International Foods
and Farms
Arthritis and Heart
Disease
Arthritis and
Heart Protection
Vitamin D, Calcium,
and Bones
Ask Dr. J: Cholesterol
Treatment
References
In The Health News
Diet and Disease
Recipe of the Month:
Eggplant Zucchini Casserole
Dear Friends,
For my recent lecture trip to
Japan, I prepared material on
the negative health effects of
processed food diets. My Japanese
nutritionist colleagues pointed
out that the dietary habits of
the Japanese were also changing
toward this “industrialized”
diet.
They noted the high salt intake
in Japan (12 grams per day), which
is not really new. However they
also informed me of the increase
of white flour products, the decrease
in vegetable consumption (particularly
green vegetables), and the increase
in fast foods, such as burgers,
fries, sweets, ice cream, buns,
(white) noodles, and beef on white
rice (at fast food outlets not
seen in the U.S.) I can see the
results in the skin of many Japanese
youths.
All of this is very disappointing
to me, especially as I go to Japan
partly to teach healthier eating
habits. However, I am pleased
to report that the news is not
all bad. I was amazed at the number
of restaurants in both Tokyo and
Kyoto that serve organic foods,
and the variety of restaurants
that serve brown rice and vegetarian
fare (and, of course, tofu and
other soy products are widely
available, including “yuba”
– a tasty, ribbon-like soy
curd).
I was able to eat at different
restaurants almost every day without
compromising my dietary habits.
(My colleagues who found all these
restaurants did a great job in
helping me to stay healthy on
the trip.) At the end, I realized
that I had not even visited two
of the restaurants where I dined
two years earlier. At all of these
restaurants, the food was not
only tasty and healthy, but also
elegantly prepared and artfully
presented. I also found a number
of healthy, small, “fast
food” shops for a quick
organic, vegetarian lunch to go
(and in my case to carry out for
my long plane journey).
The interest in healthy and organic
foods is growing rapidly in Japan
(and organic foods are the fastest
growing segment of the grocery
industry in the U.S.). A major
Japanese food import-export company
is increasingly committed to providing
organic foods, and they import
large amounts of organic bananas
and whole-grain, organic cereals
among other products. In speaking
with the head of this company,
I was pleased to learn of his
goal to expand the organic food
segment of his business to meet
the growing consumer demand and
because of his concern for health.
Another positive note is the
rise in organic cotton growing,
particularly in India, where cotton
makes up only five percent of
India’s crops but uses 50
percent of the pesticides, harming
the soil and the farmers, and
not controlling the pests! Pesticide-laden
cottonseed oil is used in many
processed foods. Now organic farming
is becoming more popular, not
only to reduce costs, but also
to make the fields safer for the
farmers and foods safer for them
and their children. The organic
farmers also have no need for
genetically modified seeds. Internationally,
in many ways, I see encouraging
changes.
Rheumatoid arthritis and cardiovascular
disease are both common conditions,
but cardiovascular disease differs
from arthritis in that it is the
number one cause of death, while
rheumatoid arthritis is not lethal.
However, it appears that arthritis
and other inflammatory conditions
contribute to an increased risk
of dying from heart disease. Inflammation
is indicated by an increase in
the serum level of C-reactive
protein (CRP), an inflammatory
marker.
In a population study, patients
with rheumatoid arthritis (RA)
were evaluated for the likelihood
of their dying of heart disease.
Researchers looked at 603 patients
over 18 years old at the start
of the study and followed them
for 15 years. After controlling
for other risk factors, they found
that the risk of death from heart
disease was more than doubled
for those with greater evidence
of chronic rheumatoid inflammation.
The same researchers did an earlier
study comparing the rates of heart
failure in 1158 subjects with
and without RA. They found that
the patients with RA were 70 percent
more likely to develop congestive
heart failure than the subjects
without arthritis. Over 30 years,
they found that the risk of heart
failure was double in RA patients
compared to non-arthritis subjects.
The same relationship does not
appear to be true for patients
with osteoarthritis.
These studies add to the growing
body of evidence that inflammatory
conditions such as arthritis contribute
to damage to the arteries resulting
in cardiac disease and mortality.
Arterial damage in diabetic women
is related to higher levels of
inflammatory markers, including
CRP and interleukin-6. Stiffness
of the arteries, an early sign
of atherosclerosis, appears to
result from asymptomatic inflammation
in these diabetic patients.
It is not clear why inflammation
causes an increase in heart disease
mortality, but among other effects
it appears to increase the fragility
of arterial plaque, which contains
high amounts of inflammatory cells
and molecules. This leads to increased
vulnerability of the plaque to
rupture, precipitating heart attacks.
Although infection within the
arterial wall (viruses, bacteria,
chlamydia) may contribute to local
inflammation and result in initiation
and faster progression of coronary
disease, inflammation at other
sites is an additional concern.
The very process of inflammation
seems to trigger the cellular
changes that lead to plaque formation
and infiltration of fat, oxidized
cholesterol, and eventually calcium
into the arterial wall, all characteristics
of atherosclerosis.
Therapies that treat RA or with
proven vascular anti-inflammatory
effects are likely to help with
prevention of cardiac mortality.
These include a diet low in animal
fat and trans fats, junk, and
sugar, as well as exercise and
smoking cessation. Conventional
drug therapies with aspirin and
statins also have anti-inflammatory
effects, but healthier options
make them unnecessary.
Diet plays a large role in reduction
of symptoms and objective measures
of rheumatoid arthritis. A short
fast followed by a vegan or vegetarian
diet leads to improvement in many
measures of RA as well as inflammatory
indicators. A vegan diet is high
in both antioxidants and anti-inflammatory
substances. Arachidonic acid,
found in land animal fats, is
a non-essential fatty acid that
increases inflammation.
Fish oil, on the other hand,
is high in omega-3 fatty acids
that reduce inflammation. In one
study, a diet low in animal fat
enhanced the benefits of fish
oil. Patients on a western diet
(WD) and those on an anti-inflammatory
diet (AID) were given either fish
oil or placebo. Even the placebo
group on the AID had fewer tender
joints, and with fish oil the
AID group had less than half as
many tender joints as the WD group.
They also had a reduction of one
inflammatory marker (LTB4) from
34 percent to 8 percent.
Some studies show that high doses
of vitamin E can reduce RA symptoms
and inflammation. Zinc, selenium,
and copper may also help. Bromelain,
a pineapple enzyme, has anti-inflammatory
effects and helps reduce symptoms
of RA. High doses of gamma-linolenic
acid (GLA, 1000 mg), fish oil
(EPA/DHA, 1200-2400 mg), and curcumin
(1200 mg) can reduce arthritic
inflammation. The herbs boswellia,
nettle, and feverfew also have
anti-inflammatory effects. Combine
supplements, diet changes, and
regular exercise to achieve the
most benefits.
Two recent studies reportedly
suggested that vitamin D and calcium
supplements were not helpful in
treating osteoporosis. One study
in the Lancet evaluated supplements
of calcium carbonate (1000 mg)
and vitamin D (800 IU) in 5292
patients over 70 years old who
had already had one fracture.
They found no difference between
those on active treatment compared
to placebo.
The problems are that these results
cannot be extrapolated to younger
age groups, higher doses of vitamin
D are needed to see results, and
calcium carbonate is not the best
absorbed form of calcium. Increasing
bone density is a very slow process,
and may take longer for improvement
to result in reduced fractures
(for patients, fracture rates
are more important than bone density).
Another problem was that fewer
than half of the participants
in the study took their supplements.
The second study in the British
Medical Journal evaluated 3314
post-menopausal women who had
already had a fracture. They used
the same doses of calcium and
vitamin D, and followed the participants
for an average of two years. The
problems with drawing conclusions
from this study are basically
the same as the first, but these
research problems do not mean
that calcium and vitamin D are
cures for osteoporosis.
In addition to these supplements
at the right doses, fracture prevention
requires regular weight-bearing
exercise, a healthy diet, and
other supplements such as ipriflavone
and boron, as well as proper hormone
balance, with bio-identical hormone
treatment if needed.
Q. Can I take
my prescription cholesterol medication
(cholestyramine) along with natural
treatments like policosanol and
garlic?
—RM, New Hampshire
This medication binds with bile
acids in the intestinal tract
and diverts cholesterol to production
of more bile acids, lowering the
level in the blood. It may have
some side effects, such as constipation,
gas, bloating, and heartburn.
It is recommended less frequently
than statin drugs.
Natural cholesterol-lowering
supplements are unlikely to have
any negative interaction with
cholestyramine (brand name Questran)
or with any of the cholesterol
drugs, including the statins.
Policosanol may have some similar
actions to the statins, but no
side effects have been reported,
and it has been shown to be almost
as effective as the best statin
drug, in addition to providing
similar vascular protection. If
you do decide to take both, you
should be sure to inform your
doctor. Most of the time I have
found it unnecessary to use the
prescriptions when patients take
the natural substances.
Other natural treatments that
control cholesterol include red
yeast rice (2000 mg daily), garlic
(1000-2000 mg), chromium (200-600
mcg), vitamin E (400-800 IU of
mixed tocopherols), niacin (vitamin
B3, 2000-3000 mg), vitamin C (2000-4000
mg), and fish oils (600-1200 mg
of EPA/DHA).
A diet rich in soy foods, almonds,
oats, barley, psyllium, and specific
vegetables that are high in viscous
fibers (eggplant and okra) can
effectively lower cholesterol.
Combining some supplements with
this diet may eliminate your need
for drugs.
Stepping off
the pesticides treadmill. www.nri.org/InTheField/india_pests.htm
Maradit-Kremers
H, et al., Cardiovascular death
in rheumatoid arthritis:... Arthritis
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Nicola PJ,
et al., The risk of congestive
heart failure in rheumatoid arthritis:....
Arthritis Rheum. 2005 Feb;52(2):412-20.
del Rincon
ID, et al., High incidence of
cardiovascular events in a rheumatoid
arthritis cohort not explained
by traditional cardiac risk factors.
Arthritis Rheum. 2001 Dec;44(12):2737-45.
Dessein PH,
et al., Cardiovascular risk in
rheumatoid arthritis versus osteoarthritis...
Arthritis Res. 2002;4(5):R5.
Heitritter
SM, et al., Subclinical Inflammation
and Vascular dysfunction... J
Clin Endocrinol Metab. 2005 Apr
19 [Epub ahead of print]
Willerson JT,
Systemic and local inflammation
in patients with unstable atherosclerotic
plaques. Prog Cardiovasc Dis.
2002 May-Jun;44(6):469-78.
Shishehbor
MH, Bhatt DL, Inflammation and
atherosclerosis. Curr Atheroscler
Rep. 2004 Mar;6(2):131-9.
Adam O, et
al., Anti-inflammatory effects
of a low arachidonic acid diet
and fish oil in patients with
rheumatoid arthritis. Rheumatol
Int. 2003 Jan;23(1):27-36.
Hanninen, et
al., Antioxidants in vegan diet
and rheumatic disorders. Toxicology.
2000 Nov 30;155(1-3):45-53.
Wittenborg
A, et al., Effectiveness of vitamin
E in...chronic polyarthritis.
Z Rheumatol. 1998 Aug;57(4):215-21.
Belch JJ, Hill
A, Evening primrose oil and borage
oil in rheumatologic conditions.
Am J Clin Nutr. 2000 Jan;71(1
Suppl):352S-6S.
Grant AM, et
al., Oral vitamin D3 and calcium
for secondary prevention of low-trauma
fractures in elderly people...Lancet
2005 Apr 28, Lancet Early Online
Publication
Porthouse J,
et al., Randomised controlled
trial of calcium and ...(vitamin
D3)...BMJ;330:1003, doi:10.1136/bmj.330.7498.1003
Resveratrol, a substance found
in red wine, grape skins, and
peanuts, has antioxidant, anti-inflammatory,
and anti-cancer effects. A recent
cellular study showed that resveratrol
can induce cancer cell death in
human brain tumors (glioma), and
found that it works by multiple
mechanisms (Jiang H, et al., Resveratrol-induced
apoptotic death in...glioma cells.
Mol Cancer Ther 2005 Apr;4(4):554-61).
Other reports indicate that resveratrol
inhibits the initiation, promotion,
and progression of tumors (Alarcon
de la Lastra C, Villegas I, Resveratrol
as an anti-inflammatory and anti-aging
agent...Mol Nutr Food Res. 2005
Apr 14; [Epub ahead of print])
and increases the lifespan of
yeasts and fruit flies.
In a study of 7504 men from
45 to 68 years old followed for
30 years, those with the highest
milk consumption had more than
double the risk of developing
Parkinson’s disease, compared
to those who drank no milk. This
was apparently not related to
the total intake of calcium in
either group. (Park M, et al.,
Consumption of milk and calcium
in midlife and the future risk
of Parkinson disease. Neurology.
2005 Mar 22;64(6):1047-51.) It
is not clear whether this is due
to a neurotoxic substance in milk
or other causes.
Pancreatic cancer is aggressive
and difficult to treat, making
prevention especially important.
A new case-control study of 585
pancreatic cancer patients compared
their diets with 4779 adults without
the disease. The researchers found
that a diet high in fresh fruits
and vegetables (particularly cruciferous
vegetables such as broccoli and
cabbage) was associated with a
49 percent reduction in the risk
of developing pancreatic cancer.
(Nkondjock A, et al., Dietary
patterns and risk of pancreatic
cancer. Int J Cancer 2005 May
1;114(5):817-23.) A separate report
from the same group shows that
lycopene also cuts pancreatic
cancer risk.
Put a layer of tomato sauce or
diced tomatoes on the bottom of
a casserole dish (I use fire-roasted
tomatoes from Muir Glen). Thinly
slice eggplant and zucchini (about
1/4 to 1/2 inch thick), and lightly
sauté them in olive oil
on a griddle with chopped onion
and crushed garlic (you can skip
this step if you cook it longer
in the oven). Next, cover the
tomato sauce with a layer of the
vegetables, a thick layer of cooked
brown rice, and a sprinkle of
oregano, thyme, and freshly ground
black pepper or a pinch of cayenne
(depending on how hot you like
it). Crumble some tofu (either
soft or firm) in the next layer,
and cover that with some more
of the tomato sauce. Add another
layer of the vegetables and onion,
and top the entire dish with more
tomato sauce. Bake this in the
oven at 375° for about forty
minutes (depending on how much
you cooked the vegetables earlier).
