obesity. Some individuals, however, do have a genetic propensity toward cholesterol abnormalities, or have hormonal changes that might contribute to it.

Fatty diet raises breast cancer risk

New research suggests that eating a high-fat diet increases the risk for women of developing the most common types of breast cancer. Earlier research came up with mixed results. A 1999 paper suggested no statistically significant association of fat intake with breast cancer, but the data showed a relationship that almost reached significance. In 2003, another study did show a relationship of animal fat intake in premenopausal women to breast cancer incidence. They assessed 90,655 subjects aged 26 to 46 years and followed them for 8 years. Animal fat intake at increasing levels led to significant 28 to 54 percent increases in breast cancer risk. (Cho E, et al., Premenopausal fat intake and risk of breast cancer. J Natl Cancer Inst. 2003 Jul 16;95(14):1079-85.)

In the most recent study, researchers prospectively evaluated fat intake as a predictor of developing breast cancer (BC) subtypes, including those positive for estrogen receptor (ER+) and progesterone receptor (PR+), and negative for human epidermal growth factor 2 receptor (HER2-). The study included 337,327 women followed for 11.5 years, during which they found 10,062 BC patients. (Sieri S, et al., Dietary fat intake and development of specific breast cancer subtypes. J Natl Cancer Inst. 2014 Apr 9. [Epub ahead of print]) High total and saturated fat were associated with a 20 percent increased risk of ER+PR+ cancers overall. The highest quintile of fat intake was associated with a 28 percent increased risk compared to the lowest quintile. Increased HER2- breast cancer risk was associated with greater saturated fat intake. The majority of breast cancers are ER+, PR+, and HER2-.

In the Women’s Intervention Nutrition Study (WINS), researchers did a randomized clinical trial starting in 1987 on 2437 women aged 48 to 79 years, who had early-stage breast cancer. They were testing the hypothesis that putting the women on low-fat diets would increase the relapse-free survival rate. They determined low-fat dietary interventions lowered body weight and decreased disease recurrence rates. (Blackburn GL, Wang KA, Dietary fat reduction and breast cancer outcome: results from the Women's Intervention Nutrition Study (WINS). Am J Clin Nutr. 2007 Sep;86(3):s878-81.)

In their earlier report on this study after five years of intervention, they noted that the women on the lower fat diet ended up an average of 6 pounds lighter than the control group. Their intake of fat was about 330 calories, while the control group consumed 450 calories as fat. They did note that the benefits were far greater for the women who were ER+ and PR+ as opposed to those whose tumors were receptor negative. (Chlebowski RT, et al., Dietary fat reduction and breast cancer outcome: interim efficacy results from the Women's Intervention Nutrition Study. J Natl Cancer Inst. 2006 Dec 20;98(24):1767-76.

Practical guidelines:

A diet with lower animal fat is likely to help prevent breast cancer. It is easy to implement with many delicious ethnic foods (just not barbeque!). Minimizing saturated and total fats is just part of a healthy approach to diet. Including lots of fresh fruits and vegetables and beans, and only whole grains rather than refined, plus seeds and nuts, makes it fairly easy to get a tasty variety of nourishing foods.

Exercise reduces COPD complications

Exercise has many benefits, and a new study adds more evidence of that. Recent changes at Medicare have made hospitals aware of the importance of taking care that patients are treated thoroughly enough so that they do not develop complications, and are not readmitted within 30 days. Patients with chronic obstructive pulmonary disease (COPD), such as emphysema and chronic bronchitis, often have multiple admissions to the hospital for management. In this study, researchers included 4596 patients, averaging 72 years old, and checked their 30-day readmission rate. They then correlated this with their level of physical activity. The study took place over a two-year period.

The overall readmission rate was 18 percent, and 59 percent of them were within the first 15 days after discharge. Patients were evaluated for their minutes of moderate or vigorous physical activity per week (MVPA). Those who had 1 to 149 minutes per week had about 34 percent less likelihood of readmission to the hospital within 30 days. (Nguyen HQ, et al, Associations between physical activity and 30-day readmission risk in chronic obstructive pulmonary disease. Ann Am Thorac Soc. 2014 Apr 8. [Epub ahead of print]). Those who had over 149 minutes of MVPA had about the same benefit. Unfortunately, they did not report the rate for various levels of activity.

Practical guidelines:

COPD is usually related to smoking or a history of chronic infections or asthma. Regular, moderate physical activity can help as long as you don’t push so hard that you precipitate symptoms. Walking and bicycling are good basic exercises with many benefits.

General Information

 


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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.

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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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