Go to Health - Vitamin K

Vitamin K is a fat-soluble vitamin – a substance essential for the human body. The K comes from the German word for coagulation – or blood clotting. Plants synthesize vitamin K1 (phylooquinone); when we eat green vegetables or certain vegetable oils, bacteria in our guts transform the K1 from food to K2, the main active form in our bodies. Vitamin K is essential for blood clotting and bone strength.

Blood Clotting: As soon as a blood vessel is damaged, the body begins to prevent serious bleeding by many mechanisms. Blood platelets form a plug at the site of injury, and proteins in the blood - called clotting factors – are activated to form fibrin strands which strengthen the platelet plug. Vitamin K is essential for the formation of many of the clotting factors in this process. Since these clotting factors are made in the liver, severe liver disease may result in lower blood levels and a risk of uncontrolled bleeding. Alternatively, some people are at risk of forming clots which could block the flow of blood in arteries to the heart, brain or lungs, resulting in heart attack, stroke or pulmonary embolism. If they take Coumadin as an anticoagulant, the drug works by antagonizing the action of vitamin K. Doctors advise patients on Coumadin to have a reasonably constant amount of green vegetables containing vitamin K in their diets, but not to avoid them..

Bone mineralization: Osteoblasts are bone-forming cells that make proteins essential for bone mineralization. Vitamin K plays a role in the synthesis of these proteins (their activity is also regulated by vitamin D). Population studies have shown a relationship between foods containing vitamin K and hip fracture – the Nurses’ Health Study followed 72,000 women for 10 years and found that those with the highest intake of vitamin K had a significantly lower risk of hip fracture than those with lesser intake. Lettuce was the food contributing the most to vitamin K intake. A similar finding was seen in the Framingham Heart Study of men and women – a 65% lower risk of hip fracture in those in the highest quartile of vitamin K intake from food, compared to those in the lowest, despite no association with bone mineral density. Researchers in Japan used very high doses of supplemental vitamin K in patients on hemodialysis and in osteoporotic women and reported significant reductions in bone loss and fracture risk. However, using supplemental K at doses attainable in the diet has shown mixed results with respect to bone density. There are inconsistencies here that need further research.

Foods containing Vitamin K: A good diet that includes a daily intake of green leafy vegetables is endorsed by all vitamin K researchers. Kale, chard, spinach and broccoli are high in K, and lettuce is moderately high. . Levels of K are not reduced by many cooking methods, however it is unwise to cook most vegetables in abundant water if you discard the cooking water. Canola, soy and olive oils all contain vitamin K. To eat the amount of foods high in K associated with a decreased risk of hip fracture in the Framingham Heart Study, an individual would need to eat at least a cup of cooked dark green vegetables a day, or a large salad of mixed greens. Many multivitamins now include small amounts of Vitamin K1; while this may be helpful, it should not substitute for leafy greens in the diet. Using olive, canola or soy oils instead of butter will increase K intake and provide less saturated fat. Prolonged use of broad spectrum antibiotics may decrease the synthesis of K by intestinal bacteria, so extra care will be needed to get adequate levels from food and multivitamins. Here in California we have access to leafy greens throughout the year, often locally grown. A really easy green vegetable to grow yourself is the fava bean – and you don’t have to wait for the beans to form. Their green leaves are delicious and are becoming a culinary trend in salad or cooked.

Sadja Greenwood, MD, MPH. Past issues on this blog. Leave me a comment if you wish.

More on Exercise

The December copy of Nutrition Action, a monthly newsletter published by Center for Science in the Public Interest - www.cspinet.org - (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

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. https://www.statineffects.com/info/index.htm

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

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

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

Melatonin

The pineal gland, located in the middle of the brain, receives light signals from our eyes, and has been called “the third eye” in times past. The pineal gland secretes a hormone called melatonin, synthesized from the amino acid tryptophan. Melatonin regulates the sleep-wake cycle, making you sleepy and lowering your body temperature as night comes on. Ever since the development of the electric light, we have been changing our sleep-wake cycle, our “chronobiology”, making sleep a problem for many people. Darkness increases melatonin production, while light, especially the blue part of the spectrum, inhibits its production. It’s not surprising that reading or working in bright lights until late at night makes it hard to fall asleep. Scientists at John Carroll University have developed blue-blocking glasses to wear in the evening to facilitate melatonin output. There are also blue-blocking nightlights, to assist you without disturbing your subsequent sleep.. (Blue-blocking glasses and lights are easily available on the internet.)

Insomnia As darkness stimulates melatonin outflow, it is wise to turn down the lights a few hours before bedtime, and/or wear blue-blocking glasses, which can be worn over reading glasses. Vigorous exercise at night blunts the outflow of melatonin, but exercise earlier in the day is known to improve sleep. According to Chinese traditional medicine, a ten minute slow walk in the dark can be helpful to promote sleep; they call it “a thousand steps at bedtime”. Over-the-counter melatonin tablets can be used on occasion for serious insomnia - start with dissolving ½ mg under the tongue about 30 minutes before going to bed. People differ in the dose they need to ensure sleep. Children with chronic sleep problems have also benefited from better sleep and better daytime behavior with occasional very low doses of melatonin. Talk to your pediatrician first!.

Jetlag Travelers across time zones find it useful to use melatonin at the new bedtime, and to expose themselves to bright light, a walk in the sun, in the morning. Long acting melatonin tablets may be the most helpful; start with a low dose such as 1.5 mg, and take more if needed.

Cancer Studies on lab animals suggest that giving melatonin reduces the incidence of breast cancer and slows its growth if the animal has been exposed to chemical carcinogens. Human breast cancer cells implanted into rats showed greater growth when the rats’ melatonin was suppressed. In humans, women who work night shifts – with increased exposure to light at night and corresponding melatonin suppression - show an increased incidence of breast cancer. The growth of prostate cancer cells is also suppressed by adding melatonin to lab cell cultures. Researchers at McMaster University in Toronto looked at multiple European studies on the use of melatonin in different solid cancers, and found that 10-40 mg/day was associated with increased survival rates and beneficial effects on sleep. Other anti-cancer treatments were used at the same time. Melatonin supplements are not regularly given to people with cancer in the US – if you want to try this approach, you should talk to your oncologist about adding melatonin to other treatments.

Sleeping Pill Withdrawal Many people are accustomed to taking a pill in the valium family (a so-called benzodiazepine) or Ambien/Lunesta for sleep on a regular basis. If you are taking a sleeping pill regularly, check with your doctor or pharmacist about its type, and its addictive potential. After a week or two of nightly use, it can be difficult to quit many prescription pills because of the resultant insomnia and nervousness. Withdrawal can cause serious problems and should be managed in gradual steps by a doctor who understands the problem. Some doctors find that melatonin tablets are helpful with the insomnia and anxiety of withdrawal from prescription sleeping pills. There are few good studies on whether melatonin is addictive, but it is believed to be safe in this regard.

Cautions with melatonin Melatonin tablets can make you drowsy, so avoid drinking alcohol after taking them, and avoid driving or operating heavy machinery. Do not take melatonin if you are pregnant or breast feeding. Do not give melatonin to children without the advice of your doctor. Melatonin supplements are associated with vivid dreams in some people.

The best approach to sleep is to do everything you can to let it occur naturally. Melatonin will be released from your pineal gland and give you restful sleep most of the time if you follow certain guidelines. Avoid caffeine and alcohol close to bedtime. Some people metabolize caffeine slowly and need to avoid it entirely or after breakfast. Exercise every day doing something you enjoy, but not too close to bedtime. Try using blue-blocking glasses in the hours before sleep, or listen to music with really dim lights. Many people sleep better after having an orgasm. If you need a sleeping pill occasionally, melatonin is one of the safer formulations, used at the lowest possible dose – such as ½ (0.5) mg. Avoid taking any sleeping pill every night; that way you should avoid addiction.

Sadja Greenwood, MD – past issues at sadjascolumns.blogspot.com. Columns will resume in November.

Go To Health - Chocolate

The first people known to have made chocolate from the cacao tree were members of the ancient cultures of Mexico and Central America. The Maya and Aztec people took the tree from the rainforest - they harvested, fermented, roasted and ground the seeds into a paste. When mixed with water, chile peppers, cornmeal and other ingredients, this paste made a frothy spicy chocolate drink. The word ‘chocolate’ comes from a combination of the terms ‘choco’ (foam) and ‘atl’ (water).

*Nitric Oxide (NO) Dr. Norman Hollenberg at Harvard University has studied the ability of cocoa to increase the amount of nitric oxide (NO) in the body. NO is a gaseous ‘signaling molecule’ that crosses membranes and freely diffuses between cells. It signals the muscular coating around arteries to relax, thus improving blood flow and lowering blood pressure. Several medicines are based on this effect - nitroglycerin is a vasodilator because it is converted to NO in the body and Viagra stimulates erections by the effects of NO on blood vessels in the penis. Another protective effect of NO on the cardiovascular system is its inhibition of blood clotting and the adhesion of white blood cells on the lining of blood vessels.

*Flavonoids – Flavonoids are a group of compounds found widely in plants that produce healthy effects on animals who eat them. Many flavonoids activate the nitric oxide system. Cocoa is one of the richest sources of flavonoids (although current processing techniques reduce the content), Dr. Hollenberg and colleagues in Panama studied the Kuna Indians who live off the coast of Panama; the Kuna drink lightly processed cocoa as their main beverage and therefore have one of the world’s richest diets in flavonoids. The Kuna do not show an increase of blood pressure with aging, or decline in kidney function. Their death rates from heart disease, stroke, diabetes and cancer are markedly lower than those of genetically similar Kuna in mainland Panama, where cocoa is replaced by local foods. The researchers wrote a paper on the Kuna, concluding that “the comparatively lower risk among Kuna in the San Blas islands from the most common causes of morbidity and mortality in much of the world, possibly reflects a very high flavanol intake and sustained nitric oxide synthesis activation. However, there are many risk factors and an observational study cannot provide definitive evidence.”

In the Dutch Zutphen Study, cocoa intake specifically was associated with a 50% reduced risk of cardiovascular mortality between the highest and lowest quintile of intake in 470 elderly men. These epidemiologic data led to the hypothesis that the health benefits of cocoa may be linked to its flavonoids. Both the flavanoid content and the total antioxidant capacity have been shown to increase in plasma after cocoa consumption.

*CocoaVia by Mars The Mars company has been studying the health benefits of chocolate for over a decade, and have isolated the particular flavonol in cocoa that relaxes blood vessels and inhibits clotting. Their formula for this - a trade secret - is in their chocolate bar CocoaVia, along with plant substances (sterols) that lower cholesterol. But there’s a big catch, reports the Harvard Heart Letter - the extra calories and saturated fat in these bars make them less desirable as a daily source of flavonols. A product called ‘Acticoa’ in Europe is said to have the same beneficial ingredients as the Mars bars, but is not available in the US.

*Theobromine Chocolate has a mild stimulating effect due to theobromine, a substance similar to caffeine. People sensitive to caffeine and parents of young children should be cautious about this, and avoid chocolate close to bedtime.

*Healthy Chocolate for You! You can buy organic, fair trade, unsweetened cocoa powder at natural food stores and some supermarkets. Make a cocoa drink with soy milk, 1% milk or hot water, and sweeten it with xylitol (a healthy sugar that’s good for your teeth!) or stevia or both. You can skip sugar by mashing a banana with unsweetened cocoa powder, and add peanut butter if desired. You can make a shake with your favorite ingredients and add cocoa powder and pomegranate concentrate for sweetness. Purists can buy organic, fair trade cocoa nibs and eat them with raisins for sweetness. Buying ‘fair trade’ cocoa or chocolate bars is important, because cocoa producers in Latin America are often badly underpaid and in Africa child labor is a serious problem. The fair trade label ensures that the cocoa workers are decently treated.

Sadja Greenwood, MD MPH, back issues on this blog

Go to Health - Vitamin D Update

The vitamin D story begins with the evolution of human skin color in Africa. The current hypothesis is that early humans had more of the dark pigment melanin in their skins to provide protection against intense sunlight. But melanin can also block the ultraviolet radiation that triggers vitamin D production in the skin. In Africa, we humans produced the right amount of Vitamin D for our health. As we migrated out of Africa to live at higher latitudes, natural selection favored those with lighter skin, who could absorb more vitamin D from sunlight. People with darker skins were more likely to have Vitamin D deficiency and develop rickets. Women with rickets often have a deformed pelvis and have great trouble giving birth, leading to an evolutionary disadvantage. In the early 20^th century (before vitamin supplementation) blacks in the US were 2-3 times more likely to suffer from rickets as whites. Dark-skinned people in higher latitudes need to be exposed to about 6 to 10 times as much sunlight as white-skinned people for the vitamin D in their blood to reach acceptable levels.

Vitamin D, formed on the skin with sun exposure, is a fat soluble vitamin essential for maintaining many body systems. Virtually all of our cells have receptors for Vitamin D. Current studies show the following:

*Osteoporotic fractures - Women who take calcium and vitamin D supplements have been shown to have a lower risk of fractures in the hip and other areas. Levels of supplementation higher than 400 IU daily were needed to achieve these results. D also helps to prevent tooth loss.

*Muscle strength -Vitamin D is helpful in promoting muscle strength and decreasing muscle pain. Recent studies show that vitamin D decreases falls in the elderly.

*Weight Loss - several studies show that overweight people on diets lose more weight when they take calcium and vitamin D. There is much current interest in adding Vitamin D and calcium supplements to all weight loss regimens.

*Heart disease - Low levels of D is associated with an increased risk of heart disease, high blood pressure, insulin resistance and systemic inflammation

*Cancer – a study from University of California San Diego has shown that higher serum levels of vitamin D are associated with substantially lower rates of colon, breast, ovarian, renal, pancreatic, aggressive prostate and other cancers. The authors of this study conclude that raising serum D in the population to optimum levels (40 to 60 ng/mL) could prevent approximately 58,000 new cases of breast cancer and 49,000 new cases of colorectal cancer each year, and three fourths of deaths from these diseases in the United States and Canada, (This is an astounding theory, and if even partially true it could prevent a great deal of suffering.)

* Autoimmune disease Adequate vitamin D levels may decrease the risk of autoimmune diseases such as type 1 diabetes, multiple sclerosis and rheumatoid arthritis.

* Memory loss with aging A recent English study showed that seniors with the lowest levels of vitamin D were twice as likely to have cognitive impairment (memory, attention span and orientation in time and space) as those with the highest levels of vitamin D. A study from Tufts University in Boston showed that seniors with higher levels of vitamin D did better with planning, organizing and thinking abstractly, and also were less likely to show damage to small blood vessels in the brain.

*Respiratory infections people of all ages with low levels of D are more at risk for colds and other respiratory infections, including tuberculosis. This finding is more important in the current flu season.

*Seasonal affective disorder (winter blues) and depression - Studies are beginning on the use of Vitamin D for SAD, which may be more effective than light therapy.

*Vitamin D deficiency in the US More than 75% of Americans have less than optimum levels of D according to a nationwide nutrition study from 2001-2004. Increasing skin protection from sunburns, less outdoor activity, and declining milk consumption may explain the decrease. Also low levels of vitamin D are associated with obesity, which has been increasing in this country.

How to get enough Vitamin D - Since Vitamin D plays such an important role in health, what should you do to protect yourself? You can start by having your health care provider order a test for a blood level of 25 hydroxy vitamin D. A level above 30 ng/ml is desirable, and 40-60 ng/ml is considered optimum. To achieve this level without high sun exposure, which can carry risks of skin cancer and skin aging, most adults in our area need to supplement with at least 1000 IU daily, and may need more. You can increase this amount until you have the desirable blood level of D. If getting a blood level for D is not practical for you, you will be safe with 1000-2000 IU daily. The researchers at UCSD (see above - Cancer) suggest 2000 IU daily, and affirm its lack of risks.. We form very little Vitamin D on our skin between October and March at this latitude. People with darker skin absorb Vitamin D from the sun more slowly, and may need higher levels of supplementation.

: Sadja Greenwood, MD, MPH –back issues at on this blog

Go to Health: Oats

Oats have been grown for human food and for livestock since ancient times. In Samuel Johnson's dictionary, oats were defined as "eaten by people in Scotland, but fit only for horses in England." The Scotsman's retort "That's why England has such good horses, and Scotland has such fine men.”

The Hype on Oats & Cholesterol: After the publication of several articles in the 1980’s on the value of oats to lower cholesterol, oat products from candy bars to pasta to chips were promoted with exaggerated claims for health and weight loss.

The Evidence: Oats contain more soluble fiber than other grains; a soluble fiber called beta-glucan is especially valuable, and is found in oats, barley, yeast and certain mushrooms. Beta-glucan in yeast and mushrooms has been found to have favorable immune-enhancing effects. Studies are incomplete on similar effects from eating oats. In 1997, the FDA said that "a diet high in soluble fiber from whole oats (oat bran, oatmeal and oat flour) and low in saturated fat and cholesterol may reduce the risk of heart disease". The FDA had reviewed 37 studies in which oats were consumed as hot and cold cereals or used in a variety of other foods - muffins, breads, shakes, and entrées. It was concluded that about 2/3 cup of oatmeal daily would provide the beta-glucan to achieve a clinically relevant decrease in serum total cholesterol concentrations. Most studies have shown a reduction of total cholesterol and LDL cholesterol of 7 to 10% . The soluble fiber in oats appears to reduce the absorption of cholesterol in the intestines. (Soluble fiber with similar effects on cholesterol are found in barley, dried beans, apples, pears, prunes and psyllium seed).

Blood Sugar: Oat fiber has also been shown to lower levels of blood sugar after a meal, making it a good food for people with diabetes. The reduction of the glucose and insulin peak after eating the soluble fiber in oats occurs because oat digestive products in the stomach and small intestine are more viscous, which retards their absorption into the bloodstream.

Inflammation: whole oats contain a beneficial polyphenol (a class of antioxidant compounds found in most plant foods) called Avenanthramides (AV) . Unique to oats, AV interferes with inflammation and the development of plaque on the arteries. Moshen Meydani at the Vascular Biology Laboratory at Tufts University studied AV and found that adhesive molecules cause blood cells to stick to artery walls. Inflammation results, leading to a buildup of plaque that narrows the artery. The suppression provided by the AV in oats may allow better blood flow.

Skin protection: Oatmeal has been used since Roman times or longer to relieve itch and skin irritation. Recent studies show that AV in oats inhibits inflammation in skin cells when applied topically. Itching and scratching are suppressed. AV has been found to be effective in reducing the redness of sunburn when used in the 24 hours after a burn. It will give temporary relief to the itching of poison oak and poison ivy. The use of oatmeal products on the skin as an anti-irritant has potential in the care of infants, people with sensitive skin, sunburns and itchy, dry skin. You can make your own soothing oatmeal bath to relieve skin itching and inflammation by grinding a small amount of rolled oats in a blender; put the resulting flour into a a cheesecloth bag and run warm tap water through it for a bath. Many oatmeal-derived products are available commercially; ask your pharmacist for advice. .

. Sadja Greenwood, MD –back issues at http://sadjascolumns.blogspot.com

.

Go To Health: Flaxseed

Flax has been grown since the beginnings of civilization, initially in Babylon & Egypt. It was used to make linen for clothing, fishnets, and to wrap mummies. In the 8^th century, Charlemagne commanded his subjects to eat flaxseed to maintain good health. In the 12^th century, Abbess Hildegard von Bingen used flaxseed poultices to treat boils. Throughout history it has been used to treat constipation, as a bulking agent, combined with plenty of water. While it is still used today to make linen and as a healthy human food, flax is also made into industrial linseed oil, linoleum, and animal feed.

*Flaxseed oil: The oil in flax seeds contains alpha-linolenic acid (ALA), an essential omega-3 fatty acid like fish oil. ALA may not have the same benefits as fish oil (see my blog on omega-3 fatty acids), as it is more difficult for the body to efficiently convert ALA to a form of omega-3 fatty acids that it can readily use –the EPA and DHA in fish oil. However, ALA is a good choice for vegetarians. Flaxseed oil should come in a dark and opaque container and be refrigerated; add it to salad or foods after cooking. It cannot withstand high heat.

*Flaxseed Meal: When you buy whole flax seeds, grind a week’s supply and refrigerate the flax meal. You can eat it on salad, cereal or in smoothies. By eating the whole ground flax seed you are getting the oil as well as beneficial compounds known as lignans. Lignans are plant compounds similar to estrogen that also act as antioxidants. Lignans may lower estrogen in humans by inhibiting enzymes that are involved in estrogen production; the exact mechanisms are not known. There is interest in flaxseed because of the potential for plant estrogens to act differently from the body’s natural estrogen. In animal and preliminary human studies, flax seeds have been shown to inhibit tumors.

Breast Cancer: Researchers at the University of Minnesota studied the effect of flaxseed supplementation in a group of 28 postmenopausal nuns - chosen because of their strict dietary practices. The volunteers were given daily dietary supplements of either zero, five or ten grams of ground flaxseed for seven week cycles over the course of a year. A heaping tablespoon of ground flax weighs about 10 grams. Consumption of five or ten grams of flax significantly decreased blood levels of certain types of estrogen that are characteristic of postmenopausal women. Since previous studies have shown that increased levels of these estrogens (estrone sulfate and estradiol) may increase a woman’s risk of developing breast cancer, reducing levels of these hormones is thought to be advantageous. This study does not show that flaxseed prevents cancer, the researchers caution. Further studies are needed to work out how the supplement lowers estrogen and also to see if flaxseed may inhibit cancer. Besides lignans, the fiber and omega-3 fatty acids in flaxseed could also be protective.

Prostate Cancer A recent study at The M.D. Anderson Cancer Center looked at prostate cancer patients at least 21 days before surgery, and found that proliferation (cancer cell division) was significantly lower in men given supplemental flax seed – 3 tablespoons daily. These findings suggest that flaxseed is safe for men and is associated with biological alterations that may protect against prostate cancer. Previous studies had shown that ALA might not be advisable for men with prostate cancer. Further studies would be helpful on this important subject.

Blood Fats: An international review of studies on the effects of flaxseed meal on cholesterol found that flax significantly reduced total and LDL cholesterol, with the greatest effects seen in people with high cholesterol readings and in post-menopausal women.

Hot Flashes A study at the Mayo Clinic looked at 29 women with bothersome hot flashes who did not want to take estrogen because of the possible increased risk of breast cancer. After six weeks of ground flaxseed therapy, 2 tablespoons daily, their frequency of hot flashes decreased 50 percent, and the overall hot flash intensity decreased an average 57 percent. Participants also reported improvements in mood, joint or muscle pain, chills and sweating; which significantly improved their quality of life. This is an example of the ability of plant estrogens to act as an estrogen as well as an anti-estrogen.

Sadja Greenwood MD, MPH –back issues on this blog http://sadjascolumns.blogspot.com