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Doctors “Just Say No”?
Expensive Urine??
Supplements in Urine
Ask Dr. J: Silymarin
Ask Dr. J: Surgery Supplements
In the Health News
Diet and Disease
Recipe of the Month: Curried
Potatoes (with eggs)
References
Dear Friends,
A recent Wall Street Journal article said some
doctors were increasingly reluctant to recommend
many drugs, both prescription and over the counter,
based on their lack of benefit, potential risks,
and fear of antibiotic resistance. They appear
to be doing this in spite of patients’
desire to receive treatments that they have
heard about on TV or read about in other media.
The doctors have good reason to resist patient
pressure to prescribe drugs for their everyday
illnesses, and especially childhood ailments.
The article noted that doctors are offering
other options for cough and congestion, headaches,
constipation, and infections. Although interest
in alternative medicine is increasing, the report
on conventional doctors shying away from drugs
was a pleasant surprise. I was not so encouraged
when I saw the chart of “alternatives”
to pain pills, decongestants, cough medicines,
and others.
They included “steam showers and fluids”
for congestion, “hot tea with lemon and
honey” for coughs, “cut back on
caffeine and chocolate” for headaches,
“increase fiber and fluids” for
constipation, and “wait and see...”
for infections. While these are not bad recommendations,
they are either inadequate (except for the fiber
and fluids), or they ignore all of the natural
remedies that are available. (Although most
infections are viral, “wait and see”
is insufficient for patient satisfaction, and
ignores all the natural treatments that help
infections.)
Here are some examples of natural remedies:
N-acetyl L-cysteine (NAC) is useful for congestion.
It helps loosen secretions and enhances the
ability to clear mucus from the lungs, ears,
and sinuses. Vitamin C is valuable for immune
support, and as an anti-inflammatory, and you
can also add echinacea, vitamin E, beta 1,3
glucan, and elderberry extract, shown to fight
viruses, including flu. I have reported on zinc
lozenges to help manage viral sore throats and
shorten infections.
For headaches, elimination of caffeine and
chocolate are sound recommendations, but in
addition, other food allergies or alcohol might
be precipitants of migraines, and dietary sugar
may be one of the culprits. Supplements of riboflavin
or standardized feverfew can prevent migraines.
Ginkgo biloba may help, as can 5-hydroxy tryptophan
(5-HTP), as well as stress management and biofeedback.
It is good that highly-promoted and expensive
drugs are getting a reappraisal, as well as
older, inexpensive drugs such as aspirin. The
new ones are frequently ineffective, and no
better than older, less expensive drugs for
the same conditions. With effective natural
remedies available, the drugs are often unnecessary.
I am hoping that these doctors who are realizing
the shortcomings of their current treatments
will investigate further into alternatives,
and take some of the courses in this field,
such as those offered by the American College
for Advancement in Medicine (ACAM).
“Taking dietary supplements is useless
and costly, and it only creates expensive urine.”
It is incredibly frequent that I hear this criticism
of taking vitamins and other dietary supplements.
It is a meaningless comment from a scientific
perspective for a number of reasons.
The assumption behind this statement is that
if you take supplements of nutrients that are
only needed in extremely small quantities, they
will be mostly excreted, and therefore not of
value in promoting health and preventing or
treating disease. This is not simply naive;
it reveals a profound ignorance of the medical
literature on the value of supplements, or a
biased agenda on the part of supplement antagonists.
It is true that a percentage of some high-dose
supplements is excreted in the urine. It is
also true that not all of the vitamins that
you take get absorbed into the bloodstream.
This does not at all mean that they are not
useful. It is not so important whether you excrete
some of the various nutrients; what is important
is what they do on their way through the body
(or on their way through the digestive tract
if they do not get completely absorbed).
One way to look at this is by comparison with
water. Of course you excrete all of the water
that you consume (otherwise you would blow up
like a water balloon). You excrete some through
the urine, some through the intestines, some
through sweat, and some as moisture vapor in
the breath. But the fact that you excrete it
does not mean that you do not need to drink
the water!
Nutrients have benefits through their effects
on cellular metabolism, through antioxidant
activity, and through detoxification of harmful
chemicals and metabolites. They may pass through
cells, but they help those cells on the way.
Vitamin C is a good example. If you take above
about 200 mg per day, you will probably excrete
some in the urine. This does not mean that your
maximum need is 200 mg. Linus Pauling had the
following interpretation:
Your body expends energy to conserve vitamin
C in the kidneys, a waste of energy if you don’t
need that much (wasted energy leads to evolutionary
failure of a species). Above 200 mg, your body
recognizes that you have met the minimum for
the day, and after that if some is lost in the
urine it is not so critical. Pauling concluded
that about 200 mg is the minimum that your body
wants, not the most it can use.
Aside from the theoretical analysis, numerous
studies show that vitamin C supplements are
beneficial for prevention and treatment of illness,
even in doses higher than 200 mg. For example,
2000 mg of vitamin C can prevent exercise induced
asthma in young adults (20 patients were studied,
and 9 of them had significantly reduced symptoms).
Vitamin C is the major antioxidant substance
in the lining of the lungs.
Similar doses of vitamin C have been shown
to reduce the frequency of colds and reduce
symptoms in those who do become ill. With doses
of 1000 mg, the subjects in the active group
also recovered faster than those on placebo.
In another trial in 1977, 500 mg of vitamin
C weekly and 1500 mg at the start of a cold
reduced the severity and days lost to illness,
but not the frequency of colds. The authors
noted that higher doses were unnecessary to
achieve the reduction in symptoms, but they
did not consider that higher doses might also
have reduced cold frequency and helped to further
alleviate symptoms.
Vitamin B2 (riboflavin) is another example
of a high dose vitamin having benefit, despite
urinary excretion. In a randomized, double-blind
study of 55 migraine sufferers, a daily dose
of 400 mg of riboflavin significantly reduced
the incidence of headaches. It is clear that
this dose leads to some B2 excretion (turning
the urine a bright yellow), but it still has
therapeutic value.
Even nutrients that are excreted have value
on their way throught the kidneys, bladder and
urethra. Magnesium and vitamin B6 help to reduce
the formation of kidney stones. Vitamin C helps
prevent inflammation, infection, and cancer.
In one study, high doses of vitamns A, C, E,
and B6 cut the recurrence rate of bladder cancer
in half. Those on the supplements had double
the average survival time.
Have no concern about biased and unscientific
comments when deciding on what nutrients to
take. “Expensive urine” is good
!
Q. Can I take silymarin for my liver continuously,
or do I need to take breaks as with some other
herbs? EJN, England, via Email
A. Silymarin is an extract of milk thistle,
and it is valuable as protection for the liver
under the stress of alcohol damage, hepatitis,
and toxic chemical exposure. It comprises several
potent antioxidant flavonoids, and supplements
help to regenerate damaged liver cells. (It
appears that much of the damage to the liver
in disease states is due to oxidative stress.)
Silymarin also helps immune function by protecting
the white blood cells (lymphocytes) from toxins,
and increasing their production. Cirrhosis patients
may have altered immune function, and this immune
enhancement may be one of its mechanisms of
action. Silymarin also appears to help as a
topical antioxidant to protect against UV and
oxidative damage (along with other topical antioxidants,
vitamins C and E, selenium, zinc, and others).
I have seen no evidence that silymarin causes
any side effects or loses value with regular
use, even if taken consistently for the long
term. In fact, it is likely that for someone
with hepatitis, cirrhosis, or toxic exposures,
it might be a good idea to take silymarin indefinitely.
The usual dose of standardized milk thistle
(80 percent silymarin extract) is 500 to 1000
mg.
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Q. How should I alter my supplements for my
upcoming surgery? JM, Lexington, MA, via Email
A. I wrote about nutrients for healing from
trauma and surgery last month, but several readers
asked me to translate that into practical guidelines
before and after surgery. (Herbs also help.)
For about 7 to 10 days before surgery, I suggest
eliminating supplements of ginkgo biloba, garlic,
and more than 400 IU of vitamin E because of
antiplatelet effects, delaying blood clotting.
After surgery, add back the extra vitamin E.
For promotion of the healing process, it depends
somewhat on the specific operation and organs
involved, but in general, for the week before
the procedure, I recommend increasing vitamin
C intake to 8-10 gms daily, plus 2-3 gms of
mixed bioflavonoids. Take L-arginine and L-glutamine
(4-8 gms of each) to promote repair and wound
healing, continuing after the operation for
several weeks, or more if the surgery is extensive.
Increase coenzyme Q10 for its antioxidant value
and immune support. Usually 200 mg is enough,
but it depends on the surgery. Curcumin (600-1200
mg) and silymarin (500 mg) are antioxidants
and anti-inflammatory (and silymarin helps the
liver detoxify the anesthetic.) Bromelain (pineapple
enzyme) hastens tissue repair (10,000 -20,000
MCU) before and after surgery.
Make sure your multi has zinc (30-50 mg), selenium
(200 mcg), manganese (10-20 mg), and other trace
elements as antioxidant cofactors, and for immunity
and tissue repair.
Before and after serious surgery, such as on
the heart: increase coQ10 to 400-800 mg, add
L-carnitine (3-6 gms), N-acetyl cysteine (1-2
gms), lipoic acid (300-600 mg), and proanthocyanidins
(100-200 mg), all to protect the heart and brain,
and D-ribose (10-30 gms), a small sugar molecule
that is important for heart muscle energy.
• A new study shows that menopausal women
who smoke cigarettes or are obese (body mass
index (BMI) over 30) are much more likely to
have moderate or severe hot flashes than women
who have a normal BMI (under 25) and are non-smokers
(Whiteman MK, et al., Smoking, body mass, and
hot flashes in midlife women. Obstet Gynecol
2003 Feb;101(2):264-72.) Women who never smoked
had about half the risk of hot flashes compared
to women who were current smokers. The statistics
were similar for obesity. High BMI doubled the
risk of hot flashes. Supplements can help relieve
hot flashes, and some women need natural hormones,
but losing weight and stopping smoking are risk
free and inexpensive, and may make a big difference.
• Sadly, only 16 percent of Americans
eat the recommended five to nine servings of
fruits and vegetables per day. A survey done
in Minnesota (DeBoer SW, et al., Dietary intake
of fruits, vegetables, and fat in Olmsted County,
Minnesota. Mayo Clin Proc 2003 Feb;78(2):161-6.)
showed that the vast majority eat too much fat
and far too few healthy fruits and vegetables.
Education, especially through setting a good
example, is one way the medical community can
help improve public health.
• The above statistic is particularly
important in light of a recent review of the
value of phytochemicals from vegetables, fruits,
whole grains, beans, nuts, and seeds, and both
flax and olive oils. (Kris-Etherton PM, et al.,
Bioactive compounds in foods: their role in
the prevention of cardiovascular disease and
cancer. Am J Med 2002 Dec 30;113 Suppl 9B:71-88.)
These beneficial compounds provide important
protection against heart disease and cancer,
and they reduce excessive blood clotting and
inflammation, preventing other diseases as well.
I love curry dishes for their flavor as well
as health value. This is a simple and quick
meal or snack. Boil, bake (or, optionally, microwave)
potatoes for as many servings as you want. Slice
them open in a crisscross pattern and drizzle
some flaxseed or olive oil into the crevices.
Sprinkle in curry powder and thyme to taste
(I use a lot, and I also add extra cayenne).
You can then spread chopped cilantro over the
top, and other herbs if you like (fresh dill
is also excellent). You can serve this with
some sliced tomatoes and cucumbers. I also poach
some organic eggs (not just free range, as these
may only see the outdoor light for 10 minutes
per day!), lay them on top of the potatoes,
and slice them to mix with all the other flavors.
Reichenberger F, Tamm M, N-acetylcystein in
the therapy of chronic bronchitis. Pneumologie
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Titus F, et al., 5-Hydroxytryptophan...in the
prophylaxis of migraine. Randomized clinical
trial. Eur Neurol 1986;25(5):327-9.
Cohen HA, et al., Blocking effect of vitamin
C in exercise-induced asthma. Arch Pediatr Adolesc
Med 1997 Apr;151(4):367-70.
Mohsenin V, et al., Effect of ascorbic acid...in
asthmatic subjects. Am Rev Respir Dis 1983 Feb;127(2):143-7.
Anah CO, et al., High dose ascorbic acid in
Nigerian asthmatics. Trop Geogr Med 1980 Jun;32(2):132-7.
Van Straten M, Josling P, Preventing the common
cold with a vitamin C supplement: ... Adv Ther
2002 May-Jun;19(3):151-9.
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.
Schoenen J, et al., Effectiveness of high-dose
riboflavin in migraine prophylaxis... Neurology
1998 Feb;50(2):466-70.
Lamm DL, et al., Megadose vitamins in bladder
cancer. J Urol 1994 Jan;151(1):21-6.
Curhan GC, Intake of vitamins B6 and C and the
risk of kidney stones in women. J Am Soc Nephrol
1999 Apr;10(4):840-5.
Johansson G, et al., Effects of magnesium hydroxide
in renal stone disease. J Am Coll Nutr 1982;1(2):179-85.
Feher J,et al., Oxidative stress in the liver
and biliary tract diseases. Scand J Gastroenterol
Suppl 1998;228:38-46.
Lang I, et al., Hepatoprotective and immunomodulatory
effects of antioxidant therapy. Acta Med Hung
1988;45(3-4):287-95.
Pinnell SR, Cutaneous photodamage, oxidative
stress, and topical antioxidant protection.
J Am Acad Dermatol 2003 Jan;48(1):1-19.
Pauly DF, Pepine CJ, D-Ribose as a supplement
for cardiac energy metabolism. J Cardiovasc
Pharmacol Ther 2000 Oct;5(4):249-58.
Williams JZ, et al., Effect of a specialized
amino acid mixture... Ann Surg 2002 Sep;236(3):369-74;
discussion 374-5.
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