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Letter from Dr. Janson
Summer Skin Protection (and
More)
Birth Defects, Zinc and Folate
In the Health News
Recipe of the Month: Chickpeas
and Rice
Dear Friends,
Why am I continually surprised when medical
doctors make unfounded, ignorant claims about
dietary supplements or alternatives in medicine?
The latest example is from a group of so-called
“aging experts” from the International
Longevity Center, based in New York, in a critique
of another anti-aging medical organization (they
complain that doctors make a living doing alternative
medicine, as if they don’t with their treatments).
One of the doctors was quoted as saying, “Antioxidants
have never been proven to be of any clinical
benefit for any illness, ever,”which begs
the question, “what constitutes proof?”since
there is a lot of evidence. It is almost impossible
to “prove” anything in the biological
sciences to a degree that would satisfy the
most resistant skeptic, but we have to make
decisions about health care based on the best
evidence of the moment, not “proof.”
Physicians make recommendations every day based
on their interpretation of medical science,
and the best experts come up with different
opinions. I attend a clinical conference on
some Friday afternoons, with some of the best
cardiologists in the Boston area. They present
cases and ask each other about what course of
action to take. They often come up with three,
four, or even five different ways to manage
a patient. The physician in charge must decide
how to manage the medical condition, considering
all of the opinions. And whether or not the
experts come to a consensus, the patient needs
treatment.
Is this science? Is this art? No, this is a
combination: applying the art of medicine to
the best information that science has to offer.
To ask anti-aging doctors to live up to a higher
standard of “proof” is unwarranted
and biased. Right now, the best evidence that
we have suggests that lifestyle, diet, dietary
supplements (yes, including antioxidants!),
exercise, stress management, and many unconventional
treatments are valuable in the prevention, management,
and treatment of a variety of conditions. I
point them out in every issue of this newsletter.
Would I like more proof? Of course! Just as
I would like more proof of any conventional
medical treatments (which are often far more
risky but not more scientific). However, we
cannot wait for perfect proof before we try
to help our patients. We are limited by uncertainty,
but not incapacitated by it.
It is unwise to exclude any of the potential
benefits from what is called alternative medicine,
complementary medicine, nutritional medicine,
anti-aging medicine, or simply “good medicine,”(with
or without conventional treatments). Doctors
who do so mistreat their patients, and they
misunderstand the value of medical science.
They also diminish themselves. Everyone suffers
when such bias and ignorance remove the potential
benefits of comprehensive health care.
It is now no secret that skin is readily
damaged by excessive exposure to the sun or
other sources of ultraviolet light (such as
tanning booths). Sunscreen can protect the skin,
but this may not be adequate during prolonged
exposure, and many sunscreens contain harmful
chemicals.
When I grew up we spent summers at the New
Jersey shore, getting very tanned playing on
the beach, swimming, and spending virtually
all day outdoors, and no one knew of sunscreen.
The risks of sun damage were little known 50
years ago.
While some sun exposure is needed for production
of vitamin D in the skin, and light received
through the eyes stimulates the pineal gland
to help regulate the body clock, sun worship
leads to significant tissue damage. It also
puts you at an increased risk of developing
skin cancer.
Skin cancer is increasingly common, and it
occurs in three forms, depending on the affected
cells. The superficial layer of skin, or epidermis,
is made up of the outermost squamous cells,
the basal cells just beneath them, and the pigment
cells, called melanocytes. The dangerous kinds
of cancer are squamous cell cancer and melanoma.
Basal cell cancers only rarely metastisize,
but they can grow locally.
Most of these tumors appear only on areas of
the skin that are exposed to the sun, so the
correlation is quite clear. Ultraviolet light
leads to free radical damage to the superficial
cells that are most exposed. This results in
premature aging and wrinkles from protein cross
linkages in collagen, and is the likely cause
of the cancers.
You need to be very cautious to avoid excessive
exposure. Even tanning is an indication of damage,
so you should avoid the sun in the middle of
the day. When you are out, wear lightweight
but opaque clothing, stay in the shade, and
use sunscreen with SPF 15 protection. While
this can help prevent squamous cell cancer,
it is not clear that it protects against melanoma.
By all means, avoid tanning booths.
Protecting the skin is important not
only for itself, but the skin is a visible model
for how to slow down the aging process and prevent
free-radical diseases in general. Some skin
creams contain antioxidants, such as vitamin
C, proanthocyanidins, and coenzyme Q10. However,
other than vitamins C and E, which do help protect
against ultraviolet light, it is not clear that
others are beneficial when applied topically.
A better idea is to protect yourself from free
radical damage by eating a diet with protective
nutrients and taking supplements that are known
to offer protection. These have been shown to
lower the incidence of various cancers.
Choose a diet that is rich in fruits and vegetables.
These are high in vitamins and minerals, and
they contain lots of flavonoids, carotenoids,
and protective phytochemicals–antioxidants
that protect us against free radical damage
and cancer, and maintain healthy and supple
skin.
Avoid hydrogenated oils (margarine and shortenings),
as they interfere with immune function and disrupt
the normal prostaglandin metabolism. Prostaglandins
regulate many different physiological functions.
The best oils are from seeds, nuts, beans, and
cold-water fish (as part of a healthy variety
of foods). You also find oils in some whole
grains and a few vegetables, such as avocados.
Most of the antioxidant supplements that
I have talked about so much are valuable in
protection against the damage from ultraviolet
exposure. These include vitamin C (2000 to 4000
mg daily), vitamin E (400 to 800 IU), coenzyme
Q10 (100 to 200 mg), selenium100 to 200 mcg),
proanthocyanidins (50 to 100 mg), and other
bioflavonoids (1000 to 2000 mg).
These also happen to be the ones that protect
against premature aging of tissues, including
the skin, by preventing the cross-linking of
protein. The benefit is just more apparent in
the skin. Sun damage is cumulative, and is likely
worsened by other free radical exposure, as
is evident in smokers, and on the neck skin
of outdoor workers.
In addition to free radical protection, nutrients
help to maintain the strength of connective
tissue, and youthful looking skin. Vitamin C,
flavonoids, and MSM (methyl sulfonyl methane,
a sulfur source, 1000 to 2000 mg) are essential
for production of strong collagen, and zinc
(15 to 30 mg) is essential for elastin, the
substance that helps maintain elasticity of
skin. This declines with age, as is evident
if you pinch the skin on the back of your hand
to form a tent, and let go. It snaps back flat
when you are young, but takes its time when
you get older.
Adequate omega-3 oil, from flaxseeds, walnuts,
and fish, such as sardines or salmon, and gamma-linolenic
acid (an omega-6 oil, from borage or evening
primrose oil) help to balance the prostaglandins.
This does not mean eating a high fat diet, or
adding lots of oil to a healthy diet. If you
prefer to avoid fish, be sure to select some
of the vegetarian sources of omega-3 oils.
Regular exercise helps maintain the enzymes
that protect against free radical damage, such
as superoxide dismutase (SOD). To produce SOD
you need adequate zinc, copper, and manganese.
You can certainly do your exercise outdoors,
but take precautions against excessive sun exposure.
These are the precautions I have been taking
to help protect my skin from the aging process
and cancer. If you protect your skin, the chances
are high that you will be protecting yourself
from aging, cancer, and other age-related diseases.
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Although the FDA has only recently acknowledged
that folic acid (or folate) supplements can
prevent birth defects (neural tube defects,
or NTD), it has been well known in the medical
research for many decades, and even other government
agencies suggest folate supplements.
NTD’s include spina bifida, a failure
of the spine to close, and anencephaly, a failure
of the brain to develop. When the spine fails
to close, corrective surgery is required, but
these children often have multiple abnormalities,
and short survival. With anencephaly, there
is a failure of the brain to develop, leading
to stillbirths or death shortly after birth.
The American Preventive Medical Association
and several other parties sued the FDA to allow
manufacturers to say on their labels that folate
helps prevent birth defects, giving consumers
more information. Fortunately for the health
of children and freedom of speech, the FDA lost
this suit. Before this lawsuit, the FDA insisted
that it was better to get folic acid from food,
rather than supplements, even though most of
the research was done with supplements. It is
still a wise idea to eat foods rich in folate,
as they are also rich in many other nutrients.
Good food sources of folate are leafy green
vegetables, bananas, peas and beans, whole grains,
and oranges.
Folate levels in foods do vary, so I recommend
supplements. Poor health habits increase the
need for folate. Smoking, drinking alcohol,
taking birth control pills, and dieting are
among the habits that reduce folate in the body.
It is now apparent that in addition to folic
acid, zinc is also beneficial in preventing
neural tube defects (NTD). Researchers in India
have correlated low hair zinc levels in pregnant
women with an increased incidence of NTD (the
serum levels were not correlated, but the serum
is not a reliable way to evaluate zinc levels).
Another report shows that maternal zinc supplements
help to prevent birth defects.
Other helpful nutrients include vitamin B12
and pantothenic acid, and it is good to have
a broad spectrum of nutrients in a comprehensive
multivitamin-mineral supplement for extra insurance.
•People at risk of peptic ulcers
from low-dose aspirin, appear to have an even
higher risk if they also have Helicobacter pylori
in the stomach. The irritation of the gastric
mucosa caused by low-dose aspirin was much worse
among those testing positive for the bacteria,
which is well known to be associated with increased
peptic ulcer disease. (Feldman M, et al., Role
of Helicobacter pylori...during long term/low
dose aspirin therapy... Am J Gastroenterol 2001
Jun;96(6):1751-7) Gastric erosions are seen
in one of six people on aspirin, but in 50 percent
of people who also have H. pylori.
•A healthy low-fat diet with supplements
of flax seeds can slow the growth of prostate
cancers (Demark-Wahnefried W, et al., Pilot
study of dietary fat restriction and flaxseed
supplementation... Urology 2001 Jul;58(1):47-52).
Flaxseeds contain both omega-3 oils, fiber,
and lignans, substances that may bind with testosterone
and thus slow the growth of prostate cancer.
These subjects were instructed in a low fat
diet, with less than 20 percent of their calories
from fat, and within 5 weeks they had improved,
and their cholesterol levels had come down also.
The average American diet is well over 30 percent
fat (high sugar intake makes this appear low).
•A new report suggests that the risk of
MS is much lower on a vegetarian diet, and higher
on a diet that contains a lot of saturated fat.
(Reuters Health, June 16, 2001). High caloric
intake also increased the risk. Even the protein
source made a difference. Men and women who
ate predominantly vegetable protein had a 60
percent lower risk of MS. They also found that
vitamins C, B1 (thiamin), and B2 (riboflavin),
and fiber, calcium and potassium were strongly
protective.
I use this versatile combination as the
foundation for several meals. Pressure cook
organic chick peas for 20 minutes and let them
cool slowly (or add 5-10 minutes). Cook brown
rice using two parts water to one part rice
(I use a rice cooker to save effort; follow
its directions). I keep these in the fridge
and combine them with some pepper, lemon or
vinegar, flaxseed or olive oil (or a mixture)
and some thyme or oregano as a snack. I also
will have them with stir-fried onions, garlic,
and mixed vegetables to make a meal. Another
choice for the rice is to make a breakfast by
warming it with soymilk or Rice Dream, adding
raisins, cinnamon, and banana or other fruit.
Chick peas can be put in salad, or if you are
ambitious you can mash them with garlic, lemon,
and tahini to make hummus.
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