Sign Up








Folic acid lowers stroke risk
L-carnitine lowers CRP after heart attack
Lycopene lowers kidney cancer risk
Exercise by elderly lowers mortality
Omega-3 oils help after heart attack
General Information

Folic acid lowers stroke risk

The vitamin folic acid (or folate) has long been known to prevent birth defects if taken during pregnancy, and it is free of any risks in almost any dose. However, high doses can mask the presence of a vitamin B12 deficiency (not cause such a deficiency). It is therefore important if you take folate in high doses to make sure that you have adequate serum B12 levels. The doses that are most common (less than 1000 mcg per day) do not mask a B12 deficiency. A new study shows that folate also has other benefits in relation to cardiovascular disease and stroke.

In this study done in China, researchers included 20,702 adults with hypertension, but no history of stroke or heart attack at the start of the study. The study was a randomized, double-blind, clinical trial called the China Stroke Primary Prevention Trial. All of the participants received enalapril (Vasotec®), an ACE inhibitor drug for hypertension. In addition, half received 800 mcg of folic acid daily, and the other half a placebo. They were then followed for an average of 4.5 years.

At the end of the study, they looked at the number of subjects who had a first stroke, including ischemic and hemorrhagic strokes. They also looked at the number of heart attacks, the number of cardiovascular deaths, and all-cause mortality. (Huo Y, et al., Efficacy of folic acid therapy in primary prevention of stroke among adults with hypertension in China: the CSPPT randomized clinical trial. JAMA. 2015 Apr 7;313(13):1325-35.)

Compared to enalapril alone, those participants who also took folate rather than a placebo had a 21 percent reduction in the risk of first stroke, a 24 percent reduction in the risk of first ischemic stroke, and a 20 percent reduction in the combined risk of either of these cardiovascular events, or cardiovascular death. There was a trend toward a reduction in the risk of hemorrhagic strokes and all-cause mortality, but these did not reach statistical significance. Those who took the combination treatments had no increase in side effects compared to those who took enalapril plus the placebo.

Practical guidelines:

Folic acid, as its name suggests, is found in foliage, or leafy greens. It is commonly available in multivitamins in doses of 400 micrograms, and some multivitamins contain 800 micrograms. Folate is essential for cell replication and growth, and the production of DNA and RNA. It helps to lower homocysteine, a metabolite associated with cardiovascular disease. Doses as high as 5000 micrograms are available without a prescription, and such high doses are helpful in lowering homocysteine more effectively than the lower doses. If you do take such high doses, it is a good idea to have your vitamin B12 level checked. Otherwise, there are no risks from high-dose folate.

L-carnitine lowers CRP after heart attack

Inflammation is a risk factor for developing coronary artery disease. Markers of inflammation include serum levels of C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α). Elevated levels of these markers have been associated with a higher incidence of coronary artery disease. L-carnitine (LC) is an amino acid derivative that has been shown to help coronary disease when taken as a supplement. We produce LC physiologically, but the production declines with age. A new study shows how LC supplements can be helpful.

Researchers identified 47 patients with coronary artery disease (CAD) evaluated by cardiac catheterization showing 50 percent obstruction in at least one major coronary artery. The patients were randomly assigned to either placebo or LC supplements of 1000 mg per day. They were followed for 12 weeks. Of the group that started the study, 39 subjects completed the entire 12 weeks. (Lee BJ, et al., Anti-inflammatory effects of L-carnitine supplementation (1000 mg/d) in coronary artery disease patients. Nutrition. 2015 Mar;31(3):475-9.)

Compared to placebo, LC supplementation led to a significant reduction in the serum levels of CRP, IL-6, and TNF-α, suggesting a significant role in prevention of heart disease. This is a relatively low level of LC supplementation. I reported another study in December that showed that for heart attack patients daily supplements of 2000 mg of LC led to less angina, less heart muscle death, lower rates of heart failure, less ventricular enlargement, and fewer arrhythmias.

Practical guidelines:

L-carnitine is a very safe supplement that helps reduce heart disease risks. I take 2000 mg per day routinely. It may not be as important as a supplement for younger people who make their own, although sometimes even for them the amount they produce is not adequate.

LC works well with coenzyme Q10, as they both are important for energy production in the mitochondria. LC transports free fatty acids across the mitochondrial membrane where they are metabolized for energy production, with coQ10 as a cofactor. A genetic disorder can lead to low LC production, and seizure medications may lower levels, as can kidney dialysis. As much as 20,000 mg have been administered in one day with no side effects, although sometimes it may cause digestive upset at high doses.

Lycopene lowers kidney cancer risk

Lycopene is a carotenoid nutrient (related to beta-carotene and lutein), a pigment found in some (but not all) red fruits and vegetables. It has been shown to protect the prostate gland from cancer (particularly the more aggressive cancers), prevent sun damage to the skin, and help improve bone density. It is an antioxidant that helps prevent the oxidation of LDL-cholesterol and also lowers the risk of age-related macular degeneration.

A new study shows that lycopene is also helpful in reducing the risk of developing kidney cancer (renal cell carcinoma, or RCC). Researchers evaluated 96,196 postmenopausal women enrolled in the Women’s Health Initiative between 1993 and 1998 and followed them until 2013. They evaluated their dietary micronutrient intake using a food frequency questionnaire and their supplement use with an interview-based inventory.

By the end of the study, they identified 240 women with RCC. Those with the highest intake of lycopene had a 39 percent lower risk of developing RCC than those with the lowest intake. None of the other micronutrients they studied had a statistically significant reduction in RCC risk. (Ho WJ, et al., Antioxidant micronutrients and the risk of renal cell carcinoma in the Women's Health Initiative cohort. Cancer. 2015 Feb 15;121(4):580-8.)

Practical guidelines:

Lycopene is abundant in tomatoes, and more concentrated in tomato sauce and tomato paste than in fresh tomatoes (making the sauce and paste removes water content, concentrating the nutrient, and releases lycopene from the cell walls). Watermelon and red navel oranges have even more lycopene than fresh tomatoes (but not blood oranges that get their deep-red pigment from anthocyanins).

Lycopene is also available as a supplement, and worth taking if you are not eating a lot of the dietary sources. Because of the ultraviolet protection of the skin, it can help prevent the aged appearance from sun damage. Typical supplement doses are from 10 to 15 mg per day.

Exercise by elderly lowers mortality

It is fairly clear that regular physical activity is an important part of maintaining health. Some reports have suggested otherwise, but they have not been supported by most other research. Sedentary lifestyles lead to loss of muscle strength and bone density, and an increase of a variety of chronic degenerative diseases. A new study shows that elderly men benefit greatly from an increase in their physical activity.

From the year 2000, researchers in Norway followed 5738 men born from 1923 to 1932 (making them 68 to 77 years old at the start of the study period) for 12 years. During that time, 2154 subjects died. They then analyzed the amount of physical activity the subjects had in relation to their mortality risk. The activity ranged from light to vigorous physical activity and they analyzed the amount of time per week spent in the activities. They also compared the relative mortality risk to the mortality risk related to smoking.

They found that 30 minutes of physical activity 6 days per week was associated with a 40 percent mortality risk reduction. This was equivalent to five years of increased lifetime when comparing sedentary men with moderately to vigorously physically active men. Lack of physical activity was almost as predictive as smoking as a risk factor for mortality from all causes, and increasing physical activity was as beneficial as smoking cessation in reducing mortality. (Holme I, Anderssen SA, Increase in physical activity is as important as smoking cessation for reduction in total mortality in elderly men: 12 years of follow-up of the Oslo II study. Br J Sports Med 2015;49:743-748.)

Practical guidelines:

The researchers noted that even at 73 years, physical activity levels were highly associated with mortality risk reduction. By now it should be fairly clear that brisk walking, jogging, sports activity, heavy gardening, or hard training for about 4 hours per week will help to reduce mortality from heart disease and all causes.

Studies like this do not show cause and effect, but just association, because it is possible that the subjects getting the least exercise lived that way because they were already sick. However, with little risk and great potential benefit it is a good idea to start an exercise program at any age. I go to a gym several times per week, and I have recently started using elastic exercise bands and tubes at home, in addition to walking, gardening, and swimming.

Omega-3 oils help after heart attack

Omega-3 oil is found in some plant foods, such as flaxseeds and walnuts, and in smaller amounts in soybeans (including tofu), Brussels sprouts, and cauliflower. However, the omega-3 oil in plants is alpha-linolenic acid (ALA), which is then converted in the body to eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) the physiologically useful forms. Some people have problems converting the ALA to EPA and DHA, which happens particularly associated with age and illness.

The direct sources of EPA and DHA are primarily fatty fish, such as sardines, salmon, mackerel, and herring. These are also available in supplements. EPA and DHA have anti-inflammatory effects.
In March, a study was reported in a news release from the American College of Cardiology showing the benefits of taking omega-3 oil supplements for people who have had heart attacks. The data was presented at their meeting in San Diego. Researchers randomized 374 patients recovering from a heart attack (infarct), and in addition to standard care, half were given either 4 grams of omega-3 fatty acids or a placebo. They were matched in terms of location of the infarct and age. They were then analyzed by blood tests and cardiac imaging at two to four weeks post-heart attack and again at six months.

With cardiac magnetic resonance imaging (MRI) researchers were able to look at changes in patients’ hearts. Patients taking the large dose of omega-3 oils were 39 percent less likely to show deterioration of heart function compared to those taking the placebo. Inflammatory markers were greatly reduced in the treatment group and the scarring of heart muscle was significantly less. They found no side effects with the high doses of omega-3 oils. (ACC News Release, March 4, 2015. Omega-3 fatty acids appear to protect damaged heart after heart attack. Study suggests this therapy may provide added benefits to standard care. See more at:

Practical guidelines:

Although my diet is mostly vegetarian, I sometimes eat fish containing EPA and DHA, including wild salmon (Alaskan salmon is all wild, as Alaska does not permit salmon farming) and sardines. I also eat flaxseed oil, flaxseeds, and walnuts for some alpha-linolenic acid. The prescription formula used in this study contained 840 mg of combined EPA and DHA, while non-prescription fish oil concentrates of EPA and DHA may contain up to 600 mg of combined EPA/DHA at a far lower cost.

General Information


To subscribe to Dr. Michael Janson's Healthy Living sign up here.

To unsubscribe please click here and then click the unsubscribe link.

Visit for more health information. Please submit your own health questions here.


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.