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Big Business in Obesity
Managing Injuries
Supplements
for Injuries
Environmental
Protection
Ask Dr. J:
Kidney Stones
References
In the Health
News
Diet and Disease
Recipe of the
Month: Buckwheat with Vegetables
Dear Friends,
Many of my readers in New England were distressed
when I wrote that I had moved to Florida, thinking
that I had quit the Northeast for good. However,
I can reassure those of you from the region
that I will be returning sometime in the Spring,
and will again see patients in my two offices,
Arlington, MA, and Amherst, NH. I very much
appreciate your concerns and desire to have
me in the area.
I made the move to Florida for a variety of
reasons, but as you might imagine, the primary
one was the winter weather. I am able to be
outdoors more, and I’ll have an easier
time exercising year round. In addition, Iwill
be able to grow melons more easily, and papayas,
which are impossible in New England. This all
fits in well with my commitment to a healthy
diet and lifestyle.
A spokesperson for the obese population, herself
324 pounds, noted that the majority of the population
is overweight, so it is simply good business
to cater to them. This may be true from a business
perspective, but overweight and obesity have
much wider implications. In fact, another “business”
thrives as a result of the high rate of obesity—health
care.
It was recently reported that one of the sectors
of the economy that was leading the recovery
was health care, with the implication that this
was a social good. This may have benefits for
the economy, but is it not shortsighted to in
any way consider an increase in the utilization
of health care services as being good for the
community? One of the contributors to increased
use of health care facilities is the high rate
of overweight and obesity.
With the increased risk of heart disease, hypertension,
diabetes, arthritis, cancer, and accidents among
the overweight and obese, it is not surprising
to find that health care costs are directly
related to weight. Several studies show that
costs go up by 10, 36, and 45 percent as body
mass index (BMI), normally 18-22, rises to 25,
30, and then above 35 Kg/sq.m., which reflects
obesity.
It is unfortunate that interest in diet and
weight loss programs, as well as fitness centers
has been declining in spite of the need for
better health and weight control. A healthy
diet is inexpensive, and a regular walking program
requires no extra expenditure—except of
calories.
While recent months have been both exciting
and stressful for me, I have also learned some
lessons—such as the importance of being
patient and careful. What with buying a home
in Florida, packing up and selling a home in
Cambridge, putting the garden to bed in New
Hampshire, and remodeling the Florida house,
I have managed to injure myself several times.
Most recently, a stack of drywall that I was
trying to reposition became unbalanced and fell
toward me. With some luck I was able to slip
out from under, but not before the edge of the
stack banged into my thigh (fortunately not
breaking it), skittered down and bruised the
muscle. (However, the visible bruise was unfortunately
not dramatic enough to elicit much sympathy.)
I believe that my high doses of dietary supplements
contributed to avoiding a worse injury and more
bruising. In addition, I modified my intake
after the injury to promote the healing and
relieve some of the pain, and two days later
my limp was gone and I was back to running.
A number of supplements help to increase tissue
and blood vessel strength, reducing damage and
bleeding in response to trauma, or promote wound
healing. Vitamin C is essential in making the
collagen in connective tissue. Bioflavonoids
and vitamin C reduce capillary fragility.
Research shows that after a variety of traumas,
injury is reduced with vitamin C supplementation.
Swelling and tissue injury are reduced after
burns when vitamin C is given at the time of
the trauma. Intravenous administration of 14
mg/Kg/hour (the amount in one study) translates
to giving 1 to 2 gm orally every hour.
Vitamin C also reduces damage and supports
recovery after exercise-induce muscle injury.
This suggests that other injuries would respond
similarly. In one study, with only 400 mg daily
for two weeks before demanding exercise, muscle
soreness was reduced and function enhanced.
Another report from 1982 stated that from 500
to 3000 mg of vitamin C, administered to non-deficient
subjects, enhanced healing from surgery, injury,
and leg ulcers and improved the quality of collagen.
Vitamin C and E enhance recovery in critically
ill surgical patients, reduce organ failure,
and lessen time in the ICU.
Capillary fragility leads to increased blood
leakage and the dramatic appearance of bruises
in response to injury (the kind that elicit
sympathy). A variety of flavonoids improve capillary
resistance to trauma, up to 40 to 65 percent
in one study (this is studied by putting a suction
cup on the skin and measuring the vacuum pressure
needed to cause capillary rupture).
In another study, flavonoids were administered
to patients undergoing surgical hemorrhoid removal.
Those who received the supplements, but not
those on placebo, had a much reduced incidence
of bleeding after the procedure.
Flavonoids also reduce acute and chronic inflammation,
and they protect against the oxidative damage.
They also lessen the swelling that accompanies
injury.
Numerous studies support the role of zinc,
arginine, vitamins A, C, and E, and essential
fatty acids in the healing process from wounds,
physical trauma, and burns. (In severe burns,
it may also be necessary to increase protein
intake.)
After my injury, I added extra L-arginine and
zinc to my supplement program, even though I
take some zinc regularly in my multivitamin.
Arginine improves both wound healing and immune
function in the elderly, enhancing white blood
cell function as a side benefit. Typical doses
of arginine are from 4 to 10 gms per day.
I also took bromelain as part of my healing
program. Bromelain is a pineapple-derived extract
containing protein-digesting enzymes and non-enzyme
substances. It removes debris left after tissue
is injured, reduces swelling, accelerates healing,
and is anti-inflammatory. Research suggests
that bromelain relieves tenderness, as well
as pain at rest and during motion after blunt
trauma to muscles.
Some side benefits of bromelain include reduction
of platelet aggregation, anti-thrombotic activity,
interference with tumor cell growth, stimulation
of immunity, and, in animal studies, inhibition
of invasiveness of tumor cells.
Bromelain activity is measured in mcu (milk
clot units). Typical doses are 5000 to 10,000
mcu daily, more at the start of therapy and
tapering off as the healing progresses.
You don’t need to work at the EPA to
worry about toxins in the environment. With
our Florida home remodeling , there is an abundance
of dust and fumes in the air, from plaster,
glues, wood, grout removal, and paint residues,
as well as the smoke that drifts in from the
workmen who have their cigarettes outside.
I can’t help but breathe these in, although
I do as much as possible to avoid the working
areas and to have a lot of cross ventilation.
In order to help protect myself, I vacuum with
a HEPA filter to remove small particles. I also
do outdoor exercise regularly to help clear
my lungs (running on the beach also helps to
clear my mind).
In addition to Vitamins C and E, and other
antioxidants such as coenzyme Q10, I recommend
N-acetyl cysteine (NAC) to help loosen mucous
secretions, which helps the cilia lining the
airways to bring up the particles that get into
the lungs. It is also an antioxidant, protecting
against a variety of environmental toxins. I
take 500 mg twice a day. This also helps chronic
bronchitis and obstructive lung disease.
Calcium D-glucarate helps the liver detoxify
chemicals (Walaszek Z, et al., Metabolism, uptake,
and excretion of a D-glucaric acid salt ....
Cancer Detect Prev. 1997;21(2):178-90). Many
toxins are excreted after the liver attaches
them to glucuronic acid. In the intestines,
this bond may be broken, and the toxin reabsorbed
and recirculated to the liver. Calcium D-glucarate
helps maintain the bond, so the toxin can be
more readily excreted. I take 500 mg twice a
day, and I recommend higher doses for more serious
exposures.
Finally, I also take 500 mg of silymarin, a
flavonoid complex from milk thistle, that is
known to support the liver, protect it from
toxins, and help regenerate damaged liver cells.
It is also known to help with liver damage from
mushroom poisoning (Enjalbert F, et al., J Toxicol
Clin Toxicol. 2002;40(6):715-57).
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Q. Do you have any suggestions
for preventing another kidney stone?
-- SK, via Internet
A. Kidney stones result from crystallization
of substances in the urine that grow to form
a hard mass. They can lead to severe pain if
they become obstructed when they pass through
the ureter. Ultrasound destruction is the usual
treatment, the fragments being passed in the
urine.
The most common stone is made of calcium oxalate.
Oxalic acid is present in some foods, such as
spinach, rhubarb, strawberries, beet greens,
tea, and chocolate, among others. Limiting these
in the diet may help. Vegetarians have about
half the rate of kidney stone formation as meat
eaters.
Limit your salt, sugar, and caffeine intake,
but dietary calcium appears to help by binding
with oxalate in the gut, thus limiting its absorption
and reducing stone formation. Drinking plenty
of water helps by diluting the urine.
Magnesium and vitamin B6 (pyridoxine) reduce
oxalate excretion, and lower the rate of stone
formation. Typical doses are 500 mg of magnesium
and 100 mg of B6, the amounts in a good multivitamin-mineral.
Vitamin C is not associated with an increased
risk of kidney stones, in spite of the current
medical myth.
Catering to Obese Becoming
Big Business, Reuters, October 24, 2003.
Thompson D, et al., Body
mass index and future healthcare costs: a retrospective
cohort study. Obes Res. 2001 Mar;9(3):210-8.
Quesenberry CP Jr, et al.,
Obesity, health services use, and health care
costs ... Arch Intern Med. 1998 Mar 9;158(5):466-72.
Matsuda T, et al., ... high-dose
vitamin C therapy on postburn lipid peroxidation.
J Burn Care Rehabil. 1993 Nov-Dec;14(6):624-9.
Matsuda T, Effects of high-dose
vitamin C administration on postburn microvascular
fluid and protein flux. J Burn Care Rehabil.
1992 Sep-Oct;13(5):560-6.
Thompson D, et al., Prolonged
vitamin C supplementation and recovery from
demanding exercise. Int J Sport Nutr Exerc Metab.
2001 Dec;11(4):466-81.
Ringsdorf WM Jr, Cheraskin
E, Vitamin C and human wound healing. Oral Surg
Oral Med Oral Pathol. 1982 Mar;53(3):231-6.
Nathens AB, ...antioxidant
supplementation in critically ill surgical patients.
Ann Surg. 2002 Dec;236(6):814-22.
Galley P, Thiollet M, A double-blind,
placebo-controlled trial of a new veno-active
flavonoid fraction (S 5682) in the treatment
of symptomatic capillary fragility. Int Angiol.
1993 Mar;12(1):69-72.
Ho YH, et al., Prospective
randomized controlled trial of a micronized
flavonidic fraction to reduce bleeding after
haemorrhoidectomy. Br J Surg. 1995 Aug;82(8):1034-5.
Pelzer LE, et al., Acute
and chronic antiinflammatory effects of plant
flavonoids. Farmaco. 1998 Jun 30;53(6):421-4.
Shi HP, et al., Supplemental
L-arginine enhances wound healing in diabetic
rats. Wound Repair Regen. 2003 May-Jun;11(3):198-203.
Kirk SJ, et al., Arginine
stimulates wound healing and immune function
in elderly human beings. Surgery 1993 Aug;114(2):155-9.
Maurer HR, Bromelain: biochemistry,
pharmacology and medical use. Cell Mol Life
Sci. 2001 Aug;58(9):1234-45.
Masson M, Bromelain
in blunt injuries of the locomotor system. A
study of observed applications in general practice.
Fortschr Med. 1995 Jul 10;113(19):303-6.
Regular exercise and increasing levels of exercise
after being diagnosed with cancer are both associated
with improved quality of life (Blanchard CM,
et al., ...exercise [and] quality of life in
adult cancer survivors? Prev Med. 2003 Nov;37(5):389-95).
At least a half hour of exercise, three times
a week, helped compared with decreasing levels
(usually as a result of depression, despondency,
fatigue or treatment), but this study did not
evaluate an effect on survival. Other studies
suggest that exercise helps survival in prostate
cancer and other cancers (Sawada SS, et al.,
Cardiorespiratory fitness and cancer mortality
in Japanese men... Med Sci Sports Exerc. 2003
Sep;35(9):1546-50), while obesity increases
recurrence and mortality in breast cancer (Rock
CL, et al., Can lifestyle modification increase
survival in ...breast cancer? J Nutr. 2002 Nov;132(11
Suppl):3504S-3507S).
A recent analysis showed the public health
benefit of preventing age-related macular degeneration,
a leading cause of blindness, with vitamins
C, E, beta carotene and zinc (Bressler NM, et
al., Potential public health impact of ...AREDS
report no. 11. Arch Ophthalmol. 2003 Nov;121(11):1621-4).
A physician ridiculously commented (Reuters,
Nov 10, 2003) that they should “only be
used in intermediate or advanced disease.”
Why wait for an exam to show you are already
diseased? How is that preventive medicine?
The Mediterranean diet, rich in fruits, vegetables,
fish, fiber, and olive oil, but low in meat,
reduces the signs of inflammation that are risk
factors for heart disease, and the findings
were independent of age, exercise, weight, sex,
or education. A related report showed that fish,
such as sardines, mackerel, and (wild) salmon,
is also related to reduced risk (Reuters, November
9, 2003). Farmed fish are not as healthful,
and the farming methods are not environmentally
sound.
Buckwheat is thought of as a cereal grain,
but it is really an herb in the rhubarb family.
It contains no gluten (for those who are gluten
sensitive). The edible portion is technically
a “fruiting body” that can be toasted
after the hull is removed (kasha), and eaten
in a variety of dishes. It is rich in protein
and fiber. My mother used to coat kasha with
beaten eggs and stir it around in a dry skillet
with onions until it was dry and toasty. You
can do this with or without the egg. Then boil
the mix in twice as much water as buckwheat
(with a little soy sauce, or replace water with
vegetable broth—organic is available from
Imagine Foods), adding garlic and cayenne pepper.
Next, blend in some stir-fried vegetables, such
as diced carrots, celery, more onion, broccoli,
and herbs to taste. You can also add some diced
tofu to the vegetables.
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