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August-September-2015

Topics:

Coenzyme Q10 and atrial fibrillation
Healthy diet lowers mortality
Sugar drinks raise diabetes risk
Vitamin D may help prevent falls
Curcumin for depression and cancer
General Information

Coenzyme Q10 and atrial fibrillation

Atrial fibrillation (AF) is a condition in which the smaller chamber of the heart does not beat regularly, but merely quivers with no rhythmic contraction. This leads to reduced heart function, but because the atrial beat contributes only about 20 percent of the blood to the left ventricle (the rest passes passively through the mitral valve) it is usually not a debilitating condition. However, because the chamber is not contracting, the blood is more likely to coagulate while collecting in the intricate channels of the atrial wall. For this reason, patients who are in persistent AF are usually put on anticoagulants, such as warfarin (Coumadin), or some of the newer agents used for the same purpose, to prevent a dislodged clot from causing a stroke or other tissue damage.

Patients with heart failure often develop AF, and they may be at a higher risk of more severe cardiac arrhythmias, depending on the severity of their heart failure. In a new study, 102 heart failure patients were given either a combination of the usual heart failure drugs with a placebo, or the same drugs plus a daily supplement of 30 mg of coenzyme Q10. The subjects included 72 men and 30 women aged 45 to 82 years. They were evaluated at the start of the study by electrocardiogram, Holter monitor for 24 hours, and blood levels of inflammatory substances that are markers for heart risks. They were then evaluated again after 6 months and 12 months.

At both follow-up evaluations, those subjects in the coenzyme Q10 treatment group had a significantly lower incidence of AF. At 12 months, the incidence of AF was 6.3 percent in the group treated with coenzyme Q10, compared with 22.2 percent in the control group. The heart muscle function (ejection fraction) was significantly better in the treatment group (24 percent increase) at both follow-up evaluations compared to the control group (19 percent increase). In addition, the inflammatory markers were markedly lower in the coenzyme Q10 treatment group than in the controls. For example, the decline in C-reactive protein (CRP) levels in the medication-only group was 20 percent, but in the coQ10 group the decline was 40 percent. (Zhao Q, et al., Effect of coenzyme q10 on the incidence of atrial fibrillation in patients with heart failure. J Investig Med. 2015 Jun;63(5):735-9.)

Practical guidelines:

Coenzyme Q10 is essential for energy production in muscle cells, and the heart requires more than any other muscle. Levels are often too low in heart patients, and treatment with statin drugs can lower it further. The dose of coenzyme Q10 in this study was very low compared to typical treatment levels (30 mg as opposed to 100 to 400 mg, or even higher in heart patients with more severe disease).

It is easy to design a study to fail, and I am surprised that this study showed such statistically significant benefits with such a small dose and with a relatively small group of subjects. In the citations found with this study, only one article gives the specific dose of coenzyme Q10, and in that one the dose averaged 100 mg per day, so I am surprised that they chose to treat with only 30 mg. My recommendation is a dose of 100 to 200 mg per day (I take 400 mg) and ubiquinol (the reduced form) is likely to be better than the more common ubiquinone (the oxidized form), although this is converted in the body to ubiquinol.

Healthy diet lowers mortality

A number of studies show that the healthy diet as defined by the US Dietary Guidelines for Americans (DGA, which I think is not really the healthiest diet one could choose) reduces morbidity and mortality from major chronic diseases, but the studies have mostly been done with non-Hispanic white individuals. Whether the data is the same for African-Americans and low-income populations was not clear.

In a new prospective study, researchers recruited 84,735 American adults aged 40-79 years, from 12 southeastern states in low-income populations. The recently published report included data from 50,434 African-Americans, 24,054 Caucasians, and 3,084 subjects from other racial/ethnic groups. For most of them, the annual household income was less than $15,000. Their diets were assessed using a validated food frequency questionnaire. How well they adhered to the DGA was measured by the Healthy Eating Index (HEI). They were followed for an average of 6.2 years.

During the follow-up period, 6906 subjects died, including 2244 from cardiovascular diseases, 1794 from cancer, and 2550 from other diseases. For those subjects with the highest HEI score, the mortality risk reduction ranged from 19 to 23 percent compared to those with the lowest HEI score. The benefits from healthier eating were observed regardless of race, sex, or income levels. The apparent components of the HEI that were most associated with healthier outcomes were whole grains, dairy, seafood, and plant proteins, as well as the ratio of unsaturated to saturated fatty acids (that is, less animal fat and more essential fatty acids from plant sources). (Yu D, et al., Healthy eating and risks of total and cause-specific death among low-income populations of African-Americans and other adults in the southeastern United States: a prospective cohort study. PLoS Med. 2015 May 26;12(5):e1001830;.)

Related information comes from a study of 20 African Americans compared to 20 rural Africans in South Africa. For two weeks, their diets were switched. The African Americans were put on a diet with low animal protein, low fat, and high fiber, and high in vegetables, beans, and cornmeal, just as the native African diet is, and the Africans were put on a typical American diet with meat and cheese high in fat content.

After only two weeks, they did colonoscopies on the subjects and found the Americans on the African diet already had improvement in markers of colon cancer risk, while the Africans on the American diet developed changes suggesting the development of precancerous cells. They also noted changes in the microbiota suggesting cancer risk reduction or increase for the African diet and American diet, respectively. (O'Keefe SJ, et al., Fat, fibre and cancer risk in African Americans and rural Africans. Nat Commun. 2015 Apr 28;6:6342.)

Practical guidelines:

It is not a surprise that a healthy diet lowers the risk of chronic disease. It is surprising that after only two weeks, markers for the changes in risk become evident. The basic message is to eat more fiber, more vegetables, less animal fat, less refined food, and less meat, and focus on whole grains, unprocessed fruits and vegetables, legumes, seeds, nuts, and fish. This diet is far removed from the typical diet of industrialized countries.

Sugar drinks raise diabetes risk

In a review article, researchers analyzed the relationship of sugar-sweetened beverages, artificially-sweetened beverages, and fruit juice to the incidence of type 2 diabetes. They only examined prospective studies using national surveys in the United States (covering 189 million adults without diabetes) and in the United Kingdom, (covering 44 million people). They included data from studies published up until 2014.

Higher consumption of sugar-sweetened beverages was associated with a greater incidence of type 2 diabetes by 18 percent per serving per day, and 13 percent after adjusting for adiposity (meaning that the diabetes risk was not all attributable to weight gain). For artificially sweetened beverages, the risk increase was 25 percent per serving, but after adjusting for adiposity, the risk increase was only 8 percent (suggesting that obesity is associated with both diabetes risk and higher consumption of artificially sweetened drinks). For fruit juice, the risk increase was almost all attributable to obesity, not the drinks themselves.

The authors estimated that over a 10-year period, about 10 percent of the cases of diabetes could be attributed to consumption of sugar-sweetened beverages. They also noted that neither artificially sweetened drinks nor fruit juice were likely to be healthy alternatives to sugar-sweetened beverages.

Practical guidelines:

Those people who drink sugar-sweetened beverages are unlikely to heed this message, but it is important to repeat it for those few who might. It is unclear from this article that fruit juice is much better, but it certainly has a greater likelihood of providing at least some nutrition. The problem is that most fruit juice is as sweet as many sugar-sweetened beverages. My suggestion is to use fruit juice only if it is very diluted. I’ll use it just to flavor water or sparkling water, with only about 10 to 15 percent juice.

Vitamin D may help prevent falls

Many recent articles have reported on the health benefits of vitamin D. In a new one, researchers set out to learn whether raising vitamin D levels with vitamin D supplements could reduce the incidence of falls in homebound older adults. Being homebound, they are unlikely to get much exposure to the sun, and that combined with their age means that they are unlikely to produce much vitamin D from the action of ultraviolet light on the skin.

They studied 68 adults aged 65 to 102 years. Using the Meals-on-Wheels program they provided the subjects with a placebo or 100,000 IU of vitamin D once per month. This is equivalent to an average daily dose of 3300 IU per day. As vitamin D is fat soluble, it persists in the body longer than water-soluble vitamins, so once-per-month dosing is not unreasonable, and it is easier to get compliance with fewer doses. The placebo was a small monthly dose of vitamin E.

At the start of the study, 57 percent of the participants had serum vitamin D levels (25(OH)D3) below 20 ng/mL, a level considered deficient. They were treated for five months. At the end of the treatment program, only one of the subjects in the vitamin D group still had a low vitamin D level, while 18 of the 25 placebo subjects still had a serum vitamin D below 20 ng/mL. (A minimum healthy level is from 20-40ng/mL, while many experts recommend 40 to 60 or even higher for optimum health.

After five months, statistical analysis showed that the treatment group had a 58 percent lower rate of falling than the control group. (Houston DK, et al., Delivery of a Vitamin D Intervention in Homebound Older Adults Using a Meals-on-Wheels Program: A Pilot Study. J Am Geriatr Soc. 2015 Aug 16. doi: 10.1111/jgs.13610. [Epub ahead of print])

A previous study in 2010 had a different design and came up with different results. However, they administered a single annual dose of 500,000 IU of vitamin D. They found a slight increase in fracture rates and falls in the treatment group compared with the placebo group. The newer study used a divided dose with a total of 500,000 IU over just five months. Another study difference is that the subjects in the earlier study were not homebound, and they had a higher level of vitamin D at the start of the study (less than 3 percent had severe deficiency). (Sanders KM, et al., Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. JAMA. 2010 May 12;303(18):1815-22.)

Practical guidelines:

Raising vitamin D levels with supplements has many health benefits that I have reported frequently in earlier newsletters. Falling is a serious health problem, as it often leads to hospitalization and permanent incapacity or death. I recommend getting tested for vitamin D level in the serum and taking adequate supplementation to bring up the level to between 40 and 60 ng/mL. This usually means doses of 2000 to 8000 IU per day, depending on age, sun exposure, where you live, diet, and individual metabolism.

Curcumin for depression and cancer

Two research articles published this year provide information on the benefits of curcumin (turmeric extract) supplements for the treatment of depression and prevention and possible treatment of cancer. In the study on depression, researchers administered a curcumin extract (500 mg twice daily) for 8 weeks or a placebo to 50 participants with major depressive disorder.  They measured depression severity with a self-rated depression scale called IDS-SR30. They also measured urinary and blood biomarkers.

After 8 weeks, the IDS-SR30 scores were significantly improved in those on the curcumin compared to the scores of those on the placebo. The biomarkers associated with depression were also reduced by the curcumin treatment. (Lopresti AL, et al., Curcumin and major depression: a randomised, double-blind, placebo-controlled trial investigating the potential of peripheral biomarkers to predict treatment response and antidepressant mechanisms of change. Eur Neuropsychopharmacol. 2015 Jan;25(1):38-50.)

In an earlier study by the same authors, they showed significant improvement in the IDS-SR30 total score and the specific mood score after supplementation with the same dose of curcumin extract at both 4 and 8 weeks. (Lopresti AL, et al., Curcumin for the treatment of major depression: a randomised, double-blind, placebo controlled study. J Affect Disord. 2014;167:368-75.)
A number of studies have shown benefits from curcumin for cancer prevention and treatment. A review in February described curcumin as a polyphenolic anti-inflammatory substance that suppresses initiation, progression, and metastasis of a variety of tumors. The authors explain that the anti-cancer effects are mediated through negative regulation of cancer-promoting molecules. It also arrests cancer cell growth, induces apoptosis (programmed cell death), and inhibits angiogenesis (the growth of new blood vessels to feed tumors). (Shanmugam MK, et al., The multifaceted role of curcumin in cancer prevention and treatment. Molecules. 2015 Feb 5;20(2):2728-69.)

Practical guidelines:

I take about 500 mg of curcumin (standardized extract of turmeric) twice per day. I also like to eat many curry dishes for their flavor and also for the turmeric that they contain. The large doses are needed because curcumin is not very well absorbed. It is quite safe even in very high doses (one study used 6000 mg per day to successfully treat radiation dermatitis in breast cancer patients). Contrary to what some oncologists claim, antioxidants (including curcumin and others) do not inhibit the effects of chemotherapy, but actually enhance it and help to prevent side effects.

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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