November 2001 Newsletter

Letter from Dr. Janson
Macular Degeneration
Healthy Snacks
Ask Dr. J.
In the Health News
A Simple Quick Breakfast

Letter from Dr. Janson
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.

Macular Degeneration
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.


Healthy Snacks
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 pat��the recipe is in the July, 2001 issue.

Ask Dr. J
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.

In the Health News
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.)

A Simple Quick Breakfast
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.