YOUR NEWSLETTER OF GOOD HEALTH AND VITALITY Dr. Michael Janson's HEALTHY LIVING Volume 2 No. 7 August, 2000
Don’t be misled by some of the press reports on the supposeddangers of alternative medicine, such as dietary supplements andherbal therapies. The news media often mislead us on these issues,and I’ll present one example later. I am in the midst of watching myorganic garden grow (well not literally watching it, but slavingaway helping it along). There is something nourishing aboutgrowing your own food, and if you have any chance to do it, even to
a small degree, I “heartily” recommend it. Supplements and More for Heart Disease In This Issue
Here is the rest of the story on heart disease, as promised in last
month’s issue. For prevention, consider taking folic acid and
vitamin B12, as these two vitamins lower homocysteine levels.
This is a substance in the blood that apparently damages arteries
and leads to increased atherosclerosis. While many supplements
help to prevent heart disease, some of them are very important for
treatment once you have heart disease. Coenzyme Q10 and L-Carnitine
Coenzyme Q10 is essential for the production of energy in every
cell, in the membranes of the tiny engines called mitochondria. Itis especially abundant in heart muscle, and it is an excellent
antioxidant, about four times more potent than vitamin E in some studies. Supplements can helpangina, shortness of breath, congestive heart failure, arrhythmias, and high blood pressure. CoQ10 alsoincreases exercise tolerance. Side benefits of taking coQ10 are improved immunity, increased generalenergy levels, and protection from free-radical damage associated with aging.
Although coQ10 is not really a vitamin because your body makes it, the amount you make declines withage and illness. The typical dose for treatment of heart disease is 100 to 400 mg daily, depending on theseverity of the problem. For prevention, I think it is a good idea to take 50 to 100 mg a day, especiallyif you are over forty, if you have any other illness, or you have a family history of heart disease.
Another supplement that helps the heart is L-carnitine. This derivative of amino acids is essential fortransport of fatty acids across the membranes of the mitochondria where they are used for energyproduction (this is how it works well with coenzyme Q10). When there is pain due to a lack of oxygenin heart muscle (angina), the level of L-carnitine drops dramatically, and the heart muscle switches toglucose metabolism instead of fat. As a result, more lactic acid is produced, and this makes the painworse. If there is enough L-carnitine available in advance, the pain is lessened, and the likelihood ofdamage to the heart is reduced. Although you normally produce L-carnitine, as with some otheressential substances the production declines with age. Supplements of L-carnitine are typically in therange of 500 to 1000 mg twice a day. Some athletes take even more to enhance stamina. Botanical Supplements for the Heart
arrhythmias. In animal studies, taurine has been
Garlic has been used for millennia, not just as a
shown to be helpful in controlling blood pressure.
culinary delight, but as a therapeutic dietary
The typical dose is 500 to 1000 mg twice a day.
supplement. It helps the heart in many ways. It
L-Arginine is a precursor to nitric oxide, the blood
reduces blood pressure, a risk factor for the devel-
vessel relaxant. In doses of 1000 to 6000 mg daily,
opment of heart disease. Garlic supplements also
it improves heart failure, angina, hypertension,
reduce the adhesiveness (stickiness) of platelets,
sexual function, and immune function.
reducing the likelihood of excessive clotting in-
L-Lysine reduces the tendency of blood lipid com-
ponents to stick to artery walls, and even releasing
Garlic reduces total cholesterol levels while in-
deposits of damaging “lipoprotein(a).” The usual
creasing the good HDL-cholesterol, so it helps in
dose is about 1500 mg daily for treatment.
both prevention and treatment. As a free-radical
Putting together a complete program for either
scavenger, garlic helps prevent the oxidative reac-
prevention or treatment must include more than
tions that promote atherosclerosis. It appears to
supplements and diet. As mentioned earlier, ex-
protect the enzymes in the cells lining the arter-
ercise is helpful for the heart, and stress manage-
ies, called endothelium. These cells produce ni-
ment may be one of the most significant support-
tric oxide, a blood vessel relaxant, and garlic ap-
ive therapies. I recommend some form of relax-
pears to promote the production of this substance.
ation for all heart patients, and many of them
As a side benefit, garlic can reduce the incidence
work well. Practice visualization, breathing exer-
of some cancers, enhance immunity, and act as an
cises, various forms of meditation, and laughter to
antibiotic and anti-viral substance without side
Norman Cousins, the author of Anatomy of an
I recommend eating garlic as part of the diet, and
Illness, also wrote about his recovery from a seri-
supplementing for treatment. The usual dose of
ous heart attack using laughter and other health-
garlic is 500 to 1500 mg twice a day of deodorized
ful practices (The Healing Heart). He emphasizes
garlic (so you can take your garlic every day with-
the powerful role that our minds play in healing.
out fear of being ostracized socially).
Hawthorn berry is a useful herb for heart disease. Ginkgo and Aspirin Together?
The active components include several pigmentscalled flavonoids. Hawthorn has been used for
Many doctors are now telling people not to take
centuries for the heart. It improves the strength of
ginkgo biloba if they are taking aspirin to protect
the heart muscle, and it relaxes the blood vessels
their hearts. It seems to be an increasing move-
ment in the medical community, which is justbecoming aware of the therapeutic value of herbs,
In patients with congestive heart failure, haw-
to warn of their dangers, rather than warning of
thorn berry supplements can improve exercise
the far greater dangers of medications, including
tolerance and mildly reduce elevated blood pres-
sure. Many herbal studies have been done inGermany using standardized extracts. These are
Numerous deaths every year are the result of side
more reliable sources of the substances known to
effects from prescription medications (well over
be helpful. The usual dose of hawthorn extract is
100,000), and many others from the side effects of
over-the-counter drugs, including aspirin. Aspi-rin and ginkgo do not interfere with each other. Amino Acids That Help
Rather, they both reduce platelet adhesiveness
Taurine, an amino acid, helps to increase the
(similar to the effect of garlic) and decrease the
strength of heart muscle and reduces excitability
of the fibers that conduct the impulse for the
When a person takes both aspirin and ginkgo
heartbeat. Supplements are safe and effective
together, it is true that they may end up with too
additions to treatment for people with congestive
much of the anti-clotting effect and have a ten-
dency to bleed excessively. Because of this, many
the medications. In a recent study reported in the
doctors warn of the dangers of ginkgo, when they
medical literature, treatment with St. John’s wort
should be warning, more appropriately, of the
dangers of aspirin. The simple solution is not to
It turned out that more people were helped by the
take less ginkgo, which has many therapeutic
herb than the drug, and the level of effect was
benefits, but to take less aspirin, or none.
equal among those who were helped. The serious
Ginkgo biloba supplements not only can replace
difference was in the side effects–about one fourth
aspirin, but also has the additional benefits of
of the patients on Prozac reported problems com-
enhancing memory, reducing migraine head-
pared with only one in twelve of those on St.
aches, controlling vertigo (Meniere’s disease), im-
John’s wort. The most common side effect with St.
proving circulation in the legs and in small blood
John’s wort was digestive upset, while Prozac
vessels (such as in the retina), reversing sexual
caused fatigue, sexual dysfunction, anxiety, dizzi-
dysfunction in both men and women on antide-
ness, stomach upset, and most commonly, agita-
pressant drugs, and improving varicose veins. It
tion. The daily dose of St. John’s wort is 900 mg.
contains flavonoids and has antioxidant activity.
Many non-drug treatments benefit depression.
Whether you should consider avoiding ginkgo
Better diet (no sugar and avoiding food allergies),
biloba if you are also taking aspirin, or avoiding
and physical activity (especially aerobic exercise),
aspirin for all the benefits that ginkgo might
help. Other supplements that help include 5-
provide is a decision only you can make, with or
hydroxy-tryptophan (5-HTP), 100 to 200 mg daily,
without your doctor’s advice and support (but
and B vitamins, including pyridoxine (B6), niacin
inform your doctor of your decision).
(B3), and others, all in individualized doses.
Ginkgo and garlic are not the only supplements
that can reduce platelet adhesion. Ginger, gin-
seng, curcumin, feverfew, and astragalus have the
Crestanello JA, et al., Elucidation of a tripartite mechanism
same effect, as well as fish oil, flaxseed oil, gamma-
underlying the improvement in cardiac tolerance to ischemia by
linolenic acid (GLA from borage or evening prim-
coenzyme Q10 pretreatment. J Thorac Cardiovasc Surg 1996Feb;111(2):443-50.
Baggio E, et al., Italian multicenter study on the safety and
efficacy of coenzyme Q10 as adjunctive therapy in heart failure
Vitamin E in high doses can also increase the
(interim analysis). Clin Investig 1993;71(8 Suppl):S145-9.
effect of coumadin, the anti-clotting drug that is
Morisco C, t ao., Effect of coenzyme Q10 therapy in patients with
congestive heart failure: a long-term multicenter randomized
recommended for patients with atrial fibrillation.
study. Clin Investig 1993;71(8 Suppl):S134-6.
When doctors say not to take your vitamin E
Mortensen SA, Perspectives on therapy of cardiovascular diseases
with coenzyme Q10 (ubiquinone). Clin Investig 1993;71(8
because of this, they are doing you a disservice. If
vitamin E can boost coumadin, a doctor can give
Ghidini O, et al., Evaluation of the therapeutic efficacy of L-
you a lower dose of the drug. A doctor will measure
carnitine in congestive heart failure. Int J Clin Pharmacol TherToxicol 1988 Apr;26(4):217-20.
your coumadin effect regularly while you are on
Foushee DB, eta l.,Garlic as a natural agent for the treatment of
the drug, so it is easy to monitor your need and
hypertension. Cytobios 1982;34(135-36):145-52.
Blesken R, Crataegus [Hawthorn] in cardiology. Fortschr Med 1992
adjust the dose. You benefit if your doctor can
reduce your dose and get the same effect.
Hishikawa K, et al., Role of L-arginine-nitric oxide pathway in
hypertension. J Hypertens 1993 Jun;11(6):639-45.
Aspirin and Ginkgo BilobaAkiba S, et al., Inhibitory effect of the leaf extract of Ginkgo biloba
St. John’s Wort for Depression
L. on oxidative stress-induced platelet aggregation. Biochem MolBiol Int 1998 Dec;46(6):1243-8.
St. John’s wort is an excellent herbal treatment
Cryer B, Feldman M, Effects of very low dose daily, long-term
for depression. It is a good idea to try it before
aspirin therapy . on mucosal injury in healthy humans. Gastroenterology 1999 Jul;117(1):17-25.
using medications such as Prozac, Zoloft, and
Paxil (serotonin reuptake inhibitors), or others.
Schrader E, Equivalence of St John’s wort extract (Ze 117) and
Why? Because the medications have numerous
fluoxetine. Int Clin Psychopharmacol 2000 Mar;15(2):61-8.
side effects, perhaps the most serious being agita-
Wyshak G, Teenaged girls, carbonated beverage consumption, and
tion and aggressive behavior. St. John’s wort has
bone fractures. Arch Pediatr Adolesc Med 2000 Jun;154(6):610-3.
minimal side effects, and is equal to or better than
In the Health News
• A recent report in the New England Journal of Medicine was misrepresented in the news and even
in the title of the article: “Urothelial Carcinoma Associated with the Use of a Chinese Herb.” Newsreports left the impression that a therapeutic herb caused urinary tract cancer. Even in the firstparagraph, the article makes clear that it was not the therapeutic herb, but a manufacturing errorsubstituting a known carcinogenic and kidney toxic herb for the one that was supposed to bepresent. The reporting appears biased. You do have to be cautious with the use of therapeuticherbs, which are valuable treatments but have some risks. But themedical literature and news media often exaggerate the risks and
Dr. Janson's Healthy Living
minimize the benefits. (NEJM 2000 Jun 8, 342:23; 1686-92)
• Niacin helps reduce serum cholesterol more than the drug gemfibrozil
(Lopid). A study done at Duke University showed that high-dose
niacin was more than twice as effective as the drug in lowering
cholesterol and raising good HDL-cholesterol, and only niacin lowered
the damaging lipoprotein(a). Gemfibrozil did lower triglyceride some-
what more than niacin, but unlike niacin, it raised the bad LDL-
cholesterol by 9 percent. Timed release niacin was studied at 1000 and
2000 mg daily. (Arch Intern Med 2000 Apr 24;160(8):1177-84.)
vided for information only. Itscontents should not be used to
Diet and Disease
provide medical advice on indi-vidual problems. Consult a health
• Carbonated sodas have been associated with loss of calcium from bone,
probably because of the sugar and phosphorus that they contain. In a
recent report from Harvard, teenaged girls had an increased risk of
bone fracture correlated with soda consumption, especially the cola
Michael Janson, M.D. Subscriptions: $29/year
drinks. It is important to educate children about better health habits. Healthy Summer Diet Tip
Summer is always a difficult time to cook, as few people want to spend time in an overheated kitchen. I have two solutions – the first is to eat a lot of salads. I put in a wide variety of vegetables, includingsome corn and peas, plus two leafy greens (spinach and arugula, are my favorites in addition tolettuce), shredded cabbage, tomato, cucumber, scallions, and cilantro. Then I might add somemarinated tofu (Tofu Lin is one I like), and some organic hard boiled egg. I top this with some balsamicvinegar-flaxseed oil-pepper-thyme-garlic dressing. It makes an easy and cool summer meal. Secondis to quick stir fry some garlic, onions and broccoli with tofu–a quick cooking meal served on top ofsome brown rice. It is easy, and the quick cooking decreases the heat build-up in the kitchen. Dr. Janson's Healthy Living VITALITY Now!®
through the Ask Dr J page on my website: www.drjanson.com. Come visit for more health updates. Listen to me on the Health and Fitness Hour with Frankie Boyer on WMEX radio, 1060 AM, Wednesdays from 9 to 10 am. Call 877-711-1060 with your own health questions.
QUANDO USARE LA BISAND E RISULTATI Case Report I Caso clinico Anestesia BiSand combinata con Peridurale toracica continua Uomo di 60 aa, 79 kg, 179 cm, ASA 2, affetto da enfisema polmonare diffuso, fumatore da oltre 40 anni, viene sottoposto ad intervento di “Resezione Gastro-duodenale allargata e Viscerolisi” per “Adenocarcinoma dell’antro gastrico”. Gli esami ematochimi
Persistent Idiopathic Facial Pain (Previously “Atypical Facial Pain”) Definition Persistent idiopathic facial pain (PIFP), previously termed “atypical facial pain,” is a persistent facial pain that does not have the characteristics of cranial neuralgias and cannot be better attributed to a different disorder. Epidemiology The prevalence of PIFP is far less frequent than that o