Sunday, November 22, 2009

More on Exercise

The December copy of Nutrition Action, a monthly newsletter published by Center for Science in the Public Interest - - (highly recommended by this writer) has some interesting data on exercise that is a good balance to holiday eating. Here is a summary:

New Brain Cells: Exercise increases blood flow to the brain, and stimulates the growth of new brain cells, synapses, and new blood capillaries. In a study at the University of Illinois, older men and women on an aerobic training program showed an increase in brain volume after 6 months. A control group doing toning and stretching did not develop greater brain volume. The abilities to make logical connections, to navigate in space, and to plan and make decisions are all improved with aerobic exercise.

Cancer protection: Studies on exercise and colon cancer show that the most active people are about 21% less likely to be diagnosed with this disease than the least active people. Numerous studies have shown that women who engage in moderate to vigorous exercise are less likely to get breast cancer. One (but not the only) protective mechanism may be preventing weight gain – weight gain is associated with cancers of the breast (after menopause), colon, uterus, pancreas, and esophagus.

Insulin Sensitivity: Both aerobic exercise and strength training increase the ability of insulin to move blood glucose (sugar) into cells. This is important in the prevention or treatment of diabetes, because in this disease cells become resistant (insensitive) to insulin. As a result, glucose levels rise in the blood instead of entering into cells. Both aerobic and strength training increase the amount of a protein called a glucose transporter, which moves glucose into cells.

­Sitting is dangerous!: A Canadian Study looked at 17,000 adults in a fitness survey, and found that mortality rates after 12 years were related to the amount of time people spent sitting. The mortality rate was 20% in people who sat most of the day, 12% in those who sat about half the day, and 6% in those who rarely sat down. The take home message – stand up and move around. Thirty minutes of exercise a day does not counteract the effects on muscles of prolonged sitting, which in turn effects the regulation of insulin and blood glucose.

Visceral Fat: Fat that lies inside the abdominal cavity is linked to insulin resistance, diabetes, and heart disease and is thus more dangerous than fat found under the skin. A daily brisk 30 minute walk will help to decrease visceral fat – but inactivity results in a rise of visceral fat with aging.

Stroke and Heart Disease: Aerobic exercise lowers the risk of both stroke and heart attack. Aim for 30 minutes or more of brisk walking or other exercise 5-6 days a week.

Blood Pressure: Aerobic exercise can lower blood pressure –the effect may be moderate, but some people are able to get off blood pressure medications.

Broken Bones: Weight bearing aerobic exercise and strength training will help to lessen osteoporosis. A study from Harvard showed that walking for at least 4 hours a week was associated with a 41% lower risk of hip fracture compared with women who walked less than 1 hour a week. More time spent standing was also associated with lower risk. Older people who are physically active are also less likely to fall. Balance and strength training are important to prevent falls

Depression and Anxiety: Numerous studies have shown that physical activity helps to relieve depression. Researchers at Princeton and the University of Colorado are finding that in animals and in the human animal, regular aerobic exercise helps to relieve stress and anxiety.

Exercise in West Marin or where you live: We have a wonderful variety of opportunities to move our bodies here at home: hiking trails, some quite steep and all beautiful, beach walking and running, a new bike path, numerous classes in our community centers, including folk, African, and ballroom dancing, special classes for seniors, and two fitness centers. I’ve left out the soccer fields, aerobic gardening and a lot more. For those who need help to get started, I suggest the buddy system: find a friend, make plans together, and keep each other on track. Hopefully we can all look as good as the Obamas one day.

Sadja Greenwood, MD, MPH past issues on this blog

Monday, November 16, 2009

Go to Health - CoQ10

An enzyme is a protein that acts as a catalyst in chemical reactions in the body, helping to turn simpler molecules into larger and more useful ones. A co-enzyme is a small molecule that enhances the action of an enzyme. Coenzyme Q10 (CoQ10) is a substance found in the mitochondria of every cell in the body, where it helps to transform simple molecules from food into energy. (Mitochondria are tiny energy producing organelles in the cell.) CoQ10 levels are reported to decrease with age, and to be low in people with some chronic diseases, such as heart failure, Parkinson’s disease, and AIDS. The use of statin drugs to reduce cholesterol levels has also been found to lower levels of CoQ10, as CoQ10 and cholesterol are made in the liver by a common biosynthetic pathway. These are the rationales for using CoQ10 as an over-the-counter supplement. Here is some of the evidence:

Parkinson’s disease: A study in 2002 from UC San Diego showed that 1200 mg of CoQ10 daily slowed the progression of Parkinson’s in patients with early onset disease. A larger multi-center clinical trial of 600 patients with Parkinson’s is underway, sponsored by the National Institute of Health, to determine if 1,200 or 2,400 mg of CoQ10 will be more helpful in slowing progression of the disease. Although the supplement has not been shown to have serious side effects, these high doses of CoQ10 should be monitored by a doctor.

Heart Disease: In congestive heart failure, the heart has lost its ability to pump enough blood for all the body’s needs. Fluid may collect in the legs and lungs, and the patient feels substantial fatigue. CoQ10 has been used in this condition, along with usual medical therapies. Although many people use this non-toxic therapy, studies to determine if CoQ10 is helpful in heart failure have not been conclusive so far; another trial is underway.

A trial in India in 1999 showed a significant decrease in blood pressure in hypertensive patients treated with CoQ10 along with their other medications, as did a similar trial in 2001 at the VA Medical Center in Boise. An Australian paper published in 2007 looked at 12 clinical trials of CoQ10 in hypertensive patients, and concluded that it had the potential to lower systolic blood pressure by 17 points and diastolic pressure by 10 points, without serious side effects. This is an important finding, which seems to have been ignored by most doctors.

Many people with elevated serum cholesterol and increased risk of heart attack take medications called statins, which lower the liver’s synthesis of cholesterol, and also of CoQ10. Statins can give side effects such as muscle pain, problems with memory and concentration, mood changes et al. UC San Diego has a helpful website on the side effects of statins and the possible help of CoQ10 with the muscle and cognitive problems that statins can bring.

Gum Disease: there is some evidence that people with swelling, redness, bleeding and pain in their gums improved with topical (mouth rinse or gel) and oral CoQ10 . If you have gingivitis/periodontal disease, talk to your dentist about this approach, and just give it a try.

Male Infertility: A study from the University of Ancona in Italy found that young men with unexplained infertility had greater sperm motility after taking 200 mg of CoQ10 twice daily for 6 months, and 14% of couples achieved pregnancy. A similar study from Shahid Beheshti University in Iran showed a significant improvement in sperm counts and motility in men receiving 300 mg of CoQ10 daily for a year. Further studies are needed to see if these results will translate into achieving pregnancy.

Cancer, AIDS, etc

There are numerous case reports of patients with breast cancer, AIDS and other serious illnesses who benefited from taking CoQ10, often in doses of 300 mg or more daily. These cases have not received adequate study, so I advise my readers to look for the evidence and talk to your doctor for advice.

Supplemental CoQ10: CoQ10 is synthesized by the body and also consumed in food – which is sufficient for healthy people. When indicated for illness, supplemental CoQ10 is best taken in gel form, absorbed with fats in a meal. Doses usually range from 100-300 mg - if you take over 100 mg, use divided doses. Side effects are minimal, and the supplement is considered safe. There is a possible interaction with coumadin (warfarin), so talk to your doctor if you take blood thinners.

Sadja Greenwood, MD, MPH past issues at on this blog

Monday, November 9, 2009

Assisted Suicide and Palliative Sedation

I was helping my sister in her office when she casually handed me a pamphlet for the ‘Exit’ file. It took me a moment to realize that I was in Switzerland, where assisted suicide was legal, and that people knew they could exit their lives under certain conditions. ‘Exit’ is otherwise known as the Association for the Right to Die with Dignity. The dying person must:

*be mentally competent

*have made repeated serious requests

*have an incurable illness

*have intolerable physical or psychological suffering

*have a terminal prognosis

Assisted suicide has been legal in Switzerland since 1940! There are clinics and doctors who assess the patients and provide the medication (usually barbiturates) to cause sleep and then death. Patients come to Switzerland from many countries for assisted suicide, as legal residency is not required. The Swiss government has been criticized for allowing ‘death tourism’, and is now considering stricter guidelines to prevent commercialization of the practice. Patients must be given time to consider their decision, and must freely declare their wish to die. They must have medical certificates from two independent doctors proving their capacity to make the decision, and the existence of a terminal illness. Belgium, Luxembourg and the Netherlands are the other European countries allowing assisted suicide. The Netherlands is the only country in the world that has legalized euthanasia - death by injection – in cases where the patient cannot swallow.

Oregon: Oregon passed a ‘Death with Dignity Act’ in 1994 , which legalized physician assisted suicide with certain restrictions. It was passed by 51.3% of voters; a repeal measure in 1997 was rejected by 60% of voters. The act was challenged by the Bush administration, but upheld by the US Supreme Court (6 to 3) in 2006. People who wish to use the law must:

*be 18 years old or older

*be a Oregon resident

*make 2 oral requests of their doctor, 15 days apart

*provide a written request signed in the presence of 2 witnesses, one of whom is not a relative

*have 2 doctors attest to his/her competency to make the decision

*have a psychological exam if needed

*be fully informed about comfort care, hospice and pain control

*know that s/he can rescind the request at any time

The physician need not be present when the dose is taken, but can be, so long as s/he does not administer the dose. Physicians and pharmacists are not required to take part in the program if they are opposed to it. Oregon has kept careful records of cases under their law – approximately 400 people had died by assisted suicide by 2008. Not everyone who was given the medication used it. Analysis of deaths under the law do not show evidence of abuse – in the sense of overuse by minorities, women, or the disabled.

Washington state: In November 2008 Washington passed a law similar to Oregon’s, by 58% of voters. A state judge in Montana has ruled that doctor assisted suicide is legal under the constitution, but the state is appealing that decision.

Palliative Sedation: Palliative care is comfort care to relieve suffering at the end of life, as is given so expertly by hospices. When suffering is too severe to be alleviated, sedation can be used, not purposefully to hasten death (although it will do so if food, water and other care is withheld), but to put the patient to sleep while the disease takes it course. In California, all doctors must take a course in pain control and palliative sedation, and some hospitals have allotted beds for this purpose.

Fear of death: Fears of intense suffering at the end of life affect most people, especially those with cancer and other debilitating diseases. Laws to allow assisted suicide or the practice of palliative sedation must be monitored extremely carefully to prevent abuse of patient choice and autonomy. That said, they represent – as I see it – an advance in the relief of suffering. It is said that Inuit elders go out on the ice to die alone in the cold. Most of us are not that brave, and may need help at the end of life.

Sadja Greenwood, MD, MPH - past issues on this blog

Tuesday, November 3, 2009

Go to Health - Pomegranate

The pomegranate, an ancient fruit from Persia, created the winter and summer in the myth of Persephone and is thought to be the mythical forbidden fruit in the Garden of Eden. Pomegranates are now in season; as you savor their juicy seeds, think about these recent studies on their health-giving properties. The antioxidant capacity of pomegranate juice has been shown to be three times higher than that of red wine and green tea, based on the evaluation of the free-radical scavenging of the juices.. The principal antioxidant ‘polyphenols’ in pomegranate juice are concentrated in the peel, membranes, and piths of the fruit. Commercial pomegranate juice is obtained by pressing the whole pomegranate fruit. Much of the commercially available pomegranate juice comes from a California variety of pomegranate called Wonderful. The 100% pomegranate juice called ‘POM Wonderful’ is from these fruits, and extracts from the POM Wonderful company have been used in many of the research trials worldwide.

Heart Health Laboratory studies at the University of Naples, Italy, and UCLA show that pomegranate juice increases the activity of nitric oxide, a blood gas that increases blood flow in the heart muscle. Pomegranate was found to be more potent than red wine, concord grape or blueberry juice in this regard.. Research at UCSF by Dr Dean Ornish showed that patients with coronary heart disease had a 17% increase in blood flow to the heart after 3 months of drinking 8.5 ounces of pomegranate juice per day. A control group had an 18% worsening of such blood flow. A study of 10 patients in Israel who were given pomegranate juice daily for a year showed a 30% reduction in the abnormal thickening of blood vessels leading to their brains, and a 12% lowering of their systolic blood pressure

Cancer Studies from UCLA have shown that pomegranate extracts inhibit cancer cell growth in the lab, prevent blood vessel growth to nourish cancer cells, and cause death of cancer cells. A 6 year study at UCLA of men with prostate cancer recurrence after surgery or radiotherapy showed a slower increase in PSA levels when treated with 8 ounces of pomegranate juice daily. Laboratory and animal studies are ongoing on pomegranate extracts and lung, breast and other common cancers.

Arthritis Recent laboratory studies from the University of South Carolina show that pomegranate juice extract inhibits certain white blood cells that cause inflammation. Researchers at Case Western Reserve University found that pomegranate extract added to cartilage samples in the lab was able to stop the degrading of cartilage cells by inflammatory molecules. Studies are ongoing to determine the absorption rate of pomegranate fruit extracts into human cartilage cells.

Erectile Dysfunction A study from the University of Southern California looked at 61 men who had difficulty getting or maintaining an erection. The men drank 8 ounces of pomegranate juice or a placebo beverage with dinner, and switched groups after a month. 47% of subjects reported that their erections improved with pomegranate juice, compared to 32% of men on the placebo. This result did not reach statistical significance, and was not as favorable as a related trial of Cialis (73% of men reported a benefit, vs. 26% on placebo). However, compared to Cialis, there are no known dangerous side effects from pomegranate juice; its benefits may result in increased blood flow to the penis, as noted in the studies in heart disease.

Recipes Many delicious ways of using pomegranate seeds in cooking are found in recipes from the middle east. Rave reviews are given to the book 'Pomegranate, 70 Celebratory Recipes', by Ann Kleinberg. I have just ordered a copy, so call me if you want to come to dinner.
Sadja Greenwood, M.D. MPH