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Letter
from Dr. Janson
Dietary Help for the Lungs
More on Diet and the Heart
In the Health News
Recipe of the Month: Peach
Banana Puree
Dear Friends,
Studies continue to show the benefits of lifestyle
change in managing or preventing chronic, degenerative
diseases, such as heart disease, strokes, cancer,
arthritis, and diabetes. An interesting report
on diabetes from a division of the National
Institutes of Health appeared recently that
must have given drug companies some serious
concern.
This study showed that people with poor blood
sugar control, who are at greater risk of developing
type 2 diabetes, can reduce that risk somewhat
by taking the drug metformin (Glucophage), but
they did far better with modest lifestyle changes,
such as regular exercise and diet. The participants
were put on a low fat diet and 30 minutes of
walking 5 times a week.
The group on the drug reduced their risk by
30 percent, compared with an almost 60 percent
reduction in the subjects who adopted the lifestyle
changes. They did not have to exercise heavily
or starve themselves to see these dramatic benefits.
The results of this study were so striking that
the government ended the study a year early.
Also, the benefits for the diet and exercise
group were consistent through many ethnic groups:
African Americans, Hispanic Americans, Asian
Americans, Pacific Islanders, and American Indians,
who are considered to be at high risk for diabetes,
making it unlikely that this is a genetic condition.
The lifestyle changes were also effective for
all weights, and all age ranges. By comparison,
the drug regimen was ineffective for those subjects
who were older or those who were not as overweight.
It is interesting that on another area of the
website of the National Institute of Diabetes
and Digestive and Kidney Diseases (NIDDKD, www.niddk.nih.gov/health)
they have information on alternative medicine,
apparently no longer able to ignore it. They
report that acupuncture and biofeedback might
help the pain of peripheral neuropathy, a nerve
degeneration common in diabetics.
They then mention dietary supplements. They
admit that studies show chromium helps insulin
function (it is a part of “glucose tolerance
factor,” or GTF). They go on to say that
due to insufficient evidence “no recommendations
for supplementation yet exist.” They are
incorrect in that. Many physicians and researchers
include chromium supplements–200 to 1000
mcg per day– as part of their treatment
protocols for diabetes. It is only the NIDDKD
that is behind the times.
They also say that magnesium and vanadium are
helpful in controlling blood sugar and reducing
the complications of diabetes, but they again
make no recommendations, saying that researchers
want to understand how they work first. This
is an unnecessary restraint when such a serious
disease can be prevented or relieved with such
simple, safe measures.
I have previously reported on the benefits
of maintaining good lung function as a way to
improve longevity and well being. In that report,
apples and tomatoes were shown to protect the
lungs and improve lung function tests. Now another
study supports the value of good nutrition in
helping preserve the lungs by preventing and
treating chronic obstructive lung disease.
A good measure of lung function is the forced
expiratory volume in one second (FEV1), or the
ability to expel a large volume of air quickly.
This function is impaired in patients with chronic
bronchitis and emphysema (the combination referred
to as chronic obstructive lung disease, or COLD),
as well as asthma, and other lung diseases.
Using a dietary intake questionnaire, Dutch
researchers showed improvements in FEV1 from
a high intake of several phytochemicals found
in fresh fruits and tea.
They studied catechins, flavonols, and flavones
found in apples, pears, and tea, as well as
other fruits and vegetables, in over 13,000
adults, and they looked for changes in FEV1,
in addition to improvements in symptoms, such
as cough, phlegm production, and shortness of
breath. They concluded that a high intake of
these phytochemicals was beneficial for both
symptoms and tests of lung function.
Other dietary practices may also make a difference
in lung health. Patients with chronic lung disease
were given caloric supplements in a study comparing
the effects of a carbohydrate-rich source with
a fat-rich supplement. The higher fat supplement
produced more shortness of breath than the carbohydrates.
A diet high in vegetables, fruits, whole grains,
and beans provides the most beneficial antioxidants
and phytochemicals.
Other health practices can also preserve
lung function. I am sure I do not even have
to mention the importance of not smoking. Regular
exercise increases lung capacity and helps maintain
circulation, supporting the capacity of the
lungs to oxygenate the blood. Many studies have
shown that exercise is valuable for chronic
lung disease, reducing symptoms and improving
measures of lung function.
Patients with chronic lung disease who participate
in regular exercise rehabilitation programs
show reductions in shortness of breath and greater
exercise capacity, in addition to better psychosocial
function. Moderate aerobic exercise is the usual
practice in these rehab programs.
Other studies show that asthmatics benefit
from a regular exercise program, with increased
exercise tolerance and easier breathing. Children
with asthma also benefit from exercise. They
increase their maximal work load, their oxygen
uptake, and their endurance, while showing a
beneficial decrease in their heart rates. Interestingly,
exercise also enhanced their self-esteem and
coping behavior.
A number of studies show that yoga and related
activities can improve lung function even when
conditions are relatively advanced. In one study
of 570 asthmatics, subjects were able to reduce
or eliminate many of their medications by practicing
yoga positions and meditation after a 2 to 4
week training program. They also improved in
their measures of lung function, and the more
they practiced the better results they had.
They maintained these benefits for up to five
years.
Dietary supplements play a role in lung
health. Antioxidant nutrients, such as vitamins
A, C and E, coenzyme Q10, and carotenoids enhance
FEV1, lung capacity, and oxygenation of the
blood, and they protect mucous membranes. Most
people do not get enough of these vitamins in
their diets, so supplements are valuable.
Folic acid and selenium are both associated
with a reduced risk of lung cancer. Often, soil
and crop selenium levels are low, partly due
to farming methods and partly to prehistoric
glacial activity. The usual recommended amount
of selenium is 200 mcg per day, readily available
in multivitamins or as an individual supplement.
N-acetyl cysteine (NAC), a sulfur-containing
amino acid, is useful in treatment of chronic
lung disease because it helps to loosen secretions,
making it easier to clear the bronchial passages.
NAC is a precursor of the antioxidant glutathione.
It protects the liver from toxins, and it may
also help prevent cancer. Typical doses of NAC
are 500 to 2000 mg per day.
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The relationship between coffee consumption
and heart disease has been controversial. Many
years ago, articles appeared showing an increased
risk of heart disease in people who consumed
more than six cups of coffee a day. Later studies
suggested that “moderate” coffee consumption
did not raise cardiovascular risks. Some research
claimed that perhaps the difference between
filtered and boiled coffee was significant.
(Boiled coffee has more “terpenoids”
that are known to raise cholesterol levels.)
A new article in the American Journal of Clinical
Nutrition suggests that even the consumption
of filtered, caffeinated coffee could increase
risk factors for heart disease. The researchers
took regular coffee drinkers and put them on
a program of no coffee, 1 to 3 cups a day, or
more than 4 cups a day. The relationship to
decaf is not clear.
Those participants who abstained from regular
coffee had a reduction of cholesterol and a
lowered homocysteine compared to their own blood
levels before the study. Elevated homocysteine
is another risk factor for heart disease. Boiled
coffee apparently has a greater effect on cholesterol
levels, as the decline was less after abstention
from filtered coffee.
Of course, coffee has other ill effects, including
increased stomach acid production and reduced
function of the esophageal sphincter, which
might exacerbate the symptoms of ulcers or heartburn,
also known as gastro-esophageal reflux disease
(GERD). In addition, caffeine is a stimulant
that often leads to a post-caffeine depression.
In order to reduce levels of cholesterol and
homocysteine, it is beneficial to make dietary
changes and to take various dietary supplements.
Homocysteine is made from the amino acid methionine,
found in high amounts in meat, chicken, and
eggs. Of course, the fat and cholesterol in
meat are not helpful either (however, cholesterol
consumption is not as important as the cholesterol
that you make in the liver, or the oxidation
of cholesterol from inadequate intake of antioxidant
nutrients).
Folic acid, found in vegetables and whole grains,
can reduce the level of homocysteine. Supplements
are usually needed to make sure you have an
adequate amount if your blood level of homocysteine
is high. The typical dose is 800 to 5000 mcg
a day, depending on your level of homocysteine.
Additionally, supplements of vitamin B12 (cobalamin,
1000 to 2500 mcg daily) and vitamin B6 (pyridoxine,
50 to 200 mg daily) can help lower homocysteine.
If you have a very high level, and these don’t
bring it down to a safer range, you can also
take betaine (trimethyl glycine, 6000 mg daily)
or choline (2000 mg daily) as part of your supplement
regimen.
I have often reported on dietary supplements
for the heart. These include coenzyme Q10, magnesium,
L-carnitine, vitamins E and C, L-arginine, selenium
and others. Phytochemicals, such as the flavonoid
quercetin (found in apples and yellow or red
onions) and proanthocyanidins are also effective
antioxidants.
Fish oil and other sources of omega-3 fatty
acids, and gamma linolenic acid can lower blood
lipids, and platelet aggregation. Many herbs,
such as garlic and hawthorn berry are also beneficial.
It is sometimes claimed that the risk of developing
osteoarthritis is increased among people who
exercise regularly, due to chronic minor joint
damage. Now a study has shown that regular exercisers
are not at increased risk of developing osteoarthritis,
unless they have a significant injury to a joint.
(Sutton AJ, et al., A case-control study to
investigate the relation between low and moderate
levels of physical activity and osteoarthritis
of the knee... Ann Rheum Dis 2001 Aug;60(8):756-64.)
After a knee injury the risk of osteoarthritis
was greatly increased. Some sports are riskier
than others. Be sure to warm up and stretch
adequately to prevent injury (and choose safer
sports).
•Patients with Crohn’s disease,
a chronic inflammatory bowel disorder, have
elevated levels of oxidation byproducts called
“reactive oxygen species.” The measures
of their oxidative stress are significantly
increased, and their levels of antioxidant nutrients
are depressed. (Wendland BE, et al., Lipid peroxidation
and plasma antioxidant micronutrients in Crohn
disease. Am J Clin Nutr 2001 Aug;74(2):259-64).
This results in increased lipid peroxidation,
a cardiovascular risk factor. This may be one
of the explanations for the association of chronic
inflammation with heart disease. The antioxidants
that were lower included ascorbic acid, alpha-
and beta-carotene, lycopene, and beta-cryptoxanthin.
•Research shows that chronic alcohol consumption,
especially liquor, can increase the likelihood
that colon cancer will be unstable, with an
increased likelihood of spreading. Interestingly,
refined grains such as white flour, were also
associated with this increased risk. (Slattery
ML, et al., Int J Cancer 2001 Aug 15;93(4):601-7.)
Diet is related to cancer prevention, and high-fiber
whole grains are far better than refined foods.
This is a great summertime dessert in the height
of peach season. I combine two peaches, two
bananas, and a half cup of strawberries (any
or all of these can be frozen to make the puree
more like a sorbet). I like to add a small piece
of ginger, which gives the dessert a pleasant
tang, usually using about a half-inch piece,
depending on taste. I use a VitaMix, but you
can use a food processor or a blender, even
if the bananas are frozen (the peaches are usually
too hard for a regular blender if they are frozen).
I puree them for about a minute or until smooth.
If you want to thicken it up, you can add ground
flax seeds or a small amount of apple pectin
and let it sit in the refrigerator. This is
a very refreshing blend for evenings on the
patio. Guests will never know how easy it is.
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