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Letter
from Dr. Janson: Real and Imagined Risks
L-Arginine for the Heart
Exercise as Medicine
Ask Dr. J.
In the Health News
Diet and Disease
Recipe of the Month: Mushroom
and Eggplant Skillet Sandwich
References
Dear Friends,
I recently saw two news articles that made me
think of the line "What's wrong with this
picture?" Each one was interesting in itself,
but seeing them in the same week started me
thinking.
The first headline had to do with the presence
of salmonella in processed meat. The USDA had
tried to remove its inspection endorsement from
one meat processor that had repeatedly produced
salmonella-contaminated meat (a very common
problem); the appeals court prevented the USDA
from taking such action.
The end result was that salmonella could more
easily get into the food supply, and consumers
would be responsible for proper handling and
cooking to make sure they were not eating contaminated
food. The implication is that the government
was less able to warn consumers of potential
food hazards (although
the USDA maintains that they are still doing
their job, while they are very disappointed
that they have lost this case).
The second article was a warning to seniors
from the General Accounting Office (GAO) that
they may be "risking their health"
(and wasting money) by taking dietary supplements.
The Associated Press article says that supplements
can have "serious health consequences"
for the elderly, and that they can "aggravate
medical conditions." The GAO report also
warned about possible side effects from herbal
supplements, or that the products might not
work at all.
The juxtaposition of these two articles shows
some misguided governmental priorities. The
Centers for Disease Control estimates that "76
million people get sick, more than 300,000 are
hospitalized, and 5,000 Americans die each year
from foodborne illness," much of it from
contaminated meat. In one study 20 percent of
meat, chicken, turkey, and pork samples were
contaminated with Salmonella (of which 84 percent
were antibiotic resistant). Estimates based
on a German study suggest that 30,000 Americans
get hemorrhagic E. coli infections from meat
contaminated with fecal material during slaughtering
and processing, yet the courts are restricting
the government from warning people about this
specific risk, even though research shows that
people are not knowledgeable about how to handle
foods to prevent these risks. If dietary supplements
led to one-tenth this level of risk, you can
be sure the government would be trying to ban
them altogether.
On the other hand, dietary supplements are
helping millions of people to prevent and treat
chronic degenerative diseases as well as everyday
health problems. Side effects from nutritional
products and herbs are few, and serious side
effects are very rare, while deaths are virtually
non-existent. If we spend time and resources
warning people about unlikely risks, they become
inured to warnings about real risks, and we
waste the energy we need to focus on serious
problems.
Recent research shows that the amino acid L
arginine is valuable as part of a supplement
program for people with angina. In combination
with soy isoflavones and vitamins C, E, and
B-complex, supplements of L-arginine enhanced
exercise tolerance in patients with coronary
artery disease.
These subjects had a 20 percent improvement
in their time on the treadmill compared to the
control group. In addition, their blood vessel
function improved, as measured by the relaxation
of the brachial artery, and they had a better
quality of life, based on a valid health questionnaire.
L-arginine is a non-essential amino acid, but
as with a number of other nutrients and physiological
substances, it is necessary in certain conditions,
and is therefore considered "conditionally
essential." In physical trauma, surgery,
burns, and wounds, L-arginine supplements promote
healing and shorter hospital stays (of course,
the less time you stay in the hospital, the
lower your chance of developing an infection).
L-arginine is also important for restoring immune
function and promoting hormone release, including
insulin and growth hormone.
Previous studies had shown that L-arginine
helps with angina and congestive heart failure.
In one, the effects of L-arginine and exercise
were better for arterial function in heart failure
patients than either intervention alone. In
that study, the researchers used 8 grams of
L-arginine, but the study ranges vary from 2
g to 20 g per day.
L-arginine is a precursor to nitric oxide, a
blood vessel relaxing factor. This helps to
open up the flow of blood to the organs. Improving
blood flow and lowering resistance not only
improves the function of most organs, but it
specifically lowers blood pressure. In research
on animals and humans, L-arginine supplements
significantly improve hypertension, with a 5
to 7 mm drop in both systolic and diastolic
pressures, and supplements were better than
increasing L-arginine from food sources.
These same studies also showed that supplements
can reduce total cholesterol, increase the level
of the good HDL-cholesterol, reduce triglycerides,
and improve regulation of blood sugar. Subjects
on supplements also showed enhanced kidney function
as measured by the ability of the kidneys to
clear creatinine from the blood. L-arginine
reduces the aggregation of platelets, the cells
that initiate blood clots. Excessive aggregation
of platelets can initiate clots inside blood
vessels that lead to heart attacks and strokes.
L-arginine improves the ability of patients
with hardening of the arteries in the legs to
walk without pain (intermittent claudication),
and to increase the total distance they can
go. Because of its blood vessel effects, L-arginine
can also help with male sexual dysfunction.
Erectile dysfunction may result from reduced
penile blood flow, and nitric oxide, which relaxes
the penile blood vessels, is a prerequisite
for normal erections.
The clinical studies are equivocal, however,
as not all of them show benefits in sexual functioning
from taking L-arginine supplements. Perhaps
it is the dose used or the timing of the supplements
that creates the disparity. In one study, measures
of function improved, but the researchers were
not able to demonstrate the physiological causes
for the improvement. Nonetheless, some people
refer to L-arginine as "natural Viagra,"
and it has no apparent side effects.
If you are taking L-arginine for its circulatory
benefits, you also need to attend to your diet
and recognize that the supplement is synergistic
with exercise. A regular exercise program is
important even for patients with heart failure.
Other supportive supplements include L-carnitine,
vitamins C and E, magnesium, garlic, hawthorn
berry, and ginkgo biloba. N-acetyl cysteine
(NAC) significantly reduces the recurrence of
heart attacks in patients on nitroglycerin,
but may increase the headaches that nitro can
cause.
Exercise
Regular exercise is known to enhance brain function
in the elderly. A new study shows that regular
exercise also improves brain function in younger
people. Seven healthy young people were put
on a regular jogging program for three months.
They then took complex computer tests to evaluate
memory and other measures of cognitive function.
Their scores were compared to the values at
the start of the study. At the end, not only
were their scores increased, but the reaction
times were measurably better and they completed
the tasks faster than in the initial testing.
However, if they stopped exercising, their scores
began to fall, indicating that for long term
preservation of brain function it is essential
to continue physical activity.
A number of earlier studies have shown that
exercise helps elderly people improve their
brain function. Not only does their general
cognitive ability improve, but they lower their
risk of Alzheimer's disease and dementia of
all kinds.
It is not clear why exercise is beneficial,
but improved circulation and oxygen availability
to the brain is one possible mechanism. Exercise
also enhances the production of natural antioxidant
molecules in the body called superoxide dismutase
(SOD), and these are protective against functional
decline from free-radical damage.
Other studies report that exercising reduces
the risk of dying of heart disease and lowers
mortality from all causes. Another benefit is
that exercise can improve mood in elderly people
who are frail, and they needn't worry about
pain or discomfort, as even those with arthritis
did not develop pain from the exercise.
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Q. Do you have any advice for treatment of hemorrhoids?
I have pressure on my veins from liver disease
and colon problems. (A.N., Internet)
A. Hemorrhoids are enlarged, varicose veins
in the rectum and anus (internal and external).
They are usually the result of excessive pressure
on the vessels, and may be due to constipation
or diarrhea and straining on the toilet, and
they often develop during pregnancy. The valves
that control the direction of blood flow become
damaged, and then the veins bulge out and the
walls get thin. This is the same mechanism that
leads to varicose veins in the legs.
These veins are very close to the surface,
so when the are bulging and thin they may bleed
during a bowel movement. Just as leg veins may
develop phlebitis, hemorrhoids can become inflamed,
causing discomfort, burning, and itching.
Hemorrhoids are associated with low-fiber diets.
Populations with a high fiber intake have a
very low incidence of hemorrhoids.
If hemorrhoids are severe, they may require
surgery or laser treatment to remove them or
tie them off. However, even with advanced hemorrhoids,
surgery may not be needed if symptoms can be
controlled with diet and supplements, especially
flavonoids (Br J Surg 2000 Jul; 87(7):868-72).
I recommend a high-fiber diet, with plenty
of vegetables, fruits, whole grains, and legumes,
and reduction of animal products (which have
no fiber). I also suggest drinking 6 to 8 glasses
of water a day, because the combination of fiber
and water promotes
easy bowel movements.
Bioflavonoids are anti-inflammatory and help
strengthen vessel walls. I usually suggest mixed
bioflavonoids (2000 mg per day), as well as
vitamins C and E, proanthocyanidins (100 mg),
and a mixture called Varitonin (from QCI Nutritionals
at
www.qcinutritionals.com or 888-922-4848)
with horse chestnut (250 mg), butcher's broom
(50 mg), gotu kola (60 mg) and the flavonoid
hesperidin (125 mg), taken twice a day.
a. Alcohol has been recommended to reduce
heart disease, but a new review suggests that
it has little if any protective effect. Alcohol
did not reduce the risk of having a fatal heart
attack, and it increased the risk of dying from
other causes (Wannamethee SG, Shaper AG, Heart
2002 87: 32-36). Long-term drinkers appear
to have some benefit, but starting to drink
for health does not improve heart risk, and
overall mortality increases. Non-drinkers might
abstain because they are already in poor health,
and that could slant the data. If you are not
a drinker, the present evidence does not indicate
that you should start.
b. Tai Chi, the Chinese art of movement, appears
to give relief from osteoarthritis. Women in
a treatment group had less pain, easier movement,
and better balance than controls (Reuters Health,
December 25, 2001). Earlier studies show that
Tai Chi also lowers blood pressure.
Breast cancer is related to diet and environmental
factors. A new analysis of population data shows
that mortality from breast cancer is increased
by animal fat in the diet, and decreased by
exposure to sunlight, which is essential for
the formation of vitamin D in the skin (Grant
WB, Cancer 2002 Jan 2;94(1):272-81).
(Excessive sunlight, however, increases the
risk of skin cancer.) Vegetables, fruits, whole
grains, and fish all reduce breast cancer mortality.
The author speculated that antioxidants, phytochemicals,
phytoestrogens, and omega-3 oils are protective.
In addition to animal fat, alcohol increases
breast cancer risk. (Other studies show that
high levels of meat and milk consumption can
double and triple the risk of stomach and esophageal
cancer, respectively. Chen H, et al., Am J Clin
Nutr 2002 Jan;75(1):137-44)
I use a covered non-stick electric skillet to
make an easy healthy lunch. Wash several portabello
mushrooms, and slice an eggplant and an onion
to about the same thickness. Coat the mushrooms
in a mixture of olive oil and balsamic vinegar
(or lemon juice) with some ground pepper. Place
them all on the electric skillet (or a large
stovetop skillet--some cover two burners) set
at 375 or medium high on the stove. Cover them
for 5-10 minutes (depending on the size), flip
them over and re-cover. Give them another few
minutes and test to see if they are done. They
should all be soft, and the onions browned and
glassy. Layer them on whole-wheat toast with
mustard or tofu mayonnaise a tomato slice and
lettuce. You can use just eggplant or mushrooms
if one is unavailable.
CDC
Website: www.cdc.gov/foodsafety.
Seniors
warned about dietary supplements, Boston Globe
Sep 14, 01
Baljer
G, Wieler LH, Animals as a source of infections
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Maxwell
AJ, et al., Randomized trial of a medical food
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Maxwell
AJ, et al., Nutritional therapy for peripheral
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Hurson
M, et al., Metabolic effects of arginine in
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Hambrecht
R, et al., Correction of endothelial dysfunction
in... heart failure: ... effects of exercise
training and oral L-arginine supplementation.
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Rector
TS, et al., ...supplemental oral L-arginine
in patients with heart failure. Circulation
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Susic
D, ...Systolic Hypertension...Reversed With
L-Arginine and ACE Inhibition. Hypertension
2001 Dec 1;38(6):1422-6.
Siani
A, et al., Blood pressure...changes during...L-arginine
supplementation. Am J Hypertens 2000 May;13(5
Pt 1):547-51.
Chen
J, et al., Effect of oral administration of
... L-arginine in men with organic erectile
dysfunction... BJU Int 1999 Feb;83(3):269-73.
Ardissino
D, et al., Effect of...nitroglycerin or N-acetylcysteine,
or both, in... angina pectoris. J Am Coll
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Laurin
D, et al., Physical activity and risk of cognitive
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2001
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