November 2003 Newsletter

Plant Sterols and Coke
Emotions and Heart Health
Exercise and Breast Cancer
Nutrition and Diabetes
Ask Dr. J: Varicose Veins

Plant Sterols and Coke

Dear Friends,

Heart disease remains the number one cause of death in the United States and other developed countries. It is clearly due to lifestyle issues, including poor diet, lack of regular exercise, smoking, and a combination of high stress with negative emotional states. Cholesterol also plays a role, but I find it tragically laughable that the Coca Cola company, a purveyor of some of the most unhealthy consumables throughout the world, is now introducing an orange juice that contains cholesterol-lowering substances called plant sterols.

Phytosterols are indeed healthful contributions to the diet, and they are already added to otherwise unhealthful margarines. Coca Cola is introducing them into an orange juice with 110 calories per serving, and recommending two servings a day. Undiluted juice is too high in sugar, which is why I always suggest diluting such drinks by at least half to two thirds. Dilution would reduce the sterols to less than recommended amounts for cholesterol lowering. (Coca Cola, by the way, also owns and markets Odwalla and Samantha juices.)

This news from Coke comes at a time when we also learn that infants from four months to two years old are consuming unhealthy “junk,” such as french fries and soft drinks, including colas, at an alarming rate. The research shows that on the survey day 25 percent of children eat no healthy vegetables or fruits. It is not surprising that even among toddlers the proportion who are overweight is up to 15 percent, and this helps explain why so many older children are obese. These parental decisions, usually made for convenience or out of ignorance, lead to early health problems, especially when children carry these habits into adulthood.

Emotions and Heart Health

Although it is a major contributor, poor diet is not the only influence on heart health. Emotional states (at least in men, in the latest study) play a significant role in the development of cardiovascular heart disease, according to a new study that confirms earlier data. Researchers found that hostility, depression, pessimism, and anxiety increased the risk of heart disease by 6 percent for each increase of one point on the survey score. They also noted that poor concentration contributed to the heart-disease link. The risks were independent of obesity, insulin resistance, or high blood pressure.

It is not yet clear that psychological or drug treatment for emotional states makes any difference in the association with heart disease. However, numerous other studies show that relaxation, yoga, meditation, and related practices can be beneficial for health. In any case, it is always helpful to cultivate the positive feelings and attitudes that enhance the value of living every day.

In the Health News

The newsletter is abbreviated this month because of my relocation to Florida, but here are some valuable health news articles.

Exercise reduces breast cancer risk, even if it is only recreational activity for a few hours a week. Evaluating over 500 women with breast carcinoma in situ (an early cancer) and comparing them with 600 comparable women without cancer, showed that “any” reported physical activity lowered the cancer risk by 35 percent. The activities were walking, jogging, dancing, bicycling, and similar exercises.

Previous studies have shown the value of exercise in cancer prevention, as well as heart health, diabetes, immune function, and more. These researchers already found that exercise helps reduce invasive cancers, with increasing levels of exercise further reducing the risk.

For some exercise benefits, you have to do more than the minimum, but even small amounts of activity are helpful. This is in addition to the sense of well being, higher energy, lessened back pain, and improved sleep that exercise provides.

Patel AV, et al., Recreational physical activity and risk of postmenopausal breast cancer in a large cohort of US women. Cancer Causes Control 2003 Aug;14(6):519-29.

Patel A, et al., Lifetime recreational exercise activity and risk of breast carcinoma in situ. Cancer 15 November 2003;98(10):2861-9. (Online publication 6 October 2003)


A group at Harvard reviewed the nutrition literature to determine the value of different carbohydrates and fats in preventing type II diabetes. They concluded that saturated fat and trans fats (from partially hydrogenated vegetable oils­ – margarine and shortening) increased the risk. Polyunsaturated fats, and especially omega-3 oils (from fish, flaxseeds, walnuts, and a few other nut or seed sources) reduced the risk.

They also urged increases in healthy unrefined carbohydrates that are high in fiber, including unprocessed grains. These foods reduce sugar responses in the blood and lower insulin levels. They were careful to make the distinction between these whole foods and refined, processed carbohydrates. This is important when making dietary choices. Diet fads that lump all carbohydrates together, and restrict them as a whole, are likely to be too low in fiber to be beneficial in the long term. In addition, whole grains and beans provide valuable essential fatty acids. Saturated fats come mainly from meat, whole dairy products, and chicken.

Hu FB, van Dam RM, Liu S, Diet and risk of Type II diabetes: the role of types of fat and carbohydrate. Diabetologia. 2001 Jul;44(7):805-17.

Ask Dr. J

Q. I have varicose veins, and surgery has been recommended. Do you have any suggestions to help me avoid the operating room?
-- VP, by Email.

A. Varicose veins are those in which blood pools as a result of damage to the valves that maintain one-way blood flow back to the heart, and weakness of the vein walls. The damage usually comes from vein pressure in susceptible vessels due to constipation, obesity, inactivity, or pregnancy. It is unlikely that anything could repair the damaged valves, but you may be able to reduce varicosities, especially prominent small veins.

While it is possible that you can help reduce varicose veins with non-surgical methods, it is not clear that any one method will succeed. However, if you do not improve, you can always get surgery later.

I have found it helpful for patients to eat a high fiber diet to prevent further excess pressure on the veins. Fiber retains water in the bowel, and keeps the stool soft and bulky to prevent straining. In addition, it helps to wear support stockings that keep pressure on the outside of the leg, which may prevent pooling of blood in the damaged vessels.

I recommend some supplements that strengthen the vein walls, and others that help reduce the risk of blood clots (thrombi) in the vessels and inflammation (phlebitis). Thrombophlebitis, can lead to dangerous clots traveling to the lungs.

Bioflavonoids (1000 to 2000 mg, daily) help strengthen vessel walls and enhance the value of vitamin C (2000 to 4000 mg), which reduces inflammation and improves vessel strength. The standardized herbs: butcher’s broom ((100 mg), horse chestnut (500 mg), and gotu kola (120 mg) are also helpful, and are available in some combination formulas. Among others, curcumin (600 mg) and fish oil (600 to 1200 mg of EPA/DHA) help to reduce inflammation.