From Apr/May '99

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Beta Carotene: Population studies indicate people with diets rich in beta carotene have less cancer, but in two studies on patients with lung cancer their risk of dying appeared to be increased by this supplement. To explain this finding scientists looked at the effects of beta carotene and smoke on the lungs of ferrets (J Natl Ca Inst 91:60, 1999). Both the groups that received smoke and those who didn’t showed increased tendencies toward cancer cell changes with beta carotene (smokers were worse). Tumor suppressor activities were suppressed and tumor promoter activities were increased by the supplement. The authors stressed, "Beta-carotene from the diet is 100% safe."

Weight loss Herb: Results of a double-blind randomized study of a widely used over-the counter weight loss product, Garcinia cambogia, found no benefit (JAMA 280:1596, 1998). The active ingredient, hydroxycitric acid, is found in at least 14 over-the-counter weight loss products. Back in the 1960s the extract became popular when it was found to suppress fatty acid synthesis, reduce food intake, and curb weight gain in animals. This plant extract, native to India, was given to 135 obese people aged 18-65. Even though the study was supported by the manufacturer of products that contain Garcinia cambogia, the supplement group lost 7 pounds on the average, but the control group lost 9 pounds.

Kava, St. John’s Wort Similar to Drugs: Studies of two herbal preparations, kava kava and St. John’s wort have consistently shown to be as effective as antidepressants (tricyclics -- eg. Elavil) and popular tranquilizers (benzodiazepines -- eg. Valium), with fewer side effects and less mental impairment (Internal Medicine News, January 15, 1990). Kava kava (300 mg) reduced anxiety and did not potentiate the effects of alcohol like tranquilizers. Kava is approved in Germany as an herbal treatment for anxiety, stress, and nervousness. This herb should not be taken by pregnant or nursing women and people with depression. More than 25 studies of St. John’s wort show 900 mg daily to be better than placebo as an antidepressant and as effective as tricyclic antidepressants. The German commission has approved St. John’s wort for treatment of depression with no known contradictions for its use.

Supplement Database: Information on supplements comes from many sources -- botany, chemistry, pharmaceuticals, medicine, and agriculture. Now there is a single site to find over 300,000 citations (often with abstracts) from the published scientific literature dating back to 1986. The address is http://dietary-supplements.info.nih.gov.

DIET AND CANCER PREVENTION

A landmark review in the December 1998 issue of the British Medical Journal, "Diet and the prevention of cancer," concluded, "Diet is one of the most important lifestyle factors and has been estimated to account for up to 80% of the cancers of the large bowel, breast and prostate." (317:1636) Stated another way, "Up to 80% of bowel and breast cancer may be preventable by dietary change." Diet may act by causing cancer from heterocyclic amines in cooked meats, or the lack of cancer protective factors in fruits and vegetables. High energy intakes and higher levels of body fatness may increase estrogen levels which promotes cancer growth. Both meat and alcohol are associated with an increased risk of breast cancer. Other dietary factors that are implicated in breast cancer are low intakes of vegetable and non-starch polysaccharides and low intakes of phytoestrogens, which act as weakly antiestrogenic compounds. The authors tell us clearly, "What is remarkable about the diet-cancer story is the consistency with which certain foods emerge as important in reducing risk across the range of cancers. Vegetables and fruits are almost invariably protective for the major cancers." "Similarly there is consistency for increased risk. High consumption of meat, especially red meat and processed meat, is linked with higher risk of bowel, breast, prostate, and pancreatic cancer."

JM: So why did we have national headlines recently telling us that diet is not a factor in breast cancer? The Journal of the American Medical Association reported a study on March 10, 1999 on the, "Association of dietary intake of fat and fatty acids with risk of breast cancer" by Michelle Holmes (281:914). The researchers found no evidence that lower intake of total fat or specific major types of fatty acids was associated with a decreased risk of breast cancer. This is the second report by the same Harvard researchers on a group of 121,700 women from the Nurses’ Health Study.

The reasons for these finding, that are contrary to the bulk of the research findings and from the conclusion from the British Medical Journal, are discussed in my new book, The McDougall Program for Women on pages 80 to 81. Essentially, this study looks at women who all eat the American diet -- some eat a high-fat version and others a low-fat version. But it is still a diet too high in animal products and processed foods and too low in starches, vegetables and fruits. There are many factors in the rich American diet besides fat that promote cancer, and hundreds of plant properties and chemicals that prevent and reverse cancers.

Why did this negative article on a single study from the Journal of the American Medical Association hit the front page of every newspaper in the country and not the article from the British Medical Journal, that reviewed hundreds of studies before it reached its conclusion? The powerful meat, dairy, and fat industries are interested in everyone hearing that we no longer have to choose our foods carefully. Furthermore, most people in the country like to hear good news about their bad habits. Now they can indulge guiltlessly.

PROTEIN CAUSES KIDNEY STONES

"Acute effects of moderate dietary protein restriction in patients with idiopathic hypercalcuria and calcium nephrolithiasis" by Sandro Giannini in the February 1999 issue of the American Journal of Clinical Nutrition found in patients with high levels of calcium in their urine (hypercalcuria), "moderate protein restriction decreases calcium excretion, mainly through a reduction in bone resorption and renal calcium loss; both are likely due to a decreased exogenous acid load. Moreover, dietary restriction ameliorates the entire lithogenic profile in these patients." (69:267)

Eighteen patients were fed a diet higher in animal protein with 14% of the calories from protein, (59% from red meat, chicken, and dairy products). The American Diet is typically 14% to 20% protein. (People on diets like the Zone are getting 30% protein. And a follower of the Atkin’s diet may be getting a diet of 35% to 75% protein.) The low protein diet was 9% of the calories from protein (43% from animal foods). This resulted in a 31% decrease in calcium lost into the urine.

JM: Kidney stones affect up to 5% of the population, with a recurrence rate in afflicted individuals of 50 to 80 percent. Calcium based stones make up 80 to 95% of the total number of stones people develop. They are most common in men and the average age of onset is in their thirties. Stones usually cause no symptoms until they start to pass through the ureter. With passage, pain begins in the back (flank) and progresses over the next 20 to 60 minutes to become so severe that narcotic drugs are required. Blood is usually found in the urine.

Diet has been recognized as the cause of kidney stones for many years. Industrialized countries have a higher incidence of stones compared to underdeveloped countries; and high dietary protein intake is believed to be the cause. Vegetarians have a low incidence of kidney stones (N Engl J Med 328:833, 1993). High protein intake is known to cause increased calcium excretion. High protein, high meat, diets also increase other substances in the urine that lead to the formation of kidney stones, such as uric acid and oxalic acid. An elevated concentration of calcium in the urine, a condition known as hypercalcuria, is the most frequently found abnormality of people who form stones and is present in up to 60% of patients with kidney stones. Supersaturation of the urine with calcium, oxalic acid, and uric acid leads to the precipitation of a stone.

The average American diet, which is high in protein and low in fruits and vegetables, generates a large amount of acid from the sulfate and phosphate containing amino acids (J Nutr 128:1051, 1998). The highest acid loads are provided by red meat, poultry, fish, and eggs. Some cheeses and grains provide acid. Phosphoric acid from colas is another source of strong acid. The skeleton acts as the primary buffering system for this acid load. The bones dissolve releasing carbonate, sodium and citrates which serve to neutralize the acid. Fruits and vegetables actually provide alkaline materials to neutralized the acids from other sources, thus protecting the bones and preventing kidney stones. The elderly may be even more sensitive to the effects of an acid-laden diet.

Interestingly, the way calcium supplements, such as calcium citrate, lactate, or carbonate may benefit the bones and prevent kidney stones is not from the calcium part of the supplement, but from the buffering activity of the citrate, lactate, or carbonate. Adding alkaline fruits and vegetables to the diet is actually believed to cause people to regain lost bone (J Nutr 128:1051, 1998).

HEART SURGERY KILLS

"Outcomes in patients with acute non-Q-wave myocardial infarction randomly assigned to an invasive as compared with a conservative management strategy" by William Boden in the June 18, 1998 issue of the New England Journal of Medicine found patients "treated initially according to conservative therapy had a significantly lower mortality at hospital discharge, at one month, and at one year." (338:1785) The risk of death for those who underwent invasive therapy--angiography, angioplasty, and/or bypass surgery--was two to three times greater at the time of discharge and at 30 days than those treated conservatively. No subgroup appeared to benefit from an early invasive approach. Patients with signs of serious heart disease, including anterior myocardial infarction, ST depression on electrocardiogram, a reduced ejection fraction, or previous infarction did not fare better with invasive therapy. The authors conclude, "A conservative initial strategy based on an ischemic guided approach to management after infarction is both safe and effective."

JM: Four previous studies have shown similar poor results with invasive treatment by physicians, but still doctors continue to take an aggressive approach (New Engl J Med 338:1838, 1998; Lancet 352:500, 1998). A recent study found the rates for all cardiac procedures was highest in the USA and Brazil, intermediate in Canada and Australia, and lowest in Hungry and Poland (Lancet 352:507, 1998). Yet there was no significant difference in rates of cardiovascular death or myocardial infarction (heart attacks) among these countries. There is a strong association between the availability of angiography and invasive treatment, yet the patients fare no better.

So why does this continue?

According to an accompanying editorial there are several reasons (New Engl J Med 338:1838, 1998). First, many patients and families insist that everything possible be done. Most patients and their doctors tend to believe a conservative approach is obsolete, inadequate, and inferior. Second, in the event of an adverse outcome they may be less likely to sue their doctor -- after all, "he did everything possible," even though the treatment in this case doubled or tripled the patient’s risk of dying. Third, preconceived notions are likely to be embraced. Initial angioplasty after a heart attack is widely recommended and used (even though studies clearly side against the benefits). Lastly, the abundance of facilities that do angioplasty and bypass surgery, all the doctors trained in these procedures, and the huge sums of money the doctors and facilities earn encourages invasive therapy.

So who should be treated aggressively? Those with continued symptoms of low blood supply to the heart (chest pain, for example) despite conservative therapy. Second, those who might benefit from surgery because of previous damage to their left ventricle (an ejection fraction below 50%). Otherwise, you need to defend yourself or a loved one from overly aggressive treatments. Some of the best ways to do this are to insist on research that supports the recommend therapy, followed by independent research on your part (search the National Medical Library at www.nlm.nih.gov). Next, get truly second opinions that have a real chance of substantially differing from the first one.

MERCURY IN FISH

"Effects of prenatal and postnatal methylmercury exposure from fish consumption on neurodevelopment. Outcomes at 66 months of age in the Seychelles Child Development Study," by Philip Davidson in the August 26, 1998 issue of the Journal of the American Medical Association found "a diet high in ocean fish appears no threat to developmental outcomes through 66 months of age" (280:701) The mean maternal hair total mercury level was 6.8 ppm and the mean child hair total mercury level at 66 months (5 1/2 years) was 6.5 ppm.

JM: These findings are in stark contrast to previous work on the toxicity of mercury exposure from fish eating and have been criticized largely because hair analysis is unreliable (JAMA 281:896, 1999). Inorganic mercury is dumped into lakes, rivers, and oceans and is there converted to the toxic form called methylmercury by bacteria. As the methylmercury moves up the food chain it is concentrated and bio magnified in the fat of animals, including fish fat. Methylmercury is toxic to the nervous system. The unborn fetus is most sensitive to this poison. Severe exposure has caused microcephaly (small head), seizures, mental retardation, deafness, and cerebral palsy. Effects may occur at maternal hair concentrations of 10 ppm. The average US concentration is 1 ppm.

Studies of people of the Faroe Islands found mental defects at age 7 years (JAMA 280:737,1998). (The Faroe Islands are found in the North Atlantic, half way between Iceland and Scotland). This island population consumes large amounts of pilot whales with 10 times the concentration of methylmercury, because these animals are even higher on the food chain than fish. Hair mercury concentrations were in the range of 3 to 10 ppm. Dysfunctions of language, attention, and memory, and to a lesser extent visual and motor functions were found in the children.

The republic of Seychelle is located in the Indian Ocean. Most (85%) of the population consumes fish daily. The concentrations in these fish were found to be .05 to 2.0 ppm. Fish in the US averages .13 ppm. Some local fresh water fish have much higher concentrations. Fish samples from the northeast U.S. analyzed in the mid-1990s found an average concentration of .5 ppm in 20% to 100% of the samples.

There are government warnings because of this toxin in fish. The state of Maine advises pregnant and nursing women, as well as children under the age of 8 years to limit or avoid fish consumption. Minnesota also offers similar advice. Fishing advisories have been issued by 41 states because of mercury. Other contaminants, like PCBs, are also recognized toxins to the nervous system, and are found in fish.

People in the US are eating more fish than ever before in hopes of saving themselves from heart disease. But unbeknownst to most of them, they are also taking more toxins into themselves and their unborn. To consume the lowest levels of environmental chemicals you should eat low on the food chain. This means a plant based diet.

SIGNS ENCOURAGE EXERCISE

"Can inexpensive signs encourage the use of stairs? Results from a community intervention" by Ross Andersen in the September 1, 1998 issue of the Annuals of Internal Medicine found an increase in the use of stairs with signs placed beside an escalator with adjacent stairs (129:363). Overall, stair use was increased from 4.8% to 6.9% with signs that promoted health benefits and to 7.2% for those that promoted weight loss benefits. Older persons almost doubled stair use from 5.1% to 8.1% with the health sign and 8.7% with the weight-control sign. Whites increased their stair use while black persons stair use decreased with the health sign. The study was performed by simply observing the choices of 17,901 shoppers during each of three phases lasting a month each (no sign, health sign, and weight control sign). The health sign read "Your heart needs exercise, use the stairs." The weight-control sign read "Improve your waistline, use the stairs."

Some interesting facts presented by the authors include:

* Only 22% of the U.S. adult population are active enough to derive health benefits

* One in four Americans are completely sedentary

* Almost one in two black women are now overweight

* People residing in Washington DC are the least active of all persons in the U.S. Nearly half of all adults are inactive.

* 26% of U.S children watch 4 or more hours of TV daily

* 43% of black children watch 4 or more hours of TV daily

* Obesity has increased from 25% to 33% over the past 12 years

* Inactive people who increase their level of activity decrease their risk of dying from all causes, and especially heart disease

* The greatest health benefits are achieved by moving from a completely sedentary state to moderately activity

* There are 1850 malls in the U.S. The cost of a sign is $60. With a 4% increase in stair use 1.6 million more Americans would take the stairs each day

* Walking up 2 flights of stairs daily would cause the average man to lose nearly 6 pounds in a year

JM: This sign idea could be expanded to encourage people to smoke less, and to drink less coffee and alcohol. Signs in all bars could warn people about the dangers of drunk driving. Restaurants could display signs about the causal connection between the steak they are about to order and heart attack.

POVERTY AND LONG LIFE

"Albanian paradox, another example of protective effect of Mediterranean lifestyle?" by Arjan Gjonca in the December 20/27, 1997 issue of the Lancet found, "This paradox of high adult life expectancy in very-low-income country can be most plausibly explained by diet--namely, low consumption of total energy, meat, and milk products but high consumption of fruit, vegetables, and carbohydrates." (350:1815) Albania is the poorest country in Europe, with gross domestic product of $380 per head (compared with Britain of $18,340). Albania has been isolated from the outside world with virtually no western influence until 1990. Albania life expectancy at birth is surprisingly high at 67.8 years for men and 74.2 years for women--the highest in central and eastern Europe for 1992. A new peak was also recorded among newborn boys--72.8 years--while average future lifetime for infant girls increased to 79.0 years--0.1 year shy of the 1992 record of 79.1 years.

Cardiovascular and coronary death rates in Hungry and Poland are 2-3 times higher than Albania. The paradox is how can a country that spends 75% of its income on food have a life expectancy as high as Western populations--with all of their hospitals, doctors, pharmaceutical medications, and other advancements--spending less than 15% of their income on food? Diet is the explanation. Even within Albania there are striking differences seen. In the northeast, where animal foods are more commonly consumed, people suffer twice the chance of dying from a heart attack compared to those in the southwest where the diet is typically higher in fruits and vegetables.

JM: Since the world is focusing on war-torn Albania and Serbia, I thought you might be interested in knowing a little bit about the health of the Albanians. People suffering economic misery and limited access to health care fare as well as we do and better than many other people living in countries in western Europe. Especially, people from countries just freed from control by the Soviet Union. For example, men of Hungry and Poland have 2 � times the risk of dying of stroke and heart attacks compared with those people of Albania. People in these two countries have very high fat diets, smoke heavily, and exercise little. These people provide an example for us on how to solve our health-care crisis without throwing a lot of money at the problem.

ANTIDEPRESSANTS AND FALLING

A study of 2,428 nursing home residents in Tennessee who were new users of tricyclic antidepressants (Elavil and Sinequan), selective serotonin-reuptake inhibitors (Prozac and Zoloft), or trazodone (Desyrel), found higher rates of falls from each type of drug compared to the nonusers. (N Engl J Med 339:875,1998) Higher doses meant more falls. The authors conclude, "... the preferential use of the newer antidepressants (Prozac and Zoloft) is unlikely to reduce the higher rate of falls among nursing home residents taking antidepressants."

JM: The elderly are very susceptible to falls and related injuries, sometimes serious injuries, such as a broken hip. Drugs which affect the mind increase this risk of falling. Unfortunately, many elderly people are also depressed. So what should be done? The cause of their depression should be addressed rather than trying to suppress the problems with powerful, expensive, and dangerous medications.

The scenario I commonly see is a person retires from a lifetime of employment, or the children are raised and gone, and now there is an abundance of free time to oversleep in the morning and take a nap or two during the day. But sleep produces depressogenic substances causing one to become depressed and in search of relief. (JAMA 267:548, 1992.) In comes the helpful doctor who prescribes an antidepressant, which, unfortunately, has a side effect of drowsiness, causing more sleep. And then more depression. This cycle is easily broken by setting the alarm clock to get only five to seven hours of sleep nightly and refusing to take naps. The relief is dramatic and almost overnight. Becoming a useful, productive person is an additional aid to relieving depression.

Here are three more alternatives to doctor-prescribed drugs to relieve depression. Exercise relieves mild depression and anxiety by producing endorphins in the nervous system. A healthy, low-animal-protein diet, allows the production of neurochemicals, like serotonin, that elevate mood. Herbs can also provide effective mood-altering therapy. Three such herbs have proven effective and relatively safe: St. John’s wort for depression, ginkgo biloba to help with memory and confusion, and kava as a relaxant. Use all of these herbal preparations for their desired effects, but be observant of side effects and discontinue if they occur.

From Apr/May '99

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