METAIRIE INSTITUTE NEWSLETTER EDWARD M. GABER,MD NEWSLETTER I hope that regular newsletters will help patients participate more with their healthcare, encourage daily goals and keep patients up to date on the new information I learn in the previous month to keep them healthy. I promise each newsletter will be chocked full of the latest information on medications, preventive health and nutrition, exercise, symptoms to watch for and the latest research on longevity. The summaries I write will be concise and in plain language. The journals and articles I read and summarize for you have information in them that sometimes takes years to become available to the general public. Also, I will have a section on frequently asked questions from patients. These are often excellent questions that require some research on my part to answer. I encourage you to read the newsletter and also participate in it by sending me your questions and also your suggestions for any improvement you would like to see in the newsletter. Everyone would also enjoy your sharing with us any event such as anniversaries, birthdays, special accomplishments that have occurred if you wish to publicize them. Also, if you wish to share anything you yourself have found of benefit to your health, please feel free to send this to me. I am also interesting in publishing any "words of wisdom" that you have found of value in life. Once you read the newsletter, please feel free to print it out and share it with friends and relatives, but please encourage them also to look at our website. The Endothelium The endothelium is the one cell layer that lines every artery and arteriole (little artery) in the body. It in fact is the largest organ in the body. There are miles of arteries. Did you know that one extra pound of fat in the body means that the heart has to push blood through three extra miles of arterioles? If we keep the endothelium young we stay young. So how do we tell how healthy the endothelium is and how do we protect it? If you have known peripheral vascular disease of the legs or documented coronary heart disease or carotid disease of the neck arteries, it is obvious that we have a sick endothelium. The more subtle indications of endothelial disease are protein in the urine (which means that the endothelium in the tiny glomerular tufts of the kidney are damaged enough to leak the protein), or indication by echo of carotid artery plaques or an EBT or fast CAT scan showing a high score of plaque buildup in the arteries on the outside wall of the heart. We keep our endothelium healthy by not smoking, exercising vigorously, getting our blood pressure to less than 120 systolic and keeping our weight down. Also, it helps to keep our "bad" cholesterol (the LDL) less than 75, getting the "good" cholesterol over 50 (this is the HDL) and making sure that our homocysteine level is normal. It is important to keep our anxiety and pressure level down, with the only cure for that being our spirituality. Antioxidants These are over-the-counter medications and some foods that have been reported to prevent aging, cardiovascular disease, Parkinson's disease, and brain aging. Large studies, completed of late, show no benefit for the prevention of heart disease by Vitamin E. In fact, antioxidants have been shown to hamper the reversal of cholesterol plaques by statin drugs like Zocor. One should never take over 400 units of Vitamin E a day as this dose can lower thyroid function. Also, Vitamin C becomes an oxidant, not an antioxidant, in doses over 500 mg a day. In the past we were taught that LDL (bad cholesterol) had to be oxidized in order to get into the arterial wall. Analysis of the LDL inside the artery recently showed only a tiny percentage of LDL was oxidized. Having said that, I still see isolated reports of antioxidant benefits and I do not mind my patients taking them as long as they are not on a statin drug such as Zocor, Pravachol, Lipitor, Crestor or Lescol. Vitamin E, Vitamin C, alpha lipoic acid, Coenzyme-Q10, bioflavonoids (in red wine or red grape juice), melatonin, blueberries, oregano, dark chocolate, tea of all types are potent antioxidants. Protein in the Urine Otherwise healthy people that have protein in the urine have increased risk of heart disease. A new study shows that even 15mg of protein per 24-hour urine was significant and that an ACE inhibitor tremendously cuts the risk of heart attacks, strokes and kidney failure. This small amount of protein is often not picked up by the regular urine dipstick and only can be found with a micro-albumin dipstick or a 24-hour urine for protein or a spot urine for protein/creatinine ratio. Irritable Bowel Syndrome Finally, a study that confirms my impression over the years that a lot of patients labeled with "irritable bowels" have only fructose (fruit and fruit juice) intolerance. Beware of high fructose corn syrup as well in fruits and in drinks. Kidney Stones Taking calcium does not increase your risk of kidney stones. In fact there are fewer stones in patients taking calcium supplements. Calcium and also phytates in cereals bind oxalate (the main ingredient in most stones) in the intestines and keep it from being absorbed into the blood stream. Too much protein intake (Americans eat twice as much protein as they need) and not enough water can also cause stones. Vitamin C Low Vitamin C levels are harmful in the elderly and contribute to an excess in death rate. Therefore, one fresh fruit or vegetable a day is important. If this is not possible, then 100mg of Ester C a day is plenty. There was no evidence that low levels of Vitamin E or A contributed to excess mortality. Green Tea Reuters Health recently reported a component in green tea may prevent cancer. Epigallocatechin interfered with the fatty acid metabolism and killed prostate cancer and "a variety of other malignancies" without any effect on normal cells. In contrast to cancer cells, normal cells have low levels of FAS (fatty acid synthetase) and are not harmed by this chemical. Salmon Basic reports question the safety of eating farm-raised salmon because of slightly higher levels of dioxin, which is a carcinogen. Salmon has been a good choice as a substitute for meat and chicken since it is lower in saturated fats, high in Omega 3 fatty acids and free of mercury contamination. I still recommend salmon, but try for the non-farm raised ones, broil it well and do not eat the skin. Artichokes German studies suggest this vegetable may be the best treatment for patients with digestive problems not helped by anything else. Grains Wheat bread, rye, etc. may be the main ingredient in a low fat diet but more and more problems such as chronic fatigue, hyperactivity, and chronic diarrhea have been associated with "gluten" which is the protein portion of the grain. The patient does not have to have chronic diarrhea to have this disease. Blood and stool tests may reveal the problem, which is called Celiac disease or Sprue. Rye Bread This is the best bread a diabetic can eat. It does not let the carbohydrate into the blood stream rapidly. Recent reports also say that buckwheat is very good for diabetes. Osteoporosis Fifteen hundred mg per day of calcium is necessary in people under 30 or women after menopause. 800 to 1000mg is acceptable otherwise. Calcium citrate is a good choice, as it does not require acid in the stomach before it is absorbed and does not cause gas. However, if dietary intake is poor, as is often the case in the elderly, then calcium phosphate is a better choice (Mayo, January 2004, Vol. 79). Also, fifty percent of people over 80 are Vitamin B deficient. Eighty percent of people admitted with hip fractures are Vitamin D deficient. It makes sense to recommend 800 units a day of Vitamin D to elderly patients. Tuna Young tuna is free of mercury, but larger tuna may be higher in mercury and should not be eaten by pregnant women and perhaps the general population as well. Tuna in cans of the non-Albacore type are the smaller, younger variety, as opposed to tuna steaks, which may be high in mercury. Having said that, I note a JAMA medical journal report of no high mercury levels in pregnant women and young children in the United States. Haddock, Cod, Pollock, Tilapia, Sole and most shellfish are also free of mercury. AN APPLE A DAY: The researchers gave rats a chemical to induce breast cancer. The scientists also brewed extracts made from Red Delicious apples, which are commonly found in grocery stores across America. The researchers tested three doses of the extract. For humans, the doses equaled eating one, three, or six apples per day. After 24 weeks, breast tumor rates were 17% lower in the rats receiving the low dose of the apple extract, 39% lower with the medium dose, and 44% lower with the high dose. The number of tumors also dropped 25% with the low dose, 25% with the medium dose, and 61% with the high dose. Tumors also took longer to show up in the rats receiving the apple extract. The tumors appeared within 11 weeks in rats that didn't get the extract. But tumors appeared by 12 weeks in rats on the low and medium doses, and by 13 weeks in those on the high dose. The extracts "effectively inhibited" breast cancer in rats, write food science professor Rui Hai Liu, PhD, MD, MS, and colleagues. "Thus, consumption of apples may be an effective strategy for cancer protection," says their study. Of course, rats aren't people. They didn't have some of our bad health habits, such as smoking or obesity. No one can promise that apples will keep humans free of breast cancer. But since many Americans don't eat enough produce, eating more apples might be a good idea. The study will appear in the March 23 edition of the Journal of Agricultural and Food Chemistry. Apples may also prevent hair loss. CHROMIUM GOOD FOR DIABETIC’S HEARTS: NEW YORK (Reuters Health) - In patients with type 2 diabetes, short-term chromium supplementation leads to a shortening of the QTc interval, according to Slovenian and US researchers. "QTc interval prolongation is a marker of ventricular repolarization and an important predictor of morbidity and mortality in diabetic patients," lead investigator Dr. Bojan Vrtovec told Reuters Health. "Therefore, the changes in QTc interval observed with chromium supplementation in patients with type 2 diabetes may also translate into survival benefit." In the April issue of the American Heart Journal, Dr. Vrtovec, from Ljubljana University Medical Center and colleagues note that a prolonged QTc interval is known to be associated with high fasting glucose levels, high plasma insulin levels and is inversely related to insulin sensitivity in type 2 diabetics. Chromium supplementation improves insulin sensitivity, lowers plasma insulin levels and improves glucose homeostasis. To investigate further, the researchers had 30 diabetic patients take 1000 micrograms of chromium picolinate daily for 3 months followed by placebo for 3 months. Another 30 patients started with 3 months of placebo and then crossed over to chromium for 3 months. However, I do not recommend over 200 micrograms a day of chromium as kidney failure has been reported with higher doses. Baseline QTc interval was similar in both groups -- 422 milliseconds in the first group and 425 in the second group. However, at 3 months, QTc interval was significantly shorter in the supplementation group (406 milliseconds) than in the placebo group (p = 0.01). In the next 3 months, QTc shortening was observed in the second group but not in the first group. Overall there was a comparable QTc interval duration in both groups at the end of the study (414 and 409 milliseconds). The researchers note that plasma insulin levels decreased significantly after 3 months of chromium supplementation. This, they conclude, "may be partly responsible for the QTc interval shortening observed in our study." Am Heart J 2005;149:632-636.