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False Claims (Pro and Con)
Black Cohosh
Tea or Capsules
Vitamin C for
Heart Disease
Breast Cancer
Risk and Diet
Ask Dr. J:
Iron Supplements
References
In the Health
News
Diet and Disease
Recipe of the
Month: Fruit Desserts
Dear Friends,
I am pleased that the Federal Trade Commission
is finally taking action against a repeating
infomercial making unjustified claims for the
supposed benefits of “coral calcium.”
Calcium is an important nutrient, but there
is no reason to believe that coral calcium (calcium
carbonate) is superior in any way to other sources.
In fact, it is relatively poorly absorbed, and
potentially contaminated with heavy metals that
are common in animal-derived calcium.
While most supplement manufacturers are reliable
and honest, a few bad apples can taint the whole
industry, so it is important that we not be
seduced by false claims and unjustified hopes,
and that abuses through advertising be exposed.
The proponents of coral calcium have been making
misleading claims that their product cures almost
everything. This is totally unjustified.
On the other hand, I have seen proponents of
nutrition, dietary supplements, and alternative
medicine make unjustified claims, in bold headlines,
that dietary supplements are harmful–until
you read the fine print and realize that they
are not against all supplements, only brands
other than their own.
While I agree that many of the commercial supplements
on the shelves of some drug stores and supermarkets
are made with artificial colors, preservatives,
and low doses of important ingredients, it is
not true in general that supplements are harmful.
In fact, even those conventional supplements
are unlikely to do harm (it is just that they
often contain doses that are below therapeutic
levels).
I lament both forms of misinformation through
advertising, infomercials, newsletters, radio
shows and other media. It is so important for
companies and professionals involved with health
care and complementary/alternative medicine
to stay close to the documented evidence, and
to have reasonable justification for their claims
(for both benefit and harm).
Reliable companies may make justifiable claims
for the benefits of their products. The laws
have recently been updated to allow more claims,
as long as they are scientifically supported.
Even the FDA is taking a more reasonable position
toward more and better public information about
dietary supplements and the health value of
foods. The most likely place the public will
get information about the health value of broccoli,
berries, and beans, or vitamin C, folic acid,
and coenzyme Q10 is at the point of sale, and
more specifically on the label or signs accompanying
the food.
I favor providing as much reliable information
as possible so consumers can make wise choices.
If a few companies abuse their trust and make
false claims, it jeopardizes the future availability
of reliable health information for all of us.
I have been asked by a reader about the relationship
between black cohosh tea and the capsules that
I usually recommend. The reader notes that her
black cohosh herb tea says each bag contains
40 mg, while I recommend 40-mg capsules twice
a day, and she wonders if she can take the tea
instead of the capsules.
These amounts are not comparable. The amount
in the tea is simply the amount of ground up
rhizome (a root-like structure) that is put
in the teabag. Not all of this will get into
the tea after infusion, and it is not a standardized
extract. While fresh and dried herbs and herb
teas are often valuable in management of health
problems, most of the recent research on herbs
is done with standardized extracts, containing
specific levels of known active compounds in
addition to other components of the herb.
Black cohosh is valuable not only for hot flashes,
but also for irritability, nervousness, and
night sweats, as well as insomnia, all of which
may accompany menopause. The usual dose is 40
mg of standardized extract twice a day. This
contains 4 mg of 27-deoxyactein, one of the
active substances called triterpene glycosides.
Numerous studies have shown the value of black
cohosh for treatment of menopausal symptoms.
Recently some researchers have expressed concerns
because of a study in mice suggesting that black
cohosh might be a problem for women who have
undetected breast cancers. While the herb does
not cause breast cancer, this study indicated
that existing breast cancers spread more readily
in treated mice. Their concern was that tumors
in women might metastasize before they were
detected.
It is not yet clear what the mechanism might
be for this effect in mice, and the study has
not yet been analyzed completely. Herbal influences
on hormones might be quite different in mice,
and so far in humans there has been no indication
of significant side effects from black cohosh,
including cancer risk. Another recent study,
from the University of Illinois, showed that
black cohosh did not have estrogenic effects,
and did not stimulate the growth of estrogen-dependent
tumors in mice. Previous studies showed similar
results, so it is not yet appropriate to draw
conclusions from just one study when it is contrary
to other data.
In addition, for prevention of breast cancer
and other tumors, I always recommend dietary
guidelines and supplements that are protective
(low-animal-fat vegetarian diets, lots of fruits
and vegetables, soyfoods, such as tofu and miso,
decaffeinated green tea, plus selenium, vitamins
C and E, folic acid, coenzyme Q10, and omega-3
fatty acids from flaxseeds or fish). These additional
health practices would lessen any potential
negative effect of any other treatment, so the
mouse study should not be viewed in isolation.
Once again, vitamin C is in the news because
it has been shown to protect against heart disease.
As an antioxidant and anti-inflammatory, vitamin
C has a theoretical basis for protecting the
heart and blood vessels, and much information
in the past has suggested that it does. However,
not all studies have confirmed this.
A new report from the Nurses’ Health
Study shows that diet alone is not enough to
provide protection, but that supplements significantly
reduce the incidence of heart disease. The dietary
intake of vitamin C in the study ranged from
61 to 209 mg daily, enough to prevent scurvy,
but apparently not enough to fully benefit the
heart.
In women who consumed 360 mg of vitamin C,
in diet and supplements, the risk of heart disease
was lowered by 28 percent . By itself, supplement
use was associated with reduced risk, probably
because to achieve these high levels, most people
require supplements.
Vitamin C supplements protect the heart, blood
vessels, and other tissues. For example, high
plasma vitamin C levels reduce mortality from
heart disease, cancer, and all causes. In cardiomyopathy,
3 gms of intravenous vitamin C reverses arterial
endothelial dysfunction. Vitamin C also lowers
blood pressure.
An intake of 360 mg reduces the risk of cataract
by 57 percent, and long-term intake of supplements
is associated with a 60 percent reduction of
cataract formation. Thus, for many reasons,
vitamin C supplements are beneficial.
Two new studies show that high saturated fat
consumption increases breast cancer, while some
past studies have dismissed this connection.
(Reducing saturated fat is risk free.)
The Nurses’ Health Study of over 90,000
women, using food frequency questionnaires,
shows that in premenopausal women, 26 to 46
years old, high dietary fat from red meat and
high-fat dairy products led to a 35 to 50 percent
increase in breast cancer. Fat from vegetable
sources, including olive oil, does not increase
the risk.
Research from England, using food diaries,
confirms this information. The relationship
has been overlooked by some researchers, but
it cannot be ignored. In this study women who
consumed 90 gms of fat had double the risk of
those who ate just 37 gms daily.
Weight-loss diets that depend heavily on protein
and fat, and aim for short-term benefits in
weight control, ignore the many long-term risks
of high-fat and high-animal-product diets. In
addition, the supposed benefits in weight loss
have never been documented. Why take such a
risk? High saturated fat intake is associated
with Alzheimer’s disease, dementia, prostate
cancer, arthritis, hypertension, and other ills.
High meat diets are also associated with more
heart disease and cancer, independent of fat
content, perhaps based on iron levels. On the
other hand, fruits, vegetables, soy foods, tea,
whole grains, and fiber are all protective against
cancers.
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Q. Is there any reason that
you do not routinely recommend taking iron in
a multivitamin? SR, via Internet
A. Iron is a very important
nutrient, necessary for red blood cell formation
as the central mineral in hemoglobin. Low iron
leads to anemia, but even without anemia, it
can cause fatigue due to poor cellular energy
production. Iron is also important for muscle
cells, as part of myoglobin, essential for the
storage of oxygen.
With iron deficiency, I definitely do recommend
iron supplements. This may be the result of
poor diet, excessive menstrual bleeding, internal
bleeding (perhaps from ulcers or intestinal
inflammation), or malabsorption. A healthy vegetarian
diet, and normal menstrual bleeding are not
likely to cause iron deficiency.
Excess iron promotes oxidative damage. As a
transition metal, it exists in different electron
states, and can lead to free radical generation.
The risk is particularly associated with heme
iron found in meats, associated with increased
cancer and heart disease, but I am somewhat
cautious with all iron supplements, unless testing
shows a need.
Common iron supplements contain ferrous sulfate,
which often causes gastrointestinal upset and
constipation. When I recommend extra iron, I
usually suggest iron carbonyl (Ferronyl) because
it is safest and is well absorbed with few intestinal
side effects.
Other forms of iron that are better than ferrous
sulfate are ferrous gluconate, ferrous fumarate,
and chelated iron. In addition to a multi with
iron, for significant deficiency it is usually
essential that extra iron be added to the treatment
program (50 to 100 mg of iron carbonyl).
Bodinet C, Freudenstein J,
Influence of Cimicifuga racemosa on the proliferation
of estrogen receptor-positive human breast cancer
cells. Breast Cancer Res Treat. 2002 Nov;76(1):1-10.
Mahady GB, Is black cohosh
estrogenic? Nutr Rev. 2003 May;61(5 Pt 1):183-6.
Mahady GB, et al., Black
cohosh: an alternative therapy for menopause?
Nutr Clin Care. 2002 Nov-Dec;5(6):283-9.
Amato P, et al., Estrogenic
activity of herbs commonly used as remedies
for menopausal symptoms. Menopause. 2002 Mar-Apr;9(2):145-50.
Huntley A, Ernst E, A systematic
review of the safety of black cohosh. Menopause.
2003 Jan-Feb;10(1):58-64.
Osganian SK, et al., Dietary
carotenoids and risk of coronary artery disease
in women. Am J Clin Nutr 2003 Jun;77(6):1390-9.
Khaw KT, et al., Relation
between plasma ascorbic acid and mortality in
men and women...Lancet 2001 Mar 3;357(9257):657-63.
Richartz BM, Reversibility
of...endothelial vasomotor dysfunction ...acute
effects of vitamin C. Am J Cardiol 2001 Nov
1;88(9):1001-5.
Bates CJ, et al., Does vitamin
C reduce blood pressure? Results of a large
study of people aged 65 or older. J Hypertens
1998 Jul;16(7):925-32.
Taylor A, et al., Long-term
intake of vitamins and carotenoids and ...[cataract].
Am J Clin Nutr 2002 Mar;75(3):540-9.
Valero MP, et al., Vitamin
C is associated with reduced risk of cataract...
J Nutr 2002 Jun;132(6):1299-306.
Cho, E, et al., Premenopausal
fat intake and risk of breast cancer. J Natl
Cancer Inst, 2003, July 16;95(14):1079-1085.
Bingham S, et al., Are imprecise
methods obscuring a relation between fat and
breast cancer? Lancet 2003 July 19;362(9379)
Kalmijn S, et al., Dietary
fat intake and the risk of incident dementia
in the Rotterdam Study. Ann Neurol 1997 Nov;42(5):776-82.
Luchsinger JA, et al., Caloric
intake and the risk of Alzheimer disease. Arch
Neurol 2002 Aug;59(8):1258-63.
Hayes RB, et al., Dietary
factors and risks for prostate cancer... Cancer
Epidemiol Biomarkers Prev 1999 Jan;8(1):25-34.
Roberts CK, et al., Enhanced
NO inactivation and hypertension induced by
a high-fat, refined-carbohydrate diet. Hypertension
2000 Sep;36(3):423-9.
Adam O, Nutrition as adjuvant
therapy in chronic polyarthritis. Z Rheumatol
1993 Sep-Oct;52(5):275-80.
Klipstein-Grobusch K, et
al., High dietary iron associated with increased
MI risk in elderly. Am J Epidemiol 1999;149:421-8.
Cross AJ, et al., Haem, not
protein or inorganic iron, is responsible for
endogenous intestinal N-nitrosation arising
from red meat. Cancer Res 2003 May 15;63(10):2358-60.
Obesity increases the risk of Alzheimer’s
disease (Gustafson D,
et al., An 18-year follow-up of overweight and
risk of Alzheimer disease. Arch Intern Med.
2003 Jul 14;163(13):1524-8). Researchers
in Sweden followed 392 women who were not demented
from the time they were 70 until 88 years old.
Alzheimer’s developed more frequently
in those whose body mass index (BMI) was higher.
For every one point increase in BMI, the risk
increased by 36 percent. Those who were overweight
at 70 had a higher risk than those who became
overweight during those years. This is one more
of many reasons to try to control weight through
diet and exercise.
Vitamin E supplements reduce the risk of bladder
cancer, but in this report, it was only effective
if taken for 10 years or more. (Jacobs
EJ, et al., Vitamin C and vitamin E supplement
use and bladder cancer... Am J Epidemiol 2002
Dec 1;156(11):1002-10.) This may be due
to antioxidant activity, inactivation of some
carcinogens, or other actions of vitamin E.
This confirms previous studies. It is important
to take supplements for the long term. Regarding
supplements and other health practices, it is
never too soon and never too late to start taking
care of yourself.
Although the soft drink companies deny that
their beverages are related to any health problems
or obesity, it is now clear that such high sugar
drinks cause children to get fat (Mrdjenovic
G, Levitsky DA, Nutritional and energetic consequences
of sweetened drink consumption... J Pediatr.
2003 Jun;142(6):604-10). The children
who consumed soft drinks failed to reduce their
food consumption. As a result they ate 244 more
calories per day, and in 8 weeks gained 0.8
pound more than their peers with lower sugar
drink consumption.
Occasionally I like to cook fruits for some
variety and to make a healthy dessert. Here
are three easy and delicious desserts that will
surprise your guests.
- Take a barely ripe banana, slice the skin
open along its inside curve. Cut slightly
across the skin on the bottom, so it will
standup on the flat surface. Put this in the
oven at 350 degrees, and cook until the skin
is brown-black. Wear gloves to squeeze it
open like a baked potato, add some freshly
ground nutmeg and a touch of vanilla inside
and serve hot.
- Core an apple, sprinkle in some cinnamon,
and bake it at 350 until soft.
- Slice pears in half, remove the seeds, drizzle
on some cherry juice (organic is available)
and add some cinnamon. Bake these or microwave
them until soft, and serve them hot or cold.
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