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May 2016

Topics:

Curcumin unfairly criticized in press
Alcohol, processed meats, and cancer
Lutein for macular degeneration
Stress reduction for cardiac rehab
General Information

Curcumin unfairly criticized in press

An article on April 22nd in the New York Times included a critique of supplements of curcumin, the phytochemical that gives turmeric its bright yellow-orange color. The article did note at the start that curcumin has antioxidant, anti-inflammatory, and anti-cancer properties, as well as neuroprotective properties. They then interviewed a Linus Pauling Institute scientist who said that the current evidence is insufficient to claim that it is beneficial for humans. The Times went on to say that “Curcumin has “very poor bioavailability, meaning that it doesn’t stick around in the human body for very long…” This is not what poor bioavailability means (it means that it is either poorly absorbed from the intestinal tract, does not efficiently get into cells, or is bound to other molecules that inhibit function). Although poorly absorbed, in the animal studies it was administered in their feed.

In animal studies, the article notes, it can “ease colitis, reduce excessive immune response in rheumatoid arthritis, and reduce nerve inflammation in traumatic brain injury.” They note that “small clinical trials have found curcumin to be as effective as nonsteroidal anti-inflammatory drugs for alleviating the stiffness and swelling of rheumatoid arthritis, and it was more effective than some standard drugs used to reduce severity and flare-ups of ulcerative colitis.”
I sent a comment to the New York Times that they published. This is what I said:

“The otherwise important issue of bioavailability, means little if small amounts are effective, which appears to be the case from numerous clinical and animal studies. For example, hypothetically, if it is only 1 percent available, but 1 mg is beneficial, then taking 100 mg would provide clinical benefits. Common doses are 300 to 500 mg in standardized extracts. We don't know from this semi-scientific opinion how the curcumin was administered to the animals. If it was in their feed or water, rather than by injection, that would argue that poor bioavailability did not hinder its physiological benefits. We would all love larger studies -- but who is going to fund them? Absent that, if there are no risks, why not take it for treatment or prevention? It might be one of the factors accounting for low rates of Alzheimer's disease where curry is common in the diet. Drugs for rheumatoid arthritis cause serious side effects and numerous deaths. Any safe alternative would be worth at least a try. As a doctor open to unconventional therapies, I know that antagonism to non-drug therapies is rampant in the media and the medical community.”

In 2006, researchers published a clinical study on 89 patients with ulcerative colitis. Their disease was quiescent at the start of the study. Half were given 1000 mg of curcumin twice a day and half were given a placebo. After six months, 20 percent of the placebo group had recurrences, while only 4.6 percent of the curcumin group did. (Hanai H, et al., Curcumin maintenance therapy for ulcerative colitis: randomized, multicenter, double-blind, placebo-controlled trial. Clin Gastroenterol Hepatol. 2006 Dec;4(12):1502-6.)

Another study showed that a curcumin-rich curry diet improved lung function in current and past smokers, but showed only a small improvement in non-smokers. (Ng TP, et al., Curcumin-rich curry diet and pulmonary function in Asian older adults. PLoS One. 2012;7(12):e51753. doi: 10.1371/journal.pone.0051753. Epub 2012 Dec 26.)

Curcumin is known to possess anti-inflammatory and anti-arthritic properties. In a randomized trial of 45 patients with rheumatoid arthritis, researchers administered curcumin (500 mg), diclofenac (an NSAID drug), or a combination of the two. The subjects on the curcumin had the most improvement. (Chandran B, Goel A, A randomized, pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis. Phytother Res. 2012 Nov;26(11):1719-25.)

Other studies show that curcumin can effectively treat chronic gingivitis as well as the antiseptic mouthwash chlorhexidine, it can reduce radiation dermatitis in breast cancer patients, and it can reduce symptoms of major depression. I’ve already reported on this last study.

Practical guidelines:

I would not be dissuaded by newspaper articles from taking supplements of curcumin in addition to eating curry dishes. The actual and potential benefits are real, and there are no side effects even up to 6000 mg per day (although in some studies a few subjects report some digestive upset). This New York Times report only makes it clear that to benefit from curcumin you have to take relatively high amounts, because as they rightly point out, it is poorly absorbed. I take 500 mg twice per day, and this makes me think that I should take even more.

Alcohol, processed meats, and cancer

A report released in April by the American Institute for Cancer Research and the World Cancer Research Fund International shows that alcohol, excessive weight, and processed meats (such as bacon, hot dogs, and ham) may raise the risk of stomach cancer. The report notes that gastric cancer is the fifth most common cancer worldwide with about 952,000 cases recorded globally in 2012, with men twice as likely as women to develop it.

The report is part of their Continuous Update Project. They gathered global scientific research on diet, weight, physical activity, and the risk of stomach cancer, and then a panel of leading international scientists independently assessed the information to draw their conclusions. They noted that other contributors to stomach cancer include smoking, infection with Helicobacter pylori, industrial chemical exposure, and occupational exposure to dusty and high-temperature environments, as well as rubber manufacturing, coal mining, metal processing, and chromium production, but this report did not address those issues.

Their findings were that there is strong evidence that consuming approximately three or more alcoholic drinks per day increases the risk of stomach cancer, as does consuming foods preserved with salt, and processed meats such as ham, bacon, pastrami, salami, hot dogs, and some sausages. They found strong evidence that being overweight or obese, as assessed by the BMI (body mass index), increases the risk of cancer in the upper part of the stomach near the esophagus. They found some evidence, but not as strong, that eating grilled or barbecued meat and fish and eating little or no fruit increases the risk of stomach cancer. (World Cancer Research Fund International/American Institute for Cancer Research. Continuous Update Project Report: Diet, Nutrition, Physical Activity and Stomach Cancer. 2016. Available at: wcrf.org/stomach-cancer-2016.)

Practical guidelines:

The recommendations of the WCRFI/AICR are to maintain weight as low as possible within your healthy range, be physically active, avoid high-calorie foods and sugary drinks, eat more whole grains, vegetables, fruits, and beans, limit red meat and especially processed meats (zero seems a good number to me), drink very little alcohol, and eat less salt. These would also be my recommendations. For some reason, they say not to rely on supplements without further explanation. I agree that supplements cannot take the place of a healthy diet, but they can effectively supplement it to make sure you are not missing out on beneficial nutrients. And some nutrients are beneficial at levels that are hard to achieve with diet alone.

Lutein for macular degeneration

Carotenoids include a large family of yellow, orange, and red pigmented nutrients found in orange, yellow, and green fruits and vegetables. Beta-carotene is probably the most widely known and it occurs in carrots, sweet potatoes, winter squashes, spinach and other leafy greens, and cantaloupe. The carotenoid family includes alpha-carotene, lutein, lycopene, zeaxanthin, and beta-cryptoxanthin. Alpha and beta carotenes can be converted in the body to vitamin A, as can beta-cryptoxanthin. All carotenoids have antioxidant and non-antioxidant properties that provide health benefits. Lutein and zeaxanthin are the only carotenoids found in the retina and lens of the eye.

Age-related macular degeneration (ARMD) is a deterioration of the area of the retina that is responsible for the sharpest vision. When the macula degenerates, vision becomes blurry in the center of the visual field. This can make it hard to read, drive, and perform various daily chores. It can also make it hard to identify faces. Risk factors for macular degeneration include smoking, hypertension, high-fat diets, and hardening of the arteries. Protection from excessive ultraviolet light exposure may help to reduce the risk.

Research on carotenoids and macular degeneration has been inconsistent, but suggestive of a protective role for lutein and zeaxanthin. A new prospective study evaluated data from the Nurses’ Health Study and the Health Professionals Follow-up Study on 63,443 women and 38,603 men followed from 1984 until 2010. At the start of the studies, all subjects were free of ARMD, diabetes, cardiovascular disease, and cancer.

They found 1361 cases of intermediate and 1118 cases of advanced ARMD by the end of the study. They then compared the highest and lowest quintiles of intake of lutein and zeaxanthin and the incidence of ARMD. Those with the highest intake of these two carotenoids had a 41 percent lower risk of advanced ARMD compared to those with the lowest intake. Other carotenoids were associated with a 25 to 35 percent lower risk. They did not determine any associated change in risk for intermediate ARMD. (Wu J, et al., Intakes of lutein, zeaxanthin, and other carotenoids and age-related macular degeneration during 2 decades of prospective follow-up. JAMA Ophthalmol. 2015 Dec;133(12):1415-24.)

Practical guidelines:

We now have another reason to consume a wide variety of colorful fruits and vegetables. Although lutein and zeaxanthin were the most effective at reducing the risk of vision loss, other carotenoids also contributed to the protection. For the most part, ARMD is irreversible, so prevention is the primary tool we have to protect our vision. Supplements of all these carotenoids are also available for when you are not eating the best food selections. (Lutein supplements are derived from marigolds.) Another collection of studies shows ARMD prevention with supplements of relatively high amounts of vitamins C and E, beta-carotene, zinc, and copper.
Some of the best foods for vision are spinach, broccoli, collard greens, kale, nectarines, papayas, berries, orange bell peppers, carrots, sweet potatoes, soy foods, and avocados, as well as foods containing omega-3 oils, such as flaxseeds, walnuts, salmon, and sardines.

Stress reduction for cardiac rehab

Patients with coronary artery disease, whether they have coronary bypass surgery or not, are usually told that they should participate in a cardiac rehabilitation program. This is primarily an exercise program, although sometimes dietary changes are also recommended. These can be very effective programs. In addition to diet and exercise, stress management can contribute to the benefits from these programs.

A new study analyzes the effects of adding stress management to the standard rehab program. Researchers included 151 patients with coronary heart disease from 36 to 84 years of age. They were randomized to receive 12 weeks of either comprehensive cardiac rehab or the same plus stress management training. They also looked at a matched sample of patients eligible for rehab who did not receive it. All participants were followed for up to 5.3 years for clinical events.

The group that received the combination therapy showed lower anxiety, less distress, and a reduced sense of perceived stress. Both groups achieved significant improvements in coronary heart disease biomarkers and these were comparable between the groups. Eighteen percent of those who received the combination therapy had clinical events during the course of the study, while among those who received rehab therapy alone 33 percent had clinical events. Among the group that had no rehab or stress management therapy at all the rate of clinical events was 47 percent. (Blumenthal JA, et al., Enhancing cardiac rehabilitation with stress management training: a randomized, clinical efficacy trial. Circulation. 2016 Apr 5;133(14):1341-50.) The authors concluded that stress management training should routinely be included in cardiac rehab programs, even if patients do not specifically request it.

Practical guidelines:

Many methods of stress management are available, from simple breathing exercises to meditation, visualization techniques, yoga, tai chi, guided imagery, and others. They do take some time, but even a few minutes of breathing and visualization several times a day can be helpful. I like visualization techniques because they give me a chance to close my eyes and imagine that I am off in one of my favorite places enjoying the scenery in my mind’s eye.


General Information

 


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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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