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Letter
from Dr. Janson
Macular Degeneration
Healthy Snacks
Ask Dr. J.
In the Health News
A Simple Quick Breakfast
Dear Readers,
Several of my patients have recently asked me
for a supply of Cipro to have on hand “just
in case.” I have advised against it, and I do
not have a supply for myself. It is not because
I don’t believe in the value of antibiotics,
and not out of concern for the public supply
of the product. And it is not because anthrax
is not a potentially serious disease that can
be spread through the mail. (Some patients have
also asked me for natural methods to protect
them from radiation sickness.)
My concern is with people living their everyday
lives trying to protect themselves from all
dangers, however remote. There is an old saying
that “you can’t protect yourself against the
world.” This means that if you focus on all
the dangers simply associated with life, you
will imprison yourself seeking protection against
every possibility. This is futile, a waste of
energy, and a waste of time.
It is also spiritually draining because it
takes you away from the real meaning of life
and your ability to find richness, happiness,
and personal growth every day. If you are depressed
because the sun sets in the evening, you are
destined to miss out on life’s great opportunities,
because the sun will come up tomorrow for many
millions of years. Real concern about immediate
dangers is important, but exaggerated concern
cultivates a habit of fear and a life of anxiety
related to things that you cannot control. Peace
of mind comes from letting go of worry about
world events that you cannot alter, and taking
reasonable precautions with everyday matters.
Anxiety about the remote dangers of life leads
you to focus less energy on the important everyday
health issues that you really can do something
about. You can reduce your risks of heart disease.
You can reduce your risks of cancer. You can
reduce your risk of other degenerative diseases,
such as hypertension, strokes, brain deterioration,
diabetes, macular degeneration and other eye
diseases, arthritis, and digestive disorders,
and you can enhance your immunity to prevent
influenza, which kills over 20,000 people per
year. Most of these conditions can be avoided
or delayed by simple lifestyle changes and a
positive attitude. You can help yourself by
letting go of anxiety and depression about things
that are out of your power, and not let them
prevent you from acting positively.
Every day, over a thousand people die prematurely
from preventable diseases because of their health
choices. You don’t have to be one of them. I
was intrigued to see a cleanup person during
the recent anthrax cases wearing protective
gear but at break had a cigarette dangling from
his mouth. I am convinced that he was in far
more danger from the chronic abuse of the lungs
than from the possibility that he might contract
anthrax. You can beat the odds by taking good
care of yourself, and rest without fear, knowing
that you have done your best to prevent what
you can and ignore what you cannot.
Polls suggest that loss of vision is the most
feared disability. The most common cause of
visual decline is age-related macular degeneration
(ARMD), the deterioration of the macula, the
central area of the retina near the optic nerve.
In fact, in the aged, it is the leading cause
of blindness. The macula is the focal point
of the sharpest vision.
The disease occurs in a “wet” and “dry”form.
In the dry form, the macular cells simply deteriorate,
while in the wet form the retinal blood vessels
rupture and leak blood into the macular area.
As the vision in the macula declines, a person
first loses a small area of central vision.
About 30 percent of those over 75 years old
have the condition.
In time, the central visual loss spreads outward,
and eventually the loss of function makes it
impossible to drive or to read, especially if
the print is small and light, or to do other
everyday tasks. It appears that prolonged or
excessive exposure to sunlight as well as oxygen
free-radical damage contribute to the development
of the condition.
Most of the medical community has thought that
there were no treatments or even ways to prevent
the development or progression of macular degeneration.
However, some doctors have suggested that sunglasses
(or regular glasses) with 100 percent UV blocking
could significantly reduce the deterioration
of the macula associated with aging.
Minerals and Antioxidants
Now a new study published in the Archives of
Ophthalmology shows that high doses of the trace
minerals and antioxidants that alternative medical
doctors have been suggesting for years are indeed
helpful in preventing and treating this eye
disease. This stands to reason if the degeneration
is due to oxygen free-radical damage, induced
in part by sunlight, because that is just the
protection these dietary supplements offer.
Researchers in the Age-Related Eye Disease
Study (AREDS) gave over 3600 subjects in 11
medical centers around the US supplements of
zinc, vitamin E, vitamin C, and beta-carotene
in what they considered to be high doses (high
by conventional medical standards). The actual
doses were 80 mg of zinc with 2 mg of copper,
400 IU of vitamin E, 25,000 IU of beta-carotene,
and 500 mg of vitamin C. (These are significant
doses, especially of zinc, although larger amounts
of vitamins C and E are not unusual among those
who take supplements.)
The subjects in the study were between 55 and
80 years old, and they were followed for over
six years. They had a range of disorders, from
mild changes in the retinal pigment cells to
advanced macular degeneration. In the treatment
group that received both the antioxidants and
the zinc, there was a highly significant 25
to 35 percent reduction in the progression of
the disease, especially in those who had more
advanced disease. The groups that took the zinc
alone and the antioxidants alone both were helped,
but the most benefit was in the group that took
both treatments together.
Although the vitamin C and beta-carotene were
given in doses that can be achieved with very
nutritious diets, the doses of vitamin E and
zinc are impossible to get from diet alone.
However, none of the supplements caused any
sided effects or toxicity during the entire
study, including kidney stones, of which subjects
were warned.
Other Supplements for
ARMD
The researchers in this study mention
the potential benefits of two other carotenoids,
lutein and zeaxanthin, but they did not evaluate
them because there were no supplements commercially
available at the time. They did note that these
nutrients are concentrated in the central retina.
Other studies suggested that these two carotenoids
could reduce the incidence of cataracts, and
they are the only carotenoids found in the lens
of the eye, but these studies had not been reported
when the AREDS study was started.
Other research doctors claim benefits from
other supplements, such as chromium and selenium,
possibly because of the free-radical protection
effects of selenium and the sugar regulation
support from chromium. I also suggest bioflavonoids,
bilberry, quercetin, and taurine for eye health.
It is important to keep in mind the benefits
of obtaining these nutrients as much as possible
from the diet, and the best way to do this is
with a large intake of fresh fruits and vegetables.
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Patients and readers often ask me what
they can eat when they are in a hurry, as we
lead such busy lifestyles today. This seems
more difficult for some people when I ask them
to eliminate from their diets the highly processed
foods containing sugar, white flour, artificial
flavors, colors, preservatives, and hydrogenated
oils.
However, it is not as difficult as it may seem.
Many foods that are healthy are also fast. Nothing
seems quicker than a banana, an apple, a pear,
or a handful of almonds or cashews (unsalted,
please), or a combination of these. I sometimes
have almond butter on apple slices. A peeled
carrot or a celery stick is easy if you plan
in advance, and you can find fresh fruit in
any town.
I also prepare in advance so that I have leftovers
that are easy to manage when I’m out. I like
hummus–a chick pea, sesame, lemon, and garlic
spread–on a slice of whole wheat pita bread,
a brown rice cake, or a whole rye cracker. It
is available at health food stores or ethnic
groceries, or to go from Middle Eastern and
Greek restaurants if you don’t want to make
your own.
I travel frequently, and I usually take snacks
with me because they are hard to find at the
common fast “food” restaurants. Trail mix with
nuts, seeds, and dried fruits travel well, and
they have lots of nutritional value, but try
to avoid those with processed food ingredients,
or lots of salt and sugar.
For plane flights, I take some of these snacks,
and veggie burgers with lettuce and tomato on
whole wheat bread. I garnish it with mustard
or soy mayonnaise and some pepper and other
herbs. I also have sandwiches with my white
bean paté–the recipe is in the July, 2001 issue.
Q. What do you recommend as a supplement
for anxiety or nervousness?
A. This is one of the most common problems
I see, often associated with allergies, hypoglycemia,
fibromyalgia, or other conditions. Before I
review supplements, it is important to realize
that diet, exercise, and relaxation play a large
role in managing anxiety. Avoid sugar, caffeine,
and alcohol, and consider possible food allergens
that might contribute to your symptoms.
Exercise can relieve anxiety, but start slowly
if you are not in shape. Try to work up a sweat
without getting out of breath. Also, regularly
practice some form of relaxation, such as deep
breathing, meditation, yoga, or visualization.
Supplements can be very effective as part of
this program. B complex vitamins make a difference
for many people, especially if they are not
eating well. Niacinamide helps to calm the central
nervous system, similar to some anti-anxiety
drugs.
Magnesium (500 to 1000 mg daily) is a calming
agent, and it has many other benefits as well.
Chromium helps to control blood sugar, so if
that is the problem 200 to 600 mcg a day might
work. The amino acid 5-hydroxytryptophan affects
serotonin levels and helps anxiety and insomnia,
as well as headaches.
Two herbs are very useful. Kava kava, a Polynesian
root used for anxiety and mood elevation (250
to 750 mg) and St. John’s wort, especially if
depression is involved (900 mg daily). I suggest
standardized herbs for best results.
Glucosamine sulfate is known to help relieve
the symptoms of osteoarthritis, and it has no
side effects, unlike the drugs used for treatment.
The typical dose is 1500 to 2000 mg daily. Now
a new report on two double-blind, controlled
three-year studies shows that not only does
it relieve symptoms, but it also slows the progression
of the structural damage to the joints. The
results were presented at the North American
Menopause Society meeting (Reuters Health, October
9, 2001). Symptom relief began within two weeks.
Medications can relieve symptoms while joint
destruction continues, so glucosamine sulfate
is a far better choice.
Diet and Disease
•Dairy products appear to increase the
risk of developing prostate cancer. (Chan JM,
et al., Dairy products, calcium, and prostate
cancer risk in the Physicians’ Health Study.
Am J Clin Nutr 2001 Oct;74(4):549-54.) This
study associates consumption of dairy calcium
with prostate cancer, perhaps by lowering a
form of vitamin D that suppresses prostate cancer
cell growth. Men who ate more than 2.5 dairy
servings (600 mg of calcium) had a 32 percent
greater risk of prostate cancer than men eating
less than a half serving of dairy (150 mg calcium)
daily. Each additional 500 mg of milk calcium
increased the risk 16 percent. Not surprisingly,
Dairy Council representatives dismissed the
findings!
•Fat in the diet worsens heartburn symptoms.
Researchers put graded amounts of acid in the
esophagus and then placed fat or saline in the
small intestine. The fat increased symptoms
more than the acid itself. High fat diets have
other more serious risks, but this one is an
everyday concern for many people. (Meyer JH,
et al., Duodenal fat intensifies the perception
of heartburn. Gut 2001 Nov;49(5):624-8.)
Sometimes this is the hardest meal for
lack of time. A quick way to make it easy is
to eat oatmeal with banana or shredded apple
or pear, and some almonds or sunflower seeds.
A timesaver is to boil water or dilute soy milk
the night before, and put it with the oatmeal
in a wide-mouth thermos jar. In the morning
add the fruit and perhaps some cinnamon and
ground cardomom. Alternatively, you can put
the cereal, spices, and water in the microwave
for 3 to 5 minutes, then add the banana (the
apple can be cooked with the cereal). These
methods save time in preparation and in cleanup.
Other cereals don’t cook as quickly as rolled
oats, but I have had this mixture with buckwheat,
millet, and brown rice. You can use left-over
rice and reheat it with the other ingredients
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