|
Drugs and Grapefruit
Mercury Toxicity
Mercury Protection
Asprin vs.
Supplements
Ask Dr. J:
Lung Disease (COPD)
References
In the Health
News
Diet and Disease
Recipe of the
Month: Whole Wheat Cous
Cous
Dear Friends,
A recent article suggested that grapefruit
sales are down in part because of physicians’
and patients’ concerns that grapefruit
can interfere with the effect of some drugs,
leading to side effects or excessive activity
of those drugs. I should put quotes around the
word “interfere” because it might
just as well read “enhance.”
The common opinion is that grapefruit might
be dangerous for people taking medications.
Another view is that eating grapefruit or drinking
grapefruit juice might reduce the doses of medications
that people have to take. Grapefruit blocks
cytochrome P450 enzymes that are involved in
drug absorption and metabolism, often providing
a greater effect for the same dose.
Lowering a dose of medication while maintaining
benefit would be a good effect, not a bad one,
as long as it is monitored. (Of course, this
may not be seen as a good thing by the pharmaceutical
companies that will sell less medication.) Some
drugs affected by grapefruit juice include antihistamines,
calcium channel blockers, and drugs for cholesterol
(statins), anxiety (Xanax), hypertension, GERD,
depression, and organ rejection.
Doctors and patients need to be in good communication
about this effect (as well as other health care
issues). Patients who are eating grapefruit
or drinking the juice need to tell their doctors
and be consistent in their consumption, and
the doctor needs to make appropriate adjustments
of the medications to account for the increased
effect. One difficulty is that the effect can
vary from one drug to another and from one patient
to another, but that is true of medications
even without grapefruit.
This is not the only situation in which foods
or supplements might alter medication effects.
After my heart valve replacement, while I had
to be on coumadin (an anticoagulant) for a short
time, I was told that I could take vitamin E
as long as I took no more than 400 IU daily.
I was informed that higher doses could enhance
the effect of the coumadin, leading to excessive
bleeding risk. Although I did not think this
was likely, I saw the situation from a different
perspective. If vitamin E could enhance the
effect of coumadin, in theory I could take less
coumadin and get the same effect if I took higher
doses of vitamin E. This would reduce the cost
and the potential side effects of coumadin.
The medical team was surprised by my view that
if you have a choice it would be better to reduce
the medication, and not automatically tell patients
to reduce the dietary supplement. I continued
to take my vitamin E, and noticed no enhancement
of the coumadin effect, but this is not to say
it doesn’t happen. No matter what supplement
you take or what drug you need, it is very important
to stay in close communication with your health
care provider because the effects might not
be consistent for some drugs or different people.
Exposure to toxic heavy metals such as lead,
mercury, arsenic, cadmium, and others poses
a serious health risk. These metals poison enzyme
systems and damage tissues.
Mercury gets into the environment from mining
ore deposits, coal burning, medical waste incineration,
and various manufacturing plants. It is found
in batteries and in dental amalgams (“silver”
fillings).
In the environment, inorganic mercury is converted
by bacteria to methylmercury, which is particularly
toxic. Methylmercury gets into the water supply
and is consumed by fish. Larger fish and scavengers
accumulate more mercury.
Mercury sources in humans come from fish, contaminated
air and water, dental amalgams, and immunizations
containing thimerosol, a preservative. Methylmercury
(or mercury vapors) damages the kidneys, brain,
and developing fetus, and impairs neurological
development in children. It is also a likely
carcinogen.
A number of physicians have associated mercury
with the development of autism in children.
High levels may cause or worsen skin rashes,
mental cloudiness, chronic fatigue, nervousness,
irritability, paresthesias (pins and needles),
and autoimmune disorders.
Out of over 200 studies on the toxicity of
mercury, only one has suggested that mercury
consumption from fish is safe, and this study
is contrary to all of the other data. Of course,
the tuna industry has promoted this study to
suggest that mercury is quite safe during fetal
development and childhood, but it is unwise
to base decisions on this one “outlier”
study.
For healthy children and adults, it is important
to limit exposure to heavy metals and to remove
the ones that have already accumulated. The
Environmental Working Group (www.ewg.org) lists
the most contaminated fish (tuna, Gulf oysters,
sea bass, halibut, and others) and the least
contaminated (wild salmon, flounder, haddock,
farmed trout and catfish, and others).
They point out that the US standards for safety
are among the worst in the world. (Farmed salmon
is usually also contaminated with excessive
levels of toxic PCB’s.) However, you can
do a lot to protect yourself from the dangers
of mercury toxicity, as well as the risks of
other heavy metal excess.
Your most important protection from mercury
and other heavy metal toxicity is prevention.
Avoid excessive immunizations, especially in
children, with thimerosol-preserved vaccines.
Preservative-free vaccines are available for
hepatitis and DTP. If you have tooth decay,
have composite fillings instead of amalgam.
Be careful of other environmental sources,
particularly the listed seafoods. Mercury may
be found in household chemicals, cosmetics,
and medications. It is important to eat organic
foods as much as possible to reduce exposure
to a variety of toxic metals and other chemicals.
If you have been exposed to mecury and other
heavy metals, you can be tested for the level
of exposure. Everyone has some of these elements
in their system, but they do not always cause
symptoms or chronic problems. The best test
is to have a urine toxic metal screen after
taking a dose of a chelating agent (one that
binds with metals and carries them into the
urine).
This challenge test has to be interpreted correctly,
as any chelator will increase the urine level
of particular metals, so the level has to be
especially high to suggest toxicity, and it
should be associated with symptoms. If the level
is only moderately elevated, it is important
to look for other causes of the health problems.
Symptoms caused by high mercury levels can
be treated with continued doses of the chelating
agents that are used for the test. I recommend
DMSA (dimercaptosuccinic acid) for the test
and treatment. It is effective and has very
low risk. It is also now available without a
prescription.
I recommend oral DMSA over intravenous DMPS
for mercury and lead excess, as it is less expensive,
and more effective in protecting the brain.
It is also valuable to take other sulfur-containing
supplements, such as alpha-lipoic acid, and
N-acetyl cysteine (NAC) (animal studies show
that it is effective in eliminating methylmercury).
At the same time, I recommend supplements that
help detoxify the body or displace heavy metals,
including zinc, selenium, and vitamin C.
Low-dose aspirin is commonly recommended for
prevention of heart disease and reduction of
excessive blood clotting within the arteries.
The benefits in reduction of heart deaths is
outweighed by the complications, unless the
risk of a coronary is high (one percent/year
or more; in other words, mainly patients who
have already had a coronary thrombosis).
I have written before about the risks of aspirin,
as even low doses are associated with increased
gastrointestinal bleeding. In one study, doses
of 325 mg (one aspirin tablet), 81 mg (a baby
aspirin), or even 10 mg daily all induced significant
gastric mucosal or duodenal damage.
Aspirin also induces kidney damage. Low dose
therapy reduces the ability of the kidneys to
clear waste from the blood. Within just one
week of taking daily aspirin, uric acid and
creatinine clearance are impaired. Creatinine
clearance stayed low even a week after stopping
aspirin.
Aspirin is effective at reducing platelet adhesiveness.
Platelets initiate blood clotting by clumping
together when they are disturbed in several
ways, but other substances also reduce platelet
stickiness without side effects. Grape flavonoids
reduce platelet clumping by 77 percent. Vitamins
C and E (mixed tocopherols only) significantly
reduce platelet aggregation.
Ginkgo biloba inhibits platelet activating
factor. In addition, 120 to 240 mg of standardized
extract reduces claudication, improves memory
and mood in Alzheimer’s patients, and
relieves tinnitus. It also contains potent antioxidants.
Platelet aggregation is inhibited by garlic,
curcumin, ginseng, ginger, fish oil and other
natural and safe substances. Animal fat increases
platelet aggregation. Aspirin is unnecessary
if you attend to your diet and supplements.
|
|
Q. What would
be a good supplement or supplements for COPD
and the accompanying shortness of breath? CC,
via email
A. Chronic obstructive pulmonary
disease, or COPD, is the result of chronic damage
to the lining of the lungs, usually from smoking,
but also from other causes, such as chronic
bronchitis. It is commonly associated with emphysema,
an irreversible destruction of the air sacs
(alveoli) and loss of elasticity of the lungs.
Shortness of breath is the primary symptom
of COPD, and severity is determined by how much
air someone can force out in one second (FEV1).
Treatment is with drugs to dilate the bronchi
and thin the mucus secretions, and steroids.
A high-fat diet increases the symptoms. Eat
lots of fruits and vegetables for their antioxidant
components. Also, take supplements that help
mucous membranes and reduce shortness of breath,
including vitamin C (4 gms/d), vitamin E (400
to 800 IU of mixed tocopherols), gamma-linolenic
acid (240 mg from borage oil), omega-3 fatty
acids (fish oil and flaxseed oil), and a variety
of flavonoids (1 to 2 gms). N-acetyl cysteine
(NAC, 1 to 2 gm) helps loosen secretions and
is a good antioxidant.
Lung function is a significant predictor of
mortality, so it is important to avoid smoke
and air pollution and follow healthy supplement
guidelines and a low-fat diet.
Lohezic-Le Devehat F, et
al., Grapefruit juice and drugs... Therapie
2002 Sep-Oct;57(5):432-45.
Why grapefruit sales are
souring. Wall St. Journal, July 17, 2003
Forman J, et al., ...mercury
exposure cases treated with ... (DMSA) Environ
Health Perspect. 2000 Jun;108(6):575-7.
Fournier L, et al., [DMSA]
treatment of heavy metal poisoning... Med Toxicol
Adverse Drug Exp. 1988 Nov-Dec;3(6):499-504.
Aaseth J, et al., Treatment
of mercury and lead poisonings with
[DMSA] and [DMPS]. A review. Analyst 1995 Mar;120(3):853-4.
Ballatori N, et al., N-acetylcysteine
as an antidote in methylmercury poisoning. Environ
Health Perspect 1998 May;106(5):267-71.
Sanmuganathan PS, et al.,
Aspirin for primary prevention of coronary heart
disease: safety and absolute benefit... Heart
2001 Mar;85(3):265-271.
Cryer B, Feldman M, Effects
of very low dose...aspirin therapy on...mucosal
injury... Gastroenterology 1999 Jul;117(1):17-25.
Caspi D, et al., The effect
of mini-dose aspirin on renal function...in
elderly patients. Arthritis Rheum 2000 Jan;43(1):103-8.
Keevil JG, et al., Grape
juice, but not orange juice or grapefruit juice,
inhibits human platelet aggregation. J Nutr
2000 Jan;130
(1):53-6.
Schindler TH, et al., Effect
of vitamin C on platelet aggregation in smokers
and nonsmokers. Med Klin 2002 May 15;97(5):263-9.
Akiba S, et al., Inhibitory
effect of the leaf extract of Ginkgo biloba
L. on oxidative stress-induced platelet aggregation.
Biochem Mol Biol Int 1998 Dec;46(6):1243-8.
Srivastava KC, et al., Curcumin...inhibits
aggregation...in...platelets. Prostaglandins
Leukot Essent Fatty Acids 1995 Apr;52
(4):223-7.
Verma SK, et al., Effect
of ginger on platelet aggregation in man. Indian
J Med Res 1993 Oct;98:240-2.
Legnani C, et al., Effects
of...garlic...on...platelet aggregation in healthy
subjects. Arzneimittelforschung 1993 Feb;43(2):119-22.
Liu M, et al., Mixed tocopherols
inhibit platelet aggregation in humans... Am
J Clin Nutr 2003 Mar;77(3):700-6
A new study in Japan shows that supplements
of the hormone DHEA (dehydroepiandrosterone)
can improve blood vessel function and increase
insulin sensitivity. Taking 25 mg of DHEA enhances
blood flow through the arteries by protecting
the endothelium, reduces sugar levels in the
blood without changing insulin levels, and lowers
the amount of plasminogen activator inhibitor,
preventing excessive blood clotting. These changes
all have the potential to reduce the risk of
heart disease and diabetes. (Kawano
H, et al., Dehydroepiandrosterone supplementation
improves endothelial function and insulin sensitivity
in men. J Clin Endocrinol Metab 2003 Jul;88(7):3190-5.)
The Environmental Working Group has issued
a warning about the dangerous levels of PCB’s
found in farmed salmon (http://www.ewg.org/reports
/farmedPCBs/es.php). PCB’s
(polychlorinated biphenyls) are doxin-like chemicals
that are carcinogenic, impair neurological development
in children, particularly if they are exposed
during pregnancy, and damage immune function.
EWG found high levels in 70 percent of the tested
fish, with 16 times as much PCB’s as the
safer wild salmon. PCB’s accumulate in
farmed salmon because of their diet and the
fattening-up process used to increase their
sale weight.
The UN Food and Agriculture Organization and
the World Health Organization advice on diet
to governments (Reuters,
March 2003) says that to prevent heart
disease, diabetes, cancer, and obesity people
should get most of their calories from complex
carbohydrates, eat adequate but not high protein,
and reduce sugar calories to less than 10 percent
of the diet (this amount of dietary sugar is
less than half that of the typical American
diet).
Cous cous is a traditional North African dish
made with a small, round pasta that is commonly
made from refined wheat, but is available as
whole wheat. It is easy to make a vegetarian
version. Sauté onions, crushed garlic,
and ginger with olive oil. Turn off the heat,
and add cooked chick peas plus diced tomatoes,
carrots, peppers, and summer squash. Boil a
cup of whole wheat cous cous in 1 1/2 cup of
vegetable broth (it only takes a few minutes),
add the cooked vegetables, and simmer until
the broth is absorbed. Add chopped cilantro
and season the dish with lemon or lime, cumin,
and black or cayenne pepper. You can use other
vegetables, such as cauliflower. You can make
this dish with millet instead of cous cous.
Boil a cup of millet in 2 cups of vegetable
broth until most is absorbed, then proceed as
above. Either way, this dish is tasty and nutritious.
|
