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Summer 2014


Fruits-veggies and vascular disease
Quercetin and reduced cancer risk
Coenzyme Q10 and heart failure mortality
Red meat and breast cancer risk
Low vitamin D and hypertension
General Information

Fruits-veggies and vascular disease

Eating fruits and vegetables (F&V) is good for your vascular health, and some F&V are better than others. The content of flavonoids in the foods makes a difference in their ability to reduce vascular inflammation and other cardiovascular risk factors. Flavonoids are plant pigments that have antioxidant effects and other physiological functions. They are part of what makes fruits and vegetables so colorful, along with chlorophyll, carotenoids, and other compounds. (Red navel oranges are red because of the carotenoid lycopene, while blood oranges are red because of the presence of anthocyanin flavonoids.)

Researchers carried out a single-blind, dose-dependent, randomized dietary intervention study. They evaluated 174 male and female subjects with a low F&V consumption and assigned them to a high-flavonoid (HF) diet, a low-flavonoid diet (LF) or their habitual diet. Every six weeks, they increased their daily consumption by two servings of HF or LF fruits and vegetables. They were followed for 18 weeks. (Macready AL, et al., Flavonoid-rich fruit and vegetables improve microvascular reactivity and inflammatory status in men at risk of cardiovascular disease--FLAVURS: a randomized controlled trial. Am J Clin Nutr. 2014 Mar;99(3):479-89. doi: 10.3945/ajcn.113.074237.)

They evaluated the subjects at 6, 12, and 18 weeks for microvascular reactivity using laser Doppler imaging, arterial stiffness with pulse-wave velocity and pulse wave analysis, 24-hour blood pressure, and biomarkers of nitric oxide (a blood vessel relaxant), vascular function, and inflammation. These are all cardiovascular disease risk factors.

In men, the HF diet at 2 additional portions per week increased vascular reactivity (relaxation) and reduced CRP (a measure of inflammation), as well as other markers of inflammation. In the group as a whole, at 12 weeks (an additional 4 portions of HF F&V per day) plasma nitric oxide was increased (nitric oxide is an endothelial-derived relaxant of blood vessels).

In the groups as a whole, an increase of fruit and vegetable intake, regardless of whether they were HF or LF, reduced the vascular stiffness increase and the nitric oxide reduction that was seen in the control group. The conclusion that is apparent is that an increase of fruit and vegetable intake of up to six portions per day leads to lower risk of cardiovascular disease, and the benefit is even greater if the fruits and vegetables are those that are high in flavonoids. It may also be of benefit to take flavonoid supplements, but foods are still the best choice for their variety of flavonoids and other valuable nutrients, as well as fiber.

Practical guidelines:

A diet high in fruits and vegetables is commonly recommended for its many benefits, and this research further supports these recommendations. Good flavonoid sources include berries, colored beans, tomatoes, bananas, cabbage, onions, parsley, and tree fruits (such as apples, apricots, pears, plums, and peaches). It is best to eat a wide variety of these foods to get the greatest variety of the many different flavonoids.

The doses that are beneficial for some of the flavonoids are often higher than those available from foods. This is true for quercetin, which is discussed in the next article. The therapeutic quercetin doses for allergies, cancer protection, and heart health are 800 to 1200 mg per day or more, and this is difficult to achieve with food alone.

Quercetin and reduced cancer risk

Quercetin is a flavonoid found in red onions, cilantro, dill, watercress, buckwheat, and kale, among other foods. For each 100-gram portion, cilantro and dill provide 55 and 53 mg of quercetin, respectively, red onions provide 32 mg, watercress provides 30 mg, while kale and buckwheat each provide 23 mg. In relatively high doses (800-1200 mg), it is helpful with allergic responses, and it can reduce the production of sugar-protein (glycoprotein) complexes associated with cataracts. As an antioxidant flavonoid, it is likely to have other protective benefits, and recent research has confirmed this.

In an animal study, four groups of rats were assigned to either Group I: control group; group II: chemically induced prostate cancer; Group III: chemically induced cancer plus 200 mg of quercetin per kilogram of body weight; or Group IV: quercetin (200 mg/kg b.w.). They measured serum levels of quercetin. Cancer markers were brought back to normal by the addition of quercetin supplementation. (Firdous AB, et al., Quercetin, a natural dietary flavonoid, acts as a chemopreventive agent against prostate cancer in an in vivo model by inhibiting the EGFR signaling pathway. Food Funct. 2014 Aug 28. [Epub ahead of print]) Quercetin was effective in preventing prostate cancer progression.

Quercetrin (a derivative of quercetin; note the different spelling) inhibits the oxidation of low-density lipoproteins (LDL) and prevents allergic reactions. In a lab study of cells, quercetrin was shown to have antiproliferative and promotion of apoptic (programmed cell death) effects in a line of non-small-cell lung cancer cells (NSCLC). The effects were dependent on both the dose of quercetrin and the time of exposure of the cells. (Cincin ZB, et al., Molecular mechanisms of quercitrin-induced apoptosis in non-small cell lung cancer. Arch Med Res. 2014 Sep 1. pii: S0188-4409(14)00175-1. doi: 10.1016/j.arcmed.2014.08.002. [Epub ahead of print])

Practical guidelines:

Quercetin supplements are available in capsules of 200 to 400 mg. I recommend them in varying doses for upper respiratory allergies, cataract prevention (even better when combined with a low-sugar diet), inflammation, cancer prevention and treatment, and heart health. My usual guideline is to take 800 to 1200 mg daily.

Coenzyme Q10 and heart failure mortality

Coenzyme Q10 (coQ10) is a cofactor in the production of the energy-storage molecule (ATP) in mitochondria. The body produces coQ10, so it is not an essential nutrient, but the production declines with age, so supplements may be the only way to maintain an adequate tissue level. The heart muscle is particularly rich in mitochondria and highly dependent on adequate coQ10. CoQ10 is a potent antioxidant, and I have previously reported on its benefits in the treatment of hypertension. It has also been used to treat diabetes, heart failure, angina, and chronic fatigue, but some of the studies have been too small to produce definitive answers.

A report from a conference presentation suggested a significant benefit in heart failure patients resulting from coQ10 therapy. It was reported in many news media, but has not yet been published in a journal. Earlier studies have shown benefits for heart failure patients, reducing symptoms, improving functional capacity, and increasing quality of life. In this Q-Symbio study1, 420 patients with severe heart failure (New York Heart Association class III or IV) were given 100 mg of coQ10 three times per day or a placebo. They were evaluated over a two-year period for the primary endpoint: a major adverse cardiac event, which included unplanned hospitalization due to worsening heart failure, cardiovascular death, urgent cardiac transplantation, and mechanical circulatory support. (S.A. Mortensen, et al., The effect of Coenzyme Q10 on morbidity and mortality in chronic heart failure. Results from the Q-SYMBIO study. European Society of Cardiology Conference, May 2013; Abstract no 440)

Last year I reported on a meta-analysis that showed benefits from coQ10 in heart failure. This study goes further in that they were able to analyze overall mortality in their subjects. At two years, the rate of major adverse cardiovascular events was 25 percent in the placebo group but only 14 percent in the coQ10 group. In addition, compared to the placebo group, the coQ10 group had lower cardiovascular mortality, fewer hospitalizations, and greater improvement in the NYHA classification. All-cause mortality was 9 percent in the coQ10 group, compared to 17 percent in the placebo group. This is a dramatic difference. Of course, it would be great to have larger studies for longer times, but with the known safety of coQ10, as well as its other benefits, it is definitely worth using it for patients with heart failure.

Practical guidelines:

I take 200 mg of coenzyme Q10 twice per day because of my history of heart valve replacement (a congenital problem that was not fixed with surgery until 2003) and the myocardial damage that resulted from my long history of a leaky valve. (I wrote about my surgery in this newsletter in April 2003, available on my website – I recommend the newest reduced form of coenzyme Q10 (ubiquinol) made by Kaneka (the same Japanese manufacturer that developed both this and the original ubiquinone). It is marketed as “QH” which is their name for it, and it is available from a number of supplement capsule manufacturers (with a wide variety of prices!). I typically recommend 200 mg per day, but a number of studies have shown benefits (and safety) at doses even higher than 1200 mg per day.

Red meat and breast cancer risk

In a new analysis of diet and breast cancer, researchers followed 88,803 women for 20 years of follow-up. The subjects in this Nurses’ Health Study II completed questionnaires on diet in 1991. They were looking at the cases of invasive breast cancer identified through self-reporting and confirmed by pathology reports. During the course of the study they documented 2830 cases of breast cancer.

In this group, a higher intake of total red meat was associated with an increased risk of breast cancer overall. There was a 22 percent higher relative risk for those women in the highest fifth of meat intake compared to women whose intake was in the lowest fifth. On the other hand, higher intakes of poultry, fish, eggs, legumes, and nuts were not related to breast cancer overall. (Farvid MS, et al., Dietary protein sources in early adulthood and breast cancer incidence: prospective cohort study. BMJ. 2014 Jun 10;348:g3437. doi: 10.1136/bmj.g3437.)

In estimating the effects of different protein sources, substituting one serving per day of legumes for one serving per day of red meat lowered breast cancer risk by 15 percent regardless of menopausal state, and by 19 percent among premenopausal women. Substituting one serving per day of combined legumes, nuts, poultry, and fish for one serving per day of red meat was associated with a 14 percent reduction of breast cancer overall.

Practical guidelines:

The message is simple, and it fits with a lot of other research that confirms the health benefits of reducing red meat intake to lower the risk of breast cancer and many other cancers, as well as heart disease, hypertension, and stroke. Legumes are a great substitute, and have a wide variety of recipes to create a variety of international flavors and textures. Avoid highly processed legume derivatives, such as texturized vegetable protein, but minimally processed soy proteins, such as tofu, tempeh, and soy milk are healthful.

Low vitamin D and hypertension

Vitamin D has been a subject of many of my recent articles. It is not truly a vitamin, but a hormone produced in the skin by the action of ultraviolet light B (UVB) from the sun on skin cell 7-dehydrocholesterol. A new study shows a strong correlation of increasing vitamin D blood levels with a significant reduction in hypertension. This new meta-analysis evaluated the genetic data of 146,581 subjects of European descent, looking at the genes that affect the production of vitamin D. The data were then analyzed for an association with blood pressure changes and a diagnosis of hypertension.

In these sophisticated analyses, each 10 percent increase in vitamin D levels was associated with a decrease of 0.29 mm Hg in diastolic blood pressure, and a 0.37 mm Hg drop in systolic blood pressure. More importantly, for each 10 percent increase in vitamin D concentration they found a corresponding 8.1 percent decrease in the odds of hypertension. (Vimaleswaran KS, et al., Association of vitamin D status with arterial blood pressure and hypertension risk: a mendelian randomisation study. Lancet Diabetes Endocrinol. 2014 Sep;2(9):719-29.)

Practical guidelines:

Most people are deficient in vitamin D. This is particularly true of elderly people everywhere (with age, vitamin D production declines), people in northern latitudes who have less exposure to the sun, those who spend most of their time indoors, and those who get little in the diet.

Vitamin D3 supplements are frequently needed to raise blood levels to a healthful range, and you can find out your own level by having your doctor order a blood test for 25-hydroxy vitamin D3. If your doctor won’t do it or you don’t have one, you can get the test through Life Extension Foundation ( A good range is 40 to 80 ng/ml (that’s nanograms per ml).

If you are below these levels, it is a good idea to take supplements of natural vitamin D3 (not the synthetic vitamin D2). They are available in a variety of doses between 1000 and 10,000 IU. There is a wide range of safety, even with serum levels up to 100 ng/ml. Get retested after two or three months to make sure your level is rising to the healthful ranges and then adjust your supplement dose, if necessary.

General Information


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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.