May 2002

Letter from Dr. Janson: Healthy Diet Costs
St. John's Wort Research
Other Treatment Options
Vitamin E Protects Muscles
Allergies: Ask Dr. J
In the Health News
Recipe of the Month: Mashed Sweet Potato With Lime
References

Letter from Dr. Janson: Healthy Diet Costs

Dear Friends,
I recently saw a TV discussion group on healthy diets, and one of the commentators was saying that shopping at the health food store was expensive, and several others nodded in almost automatic agreement, as though this were a well-known fact.

It is true that some foods at the health food store, particularly organic foods, are somewhat more expensive than their conventional counterparts. However, it is not true that eating a healthy diet has to be expensive, even if you shop at a health food store. This is a myth, because it totally depends on what you choose.

A healthy diet based on unprocessed fresh vegetables, fruits, whole grains, and legumes is generally quite inexpensive. For example, a nutritious breakfast of oatmeal, banana or shredded apple, and raisins, cooked in dilute soymilk, with sunflower seeds and some cinnamon and nutmeg, usually costs under a dollar (a little more if you use almonds instead of sunflower seeds). It provides a lots of fiber, phytonutrients, and essential fatty acids, and helps to control blood sugar and appetite for a long time.

Similar choices of basic foods as I describe in my recipes for lunch and dinner are just as cost effective. Costs are higher when you buy prepared foods (rice cakes, for example, cost far more than brown rice that you cook; granola is more expensive than oatmeal).

I was recently reducing clutter in my home office (an action that is as therapeutic as any that I recommend in my newsletter!), and while clearing up a pile of papers, I came across a Boston Globe article from 1996. The headline said, "Poor people's diets winning the hearts of the affluent." The winning diet consisted of basic foods, mostly vegetarian, minimally processed, and with varied nutritional content, such as they eat in most of the economically emerging countries. They might eat this way for religious or economic reasons, and sometimes for health reasons, but the fact is they can afford to eat this way, and people in developed countries can't afford not to.

I realize that even when that article was written the costs of eating three meals a day at the fast junk joints (formerly called fast food restaurants) could be quite cheap (in every sense), although that was not the comparison I envisioned. However, the direct costs of the diet are only one consideration. The costs of illness, degenerative diseases, and accelerated aging must be added to the price of the food. And these costs go beyond the monetary to the emotional and spiritual drain on individuals, families, and friends. It is unfortunate that unhealthy diets are now so widely exported to other countries.

In choosing a healthy diet for yourself, you will not only protect your health without straining your pocketbook, but you will set an example for others, and you will add to their health while supporting increased availability of healthy food, and promoting a healthier environment.

St. John's Wort Research
Recent headlines repeating previous negative claims about St. John's wort (SJW) are apparently designed to discredit natural remedies in general, and particularly SJW in this case. So I have to repeat myself in criticizing these reports. The study in question suggested that SJW appears useless in the treatment of moderately severe depression. This is not news and it is not relevant.

No one so far has claimed that SJW is useful for severe depression, only mild to moderate depression, although in the right dose with the right combination of other supplements, it might still help more serious psychiatric illness.

To do a study such as this, and make the claim that SJW is no better than placebo, leaves the reader thinking it is useless. This is misleading at best, and deceitful at worst, and many people may miss out on this beneficial treatment, because other research shows that it is very useful for treatment of other levels of depression.

Interestingly, in this study, published in the Journal of the American Medical Association, Sertraline (Zoloft), a "serious" treatment for depression, and one that generates billions of dollars in sales each year, was also no better than placebo, and for the most part no better than SJW. The report says "On the 2 primary outcome measures, neither sertraline nor H perforatum was significantly different from placebo."

Another study a week later drew the same negative conclusion, in spite of the authors' statement that "The number reaching remission of illness was significantly higher with St John's wort than with placebo."

The newspaper headlines blared the supposed ineffectiveness of SJW, but little mention was made of the uselessness of Zoloft. Perhaps they should have read "Zoloft no better than placebo for severe depression." SJW has been shown to help with mild to moderate depression.

Studies Support St. John's Wort:

For example, a German study published in the British Medical Journal showed that SJW was equivalent to imipramine (Tofranil) in treatment of mild to moderate depression, but with fewer side effects. A 2001 German study showed significant benefit compared to placebo after just 4 weeks on SJW, and the benefits started to appear after just one week.

Another placebo-controlled, double blind study in 1998 showed similar results using standardized extract containing hyperforin, one of the components of SJW. A 1995 study showed similar benefits compared to placebo, and a 70 percent response rate, which is as much as you can see with the drugs. In addition, the SJW also relieved anxiety, and had no side effects in this study.

This does not mean that SJW has no side effects. It can cause sun sensitivity, which is lessened if you divide the dose to three times per day. Interference with some medications is possible, and occasional digestive upset.

It is interesting to note that the lead authors of the JAMA study hold stock in, have received grant money from, and been paid consultants to Pfizer, the manufacturer of Zoloft, and have been paid speakers for this and other drug companies. They note that all the previous studies have flaws (as all studies do), implying that their study corrects all prior research. I don't believe it.

Other Treatment Options
In addition to SJW for depression (the usual dose is 300 mg of standardized extract taken three times a day), I also recommend a number of other treatments. Not surprisingly, regular aerobic exercise frequently helps relieve depression. It is not uncommon to see poor regulation of blood sugar contributing to mood abnormalities, so a diet free of sugar and refined foods can help. Food allergens often play a role, and avoiding them may be an essential part of treatment.

Other supplements that help include 5-hydroxy tryptophan (5-HTP 100 to 200 mg daily), which is a precursor of serotonin, one of the neurotransmitters. The SSRI medications (Zoloft, Paxil, Prozac) increase the available serotonin in the junction between nerves, but increasing the production of serotonin can help also.

I have found that B vitamins, zinc, magnesium, and vitamin C are helpful. S-adenosyl methionine (SAMe, 400 to 800 mg) is another valuable treatment. For the elderly, B12 and ginkgo biloba can relieve depression, and finally, melatonin (3 mg at night) can elevate mood.

Vitamin E Protects Muscles
The antioxidant activity of vitamin E is well known, and as a result, it appears to reduce damage to muscles related to oxygen free radicals. A report at the Experimental Biology 2002 conference in San Diego showed that vitamin E can reduce muscle soreness, inflammation, and fatigue that occur after strenuous exercise.

Vitamin E mops up these harmful chemicals, reducing symptoms and aiding recovery. The researchers used 1000 IU of vitamin E in both younger and older age groups. The younger group responded better, but both groups were helped by the supplements. The researchers noted that this is a high dose, and suggested that lower doses might also be effective, although this appears to be purely speculative.

Earlier studies have shown that vitamin E can protect the heart muscle in congestive heart failure, in which the muscle is weak and cannot pump blood as effectively as in healthy people. A study in animals revealed that antioxidant supplements reduced oxidative stress on heart muscles and improved cardiac function.

They used either a combination of vitamins C and E and beta-carotene, or vitamin E alone, and found good results with both regimens, but the combination was better than the single vitamin. The researchers suggested that these antioxidants would help congestive heart failure in humans. I would suggest adding coenzyme Q10.

Allergies: Ask Dr. J
Q. It seems to be a terrible allergy season this year. Any suggestions? (J.R., Connecticut)

A. Probably because of the warm winter, especially in the northeast, allergies do seem to be more prevalent this year than most. Symptoms of hay fever or pollen allergies include runny nose, watery eyes, sneezing, conjunctivitis, sinus congestion, or even cough, and asthmatic breathing.

Staying away from food allergens is a good start, particularly milk products, which always seem to exacerbate the congestion from other allergens. Other foods may be allergens also, but this is individual, so you may need to do some self testing to find out which ones may be causing your sensitivity.

Environmental controls that reduce exposure to allergens, such as a home air filter, hypoallergenic bedding, and air conditioning on hot, humid days, play a large role in reducing symptoms.

Supplements can also help a lot with both allergies and asthma. Vitamin C (2 to 6 gms daily) reduces the histamine response, and has anti-inflammatory benefits. Vitamin B6 (50 to 200 mg) and magnesium (500 to 1000 mg) both relax the airways and are useful treatments, especially if asthma is part of the allergic response.

Quercetin is a bioflavonoid that reduces the histamine release from the tissue mast cells and blood basophils. It works by stabilizing the cell membranes and making them less sensitive to the allergic trigger for histamine release. The usual dose is 800 to 1200 mg daily.

Nettle (250 to 1000 mg of standardized extract) is an herb with a long history of use for inflammation and allergies. It works fairly quickly to reduce symptoms such as runny nose, sinus congestion, and watery eyes.

In the Health News
a. Antioxidant vitamins are associated with protection of the heart from atherosclerosis. A new study shows that heart transplant patients, 70 percent of whom develop atherosclerosis within 3 years, are protected by supplements of vitamins C and E (Fang JC, et al., Effect of vitamins C and E on progression of transplant-associated arteriosclerosis: a randomised trial. Lancet 2002 Mar 30;359(9312):1108-13). It is suspected that the transplant operation itself leads to oxidative stress that increases the risk of atherosclerosis. The researchers gave supplements of 500 mg of vitamin C and 400 IU of vitamin E twice a day and compared this to a placebo. They measured damage to the lining cells in the arteries, and found significant protection in those subjects receiving the vitamin supplements.

b. Antibiotics in animal feed and overuse in humans is an increasingly serious problem. About 50 percent of all antibiotics in the US are put into animal feed as a growth enhancer. The European Union has just banned such use of antibiotics in animal feed (Reuters Health, March 25, 2002). In the US, overuse of antibiotic prescriptions has led to increasing resistance of group A Strep to erythromycin and azithromycin (Martin JM, et al., N Engl J Med 2002 Apr 18;346(16):1200-6). Reducing unnecessary prescriptions can reverese this trend.

Recipe of the Month: Mashed Sweet Potato with Lime
For those of you who want a side dish rich in natural carotenoids and the vitamin C and other beneficial phytochemicals found in lime juice, this one is delicious and simple. Wash, trim, and cut two or three medium sweet potatoes (with or without the peel, your choice, but I usually leave it on), and put them in a steamer until they are quite soft. Squeeze the juice of one or two limes and mash together with the sweet potatoes, into a creamy blend. You can add a pinch of sea salt if you choose. I serve this with a salad and either a piece of wild salmon, or the grilled tofu or grilled portobello mushroom from previous newsletters. You can also make the same dish with butternut squash, or a pumpkin, although these are not usually as rich as the sweet potatoes (or as easy to prepare).

References

Editorial
Boston Globe, September 5, 1996, Poor people's diets winning hearts of affluent.

St. John's Wort and Depression
Hypericum Depression Trial Study Group, Effect of Hypericum perforatum (St John's Wort) in Major Depressive Disorder. JAMA 2002 Apr 10;287(14):1807-14.

Shelton RC, et al., Effectiveness of St John's wort in major depression: a randomized controlled trial. JAMA 2001 Apr 18;285(15):1978-86.

Kalb R, et al., Efficacy and tolerability of hypericum extract WS 5572 versus placebo in mildly to moderately depressed patients. Pharmacopsychiatry 2001 May;34(3):96-103.

Laakmann G, et al., St. John's wort in mild to moderate depression: the relevance of hyperforin for the clinical efficacy. Pharmacopsychiatry 1998 Jun;31 Suppl 1:54-9.

Witte B, et al., Treatment of depressive symptoms with a high concentration hypericum preparation. Fortschr Med 1995 Oct 10;113(28):404-8.

Philipp M, et al., Hypericum extract versus imipramine or placebo in patients with moderate depression... BMJ 1999 Dec 11;319(7224):1534-8.

Penninx BW, et al., Exercise and depressive symptoms... J Gerontol B Psychol Sci Soc Sci 2002 Mar;57(2):P124-32.

Vitamin E and Muscles
Vitamin E May Lessen Post-Workout Muscle Soreness, Reuters Health, April 23, 2002.

Shite J, et al., Antioxidant vitamins attenuate oxidative stress and cardiac dysfunction in tachycardia-induced cardiomyopathy. J Am Coll Cardiol 2001 Nov 15;38(6):1734-40.

Allergies
Middleton E, Effect of flavonoids on basophil histamine release and other secretory systems. Prog Clin Biol Res 1986;213:493-506.

Mittman P, Randomized, double-blind study of freeze-dried Urtica dioica in...allergic rhinitis. Planta Med 1990 Feb;56(1):44-7