Important Supplements

IMPORTANT SUPPLEMENTS
Dear readers: this is a summary of a talk I gave at Commonweal on March 7, 2010. Below are some suggested supplements that may help to give you maximum health. However, eating a good diet is the first key to health. Here in West Marin we are blessed to have great organic farmers giving us wonderful vegetables and fruits. Have these every day, along with local diary products and eggs, and small amounts of poultry, fish and meat. Walk, run or bike - spring is on its way. And remember to give thanks to your local farmers, especially organic farmers, for their hard work and provisions.

WOMEN 18-50
*Multivitamin (for folic acid) in case of pregnancy. Folic acid helps prevent birth defects. Multis should contain iron because of menstrual blood loss.
*Calcium - 600-1000 mg daily – to get 1200 mg from pills and diet. Calcium helps bone strength and may help with premenstrual tension.
*Magnesium 300 – 350 mg daily. Magnesium helps bone strength and has numerous positive effects on the body.
*Vitamin D – 1000 – 2000 IU – or enough to keep blood level of 25 hydroxy vitamin D 35 – 40 ng/ml. People with darker skin may need more D to get to these levels. Vitamin D helps with bone strength, prevention of infection and cancer and keeps your brain sharp.
*Vitamin C - 500 mg daily – taking 250 twice a day is ideal
*Fish oil capsule – or eat fish 2-3 times a week. The omega-3 fatty acids in fish oil help your heart and are important for your brain and mood.
*Probiotic on arising – these contain beneficial bacteria that help your immune system fight off colds, and infections of the vagina and bladder

WOMEN OVER 50
*Multivitamin without iron – if diet is haphazard
*Calcium and magnesium as above
*Vitamin D, Vitamin C, Probiotic -the same as for women under 50.
*Fish Oil capsules 2 daily
*Vitamin B12 500-1000 mcg sublingually once or twice a week. A level of 500pg/ml is desirable. As you get older, you may not absorb this essential vitamin from the meat, fish, dairy or eggs that you eat. B12 prevents anemia and keeps your brain sharp. Letting it dissolve under your tongue will take it directly into your bloodstream.

MEN 18-50
*Multivitamin without iron–if diet is haphazard
*Vitamin D – 1000 IU -2000- or enough to keep blood level of 25 hydroxy vitamin D 35 - 40 ng/ml. People with darker skin may need more D to get to these levels.
*Vitamin C - 500 mg daily – taking 250 twice a day is ideal
*Fish oil capsule - or eat fish 2-3 times a week
*Probiotic on arising

MEN OVER 50
*Multivitamin without iron–if diet is haphazard
*Vitamin D , Vitamin C, Probiotic, the same as for men under 50
*Fish oil capsules 2 daily
*Vitamin B12 500-1000 mcg sublingually once or twice a week. A level of 500 pg/ml is desirable
As you get older, you may not absorb this essential vitamin from the meat, fish, dairy or eggs that you eat. B12 prevents anemia and keeps your brain sharp. Letting it dissolve under your tongue will take it directly into your bloodstream.
Sadja Greenwood, MD, MPH back issues on this blog

Folic acid: an essential B vitamin with a warning on overdose

Folate is the naturally occurring form of vitamin B9, while folic acid is the synthesized form. This vitamin is essential in the synthesis and repair of DNA, in the production of red and white blood cells, in the synthesis of important amino acids, and in any period of rapid cell growth, such as childhood and pregnancy.

The urgent need for Folate in pregnancy Neural tube defects are among the most dreaded birth defects, affecting 1 in 1500 births in the US today. The baby is born without a major portion of its brain and skull (and dies shortly after birth) or with incomplete closure of the spinal cord in the back, leading to some degree of paralysis, pain, and problems with bowel and bladder function. Insufficient folate in the diet (along with genetic and unknown factors) plays a role in this problem, and supplementation of the mother’s diet can decrease the incidence of neural tube defects by more than 70%. The folic acid supplement, as well as adequate dietary intake of folate, should start even before the beginning of pregnancy, as the neural tube starts developing in the first month. It is extremely important for young women to take a multivitamin containing 400 micrograms (mcg) of folic acid on a regular basis; even if she does not plan to become pregnant (at least 50% of pregnancies are unplanned; in celibate or lesbian women the multi will also help with a possibly haphazard diet.) More folate is needed during pregnancy and lactation. Because not all girls and young women take vitamins, the FDA mandated the fortification of refined grain products (white flour, pasta, breakfast cereals) with folic acid in 1998. It is estimated that young women get about 100 mcg a day of folic acid from fortified cereal grains – which is an improvement, but insufficient. An excellent diet and/or a multivitamin is still important. Studies show an approximate 50% reduction in neural tube defects in the US since fortification in 1998. Similar programs of fortification have taken place in Costa Rica and many European countries. Other problems in pregnancy, such as fetal cleft lip, premature delivery and serious bleeding at delivery from placental detachment, have been associated with folate deficiency. See http://www.nytimes.com/2010/01/03/opinion/03kristof.html for Nicolas Kristof’s opinion page article on the benefits of micronutrient enrichment of foods in Honduras and elsewhere.

Homocysteine: Homocysteine is an amino acid that used to be associated with higher rates of heart disease amd stroke; it can be lowered by conversion into methionine (another amino acid) by folic acid, vitamins B6 and B12. However, studies from two Canadian Universities in 2006 showed that lowering homocysteine levels with these B vitamins did not decrease the risk of heart attack or death from heart disease, but did significantly decrease the risk of stroke. Studies also show that lowering homocysteine levels with B vitamins in people with former strokes lowers their risk of hip fractures.

Anemia: People with a low intake of folate from food, or with chronic alcoholism, can develop a kind of anemia characterized by large, malformed red blood cells. This anemia is akin to ‘pernicious anemia’ related to vitamin B12 deficiency, and can have serious consequences. Medical care is essential.

Cancer: There is growing controversy over the effects of giving high dose folic acid supplements to prevent cancer or other diseases, since recent clinical trials have shown an increase in lung cancer and polyps of the colon. Animal experiments show that small amounts of folic acid supplements can decrease cancer risk, and high amounts can increase it. However, no amount of folate in foods is dangerous and studies show a decreased cancer risk, including breast cancer, among those with the highest dietary intakes.

Foods containing folate: All forms of green leafy vegetables, broccoli, avocado, asparagus, peas, beans of all kinds, lentils, peanuts, wheat germ, oranges and other citrus fruits, and many other whole foods contain folate. You will benefit from folate by making vegetables and fruits the center of your diet. Cooking can destroy folate, so it is best to steam or stir fry vegetables lightly, or cook them in a microwave. Avoid boiling in abundant water.

What’s the bottom line with folate and folic acid supplements?
Keep eating as many vegetables and fruits as possible, and include raw salads in your daily fare. You will be ingesting plenty of folate, which is a very good thing. Young women who might become pregnant should take a daily multi with 400 mcg of folic acid and special vitamins during pregnancy. Adult multivitamins with 400 mcg of folic acid should be taken by people with high risk of stroke or a prior stroke, and by those dependent on alcohol. For other adults, a multi is probably safe, if it contains no more than 400 mcg of folic acid. Who said it would be simple?
Sadja Greenwood, MD, MPH past issues on this blog

Selenium: Take a Supplement, or a Brazil Nut?

Selenium is an element that is essential in the human diet in small amounts, but toxic at high levels. All animals require selenium, since we evolved from the sea where it is abundant. Plants do not appear to require selenium for survival, but incorporate it into their structures. Edible plants contain differing amounts of selenium, as the element is found in varying amounts in rocks and soil throughout the world. The element is found in higher amounts where there were inland seas.

Thyroid hormone: While iodine is essential for the synthesis of thyroid hormone, a selenium dependent enzyme must be present to activate this hormone, which in turn regulates normal growth, development and metabolism.

Sperm development: a recent study from Vanderbilt University showed that a protein containing selenium is essential for normal sperm development and male fertility.

Viral Infection: selenium deficiency appears to enhance the virulence of some viral infections, by inducing mutations in the expression of some viral genes. In a region of China where soils are very low in selenium, young women and children develop a disease of the heart muscle; this seems to be worsened by a change in a common virus that affects the heart. Selenium supplementation can protect against this, but cannot reverse the damage to the heart muscle.

Cancer – a mixed picture: Chronic infection with viral hepatitis B or C increases the risk of liver cancer; selenium supplements given in China in an area with a high incidence of hepatitis B and liver cancer reduced the incidence of this cancer. Similar findings were seen in Taiwan. A study in Finland showed that low selenium status in creased the risk of lung cancer: the association was more pronounced in smokers. On the other hand, a prospective study of more than 60,000 female nurses in the US found no association between selenium levels and total cancer risk. The data on prostate cancer are confusing – several studies have shown lower selenium levels in men with prostate cancer, but a recent large study from the National Cancer Institute, following 295,344 men who were cancer free on enrollment, found that excessive multivitamin use (more than 7 times per week) increased the risk of fatal prostate cancer compared with never users. The positive association with prostate cancer and excessive multivitamin use was strongest in men with a family history of prostate cancer or in men who took supplemental selenium, zinc, or beta-carotene. Further studies are needed to understand whether selenium levels in the body are linked to prostate cancer, and several are underway. Selenium supplements (200 micrograms daily) increased the risk of squamous cell skin cancer in a study from Memorial Sloan-Kettering, and did not alter the incidence of basal cell skin cancers.

HIV/AIDS: Declining selenium levels are found in HIV infected people and are markers of disease progression and severity. A randomized control trial of HIV positive men and women from the University of Miami found that selenium supplements (200 micrograms a day) taken for 2 years significantly decreased the rates of hospitalization. A further study showed a decreased viral load and more CD4 cells with the same dose of selenium.. Proteins containing selenium negatively affect the replication of the AIDS virus. Many AIDS patients in the US take selenium supplements, and it is also used in some African countries/
Who needs selenium supplements? Based on the information currently available, it is wise for most people to get this trace element in their diet, and not from supplements. Supplemental selenium should be considered by people with HIV infections, and by those with severe gastrointestinal problems such as Crohn’s disease or surgical removal of part of the stomach or intestines.

Food Sources of Selenium: Organ meats, shellfish and other healthy (non-endangered) fish are the important sources of selenium in our diets. Whole grains are also important sources (avoid white flour and white rice), as are sunflower seeds, and other nuts. Whole grains grown in Nebraska and the Dakotas have high levels (but who knows the origin of the wheat in our daily bread?) Brazil nuts grown in areas of Brazil with selenium-rich soil may provide 50 to 100 mcg in one nut, which is an excellent daily amount for adults. However, Brazil nuts grown on selenium-poor soil may provide 10 times less – another ‘who knows?’ conundrum. Studies from New Zealand have shown that the selenium in Brazil nuts improves serum selenium levels as effectively as supplements. My final conclusion from all this is that adults can benefit from a daily Brazil nut! You can give a few Brazil nuts a week to children over age 9. Good news - it seems that the cultivation of Brazil nuts will improve conditions in the rainforests of Brazil; the nut is not suitable for growth in plantations and can only grow in the rainforest itself.
Sadja Greenwood, MD back issues onsadjascolumns.blogspot.com

Is there a Supreme Bean?

Go to Health: Is there a Supreme Bean?

Some insist that it’s coffee, but for many it’s the soybean, which nourishes hungry people throughout the world; its balance of essential amino acids makes soy a plant protein as valuable as eggs or meat.  Soy has been grown in China for some 5000 years, to enrich the soil (like other beans it has bacteria on its roots that fix nitrogen), and for human consumption.

Heart Disease Prevention:  Following studies showing significant decreases in serum cholesterol, LDL cholesterol (the ‘bad’ kind) and triglycerides, the FDA granted a health claim for soy in 1999: “25 grams of soy protein a day, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease.”  HDL, (‘good cholesterol’) did not increase.  Recently, new studies have challenged the ‘heart healthy’ claim for soy protein per se, but concede that soy milk, tofu, soy nuts and some soy burgers should be beneficial to heart health because of their polyunsaturated fats, fiber, vitamins and low content of saturated fat.  The American Heart Association said: “Using these soy foods to replace foods high in animal protein that contain saturated fat and cholesterol may confer benefits to cardiovascular health.” 

Breast Cancer:  Genistein and daidzein (so called phytoestrogens,  or plant estrogens) are substances in soy that are similar structurally to human estrogen but act differently in the human body.  They have much lower biologic activity than human estrogens and in some cases may function as anti-estrogens.  A recent study on breast cancer and soy from Vanderbilt University was encouraging.   The researchers looked at 5000 Chinese women in Shanghai, ages 20 -75, who were breast cancer survivors. They found those who ate the most soy (15 grams or more of soy protein daily) had a 29% lower risk of dying than those who consumed the least (5 grams or less).  A similar benefit appeared for breast cancer recurrence risk regardless of tamoxifen use.  The benefits of soy increased up to 11 grams of soy protein daily, and then leveled off or reversed, so more was not necessarily better.  The women ate mainly tofu and whole soy beans. The researchers warned that similar benefits can not be extrapolated to dietary supplements containing soy (pills, bars or foods containing isolated soy protein). The associations did not vary with menopausal status, cancer stage, or estrogen receptor status of a woman’s cancer.

Vitamin K2 & Hip Fracture: a recent study from the University of Tokyo School of Medicine showed that natto, a Japanese fermented soybean food, contains large amounts of Vitamin K2; there is increasing evidence that Vitamin K plays a positive role in bone strength and osteoporosis prevention.  Serum concentrations of vitamin K2 were significantly higher in frequent natto eaters, and the incidence of hip fracture was correspondingly lower, in every prefecture of Japan.

Soybean foods in the US: Today about 90% of soybeans grown in the US are genetically modified to make the plant resistant to the herbicide Roundup. Ninety percent of these beans are turned into soy oil and defatted soy meal that is fed to chickens, turkeys and pigs.  The abundance of soy meal, as well as corn, makes possible the new and very problematic industrial farming of these animals.  The US, Brazil and Argentina are major growers and exporters of soybeans, and the Brazilian crop has been responsible for a considerable loss of rainforest. Some soybeans, including organic soybeans, made into human foods in the US are imported from Brazil and China, where organic standards may differ from ours. Most Silk soymilk is no longer organic; the company was bought over by Dean Foods and switched many of their products to “natural” rather than organic. Edensoy products are made from organic soybeans grown in the US; Westsoy, Wildwood and others also have organic soy products.  If you care about this issue, read labels!   To get the benefits of soy, nutritionists advise people to eat whole soy products, such as tofu, tempeh, soy milk and soy nuts, rather than manufactured foods containing isolated soy protein.   Happy New Year, dear readers, and let us all appreciate the natural foods stores and organic farmers in West Marin.

Sadja Greenwood, MD, back issues at sadjascolumns.blogspot.com

Mushrooms & Green Tea are associated with lower breast cancer risk in a Chinese study

A study in the International Journal of Cancer, March 15, 2009, looked at 1009 women in China newly diagnosed with breast cancer and compared them with 1009 healthy age-matched women. The researchers – from the University of Perth in Australia - adjusted for known risk factors for breast cancer, such as smoking, passive smoke exposure or close relatives with breast cancer. Working with detailed registers of the women’s consumption of 100 different foods, they found that women who consumed (on the average) more than 10 grams (.353 ounces) of fresh mushrooms a day had 64% less risk of developing breast cancer that those who did not eat mushrooms. The effect was dose dependent – the more mushrooms women reported eating, the lower their risk. Moreover, intake of fresh or dried mushrooms plus green tea had an additive, dose dependent effect on risk. Those who consumed the most green tea plus fresh mushrooms lowered their risk of breast cancer by 89%. All types of mushrooms consumed by the women in this study were counted.; the most common types were white button mushrooms (Agaricus bisporus) and fragrant dried mushrooms (Lentinula edodes). The author of this study, Dr. Min Zhang, noted that the rate of breast cancer in China is 4-5 times lower that that in developed countries. She speculated that the Chinese diet, high in green tea and mushrooms, might play a role. Rates of breast cancer are currently rising in the more affluent parts of China. Researchers have suggested that the adoption of a more western diet may be a causative factor.

So – if you are looking for a way to counteract the western diet of cookies and egg-nog in the next few weeks – here is the famous list of

The 11 Best Foods You Aren’t Eating by nutritionist and author Jonny Bowden, printed in the New York Times and a ‘most viewed story’ of 2008.

Beets – Think of beets as red spinach says Bowden, with folate and red pigments that may be cancer fighters.

Eat them raw – grated into salad

Cabbage – a brassica vegetable, similar to broccoli – with anti cancer effects – see my blog on brassicas.

Swiss Chard - lots of beneficial carotenes in the leaves.

Cinnamon –lowers blood sugar and LDL cholesterol

Pomegranate juice – increases blood flow in the heart muscle. See my blog on pomegranate for details.

Prunes – packed with antioxidants, and a safe laxative

Pumpkin Seeds – good source of protein, magnesium and zinc. Toast and eat.

Canned Pumpkin –an easy way to get lots of carotenes - use in soup and whole grain pancakes.

Sardines – lots of omega-3 fatty acids, high in calcium – try the low sodium kind with bones and skin intact. Turmeric – anti-cancer, good for the brain, see my blog for details. It’s in curry powder. Add to rice and stir fries.

Frozen Blueberries – associated with better memory in studies of aging animals. Add to a yogurt or soy smoothie.

Dear Readers – I wish you a wonderful Solstice as you celebrate the light returning. Stay warm with a cup of green tea and some sauteed mushrooms. They are protective for men as well as women. Have a joyous Christmas, whether you are a Christian, Jew, Atheist, Muslim, Buddhist, Pagan, Pantheist or other spiritual path. It’s the spirit of friendship that counts.

Sadja Greenwood, MD, MPH back issues on this blog

Exploring Slow

Life in the fast lane: multi tasking, 24/7, the 70 hour work week, texting while driving, texting during sex, road rage, fast food, take-out (wrapped in plastic), after-school classes and scheduled sports every afternoon and weekend. If you want to hang on, you’d better speed up.

However, there’s a counter-trend in the world, called the Slow Movement.

Slow Food In 1986 McDonald’s tried to open a shop near the Spanish steps in Rome; this triggered a movement that has spread to over 132 countries. Slow Food aims to preserve and celebrate the cultural cuisine, associated plants and animals and farming practices of an ecoregion. Its aims include forming seed banks to preserve heirloom varieties of local foods, educating the public on the risks of factory farms, pesticides and fast food, teaching gardening to students and prisoners, preserving family farms and reviving home cooked meals with local ingredients from each locale. Family farmers from every continent attend Terra Madre, the bi-annual slow food conference in Italy, The work of Alice Waters to teach students about food and healthy eating through schoolyard gardens, and Michelle Obama’s organic garden on the White House lawn are all related to the slow food movement.

Slow Parenting Children (in middle and upper class families) are generally enrolled in numerous after-school classes and organized sports – while each of these activities is valuable in itself, the result is that there is little time for free play before or after a heavy load of homework. One rationale is that the world is more dangerous, so that unsupervised play outside is risky; another is that such activities are needed for entry to a good high school or college, and another that both parents are working and need after-school childcare. It is hard for parents to find a way out of these problems, but awareness of the child’s need for free play and an individual learning style is a start. The slow parenting movement advises that children should pick their own activities, rather than fulfill their parents’ dreams. Parents should turn off the television and allow children to play with simple toys, make their own breakfast, and explore the out-of-doors whenever possible. ‘Cramming schools’ to push for higher academic results put children under continuous competitive pressure and take away their own creativity and independence. The slow movement has even reached the Ivy League. In a 2005 letter to Harvard students, the Dean advised students not to become overcommitted with athletics, clubs, arts and classes, or to be stretched too thin to appreciate other aspects of college life, including friendships and time to explore unexpected areas of knowledge.

Slow Medicine American medicine manages acute problems and specialized procedures such as organ transplants, eye surgeries and joint replacements extremely well. Chronic diseases that require education, lifestyle changes and home support are often handled less well by overworked doctors and nurses. Slower acting modalities such as appropriate exercise, healthy eating, and meditation are not paid for or readily available. Some elderly patients are subjected to ‘death by intensive care’ when home-based care would be more comforting and comfortable. The ‘slow medicine’ movement sees family, friends, visiting nurses and hospice workers improving the life of older patients at home by offering emotional support, social stimulation, better nutrition and help with sleeping, moving, bathing and other activities. Many towns and cities have organizations providing such services, and they deserve support.

Slow sex The movement for slow food, and enjoying a slower life began in Italy. So did the discussion of slow sex. There are current articles in our popular magazines about what sex researchers found in the 1960’s – the longer the foreplay, the better the climax for both partners. Many women who cannot achieve orgasm in intercourse can easily do so by clitoral stimulation. The Pointer Sisters have a song that lays it out for heterosexual couples - Slow Hand: I want a man with a slow hand – I want a lover with an easy touch….. (YouTube Pointer Sisters – Slow Hand)

The Slow Movement Summed Up:

“The trouble with the rat race is that even if you win, you’re still a rat.” Lily Tomlin. “Anything worth doing is worth doing slowly.” Mae West

In Praise of Slowness: How a Worldwide Movement is Challenging the Cult of Speed by Carl Honore

Under Pressure: Rescuing Our Children from the Culture of Hyper-Parenting by Carl Honore

Sadja Greenwood, MD, MPH back issues on this website

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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