Artery Problems
Start Early
Flu Protection without
Vaccine
Supplements against
Viruses
Vitamin D and Osteoarthritis
Ask Dr. J: Prostate
and PSA
References
In the Health News
Diet and Disease
Recipe of the Month:
Soba Noodle Vegetable Soup
Dear Friends,
For a the past five years I have
been reporting in my medical lectures
about the early signs of atherosclerosis
that are now appearing in young
adults in the U.S. In 1999, researchers
reported on their evaluation of
arteries in almost 3000 subjects
from 15 to 34 years old (male
and female, black and white) who
died of external causes. They
found fatty deposits (called intimal
lesions–those occurring
in the innermost lining of the
arterial wall) in the arteries
of all subjects.
Even in the youngest group of
15- to 19-year olds, lesions were
present in 50 percent of their
right coronary arteries and 100
percent of their aortas, and the
extent and severity of the lesions
(from fatty streaks to raised
lesions) increased with age, right
up to the oldest group that they
studied.
Now, researchers find that the
problem can start even earlier,
and it is associated with obesity.
In a new report, 100 obese children
from 6 to 14 years old were evaluated
and compared to 47 normal-weight
children. The obese subjects had
higher blood pressures and higher
cholesterol levels as well as
a greater tendency to insulin
resistance. Of even greater concern
was that subjects as young as
seven years old already had thickening
of their carotid arteries and
greater stiffness of the arterial
wall. Arterial thickening and
stiffness is an early warning
of developing coronary artery
disease, so it should be taken
seriously. The obesity itself
may be causing the arterial damage
in these children, or it may be
the lifestyle that leads to obesity,
primarily poor dietary choices
and lack of exercise.
This is becoming an international
problem, as Britain, Italy, and
other countries are seeing a rapidly
growing incidence of obesity.
If this situation persists and
worsens, and the evidence suggests
that the problem is increasing
worldwide, the associated explosion
of health care costs that we are
already seeing will make health
care unaffordable. It is therefore
important to encourage the initiatives
that are beginning in several
school systems to expose children
to healthier eating, with more
vegetables, fruits, whole grains
(being aware of childhood allergies
to some grains), higher-fiber
diets, and organic foods. San
Francisco banned sodas and snacks
from cafeterias. New York City
and counties in Florida and Washington
state are also providing better
school food–more organic
products and fresh fruit (in Washington
they hold down costs by offering
only fruit for dessert).
If parents are not happy with
the foods being offered at their
children’s schools, they
can make a difference by contacting
the school district and asking
them to make healthier foods available.
This does not mean smaller portions
of junk (although that would help
also), but availability of better
food overall. Some object that
kids still want their junk, but
improving the food that is available
to them will go a long way toward
changing their habits and their
tastes.
The shortage of flu vaccine is
all over the news with medical,
financial, and even political
implications. I have always thought
that the vaccine was administered
too liberally, so it will be interesting
to see whether this shortage has
any effect on the incidence of
flu (I would not be surprised
if there were fewer cases this
year).
However, without even the potential
protection of the vaccine, you
can do many things to help protect
yourself, whether you are someone
at high risk or not. All of us
should take precautions against
the flu, not only for our own
health but for that of our friends,
families, and coworkers. I have
never taken a flu shot. Instead,
these are the precautions that
I take myself.
One of the most effective protections
is frequent handwashing and the
use of alcohol-based hand sanitizers.
These have been shown to be valuable
methods to reduce the spread of
infections in hospitals, schools,
and nursing homes. In the flu
season, it is wise to avoid shaking
hands and use hand sanitizer when
it is unavoidable.
Beware of surfaces that might
be contaminated, such as doorknobs,
telephone handsets, shared keyboards,
and shared party dishes and glassware.
Stay away from people with obvious
colds and sinus infections, and
if you are already ill, stay away
from work where you might transmit
your illness to others. If sick
co-workers insist on coming to
work, see if you can work at home.
In addition, it becomes even
more important to maintain your
immunity through healthful lifestyle
practices. Regular exercise boosts
immune function, but be sure to
dress appropriately if you exercise
outdoors. If you exercise indoors,
remember the hand sanitizer after
using shared machines or equipment.
Repeated changes of temperature,
and going in and out of heated
buildings with dry air may make
your mucous membranes more susceptible
to infection. In cold climates,
if you can keep your environment
humidified it will help protect
those membranes from drying out.
At the same time make sure you
consume enough fluids to maintain
hydration.
Fluid consumption includes water,
sparkling water, diluted fruit
juice (very dilute, to avoid sugar
excess), soups, and herb teas,
but not wine or beer, coffee,
tea, or other caffeinated drinks–their
diuretic effect can cause fluid
loss.
It also helps to avoid refined
sugar in the diet, as this can
reduce your defenses. Sugar can
reduce the ability of white blood
cells to attack viruses and bacteria,
leaving you open to a greater
risk of infection. Five teaspoons
of sugar inhibits the white cells
by 25 percent, and the amount
in two sodas or a pie and ice
cream can knock them down by 90
percent.
Vitamin C is still my first choice
in a supplement that helps immunity
and reducing both the severity
and duration of viral infections.
In acute illness, intravenous
vitamin C has been effective for
many patients. Typical oral doses
are from 2 to 4 grams twice a
day, and even much higher for
severe symptoms. Vitamin C enhances
interferon production, improves
white blood cell function, and
has direct antiviral effects.
Supplements of vitamin E (800
IU), zinc (30 mg), and selenium
(100 mcg) can reduce infection
rates in elderly people. A recent
study of echinacea showed reduction
of cold virus infections from
82 percent to 58 percent in people
inoculated with the virus, but
because the study only had 39
subjects, they could not say it
was a significant difference.
In a study of children, echinacea,
propolis, and vitamin C reduced
infections by 55 percent. A larger
study showed that standardized
echinacea supplements reduced
symptom severity and duration
of colds by 25 percent.
While elderberry extract has
a history of use for viral infections
and some supportive research,
a recent study confirms that flu
patients who take it recover an
average of four days earlier than
those in the placebo control group.
One study of a nutritional mixture
including vitamin E, folic acid,
B12, and lactobacilli showed increased
natural killer activity and improved
numbers of white cells in the
treated group in response to flu
immunization.
Other supportive nutrients include
garlic, astragalus, maitake (and
other mushrooms), beta-glucan,
Asian ginseng, and eleuthero (Siberian
ginseng). You are not defenseless
against the flu just because immunization
is not available.
A number of studies have shown
an association of low vitamin
D levels with increases in knee
osteoarthritis. A recent report
on 221 subjects showed that 50
percent of them were deficient
in vitamin D based on blood levels.
The researchers studied knee pain,
physical function, and muscle
strength. They found that low
levels of vitamin D were associated
with higher levels of pain, disability,
and muscle weakness.
Previous studies have shown an
association between muscle weakness
and low vitamin D, with 100 percent
of subjects in a Minnesota study
showing this correlation. This
muscle weakness may be contributing
to the symptoms of osteoarthritis.
At the same time, low vitamin
D is associated with falls and
hip fractures due to osteoporosis.
Muscle weakness related to low
vitamin D may also be contributing
to these falls.
It is easy to raise serum levels
of vitamin D with some exposure
of the skin to the sun, and with
dietary supplements. Sun exposure
is less reliable because elderly
people tend to be less efficient
in making vitamin D in the skin.
Also, in the northern hemisphere
and among darker skinned individuals
vitamin D manufacture may be inadequate.
Typical supplements range from
400 to 2000 IU per day, with some
estimates that we need a minimum
of 1000 IU to maintain adequate
blood levels.
Q. I have a
rising PSA level and want to know
what to do to protect my prostate?
—TL, Connecticut, via email
A rising PSA, needs a urological
evaluation to find out whether
it reflects prostate cancer. PSA
(prostate specific antigen) is
sometimes elevated on one or two
tests but then returns to normal,
so any biopsy or treatment should
be delayed until the elevation
is confirmed. In one report, half
of men who had high PSA levels
above 4 had normal tests when
it was repeated later.
The natural variation in PSA
elevation can range from 4 to
10, and it can be high with benign
prostate enlargement, prostate
inflammation, and after ejaculation,
so a high level does not automatically
mean cancer, and most prostate
cancers are slow growing, so waiting
to confirm the diagnosis is usually
not dangerous. While prostate
cancer can be aggressive (usually
associated with a rapidly rising
PSA), most of them grow so slowly
that men will have them for many
years and then die of some other
cause.
Some of the same treatments for
benign enlargement also help prostate
cancer. Symptoms of prostate enlargement
include frequent urination, urgency
to urinate, nighttime urination,
difficulty starting or stopping,
and weak urine flow. Helpful supplements
include saw palmetto (320 mg of
standardized extract), pygeum
(100-200 mg, standardized), nettle
(250 mg), zinc (30-50 mg), and
essential fatty acids such as
pumpkin seed oil.
The carotenoid lycopene (6 to
10 mg), found mainly in tomatoes,
helps to prevent prostate cancer.
Higher doses (10 to 30 mg) are
associated with reduced cancer
aggression. Soy isoflavones, coenzyme
Q10, vitamins C and E, selenium,
and melatonin are also protective
supplements.
Strong JP,
et al., Prevalence and extent
of atherosclerosis in adolescents
and young adults... JAMA 1999
Feb 24;281(8):727-35.
Iannuzzi A,
et al., Increased carotid intima-media
thickness and stiffness in obese
children. Diabetes Care. 2004
Oct;27(10):2506-8.
Anderson TW,
et al., Winter illness and vitamin
C: the effect of relatively low
doses. Can Med Assoc J 1975 Apr
5;112(7):823-6.
Riordan HD,
et al., Intravenous ascorbic acid:
protocol for its application and
use. P R Health Sci J. 2003 Sep;22(3):287-90.
Barringer TA,
et al., Effect of a multivitamin
and mineral supplement on infection
.... Ann Intern Med. 2003 Mar
4;138(5):365-71.
Girodon F,
et al., Effect of micronutrient
supplementation on infection...
a controlled trial. Ann Nutr Metab.
1997;41(2):98-107.
Sperber SJ,
et al., Echinacea purpurea for
prevention of experimental rhinovirus
colds. Clin Infect Dis. 2004 May
15;38(10):1367-71.
Cohen HA, Effectiveness
of...echinacea, propolis, and
vitamin C in preventing respiratory
tract infections...Arch Pediatr
Adolesc Med. 2004 Mar;158(3):217-21.
Goel V, et
al., Efficacy of a standardized
echinacea preparation (Echinilin)
for the treatment of the common
cold... J Clin Pharm Ther. 2004
Feb;29(1):75-83.
Zakay-Rones
Z, et al., Randomized study of
the efficacy and safety of oral
elderberry extract in the treatment
of influenza A and B virus infections.
J Int Med Res. 2004 Mar-Apr;32(2):132-40.
Bunout D, et
al., Effects of a nutritional
supplement on the immune response
and cytokine production in free-living
Chilean elderly. JPEN J Parenter
Enteral Nutr. 2004 Sep-Oct;28(5):348-54.
Josling P,
Preventing the common cold with
a garlic supplement... Adv Ther
2001 Jul-Aug;18(4):189-93.
American College
of Rheumatology, Improved vitamin
D levels may decrease knee disability
in osteoarthritis patients. October
17, 2004.
Holick MF,
Vitamin D: importance in the prevention
of cancers, type 1 diabetes, heart
disease, and osteoporosis. Am
J Clin Nutr. 2004 Mar;79(3):362-71.
Metabolic syndrome includes high
blood pressure, blood sugar, cholesterol,
and insulin, low HDL, and abdominal
obesity. It is also referred to
as insulin resistance or syndrome
X, and is associated with an increased
risk of type 2 diabetes and heart
disease. A study of 6436 subjects
from 1988 to 1994, and 1677 from
1999-2000 showed that the condition
is rising in the United States.
A small increase of 2.2 percent
was observed in men, but in women
the rise was 23.5 percent.(Ford
ES, et al., Increasing prevalence
of the metabolic syndrome among
u.s. Adults. Diabetes Care. 2004
Oct;27(10):2444-9.) Weight control,
exercise, and high fiber diets
are essential to prevent the otherwise
likely rise in diabetes and heart
disease.
a. A high intake of folic acid
reduces the risk of birth defects
and cancer. It now appears also
to reduce the risk of high blood
pressure. Daily consumption of
800 mcg of folate compared to
200 mcg was associated with a
29 percent lower risk of hypertension
among younger women and a 13 percent
reduction among older women. When
supplements alone were considered,
the reduction was 48 and 40 percent
in the two groups respectively.
(American Heart Assoc. Meeting
Report, 10/11/2004). Folate is
found in beans, leafy greens,
whole grains, and supplements.
b. In patients with ulcerative
colitis, consumption of higher
levels of red meat or alcohol
increases the likelihood of relapses.
In a study of 191 patients, the
highest consumption of red meat
increased the odds of a relapse
by 3-fold, and processed meats
by 5-fold. Alcohol consumption
raised the risk by 2.7 fold. (Jowett
SL, et al., Influence of dietary
factors on the clinical course
of ulcerative colitis: a prospective
cohort study. Gut. 2004 Oct;53(10):1479-84.)
Noodle soup is comforting in
flu season, and soba (buckwheat)
noodles are my favorite (I use
Sobaya organic brand). In a large
soup pot , sauté diced
onions, crushed garlic, a minced
fresh hot pepper, sliced carrots
and celery, and grated fresh ginger
in a small amount of olive oil
(I use 2-3 onions, six cloves
of garlic, 4 stalks of celery,
2 carrots, and one pepper in an
8 quart pot). Add chunks of soft
tofu, and sliced mushrooms, and
cook lightly, then add about 5
quarts of water. When this is
boiling briskly, add about two
handfuls of the noodles broken
in half and boil this for about
eight minutes. Near the end of
this time add two bunches of chopped
greens, (spinach, escarole, or
green chard all work well), soy
sauce and cider vinegar to taste.
Add some fresh, chopped cilantro
at the end. You can stir in a
small amount of miso when served.
