Newsletter for 2006 by Ray Sahelian, M.D. Health Newsletter - Free Email Newsletter - Online Newsletter

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Emails from subscribers
Dr. Sahelian is always interesting to read. I always learn something new each time I read his articles. Thanks for his comments.

I received a copy of your Feb 15, 2006 newsletter about the dietary study of fats done recently (the one that cost us taxpayers 450 million or so, and got no results). I am impressed with your analysis of that study, and also with your food recommendations. I heartily agree: Stupid is the only word to describe the researchers' analyses of their results!

I have just read your latest newsletter (Vol.3, issue 13-- July 24, 06 ) and I felt compelled to let you know that I strongly agree with all that you have said here. I also wanted you to know that I read most of your newsletters and really appreciate the excellent information that you talk about. Thank you for your excellent advice and also, thank you for the kind, considerate, and respectful way that you present these things. I have a great deal of experience in having tried many of these herbs in many combinations and I know that you speak the truth on all these matters. I am well acquainted with several health problems many of which you have addressed very nicely and frequently, quite timely. I am type two diabetic, and have all the typical associated health problems that go along with diabetes. ED is one of those problems, and being 54 years of age adds to those problems. I have used herbs for several years now, and have found that they help with most of my health problems. Your kindly advice has reaffirmed what I have found to be true over the years. I hope that you will continue to pass on the rich wealth of knowledge and wisdom that you obviously have, to others who may be in need. I view you as a kind, and benevolent person. And, if you aren't already, please come and be a Christian. You have a good heart from what I can see, and it would be a real tragedy for you to miss out on becoming a member of the Christian family. Do you know the best vitamin for a Christian? B1 May God bless you.

Dr. Sahelian, I would like to first of all thank you and your associates / staff, for the incredible web site put together with much time and effort. Like a previous letter writer said, it's important to find someone who one can trust somewhat, because doctors, pharma companies, supplement companies, and celebrity spokespersons along with the advertisers they "shill" for, all have their own reasons and agenda - usually financially motivated, for endorsing products. I wish more doctors would bother to keep current with information available from sites like yours. Here in Canada, most doctors are foils for the big pharma conglomerates, because the mindset is all drug related with nary a thought to natural alternatives or treatments.

SUPPLEMENT RESEARCH UPDATE
Vol. 3, Issue 20 -- December 4, 2006
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How is it possible that hundreds of thousands of medical doctors in this country who prescribe statin drugs are misguided, while I may turn out to have made an accurate prediction? Those of you who are regular readers of my newsletter have heard me repeatedly say that, even though statin drugs such as Lipitor and Zocor reduce cholesterol levels, there is no proof that statin drugs help people live longer. A recent medical journal article appears to validate my viewpoint. Fortunately, this journal article from Archives of Internal Medicine, November 27, 2006 got picked up by the news media. The CNN headline said, " Study doubts benefits of universal statin drug use." The CNN article begins, "Cholesterol-regulating statin drugs slightly lower the risk of heart attack and stroke in people with no history of cardiovascular disease but may do little to reduce their risk of death."
   I have had many emails from doctors criticizing me for not endorsing the wide use of stating drugs. Well, I think they judged too soon. The medical establishment needs to apologize to the public for pushing these expensive and potentially dangerous statin drugs for so many years when there has been no proof that they help patients live longer. Would you rather have a high cholesterol level and live longer, or have a lower cholesterol level but die sooner? Never mind the decreased quality of life from repeated doctor visits for cholesterol checks, muscle aches and liver damage from the drugs, let alone the high drug expense of up to two thousand dollars a year that could be well spent on something else. The discussion follows below. In this issue I also review the benefit of lipoic acid for diabetic neuropathy and the cancer reducing potential of garlic and onion.

Could Half a Million Doctors be Misguided?
Statins are currently the most widely prescribed drugs in many countries. There are hundreds of thousands of doctors in the USA, and many more in the rest of the world, who prescribe statin drugs to their patients and have been doing so for the past decade or so. Most of these doctors are well meaning and do think they are helping their patients. But, unfortunately, they have been misguided by the drug companies and by the medical journals they read and trust. These medical journals have repeatedly reinforced the notion that lowering cholesterol is a good thing. I don't dispute the fact that studies show those with high cholesterol levels have a higher rate of cardiovascular conditions. However, I do dispute the fact that lowering cholesterol with statin drugs is a good thing.
This is what the CNN article says: Statins are prescribed to lower excessive levels of artery-clogging "bad" cholesterol and to lessen inflammation in blood vessels. But the latest study casts doubt on the benefits of prescribing statins to prevent cardiovascular disease in individuals with healthy cholesterol levels. While statins lessen the risk of heart attacks and strokes in people already at risk because of heart disease or high cholesterol, routine use of such drugs by otherwise healthy adults produces such limited benefits that it may not be cost-effective. For example, an analysis of seven previous trials involving nearly 43,000 adults aged 55 to 75 found that the average adult had a nearly 6 percent chance of suffering a heart attack or stroke over a 4 1/3-year period, compared with a 4 percent risk among those who took statins. Therefore, 60 patients would need to be treated for an average of 4.3 years to prevent one major coronary event," the study's author, Dr. Paaladinesh Thavendiranathan of the University of Toronto, wrote in the article. To prevent a single stroke, 268 people would need to undergo statin treatment, and to prevent one nonfatal heart attack 61 would have to take the drugs, he added. Moreover, statin use did not improve the overall risk of dying from cardiovascular disease or from other causes.
   My comments: Most of you realize by now that doctors and the medical establishment do not know it all and are fallible. (Just to be clear, I don't claim to know it all, either, but I do my best to keep an open mind and accept the use of drugs or supplements if they work.) For decades doctors prescribed hormone replacement therapy for women in high doses and a few years ago we found out that this treatment increased breast cancer rates. It is quite possible that we may in the next few years discover that the widespread use of statin therapy was not such a good idea after all. I do not deny the possibility that there are certain patients that may be helped by statins. However, statins are overused and misused. Too many people are focusing too heavily on blood cholesterol levels as opposed to looking at the effects of these drugs on the whole body. If you have an extremely high cholesterol level, then a statin drug could lower it, but would this result in you living longer? I don't know if anyone can promise this to you in great confidence. If you have a mild to moderate cholesterol elevation, and your doctor has you on a statin drug, then it is legitimate to question your doctor. Ask your doctor to show you studies or prove to you that the use of statin drugs for mild to moderate cholesterol elevation leads to a longer lifespan. If he or she can't, then why is the statin drug being prescribed? There are a number of steps one can take to improve cardiovascular health without drugs, and I list some of them at this site. See http://www.raysahelian.com/heartdisease.html

 

Bad Breath or Less Cancer?
Using data from a network of Italian and Swiss case-control studies, researchers analyzed the relation between frequency of onion and garlic use and cancer at several sites. They found that those who ate the most garlic and onion had a lesser risk for several cancers include cancer of the oral cavity, esophageal cancer, prostate cancer, colon cancer, and other cancers. For an abstract of the study, see http://www.raysahelian.com/allium.html


Alpha Lipoic Acid and Diabetic Neuropathy
An alpha lipoic acid supplement improves nerve pain or "polyneuropathy" in patients with diabetes. Dr. Dan Ziegler from Heinrich Heine University, Duesseldorf, Germany and colleagues gave lipoic acid to patients with diabetic neuropathy. Symptom scores and stabbing and burning pain subscores were significantly reduced after 5 weeks. Symptoms improved significantly as early as 1 week with the highest alpha lipoic acid dose (1800 mg daily) and within 2 weeks with the other doses (600 mg and 1200 mg daily), and there were no significant differences among the three alpha lipoic acid groups for changes in mean total symptom score at any time point. Side effects of high dose lipoic acid were nausea, vomiting, and dizziness. Researchers say, "Whether the observed favorable short-term effect of alpha lipoic acid on nerve pain and deficits can be translated into slowing the progression of diabetic polyneuropathy in the long term is unknown."
   My comments: The authors suggest using 600 mg a day of lipoic acid for the treatment of diabetic neuropathy. I suggest using a lower amount. Most of the time when researchers are doing a study, they only have a limited time since it is expensive to do a long term study. So, they end up using a very high dose of a supplement to elicit a response. However this does not mean that the dosages they used are appropriate for long term supplementation. I suggest using 50 mg of r lipoic acid a day for 2 months and then determine the dosage to go up or down based on response and side effects. Ask your doctor to read the study abstract at http://www.raysahelian.com/diabeticneuropathy.html


Emails from Newsletter Subscribers
Q. I am a medical doctor who takes statin drugs for high cholesterol. I decided to stop the Lipitor and instead take 3 fish oil capsules a day. I took the fish oil pills for 6 weeks and saw no beneficial effect of the fish oil on my cholesterol level. I think fish oil is another example of a hyped up natural product that has not been well tested. I'm going back to my statin drug since I know for sure it lowers my cholesterol.
   A. Sometimes we tend to look at absolute numbers on lab studies rather than other important matters. For instance, fish and fish oil are full of EPA and DHA. These fatty acids get incorporated in many tissues in the body, including eye, brain, skin, various organs, heart, etc., and could lead to improved microcirculation in blood vessels and capillaries, and decreased blood viscosity. By just looking at total cholesterol level, without taking into account the fatty acid composition of your cells, and without taking into account the beneficial aspects of these fatty acids from fish oil on other parts of the body does not give us the full picture of the benefits. Doctors and drug companies make the mistake of looking at cholesterol levels as if it that is the most important thing in cardiovascular health. Who knows, maybe by taking a statin you could lower your cholesterol but then die sooner? Whereas taking fish oil may not reduce cholesterol to any significant extent, but because of all the other potential benefits that fish oils provide, such as blood thinning, you may live longer. This is all still theoretical of course, but the main point I want to make is that looking at cholesterol numbers as if that is the be all and the end all is not being holistic or scientifically comprehensive.

Q. I just wanted to let you know how well Good Night Rx works for me. It gives me sound sleep with no side effects. I take it 2 hours before bed on an empty stomach. One time I took it right after dinner and it didn't work at all.
   A. Yes, it seems just about everyone who has given us feedback has mentioned that empty stomach is working better.

SUPPLEMENT RESEARCH UPDATE
Vol. 3, Issue 19 -- November 13, 2006
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With all the news channels focused on the elections and the post election results, an anti-aging study with a wine extract didn't get as much media attention as it would have otherwise. The title of the study done at Harvard University in Boston, was, "Resveratrol improves health and survival of mice on a high-calorie diet." Now, you can see why this would perk up everyone's attention. Based on the result of this study, should everyone be taking a resveratrol supplement, eating more red grapes, or drinking more red wine?
   Another interesting recent finding was that turmeric, which contains curcumin, was found in a rodent study to be beneficial in rheumatoid arthritis.
   I want to occasionally remind users of supplements that when trying a new product, it is preferable that you take it alone for one, two or three days so that you notice its benefits and side effects without interference from other supplements or medicines. I realize this is not always possible since many of you may need to be taking medicines on a daily basis. Just keep in mind that certain herbs and nutrients are quite potent and unexpected reactions may occur when combining supplements and medicines. If you plan to take a supplement for prolonged periods, it is a good idea to know how it influences your body and how it makes you feel.
 
Resveratrol, an Anti-Aging Supplement?
I find it quite interesting that resveratrol, found in red wine, extends survival in mice. How do we make practical use of this finding?
   Harvard researchers tested the wine extract resveratrol on middle aged mice. Resveratrol supplementation shifted the physiology of middle-aged mice on a high-calorie diet towards that of mice on a standard diet and significantly increased their survival. The news media took a hold of this finding and one headline said, "Compound found in red wine and grapes extends lifespan of mice." What makes this interesting is that in previous studies over the past few years, resveratrol was found to have a similar benefit on yeast, flies and worms. This was the first evaluation of resveratrol on survival extension in mammals. One group of mice ate a normal diet. The second was fed a high-calorie diet and the third had the same high calorie diet but was given resveratrol supplements. By the time the mice were 114 weeks old, about 60 percent in the high-calorie group had died, compared to about 40 percent in the low calorie diet group and the group with the high calorie diet supplemented with resveratrol. The mice taking resveratrol had healthier heart and liver tissue, decreased blood sugar levels, better insulin sensitivity and were more active than the other rodents.
   My thoughts: Will a resveratrol supplement help you live longer? We won't know until resveratrol, in varying dosages, is given to hundreds or thousands of people for at least 10 to 20 years, and I am not aware of any large scale resveratrol human studies testing for lifespan extension that have started. Do we wait a couple of decades for more research or do we start taking a resveratrol supplement now? I don't think anyone knows for sure, and there can be a legitimate number of opinions on this topic. I can only tell you what I plan to do. I will take a 10 mg resveratrol supplement once or twice a week and drink an ounce or two of red wine some evenings with dinner. Wine has several additional beneficial polyphenolic substances with antioxidant properties. For more info on resveratrol, including the amount found in red wine, see http://www.raysahelian.com/resveratrol.html


Curry. Curcumin, Turmeric for Rheumatoid Arthritis and Alzheimer's
Curry, curcumin, and turmeric may be helpful in rheumatoid arthritis and Alzheimer's disease. But first, let me explain the difference between them. Turmeric is a yellow spice which has many beneficial compounds, some of them are called curcuminoids, the best known being curcumin. Curry is mix of several spices (most often turmeric combined with coriander and fenugreek).
   Dr. Tze-Pin Ng from National University of Singapore and colleagues compared test results on mental health for three categories of regular curry consumption in 1,010 elderly Asians who did not have dementia. People who consumed curry "occasionally" and "often or very often" had significantly better scores than did those who "never or rarely" consumed curry. These results, they say, provide "the first epidemiologic evidence supporting a link between curry consumption and cognitive performance that has been suggested by a large volume of earlier experimental evidence." See http://www.raysahelian.com/curry.html for details of the study.
   In experiments with rats, scientists at the University of Arizona in Tucson found that turmeric extract was able to prevent rheumatoid arthritis-like joint inflammation and destruction in the animals. The findings, published in the journal Arthritis & Rheumatism, are the first to show that a turmeric extract like those currently sold as dietary supplements has anti-arthritis powers. Rheumatoid arthritis arises when the immune system mistakenly attacks tissue in the joints, leading to inflammation, pain and progressive joint damage. Turmeric inhibited a key protein called NF-kappa B, which controls the activity of a number of inflammatory substances harmful to the joints in RA. In fact, NF-kappa B is the target of certain drugs now under development for RA.
   My thoughts: If you have rheumatoid arthritis, should you take a curcumin and turmeric supplement? I don't see any harm in trying it as long as your doctor is aware and approves. A cautious way would be to start with one capsule of a 500 mg curcumin / turmeric combination with breakfast. So many dangerous drugs are prescribed by doctors to their patients with RA that giving a natural supplement a trial should be so much safer in comparison. After a month or so the dosage could be increased to 2 capsules and then adjusted up or down. It is impossible to predict whether curcumin and turmeric will be found to be helpful in humans with RA until actual studies are done. It is difficult to predict how this natural supplement would interact with the drugs commonly used for RA. Perhaps the dosages of the drugs could be slightly reduced? Hard to say. There are more questions than answers, therefore have a frank discussion with your rheumatologist and have him or her read the information on these web pages http://www.raysahelian.com/rheumatoidarthritis.html  and http://www.raysahelian.com/curcumin.html  then decide whether natural supplements are appropriate for your condition. For an abstract of the turmeric and rheumatoid arthritis studies, see http://www.raysahelian.com/turmeric.html


Emails from Newsletter Subscribers
Q. I came across an article on Pycnogenol mentioned in Newsweek - Nov. 6, 2006 issue - "A French maritime pine bark extract called Pycnogenol — a mix of antioxidant and anti-inflammatory compounds — is a fast-growing supplement on the U.S. market, with sales up 25 percent this year to date. Unlike most supplements, which have very little research behind them, Pycnogenol has 36 double-blind, placebo-controlled trials. The strongest evidence relates to heart health—helping to reduce unwanted clotting, lower "bad" cholesterol and bring down mild hypertension. But the latest studies suggest benefits for diabetes, too. Diabetic patients eventually tend to develop leaky capillaries, which can lead to vision loss, leg ulcers and even amputation of toes or feet. A small study in September found that 150mg of Pycnogenol a day for four weeks helped repair blood vessels and improve capillary blood flow by 34 percent—versus 5 percent for those receiving a placebo. For general health, 25mg to 50mg a day will do. But it won't come cheap (think $30 to $50 a bottle)." Do you think it is safe to take 25 or 50 mg of Pycnogenol daily?
   A. Pycnogenol seems to have good research supporting its benefits, but then again there are hundreds or thousands of beneficial substances in various fruits, vegetables, roots, barks, herbs, etc. I just discussed the benefits of resveratrol and curcumin, and last week talked about EGCG from green tea. We certainly can't take all of these supplements every day! For the time being, I think it is safe to take Pycnogenol 25 mg or 50 once or twice a week with breakfast. I prefer alternating several supplements rather than taking the same ones every day. For more info, see http://www.raysahelian.com/pycnogenol.html


Q. I am a graduate student at MIT. I have been assigned to write about a recent Mayo Clinic study that suggests the popular antiaging supplement DHEA has no beneficial effects. The two-year study appeared in the October 19, 2006 issue of New England Journal of Medicine. I was wondering if you think elderly people should stop taking DHEA in light of the findings? Do you think more research is necessary to evaluate the potential long-term health risks associated with DHEA?
   A. Two years is not long enough to determine if a supplement has anti-aging benefits. I am not a big proponent of DHEA. In my opinion, hormone supplementation is very risky. DHEA side effects could occur with high dose use. These include hair loss and potential tumor formation. DHEA may be appropriate in some people who have very low DHEA or testosterone levels. Low dosages of 1 to 5 mg, with a week off each month, may be appropriate for some people who may notice an increase in vitality and libido. The whole topic of hormone supplement use is very controversial and there is a variety of opinions among physicians and scientists. For more info, see http://www.raysahelian.com/dhea.html


SUPPLEMENT RESEARCH
Vol. 3, Issue 18 -- October 26, 2006
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EGCG - In the future you're going to see these initials quite often. EGCG (epigallocatechin gallate) is a potent antioxidant found in green tea, which has shown promise as a cancer fighter and to speed up metabolism, hence its potential popularity as a weight loss supplement. Many laboratory studies in cultured cells, and some rodent studies have shown that EGCG prevents fat formation. The Coca Cola company has come out with a green tea product with the promise that consumers will lose weight. So, does green tea lead to weight loss? I will discuss this matter, along with some disturbing news that drugs used to control agitation in Alzheimer's disease may actually be causing more harm than good. Are there better alternatives? Also, would you really benefit from a lycopene supplement?

Green Tea for Weight Loss?
"Enviga increases calorie burning. It represents the perfect partnership of science and nature," says Dr. Rhona Applebaum, chief scientist, The Coca- Cola Company. "Enviga contains the optimum blend of green tea extracts (EGCG), caffeine and naturally active plant micronutrients designed to work with your body to increase calorie burning, thus creating a negative calorie effect." The press release continues: "The accumulated body of scientific research shows the ability of green tea's powerful antioxidant EGCG to speed up metabolism and increase energy use, especially when combined with caffeine," adds Nestle researcher Dr. Hilary Green. Nestle is cooperating with Coca-Cola Company to promote this product.
   Enviga will be available to the consumer in a few weeks. However, in many newspaper articles that followed the press release, health experts dismissed claims that Enviga would burn calories by speeding up the drinker's metabolic rate, and cast doubt on the chances it would help people lose weight.
    My thoughts: Now that one of the largest companies in the US is heavily promoting green tea and EGCG, it is time to seriously evaluate the potential benefit and harm of overconsumption of green tea. I think it is premature to make the claim that ingesting Enviga leads to weight loss. The Coca Cola Company has not provided any direct research that indicates drinking several cans of this green tea and caffeine product is safe and effective, yet their press release makes quite promising statements. I am concerned about the overstimulation of heart muscle when so much green tea and caffeine are ingested, and the potential for irritability, anxiety, and insomnia. It is possible that many people will continue drinking their coffee throughout the day while ingesting one or more cans of Enviga, hence potentially increasing their blood pressure and causing heart problems. EGCG, one of the beneficial substances in green tea, shows a lot of promise. In lab studies, the potential health benefits ascribed to green tea and EGCG include antioxidant effects, cancer chemoprevention, improving cardiovascular health, preventing fat formation, protecting the skin from the damage caused by ionizing radiation, and others. The compound EGCG has been shown to regulate dozens of disease-specific molecular targets. However, at this time, it is too early to say whether consuming large amounts of EGCG will provide more benefit than harm. There are countless beneficial substances in herbs and plant products that have been shown to have similar benefits. For instance, lycopene from tomatoes, curcumin from turmeric, resveratrol from grapes, genistein from soy, etc. How do we know whether taking a very high dose of a single substance is safe in the long run? Logic tells us that ingesting smaller amounts of many substances is healthier than taking a large dose of just one. Oranges are a healthy fruit. But, does it make sense to only eat several oranges a day and no other fruits? One would think that eating a variety of fruits would be a healthier option. Same with green tea and EGCG. I would recommend you avoid the temptation of taking too much of this beneficial substance until we have long term studies to indicate its safety. You may be better off just drinking an old fashioned cup of regular green tea or taking a green tea extract capsule.
For more info on EGCG and green tea, see http://www.raysahelian.com/greentea.html

For suggestions on weight loss, see  http://www.raysahelian.com/weightloss.html

 

Safer Alternatives to Alzheimer's Disease Drugs
"Alzheimer’s Drugs Offer No Help, Study Finds" was an article in the October 12 issue of New York Times written by Benedict Carey. According to this interesting article, the medicines most commonly prescribed for agitation and delusions in Alzheimer’s disease are no more effective than placebos, and put them at risk of serious side effects, including confusion, sleepiness and Parkinson’s disease-like symptoms. The drugs tested in the study — Zyprexa from Eli Lilly; Seroquel from AstraZeneca; and Risperdal from Janssen Pharmaceutical — belong to a class of medications known as atypical antipsychotics. These drugs are used to treat schizophrenia and other psychoses, and are commonly prescribed for elderly patients in long-term care facilities. About a third of the estimated 2.5 million Medicare beneficiaries in nursing homes in the United States have taken the medications. Within the past two weeks, two new studies became available that show the untapped potential of natural supplements in the prevention or treatment of AD. In the first study, 200 patients with AD were given DHA and EPA, the fatty acids found in fish oils, for a period of 6 months. Improvement was noted in patients who had a mild case of AD. A study by researchers at the David Geffen School of Medicine at UCLA and the VA Greater Los Angeles Health Care System show that curcumin, a compound occurring in the spice turmeric, assists the immune system in the clearance of amyloid beta in the brain. Amyloid beta is a substance that accumulates in the brains of Alzheimer's patients to form the plaques that are characteristic of the disease.
   My thoughts: So much time and money has been spent on finding drugs that treat Alzheimer's disease, but as of now the anticholinesterase drugs and the antipsychotics have been quite disappointing. What if all these years, rather than having wasted all this effort on drugs, the focus had been on finding natural ways to prevent or reduce the occurrence of this disturbing condition? For research info on natural options to address Alzheimer's Disease, see http://www.raysahelian.com/alzheimer.html


Do You Need More Lycopene?
Lycopene, found in many fruits and vegetables -- especially tomatoes and watermelon -- may play an important role in reducing risks of many diseases, including prostate cancer and breast cancer. Some epidemiological studies indicate that high consumption of lycopene may lower the risk of heart disease, atherosclerosis, and macular degeneration. However, would you benefit from taking a lycopene supplement? It is difficult to say. I think tomatoes and tomato based products are consumed by Americans in a disproportionate basis compared to other fruits and vegetables. In other words, we may be consuming enough lycopene in our diet but perhaps not enough of other healthy substances found in a number of fruits and vegetables that are eaten infrequently. Therefore, I am not yet convinced that taking a lycopene supplement will provide benefits to most people, unless their diet is low on tomato based products. Perhaps those who consume adequate or large amounts of tomato based products may be better off taking other types of supplements such as those found in acai, goji, noni, pomegranate, curcumin, soy extracts, artichoke, asparagus, barley grass, etc. The point is, if you plan to take supplements, it may be better to take those that you don't normally consume in your diet as opposed to something like lycopene where it may already be abundant in your diet.
For more information on lycopene, see http://www.raysahelian.com/lycopene.html


Emails from Newsletter Subscribers
Q. I was skeptical about trying Good Night Rx, and my first night that I took it it did not seem to work well. So I emailed Physician Formulas and they asked if I had taken it with a meal or on an empty stomach. I had actually taken it right after dinner. So the next night I took it an hour before bed and about 2 to 3 hours after dinner. It worked so well. Within a half hour I could tell feeling relaxed and shortly thereafter I yawned. I did not have any side effects except maybe a slightly more vivid dream, and woke up quite refreshed and in a good mood.
   A. The effectiveness of certain supplements has a lot to do whether they are taken with food or on an empty stomach. Each supplement is different on how it should be taken, but, as a general rule, if you wish to feel a mental or physical effect from a supplement, take it on an empty stomach. If you are just taking a supplement for health reasons, such as an antioxidant, for instance curcumin or vitamin E, take it with food. We have had good feedback with Good Night Rx. Most people really like the sleep inducing effect, but we do suggest to just using it 2 or 3 times a week. People who seem not to notice the sleep inducing effects as much, at least initially, are those who happen to be addicted or habituated to potent pharmaceutical sleep drugs.

Q. Generally speaking, is it safe to give supplements to children?
A. There have been few studies with children and supplements, and, as a rule, except for low dose multivitamins, whole vegetable and fruit extract, and fish oils or cod liver oil, it may be best to be cautious in giving supplements to children for prolonged periods except when necessary to treat a medical condition. I rather have children get their nutritional needs from whole foods.

SUPPLEMENT RESEARCH UPDATE
Vol. 3, Issue 17 -- October 5, 2006
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"Millions use alternative medicine for sleep," was a CNN headline last week Most respondents who used herbal therapies or relaxation techniques found these methods helpful for managing their insomnia. Some of the reasons for the high rate of sleeping problems in this country include physical inactivity (desk work), psychological stress, lack of adequate sunlight exposure, and bright light exposure late into the night. Below I discuss the common herbs and nutrients used for sleep and a summary of their benefits and shortcomings.

Using Alternative Medicine for Sleep
An estimated 1.6 million people, are using complementary and alternative medicine to help themselves sleep better. People with anxiety, depression, congestive heart failure, hypertension and obesity are more likely to have problems sleeping. Keep in mind that taking high doses of certain herbs and supplements can lead to alertness at bedtime and cause shallow sleep.
   Prescription sleep drugs are often effective, but have many side effects including memory loss, decrease in sexual desire, and morning grogginess leading to car accidents. The advantage of herbs and supplements is that they are safer than sleep drugs. The disadvantage of the supplements is that they are not as consistently effective and are not as potent as the pharmaceutical sleep medicines. But, a combination of herbs and nutrients can provide good results in most people. It is best not to use drugs or supplements every night, but at most 3 nights a week. Tolerance and dependence may develop if used nightly. I don't have any objections to the occasional use of a prescription sleep medicine. Which herbs and nutrients are effective for sleep? Below are the most commonly used supplements in alphabetical order. Please note that dosage and timing can vary significantly among people.

5-HTP or 5-hydroxytryptophan is a nutrient that converts into serotonin. Serotonin is involved in relaxation. At night, serotonin is converted in the pineal gland to melatonin, the sleep hormone. 5-HTP is not consistent in its sleep effects, but sometimes a smaller amount than the usual 50 mg capsule can be effective when taken on an empty stomach about an hour or two before bed. The capsule can be easily opened and perhaps half or 2/3 used. Higher amounts can cause nightmares.

Chamomile may help you relax, but I have not found it to be very effective for sleep. The effects from chamomile are quite mild.

Good Night Rx is a combination of 5-HTP, melatonin, GABA, taurine, kava, valerian, hops, chamomile, and several other herbs. I am actually quite proud of this formula -- which took me years of trial and error to develop -- and thus far our feedback has been quite positive. One capsule is taken half an hour to 3 hours before bed on an empty stomach. Good Night Rx, when taken with or after a meal, will not work as well. Wait at least half an hour after taking Good Night Rx if you plan to have a late night snack. Some people say that they notice the sleep inducing effects even better the second or third night of use. Good Night Rx, in my opinion, is more effective than any individual herb or nutrient. Our feedback thus far has an 80 percent satisfaction rate which is quite high for an herbal product.

 

Hops is the herb that beer is made from. Hops is a good herb to induce sleep but it is not as good in maintaining sleep throughout the night. Many people find hops to have a sedating nature. A dosage of 300 to 600 mg of hops is one option an hour or two before bed.

Kava, a plant from the South Pacific, is better known for relaxation as opposed to sleep although some formulations or extracts can have more sedative activity than others. A dose of 300 mg of a 30 percent extract can be used an hour to 3 hours before bed on an empty stomach.

Melatonin is the sleep hormone made by the pineal gland at night. Melatonin is perhaps the most consistently effective natural supplement for sleep, although at least a third or half of users may still not find it helpful. The dosage varies between a quarter of a milligram to 3 mg. Higher dosages can cause nightmares and morning grogginess. I suggest using a third or half
of a mg at first, taken 1 to 3 hours before bed on an empty stomach. The sustained release form is a good option.

Tryptophan is an amino acid that converts into 5-HTP which then converts into serotonin, and then into melatonin. I have been asked which of the 3 supplements is best for sleep: 5-HTP, melatonin, or tryptophan. I think it is a matter of personal preference. It is difficult to predict which one you will find best suited for you until you try them. The dose of tryptophan is 500 mg one to 3 hours before bed on an empty stomach. At least half of users notice a good sleep inducing effect from tryptophan.

Colostrum Helpful for Athletes
Colostrum is the early milk produced for a few days after delivery. In cows, it's called bovine colostrum. Athletes may have more energy when taking a bovine colostrum supplement. A study published in the British Journal of Sports Medicine, reports that bovine colostrum helped male cyclists have more energy during a bout of intense training. Cecelia Shing of the University of Queensland in Australia followed 29 male distance cyclists. After taking baseline measurements of the men's performance on a 40-kilometer time trial, the researchers randomly assigned them to drink either a supplement containing 10 grams of bovine colostrum protein or a whey protein supplement every day for eight weeks. During week eight, the men underwent five consecutive days of high-intensity training; their performance was tested before and after the training bout. There were no clear differences between the two groups during normal training. However, volunteers who used bovine colostrum performed at a higher level, with fewer signs of fatigue, during tests taken after the five-day run of intense training. See http://www.raysahelian.com/colostrum.html

   My comments: I think there are certain foods that I would consider superfoods in that they have a high concentration of beneficial substances useful for wellbeing and overall health. I believe colostrum falls into this category. You can find bovine colostrum in the dairy section of a health food store, and it is also available as a supplement in capsules. Every few weeks I will choose a superfood as a discussion topic.

Emails from Newsletter Subscribers
Q. I was watching home shopping network and they were selling CoQ10 in capsule form as opposed to softgel with oil. CoQ10 is fat soluble, isn't oil necessary in the softgel for the CoQ10 to be absorbed and won't the CoQ10 in a capsule not be as effective?
   A. I really don't see a problem with the capsule. Since CoQ10 is taken with breakfast, there's always some form of fat or oil in one's breakfast and I think the CoQ10 will be absorbed whether taken as a softgel or a capsule. Some people, in my opinion, are taking too high a dose of CoQ10, so even if there is a slight reduced absorption (which I doubt), perhaps that's for the better.

Q. Should krill oil be refrigerated?...and how long can it be stored in the refrigerator?
   A. Yes, it is better for krill oil and fish oils to be refrigerated, and hopefully to be used within a few months, preferably a few weeks, of opening the bottle.

Q. There's been a lot of talk about EGCG lately, the extract from green tea. I see supplements of EGCG being sold in high dosages. Are these safe to take?
   A. Green tea is hot these days (no pun intended). Consumers are switching from regular tea to green tea and other herbal teas. I am not a big fan of taking large doses of isolated substances from herbs, such as a high amount of EGCG, preferring to take the whole powder or a less concentrated extract. Many people think the higher the dose of a substance they supplement, the healthier they will be, but that may not always be the case, and often is not the case. So, for the time being, I don't see the need to take a high dose of EGCG unless perhaps under medically supervised treatment for a health condition.

Q. Within 3 days of stopping Lipitor, the pain in my legs went away. I had been on Lipitor for 18 months, and the pains started a few months ago. My doctor did not tell me that the Lipitor could cause muscle aches. I had not been taking walks for the past few months because of aches in muscles and joints and I thought it was due to possible onset of arthritis. Now I'm able to walk around the neighborhood and get some exercise.
   A. We've had quite a few people email a similar response, that their muscle aches stopped soon after stopping a statin drug for cholesterol. We did have one person who emailed and said he had been taking Lipitor for ten years without problems.

SUPPLEMENT RESEARCH UPDATE
Vol. 3, Issue 16 -- Sept 20, 2006
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Will drinking green tea help you live longer? Maybe, maybe not. An epidemiological study done in Japan showed those who drank the most cups of green tea lived longer than those who drank fewer cups. An epidemiological study is a study on a human population which attempts to find a connection between a cause (exposure to a specific chemical, herb, medicine dietary choice, etc.) to a health effect (for example longevity, heart disease, cancer, etc.).
I think we can get some good information from epidemiological studies, but there are so many factors involved in trying to weed out all other factors that influence longevity that it is difficult to know for sure whether drinking more green tea was the factor that made these Japanese live longer. And even if it did, would this apply to those consuming a western diet? See my thoughts below.

Does Diet Influence Uterine Fibroids?
A study published in the American Journal of Clinical Medicine hints at the possibility that diet may have an influence on fibroid tumor growth. Uterine fibroids are hormonally responsive; estrogen and progesterone stimulate their growth. Lignans can act as weak estrogens or antiestrogens. Researchers found that women who excreted a higher amount of lignans in their urine (meaning their diets included foods with a high lignan content) were less likely to have fibroid tumors. See http://www.raysahelian.com/lignan.html  for a list of foods with high lignan content.
   My thoughts: Have you considered adding flax seeds to your soups?


Vitamin D and Pancreatic Cancer
Taking a Vitamin D supplement may reduce your risk for fatal pancreatic cancer. Vitamin D has shown strong potential for preventing and treating several types of cancer. Regions with greater sunlight exposure have lower incidence and mortality for prostate, breast, and colon cancers. Harvard University researchers examined data from two large, long-term health surveys involving 46,771 men between 40 and 75 years old and 75,427 women between 38 and 65. They found that people who took Vitamin D, 400 IU a day had a 40 percent lower risk of pancreatic cancer. Those who took doses of less than 150 IU per day had a 22 percent reduced risk of cancer. Taking more than 400 IU a day did not reduce the risk further.
   My thoughts: Most multivitamins include vitamin D usually at 100 to 400 units. You could consider getting more sun exposure or taking an additional vitamin D supplement. A supplement of 200 to 400 units a day is sufficient for most people. For additional info, see http://www.raysahelian.com/vitamind.html


Fish OIls better than Cardiac Defibrillators?
Fish oils could potentially save more lives than cardiac defibrillators. Many studies have already established a link between consumption of EPA and DHA fatty acids found in oily fish to a lower risk of fatal heart rhythm abnormalities. This latest study tried to estimate the potential public health impact of raising omega-3 levels with fish oil supplements. Using a computer-simulated community of 100,000 Americans and data from past medical studies, the researchers estimated that raising omega-3 levels would save 58 lives each year. This amounts to a 6 percent total death reduction -- mostly by preventing sudden cardiac death, according to the study authors, led by Dr. Thomas E. Kottke of the Heart Center at Regions Hospital in St. Paul, Minnesota. Even if automated external defibrillators (AEDs) were available in every home and public area, the devices would lower a community's annual death rate by less than 1 percent. Based on this analysis, it appears that communities where people eat more fish or supplement with fish oil would have more widespread benefits than either AEDs or implanted defibrillators. American Journal of Preventive Medicine, October 2006.
   My thoughts: I think most people can benefit from taking one, two or three fish oil capsules a day unless they consume fish at least 2 times a week. For fish oil info, see http://www.raysahelian.com/fishoils.html


Drink Green Tea so you can live longer to drink more green tea
According to a study done with Japanese adults, those who consumed the most green tea were less likely to die from cardiovascular disease or any other cause, except cancer, than were the less-frequent green tea drinkers. Dr. Kuriyama and colleagues analyzed information on 40,530 Japanese adults, 40 to 79 years old, who participated in the Ohsaki National Health Insurance Cohort Study. The subjects, who were followed an 11 year period from 1995 to 2005, were from a northeastern region of the country where most of the adults drink green tea three or more times per day. Adults who drank the most green tea were the least likely to die from cardiovascular disease. Men who consumed at least five cups of green tea each day were 12 percent less likely to die from any cause. Whereas, women who drank five or more cups of green tea each day were 23 percent less likely to die from any cause and 31 percent less likely to die from cardiovascular disease. For more details, see http://www.raysahelian.com/greentea.html
My thoughts: For the time being, if you don't drink green tea, it may be a good idea to have a cup a day or a few times a week. If you already drink green tea on a daily basis, you could perhaps add another dup a day. It's also possible that drinking a variety of teas may provide more benefit than just drinking additional green tea. Who's to say other herbal teas (and there are so many to choose from) are not as healthy as green tea? Another option is to take a green tea extract supplement a few times a week. Avoid the use of the tea or the supplement after mid afternoon since the caffeine and stimulants may interfere with sleep. One factor to consider is that this study was done in Japan. Americans have a different diet and lifestyle. Will green tea have similar benefits in those on a Western diet? Probably, but we can't say for sure.
   I know many people who like the taste of green tea, but it is not my favorite, but I drink a cup a few times a week anyway, particularly when I visit a Japanese restaurant to have wild Alaskan salmon teriyaki. Sometimes I bring a small bottle of stevia to the restaurant and add a couple drops of clear stevia liquid to sweeten the green tea.

Email from Newsletter Subscriber
Q. Is there any evidence that the use of statins for cholesterol reduction prolongs life?
A. Statins do lower cholesterol levels, but I have not come across convincing evidence yet that the use of statin drugs prolongs lifespan.

Q. From Lou Mancano, M.D. (a doctor friend) - I read your September 5 Newsletter today regarding the atorvastatin (Lipitor) and stroke study. You might comment in a future edition on the Number Needed to Treat (NNT) analysis. The NNT is the number of patients who need to be treated in order to prevent one additional bad outcome. It is the inverse of the Absolute Risk Reduction (ARR). How to Calculate NNTs.

NNT = 1/ARR
ARR = [CER - EER]
where
CER = control group event rate
EER = experimental group event rate

In the statin and stroke article, the CER was 13% and the EER was 11%. Therefore the ARR is 2%. One divided by 0.02 = 50. Therefore, one needs to treat 50 patients to avoid one stroke, meaning 49 out of 50 patients derive no benefit.
Number Needed to Treat is a quick method I use for determining how many patients I need to treat in order to (probably) benefit one. However, it doesn't account for how many people will develop side effects that are not included in the outcomes statistics. It's interesting to me that NNT calculations show us that many pharmaceutical treatments don't benefit most patients who take the medicines. Drug companies often report Relative Risk Reductions which can easily fool doctors and the public. They find the statistical method that best suits their purposes.

   A. Thanks, Dr. Mancano. If that is the case that only one person out of 50 may have a reduced chance of stroke from this expensive and potentially harmful medicine, I think the editors of The New England Journal of Medicine should have mentioned this to the public and the news media. I also had another thought. The study went on for about 4 to 7 years. What if the study continues and we find out that the side effects from Lipitor actually caused premature death after a more extended period of Lipitor use? It is a possibility to consider.

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SUPPLEMENT RESEARCH UPDATE

Vol. 3, Issue 15 -- Sept 1, 2006
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I'm now convinced more than ever that The New England Journal of Medicine, which at one time was a respected medical journal, cannot be entirely trusted. It is my sad conclusion that The NEJM, in many cases, is basically a marketing extension of the pharmaceutical industry. What was it that finally made me accept this sad fact? It began two weeks ago when I came across a headline on MSNBC website that said, "Statin Use Lowers Stroke Risk." "That's interesting," I though to myself. I started reading the article and what I found is quite disturbing. More details below.
In this issue I will discuss age related macular degeneration, a leading cause of vision loss and the use of chromium supplements for diabetes;

Macular Degeneration
Macular degeneration is a condition in which there is progressive deterioration of the central area of the retina of the eye, resulting in gradual sight loss in the center of the field of vision. There are several carotenoids in the eye, the predominant ones being lutein and zeaxanthin. In a study of healthy women younger than 75 years, whose diets were rich in lutein and zeaxzanthin had a lower rate of age-related macular degeneration.
Lutein and zeaxanthin are found in green leafy vegetables, corn, and squash. Zeazanthin is also found in Goji berries.
My thoughts: Many people limit their vegetable intake to a few of their favorites, such as carrots, tomatoes, lettuce, etc. It's important to have a wide variety in order to obtain various types of carotenoids. I had not eaten corn for quite some time, and recently I ate 2 ears at one time,. About 10 to 16 hours later I noticed my vision was clearer and colors were brighter. Corn has a lot of lutein. I am not sure whether my vision improvement was due to the corn, but if anyone else notices this effect, do email us. Over many years of experimenting with different herbs and foods, I have become quite sensitive in noticing minor changes in my body.
   As to using a lutein supplement, most of the capsules come in 20 mg dosage. I don't think this dosage is necessary to take on a daily basis. Taking a 20 mg lutein capsule 2 or 3 times a week should be fine. Fish oils could also be helpful at 1 to 3 capsules a day, especially for those who don't eat much fish. See www.raysahelian.com/maculardegeneration.html  for additional suggestions. Before you resort to supplements, make sure your diet is the best that it can be. Supplements are just that, supplemental.

Chromium Picolinate and Diabetes
The mineral chromium picolinate may help people with type 2 diabetes better control their blood sugar. Chromium supplements are marketed as a way to improve the body's use of insulin. Previous research has provided conflicting results on chromium's insulin and blood sugar effects. Researchers tested whether chromium picolinate supplements were useful in combination with a sulfonylurea medication -- an older class of diabetes drugs that often promote weight gain. Diabetic adults took either the medication plus 1,000 micrograms of chromium picolinate per day or the drug plus a placebo. After 6 months, those who took the chromium picolinate supplement showed greater improvements in insulin sensitivity and long-term blood sugar control. They also gained less weight and body fat than those on the medication alone. For more info, see  www.raysahelian.com/chromium.html

   My thoughts: This is encouraging news. I prefer a lower dosage of chromium picolinate to be used if a diabetic plans to take this supplement for prolonged periods. Rather than 1,000 mcg, perhaps a 200 mcg pill with breakfast and lunch might be appropriate.

Statins and Stroke - Don't Let the Medical Establishment and Drug Pushers Mislead You
Would you pay 150 dollars a month for a pill that would not help you live longer, and may cause you to have muscle aches, liver damage and possibly hurt your body in other ways? That's what the medical establishment wants you to do. If you have had a stroke, they want you to take high dose Lipitor because it may slightly reduce your risk for stroke. But, you're not going to live longer, so what's the point?
Let's look at how the news media promoted a recent study in the August 10, 2006 issue of The New England Journal of Medicine.

Reuters Health - Statins helps prevent repeat strokes
Treatment with high doses of Lipitor (also called atorvastatin) reduces the overall risk of stroke and cardiovascular events in patients who have experienced a recent stroke or "mini-stroke," new research shows. While Lipitor was associated with a reduced risk of ischemic strokes -- the type caused by a blood clot -- it was also associated with an increased risk of hemorrhagic strokes -- the type caused by bleeding in the brain. After 4 to 7 years of follow-up, the stroke rate in the Lipitor group was 11 percent compared with 13 percent in the control group, a risk reduction of 16 percent. Lipitor use did not affect overall mortality: 216 patients died in the Lipitor group versus 211 in the placebo group.

My thoughts: Can you believe this? An expensive drug -- Lipitor -- is given at a cost of 150 dollars a month, and after 4 or more years more people died who took the drug than those who didn't. Yet, the people at The NEJM want patients with a history of stroke to take this drug and the news media emphasizes the meager 16 percent reduction in stroke but does not headline the fact that those who took the drug did not live longer. This kind of drug promotion by a medical journal borders on outright deception. It is misleading, unethical, and irresponsible. The headlines should have been, "Statin use after stroke found not to influence mortality." Shame on the news media, and shame on the doctors who wrote the abstract in a manner that emphasizes the meager benefitsl.
Am I misinterpreting this study or is the news media and The NEJM misinterpreting it? I called my dear friend and colleague from residency days, Dr. Louis Mancano, from Reading, PA whose honest opinion I respect. After reading the abstract, he came to the same conclusion I did.
   Is it possible that just taking a simply fiber such as psyllium -- a teaspoon with a glass of water twice daily with a meal -- could decrease cholesterol levels and have a similar effect to taking the expensive and dangerous drug, Lipitor? What about eating more omega-3 oils? Increasing overal vegetable and fiber intake? Learning relaxation and meditation techniques? There are many natural, simple, and cheap steps that can be taken to reduce stroke risk than going the dangerous statin direction. For info on natural ways to prevent stroke, see www.raysahelian.com/stroke.html On this web page you will find the full abstract of the study. Notice that several people involved in the study actually work for the drug company Pfizer, maker of Lipitor.

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SUPPLEMENT RESEARCH UPDATE
Vol. 3, Issue 14 -- August 10, 2006
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If you are taking statin drugs (such as Lipitor, Zocor, and others) to lower your cholesterol level, or you know anyone else who is taking a statin drug, you must be aware about potential serious side effects. I recently saw an ad on TV for Lipitor. The promoter of this drug was Dr. Robert Jarvik, the inventor of the first successful permanent artificial heart. I was surprised that he would be promoting this drug when it is becoming clear that it can have serious side effects.
The American Diabetes Association has specified a diet to lower cholesterol and blood sugar. Is there another diet that works better? For a full discussion, see below.

Statins May Reveal Underlying Neuromuscular Conditions
It has been known for quite a few years that one of the side effects of statin drugs is damage to muscle tissue. I think this side effect is more prevalent that patients and doctors realize. In the June 2005 newsletter, I mentioned that even my mother had muscle aches when on Lipitor. The muscle aches stopped when she got off the drug. Now, it appears that patients with a predisposition to a neuromuscular disorders (that they may not yet be aware of), could have their condition precipitated by statin use. Greek doctors from the University of Athens Medical School report four such cases.

Case 1 was a 46-year-old man with a history of hypertension and diabetes mellitus who was prescribed Pravachol for hypercholesterolemia. Three months later he mentioned to his doctor that he had fatigue, muscle pain and stiffness. Genetic testing revealed myotonic dystrophy.

Case 2 was a 62-year-old man with a history of heart attack and diabetes. His high cholesterol was treated with Zocor. Blood creatine kinase levels (an indicator of muscle damage) became persistently elevated and did not return to normal after drug discontinuation. He was diagnosed with McArdle disease.

Case 3 was a 51-year-old man with hypertension and high cholesterol who was hospitalized with acute rhabdomyolytis (muscle tissue breakdown) after taking Lipitor for 18 months. He was diagnosed with mitochondrial myopathy.

The last case was a 58-year-old man who began treatment with Pravachol. Shortly after a dose increase, he developed muscle twitching, muscle cramps and difficulty walking. He was diagnosed with Kennedy disease.

My thoughts: There's always a tradeoff regarding benefits versus risks when using a drug or a supplement. Without question there are patients who have very high levels of cholesterol and have benefited from statin drug therapy. However, doctors are placing individuals who have mild cholesterol elevations on these drugs as if they are perfectly safe. My intention is not to scare everyone from totally abstaining from the use of statin drugs. I just want to let people (and their doctors) know that they should be much more cautious about the use of these medicines, to use the lowest dosages that work, to perhaps take occasional breaks; and to evaluate thoroughly the need for these drugs before taking them. Also, natural methods should first be explored before using these medications. Statin drugs are known to lower CoQ10 levels in the blood. CoQ10 is a nutrient involved in the formation of energy within mitochondria. I am not sure if the muscle tissue damage is due to a decrease in CoQ10 levels or other factors.
 
For info on natural ways to deal with cholesterol, see www.raysahelian.com/cholesterol.html

For info on statin drugs, see www.raysahelian.com/statins.html

For info on the above neuromuscular diseases, see www.raysahelian.com/neuromuscular.html


Vegan Diet better than ADA diet?
According to a report in Diabetes Care, a journal published by the American Diabetes Association, those who eat a low-fat vegan diet lower their blood sugar more, have lower cholesterol levels, and lose more weight than people on a standard American Diabetes Association diet. The vegan diet does not have animal products such as meat, fish and dairy and is low in fat and sugar. Researchers tested 99 people with type 2 diabetes, assigning them randomly to either a low-fat, low-sugar vegan diet (without meat, fish, or dairy) or the standard American Diabetes Association diet. After 22 weeks on the diet, 43 percent of those on the vegan diet and 26 percent of those on the standard diet were either able to stop taking some of their drugs such as insulin or glucose-control medications, or lowered the doses. The vegan dieters lost 14 pounds on average while the diabetes association dieters lost 7 pounds. An important level of glucose control called hemoglobin a1c fell by 1.2 points in the vegan group and by 0.38 in the group on the standard diet. In the dieters who did not change whatever cholesterol drugs they were on during the study, LDL or "bad" cholesterol fell by 21 percent in the vegan group and 10 percent in the standard diet group. Participants said the vegan diet was easier to follow because they did not have to measure portions or count calories.
   My thoughts: I give credit to the ADA for admitting that another type of diet works better than their diet. I appreciate honesty. There is no doubt that diet has much more to do with blood sugar and cholesterol control than most doctors realize. However, vegans and vegetarians need to make sure they are getting adequate amounts of nutrients that could be lacking in their diet. These include B12, carnitine, the omega3 fatty acids EPA and DHA, creatine, CoQ10, etc. For more info, see  www.raysahelian.com/vegetarian.html


Email from Newsletter Subscriber
Q. I have used Passion Rx every other day for a year and half with good results. In the last 6 weeks it has been less effective. Actually last week I took it several days in a row to try to increase the effect but it didn't happen. Any thoughts?
   A. Tolerance can develop to certain sexual herbs or combinations of herbs. We prefer people using Passion Rx or any sex herbs to take at least one full week off a month. In your case it may be a good idea to take at least a month or two completely off from sexual herbs since you have been using this product regularly for a long time. Sometimes the body may get used to a particular herb or herbal combination and another herb or product may provide better results since it could work with a different mechanism of action. But, the most important factor is to take frequent breaks to allow the body to readjust hormones and neurotransmitters.
   I have been using Passion Rx two days a week with a complete week off a month for nearly 3 years and it still works great for me. In my case Passion Rx with yohimbe works quicker, but we have feedback that different people have different preferences. Some people prefer to take individual herbs as opposed to combinations.

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SUPPLEMENT RESEARCH UPDATE
Vol. 3, Issue 13 -- July 24, 2006
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You may have heard the news that some products touted on the Internet for sexual enhancement illegally contain the same active ingredients as Viagra or the other prescription impotence medicines. Recently the FDA sent a press release warning consumers not to use certain herbal sexual products. FDA tested many products advertised on the internet and determined these seven to be laced with the drugs: They are Zimaxx, Nasutra, Libidus, Neophase, Vigor-25, Actra-Rx and 4Everon. People who take nitrates or other heart medicines may have not realized they were being exposed to these drugs. Also, those who have impotence or erectile dysfunction should have a medical evaluation since in many cases this could be an indication of heart disease. Just as the arteries in the heart can get atherosclerosis, so can the arteries to the genital organs. I'll share more thoughts about herbal sexual enhancement later.
   For many years I have been trying to formulate a product that provides a deeper sleep, not cause morning drowsiness, and not cause nightmares. Melatonin and 5-HTP can help with sleep, but they can also induce nightmares. I personally have difficulty sleeping at times since I have an active mind late into the night and can't always shut it off at bedtime. I have trouble sleeping also if I have not exercised that day. After many years of trial and error, I think I have finally developed a good sleep enhancer. For more than a decade I have experimented with combinations of several herbs and nutrients such as valerian, hops, chamomile, sleep inducing Chinese herbs such as jujube and bupleurium, lemon balm, kava, gaba, 5-HTP and melatonin, etc I have finally found a combination that seems to be quite helpful. Good Night Rx does not have the knockout punch as do some pharmaceutical sleep meds such as Ambien or Lunesta, but it seems to be quite helpful for those who sometimes are tense in the evening, have occasional sleepless nights, and need something to help them relax and provide a deeper sleep than normal. This is a new product, and so far almost everyone who has tried it has noticed a benefit. As with many herbal products, or even pharmaceutical drugs, Good Night Rx will not work in everyone. Sometimes the benefits are noticed on subsequent nights. The capsule is best absorbed on an empty stomach, generally anywhere between half an hour to 3 hours before bed. My research staff and I found that taking it after a meal was not as effective. We suggest not using it more than 3 nights a week, and it is a good idea to take a week off from it each month. As with any pill, it is impossible to have one dosage that works for everyone. Some may find 2/3 of a capsule works better for them whereas others may find taking more than one capsule works better. Those over the age of 70 may wish to use less than a full capsule the first night just to see how their body reacts to it. Discuss with your doctor before use if you have any medical conditions or are taking medicines.

A Few Thoughts about Sexual Herbs
I have been frustrated for quite a while formulating Passion Rx and Passion Rx with yohimbe. I had heard that there were products on the market that gave results in one hour, and it bugged me that I could not formulate Passion Rx to be effective as quickly. I thought to myself, how are a few of the other products working so fast? Do the formulators know something I don't know? I was relieved to hear that the reason these products worked so quickly was because of the laced drugs, not because the formulators were so advanced in their herbal knowledge.


For those who wish to have a quick erectile response in an hour or two, the pharmaceutical drugs are an option. However, Viagra and its cousins do little to enhance libido, sensation, or overall sexual pleasure, and they really are not meant for women. These drugs may, in rare cases, have serious side effects such as blindness. Herbs don't work as quickly as the drugs (although Passion Rx with yohimbe sometimes works within hours or even within an hour or two), but once the effects begin, normally within a day to four days, the overall sexual enhancement with herbs is more holistic. Yohimbe can work very quickly at a high dose, in less than an hour, but the side effects are quite unpleasant, hence the amount of yohimbe in the Passion Rx with yohimbe version is a rather small amount in order to minimize some of the side effects such as rapid heart beat, anxiety, and sweating.
 

If you are not in a rush, the sexual herbs and their combinations are preferable, providing increased arousal, sexual drive, pleasurable sensation of genital organs, better blood flow, and more stamina. Sex herbs are not totally free of side effects. The side effects are dose dependent. That is, the higher the dose, the more likely you will notice overstimulation, increased body temperature, rapid heart beat, alertness, irritability, and insomnia. If you have erectile dysfunction, have a medical evaluation to make sure you don't also have heart disease. Most sex herbs should not be used by those with heart disease and extreme care should be taken if you are currently taking antidepressants, stimulants, or other medicines. If you have a medical condition, always discuss with your doctor before using potent herbs or supplements.

 

I prefer using lower dosages of sex herbs (even if it involves taking a portion of a capsule) over several days with a day or two off in between rather than to take a high dose at one time. I remember a few years ago speaking with an elderly Chinese doctor familiar with herbal medicine. I asked him if he was aware of Chinese sex herbs that worked very quickly. He responded that Chinese medicine doctors prefer to enhance sexuality gradually over several days than shock the system with a high dose of an herb. Us westerners are quite impatient and want results rather quickly. We can get quick results with Viagra, but we also pay the price with potential serious side effects.


It is nearly impossible to develop a pill that provides a satisfactory sexual enhancement to every user. Viagra and its cousins improve erectile function at best in about 60 to 70 percent of users, and the feedback that I have over the years from users of sexual herbs is that, with patience, these herbs have a higher rate of providing sexual enhancement, maybe close to 70 to 75 percent. It is impossible to predict which herbal product or individual sex herb (tongkat ali powder, tribulus, horny goat weed, maca, ashwagandha, catuaba, mucuna pruriens, or combination, etc) will work in any particular person. Sometimes it may take trial and error over several days or weeks until the right herb or combination is found. Taking breaks from the use of these herbs actually helps them work better than taking them every day. Sometimes you may not notice an effect the first day or two, but then surprisingly a few days later you may notice a significant sexual arousal, even if you have been off the herbs for a day or two. Many of these herbs have a delayed effect.


Eating more cold water fish, perhaps taking fish oil capsules, trying to minimize stress, getting a good night's sleep, doing mild to moderate physical activity, eating a healthy diet with lots of fresh produce, being exposed to erotic or sensual stimuli, all help improve sexual desire and enjoyment.
See www.raysahelian.com/libido.html


Do Supplements Help Prevent Cancer?
As long as I remember there has been has been controversy in the medical and scientific community regarding the role of supplements and cancer prevention. There have been dozens of studies looking into this matter. I'm not going to bore you with the statistical details of each of the studies. Moreover, different scientists looking at the same data can come to different conclusions based on their bias. I just want to give you my overall impression as a doctor who has been following this topic for many years. My impression is that it is very difficult to do a study long enough to determine for certain and conclusively that supplements prevent cancer. Plus, when scientists do research on this topic, they usually pick a couple of well-known vitamins, such as vitamin E or beta carotene, sometimes give them in illogically high doses, and base their conclusions regarding the whole supplement topic on whether these couple of supplements, given for an inadequate period of time to a group of people, made a difference in cancer occurrence. It takes many, many years or decades for certain cancers to form and be detected, and it is quite difficult to expect research subjects to take their supplements on a daily basis for such a long time. Plus, some people in the placebo group may take other supplements on the side, without informing the researchers, that would confuse the matter.
   Bottom line: I think it is very difficult to say whether supplements prevent cancer. My impression is that the right combination of herbs and nutrients, at the right dose (not too high) can make a difference, but it is very difficult to know what this combination is, and what the right dosage would be. Plus, since each one of us has a completely different biochemistry and dietary habits, what works for one may not work for another. My advice: just don't worry about this topic until scientists figure out how to do reliable studies for a long period of time. Do your best to live a healthy lifestyle with the best diet that you can manage. Exercise, sleep deep, lead a low stress life if possible, have a positive attitude, and take your supplements if they make you feel better or are effective in treating a particular condition that you have. For more info, see www.raysahelian.com/cancer.html  which discusses some supplements tested in cancer. No firm answers are yet available.

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SUPPLEMENT RESEARCH
Vol. 3, Issue 12 -- July 6, 2006
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We're going through a major heat wave in Los Angeles. I read an article that the earth has been warmer this year than at any time in the past few hundred years. I tend to think global warning is for real, but I am not an expert in this field to know for sure. Recently I had several friends who saw the Al Gore documentary "An Inconvenient Truth" and had great things to say about it. I haven't had a chance to see it yet, but it's on my list. The movie that touched my heart the most in the past year was "March of the Penguins." I wonder how these penguins will fare as the Antarctic ice begins to thaw.
   If global warning is really happening, then chances are in the future we are going to drink more fluids to keep hydrated. This brings me to the topic of fluid intake. In the previous issues I mentioned my concern regarding drinking sodas sweetened with artificial sweeteners such as aspartame. Besides water, what other options do we have? I thought it would be a great idea to list a number of different healthy drinks with little or no sugar. You may realize you have more options that you imagined.
   In this issue I will also give my thoughts on the possible dangers from bisphosphonate drugs heavily pushed by the pharmaceutical industry for the treatment of osteoporosis; the possible prostate benefits of pomegranate; and a review of huperzine A, a compound isolated from Chinese club moss that is being evaluated for it's role in treating Alzheimer's disease.

Go Natural with Osteoporosis Prevention
Bisphosphonates are a class of drugs that inhibit the resorption or breakdown of bone tissue. Bisphosphanates are used for the prevention and treatment of osteoporosis, multiple myeloma and other conditions that involve bone fragility. In the last 10 years, millions of patients have taken biphosphanates for the prevention of osteoporosis and bone thinning from cancer. Bisphosphantes once seemed safe, but lately concerns have been raised. Bisphosphante use is now believed to be associated with osteonecrosis (dead bone) of the jaw. Osteonecrosis of the jaw is an uncommon complication, but it is estimated that among the 500,000 American cancer patients who take the drugs because their disease is affecting their bones, up to 10 percent may develop the problem. Some dentists are refusing to treat patients taking the drugs, fearful that the dental work will induce a case of osteonecrosis, and lawyers are lining up to sue the drugs' makers, saying they failed to give patients adequate warning. Cancer patients, mostly those with multiple myeloma and breast cancer whose disease has spread to their bones, generally take one of two bisphosphonates, Zometa or the older Aredia, intravenously. Osteoporosis patients usually take bisphosphonates as oral pills, in lower doses that patients with cancer. These bisphosphanate drugs include Fosamax, Actonel and Boniva.
   My thoughts: It may be too early to know for certain how prevalent and serious are the risks from bisphophanates, including osteonecrosis, but if you are taking them, ask your doctor if you really need them and whether the potential risks are worth the potential benefits. In previous issues I mentioned that calcium supplements and vitamin D are beneficial; and, of course, exercise and weight lifting are the most helpful.

Healthy Fluids as the Globe Warms
I used to drink bottled water until I bought a high end water purifier. Now, I just drink this purified water and rarely drink bottled water unless I am traveling. I hope more people try this method rather than spending so much money on bottled water. With the price of fuel going higher, the transport of bottled water will raise prices and also contribute to pollution from fuel use and the dumping of these bottles in the trash. Besides water, have you considered what fluids you normally consume? Here are some suggestions for healthy fluid alternatives to soft drinks:
 
Fruit juice - there are so many to choose from. Why limit yourself to orange or apple? Try mango, guava, cherry, prune, grape, pomegranate, berries, watermelon, mixed juices, and others. Make sure the juice you buy is 100% fruit rather than a sugared version. Consider diluting the fruit juices in water. For extra antioxidants, you could open a capsule or two of acai, goji, mangosteen, pomegranate, and other fruit extracts to mix with your fruit juice.
 

Vegetable juice - you can drink tomato juice in a bottle or can, and also the mixed vegetable juices such as V8. If you are ambitious, you can make your own juice adding carrot, beet, parsley, spinach, ginger, etc. If you live near a health food store, you can get fresh carrot juice, greens, and other fresh, mixed vegetable juices. Offer your children vegetables juices rather than sugared drinks and sodas.

Herbal teas - there are countless herbal teas you can choose from, and make sure the tea you buy is the actual herb rather than artificially flavored regular tea. Have you ever tried licorice tea? It is so sweet. You can buy licorice root from a health food store and soak it in water and then filter it. You can add ice and make it a delicious cool summer drink. I have at least a dozen different teas on my kitchen counter and I alternate them. Some of them can be made into cool summer drinks. You can sweeten iced tea with stevia.

Lemonade sweetened - you can have delicious lemonade, sugar and calorie free. Squeeze your own lemons or buy lemon juice from the store, add water and stevia. Health food stores now carry organic lemon and lime juice. Stevia goes very well with lemon juice. Once you get used to lemonade with stevia, you won't miss the sugar. I prefer the clear liquid stevia.
Soy milk, almond milk, rice milk - these are good alternatives to milk. I am not against milk consumption, I just think many people drink too much. One glass a day of milk is plenty. Substitute these other drinks instead. Most of the soy milk in stores has added sugar. You can buy the unsweetened soy milk and add stevia. Or, sometimes I buy the sweetened ones and use a small amount of this sweetened soy milk mixed with a larger amount of the unsweetened.

Coffee - I suggest not more than 2 cups of caffeinated coffee a day, and preferably in the early part of the day. At times, when I am having breakfast at at restaurant, I ask them to pour half the cup with regular coffee, and the other half with decaf. Regular coffee may have more antioxidants, but the caffeine is not that helpful if used in excess.

Sports Drinks - Most of the sports drinks, energy drinks and enriched drinks on the market are laden with sugar. I am not against the use of these sports drinks or soft drinks when used infrequently.

Other types of fluids introduced in recent years include water with added vitamins and minerals. I really don't think these are necessarily, it is just a marketing gimmick to charge more for the water. There is no scientific evidence to support that drinking "super oxygenated" water enhances athletic performance or wellbeing. So-called super oxygenated water -- water in which the oxygen content is increased significantly -- are marketed by various companies as a way to improve athletic performance by feeding extra oxygen to the muscles through the blood stream.

Pomegranate for Prostate
A study funded by a pomegranate juice maker found men who drank the fruit juice took longer to double their blood levels of PSA -- a protein that indicates the presence of prostate cancer. The quicker PSA doubles means the quicker the prostate cancer is growing. When the men started drinking eight ounces of pomegranate juice a day, the time until PSA doubling after treatment extended to 54 months on average while before drinking the juice, PSA doubled in an average of 15 months. No major side effects were reported from drinking the juice. The findings were published in the peer-reviewed journal Clinical Cancer Research and funded by a trust established by the owners of Pom Wonderful, a brand of pomegranate juice.
My comments: There are many herbs and fruit extracts that have shown promise to help reduce prostate cancer. For those who do not wish to ingest pomegranate juice either because of the taste or because of added calories or fructose (particularly diabetics), a pomegranate extract capsule is a good option. Eight ounces of pomegranate juice is a lot of calories and a lot of fructose. For more information on pomegranate  http://www.raysahelian.com/pomegranate.html


4. Huperzine A for Alzheimer's
Researchers are trying to find out whether a compound derived from the Chinese club moss Huperzia serrata improves brain function in Alzheimer's patients. Huperzine A is a naturally occurring cholinesterase inhibitor that's commonly used in China to treat Alzheimer's. The Phase II clinical trial will enroll about 150 patients, age 55 and older, with mild to moderate Alzheimer's disease. According to Dr. Paul Aisen, leader of the new study and professor of neurology at Georgetown University Medical Center's Memory Disorders Program, "Based on studies in China, huperzine A may be more effective and better tolerated than currently prescribed drugs for Alzheimer's disease. In addition, laboratory studies suggest that huperzine A may have unique effects that could slow down the progression of the disease." "This trial is essential to better understand the promise of huperzine A," Aisen said. "Though it is a rigorous placebo-controlled trial, all participants do receive the active medication. The first portion of the trial, lasting 16 weeks, includes a placebo arm, but all participants have the opportunity to take active huperzine A for at least eight months. The study, directed by Georgetown University researchers, is funded by the U.S. National Institutes of Health and Neuro-Hitech Pharmaceuticals Inc. For more information about huperzine and previously published studies, click here http://www.raysahelian.com/huperzinea.html


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SUPPLEMENT RESEARCH UPDATE
Vol. 3, Issue 11 -- June 1, 2006
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Would you allow your child to drink as much soft drinks as he or she desires? I just returned from a wonderful trip on the cruise ship Sapphire operated by Princess cruise line. The route between Vancouver and Alaska through the Inside Passage covers truly spectacular landscape with countless untouched islands, pristine water, whales making their way north and spouting along the way, eagles with their wide wing spans, unexplored forests of spruce, hemlock, and pine and the small, quaint communities of Ketchikan, Juneau, and Skagway. Further north were majestic glaciers and snow covered rocky mountains. The air was clean and crisp and daylight continued close to midnight.
   As soon as I entered the ship for boarding, there were tables set up for people to purchase a 24 ounce bottle for unlimited refills of diet and regular sodas. Cruise ships used to charge per glass, but now have this new option. For the one time price of 35 dollars, a person can have their bottle refilled as many times a day as they wish for the entire cruise week. I saw lots of kids walking around clutching their bottles and constantly sipping from them. In the last issue of the newsletter I discussed the potential danger from overconsumption of aspartame, normally found in high amounts in diet sodas. If you were traveling on these ships with your children, would you let them drink several pints of soda a day, whether sugared or sweetened with aspartame? As I have mentioned before, I am not a purist. I will have a diet or regular coke once in a while, or eat an unhealthy food, but we really do a disservice to children granting them unlimited access to these soft drinks. In a future issue I will mention other types of fluids that could be healthy substitutes.
   In this issue I discuss the benefit of phytoestrogens, an unexpected side effect from NSAIDs, the role of screening for prostate cancer in elderly men, and a disturbing email regarding a potential serious danger from high doses of lipoic acid.

Phytoestrogens and Menopause
Phytoestrogens are estrogen-like compounds found in certain plants. In a study conducted at the University La Sapienza in Rome, Italy, postmenopausal women were given phytoestrogen tablets containing 60 milligrams of isoflavones for 6 months and compared to women who received placebo pills. The women receiving the phytoestrogens did better on measures of mental performance and mood. When asked which treatment they preferred, 49 women favored the phytoestrogen pill, 9 favored placebo, and 18 had no preference. The researchers say, "The current findings suggest a possible role for phytoestrogens in relieving the psychological disturbances often associated with the complex symptomatology of menopause."
   Another study continues to raise cautions about the long term use of estrogen. Women who took estrogen-only pills for at least 15 years had a higher risk of developing breast cancer, according to a study of nearly 29,000 nurses. But no increased danger was found among those who took the hormone for less than 10 years.
   My comments: As far back as I remember, there has been controversy regarding the role of phytoestrogens in the treatment of symptoms of menopause. If you plan to take isoflavones, try a lower dose first before moving on to higher amounts. You may consider at first using half the dose used by the researchers and take a day or two off a week. If you are using estrogen, use as low a dose as possible for as short a time as possible.
For more information, and to learn more about phytoestrogens and isoflavones, see www.raysahelian.com/phytoestrogens.html


Erectile Dysfunction and NSAIDs 
It has been known for quite some time that certain drugs cause impotence or erectile dysfunction. The most common of these drugs are the SSRI antidepressants such as Prozac, and beta blockers such as Inderal. Beta blockers are used for cardiovascular conditions. However, it was a surprise when researchers in Finland discovered that the use of non-steroidal anti-inflammatory drugs (NSAIDs) increases the risk of erectile dysfunction in middle-age and elderly men. NSAIDs include prescription and over the counter drugs such as ibuprofen and naproxen mainly used for arthritis or musculoskeletal pain. There are at least 2 supplements that I know of that may also interfere with erectile function in some men: 5-HTP can lead to sexual dysfunction since it converts into serotonin. Serotonin inhibits proper sexual function. High doses of kava can numb nerve endings and lessen sexual enjoyment.

For more information, see www.raysahelian.com/erectiledysfunction.html


Is Screening for Prostate Cancer more Harmful than Helpful?
Screening older men for prostate cancer -- with a PSA blood test or by a doctor's exam -- may actually do more harm than good. Prostate cancer normally grows very slowly. If untreated, older men with screen-detected prostate disease are more likely to die with prostate cancer rather than from it.
   Dr. Richard M. Hoffman, from the New Mexico VA Health Care System, and colleagues, evaluated 465 men, between 75 and 84 years of age, who underwent aggressive or conservative treatment for localized prostate cancer. The 175 men in the aggressive treatment group underwent prostate surgery or radiation therapy. The conservative management group included the remaining 290 patients who received hormone therapy or no treatment. Aggressive treatment had little impact on the prostate cancer survival rate. The absolute difference in prostate cancer survival over 5 years was similar in both treatment groups. The majority of all deaths -- 80 percent -- were not due to prostate cancer. At 2-year follow-up, aggressive treatment was more likely to interfere with quality of life than was conservative management. Those treated with aggressive therapy were three times more likely to report daily urinary leakage and complain of sexual problems.
   My comments: I think that men over the age of 75 or 80 don't really need to be evaluated for prostate cancer unless perhaps they are extremely healthy and have no other illness. I recall my father who, at age 77, was found to have a suspicious growth in his prostate gland. He underwent numerous PSA tests and doctor visits. He had a needle biopsy that discovered a small cancer. This worried him significantly for many months. The doctors decided that the cancer was too small to operate or treat. Nevertheless, he was constantly concerned about his prostate gland and this impacted his quality of life. He died at age 79 from a heart condition. If he had never had the prostate exam at age 77, he would not have had the additional worry the last couple of years of his life and not had to undergo multiple doctor visits, blood tests for PSA levels, and the painful prostate needle biopsy.

Email received recently - Another reason to be cautious using high doses of supplements
I found your lipoic acid web page while surfing the internet and read that you recommend no more than 10 to 50mg/day of alpha-lipoic acid. At the advice of a consultant at a vitamin store, I started taking 900 mg (300mg 3 times a day) of alpha-lipoic acid on May 2nd. On May 18th I suffered atrial fibrillation/flutter which required hospitalization to get my heart in normal sinus rhythm. I've got a trans-esophageal echogram and an ablation scheduled. I am post-menopausal, healthy, non-smoking, active, normal weight. I had open heart/bypass surgery in 2001 for a blocked artery, but was discharged from cardiac follow-up. Apparently this has no bearing on the current incident. This is just for your information, in that I believe the high doses of alpha-lipoic acid had everything to do with this incident.

My comments: Although this is just one anecdote, it is quite possible that these high doses of alpha lipoic acid caused the irregular heart rhythm. I am sometimes criticized by some people in the vitamin industry for making my dosage recommendations on supplements too low. But, I prefer people take too low a dose than experience a severe side effect such as a cardiac abnormality. People don't realize that herbs and supplements, if misused, can cause harm. As a general guideline, take at least a day off each week from your supplements, and a 3 day break each month.
I personally get insomnia if I take more than 50 mg of lipoic acid.

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SUPPLEMENT RESEARCH UPDATE
Vol. 3, Issue 10 -- May 15, 2006
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Remember a month ago I discussed research regarding a calcium study in the New England Journal of Medicine (NEJM). You may recall that the interpretations of the study were not overly positive and the media, along with some members of the medical establishment, questioned the effectiveness of calcium supplements.
Well, surprise. Just a few weeks later, a new study now says that calcium supplements do work after all in reducing the rate of fractures. And no surprise that this study was not published in the NEJM. More later.
In this issue I will also address the continuing controversy of aspartame, the artificial sweetener found widely in diet sodas and many foods. An Italian study raises serious cautions regarding the association between aspartame, lymphoma, leukemia, and other cancers. You will be interested to know what the political repercussions could be.
In the next issue I will discuss whether you need to continue being screened for prostate cancer after a certain age. I will also put in perspective the role of estrogen replacement in breast cancer. Do herbal alternatives work?

Calcium Supplementation Effective In Reducing Fractures
Remember last time I discussed a study in the New England Journal of Medicine that had questioned the effectiveness of calcium in preventing bone fractures? Well, a new study finds calcium to be effective. I hope you followed my advice from last time and did not lob your calcium supplement bottle into a trash container.
According to a study published in the Archives of Internal Medicine, calcium supplements are effective in preventing fractures in older women who take the appropriate dose consistently. The double blind, placebo-controlled study lasted five years. A large number of women were evaluated, 1,400 women aged 70 or older. They were supplemented with two 600 mg doses per day of calcium carbonate or placebo. During the study period, 16 percent of patients had one or more fractures, with no reduction of fracture risk seen between the calcium and placebo groups. However, among the 830 patients who took 80 percent or more of their tablets, there was a significant reduction of fracture risk and improved bone structure and strength compared to placebo.
   These results support the already strong body of evidence demonstrating calcium’s benefits in strengthening bones, preventing fractures and fighting osteoporosis. Most recently the NEJM study reported results that on the surface appeared negative, but closer examination of the details revealed that these results, too, support the conventional wisdom that calcium helps strengthen bones.
   My comments: The consensus seems to be that calcium supplements are effective if used consistently. The actual dosage needed is still being worked out, but it appears that if a woman takes 500 mg twice a day of a calcium supplement on a regular basis, she should be on solid ground. Drink an extra glass of water a day just to reduce the risk of potential kidney stones. As to which form of calcium is best, for instance calcium citrate or calcium carbonate, I am not sure. I suspect for practical reasons there should not be a major difference. If you wish, you can alternate different bottles.
For more information, see http://www.raysahelian.com/calcium.html

 
The Aspartame Controversy Continues - This Will Be Big News
A new Italian study in rats by the Ramazzini Foundation indicates aspartame may be dangerous. Aspartame was given to 8-week-old rats. The treatment lasted until natural death. The results showed that aspartame increased the risk of lymphoma, leukemia, urinary tumors, and tumors of certain nerves. The researchers state, "The results of this experiment indicate that aspartame is a carcinogenic agent (cancer causing), even at a daily dose of 20 mg/kg body weight, much less than the current acceptable daily intake. On the basis of these results, a reevaluation of the present guidelines on the use and consumption of aspartame is urgent and cannot be delayed."
   Now I am going to try an attempt at my "The Daily Show with Joh Stewart" satire. Immediately after these findings were published, the European Food Safety authority put out an all bulletin alert. Right?
   Sorry. A panel of scientists advising the European Food Safety Authority immediately disputed the findings and claimed aspartame was safe and should continue being used. But wait. Our FDA has come to the rescue to protect us and immediately sent an all alert bulletin to warm all consumers, right? I took a look at FDA website. As of May 8, 2006, this is what they say:

"FDA is issuing this statement in response to the European Food Safety Authority (EFSA) press release on its review of the long-term carcinogenicity study of aspartame conducted by the European Ramazzini Foundation (ERF).
Aspartame, a low-calorie sweetener, is composed primarily of two common amino acids, aspartic acid and phenylalanine. Each of these is also a building block for conventional foods such as protein and natural flavor molecules.
In 2005, ERF published new findings of a long-term feeding study on aspartame conducted in rats. Scientists from ERF concluded from their study that aspartame causes cancer and that current uses and consumption of the sweetener should be re-evaluated.
EFSA's review of ERF's study concluded, among other things, that on the basis of all evidence currently available to EFSA:

ERF's conclusion that aspartame is a carcinogen is not supported by the data; and
EFSA sees no need to further review its earlier scientific opinion on the safety of aspartame or to revise the Acceptable Daily Intake.

Upon learning of the ERF study results, FDA requested the study data from ERF to evaluate the findings. On February 28, 2006, the agency received a portion of the data requested. We are actively reviewing the data provided by ERF and will complete our review of those data as soon as possible. When FDA completes its review of the ERF study data, it will announce its conclusion.
Since it was first approved for use in the United States, the safety of aspartame has been questioned by some. To date, however, the agency has not been presented with scientific information that would support a change in our conclusions about the safety of aspartame. Those conclusions are based on a detailed review of a large body of information, including more than 100 toxicological and clinical studies regarding the sweetener's safety. "
This can be found at http://www.fda.gov/bbs/topics/NEWS/2006/NEW01369.html

My Comments: I wonder what the governmental authorities would have said if a study was done on stevia, or another natural sweetener, and the results showed the same findings of increased cancer risk. I will let you, the reader, ponder on this.
Do you know that FDA does not allow manufacturers to label a stevia supplement as a sweetener?
Now, as a practical matter, I don't think you need to eliminate every potential source of aspartame in your diet, unless you are a purist. I'm not. I try to eat and live my life at a grade A or A-. Trying to live a perfect life as an A+ is too much effort for me. I accept my imperfections whether they be in dietary choices or interpersonal interactions or other matters of daily life.
So, if you wish, you can still consume some foods with aspartame, just try to reduce your exposure as much as you can until a few more studies are published by independent researchers. I eagerly await FDA interpretation of the aspartame study.

For more details on the aspartame study, see www.raysahelian.com/aspartame.html


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Vol. 3, Issue 9 -- May 1, 2006
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I read something quite disturbing last week. I can't say I was shocked, but what I came across continues to erode some of my remaining trust in the medical establishment.
   First, a little background. There is a big book updated every few years called the Diagnostic and Statistical Manual of Mental Disorders, known as the DSM. It is now in the fourth edition and the latest version is known as DSM-IV. The DSM discusses and categorizes the latest understanding of psychiatric disorders. Most psychiatrists consider this book their "Bible" and medical students use it as a highly respected reference book. I will discuss later why I feel shattered after reading the findings from a new study regarding the writers of this book.
   In this issue I will also address the role of B vitamins in terms of homocysteine reduction and the effect of B vitamins on heart disease and stroke. Are B vitamins helpful or harmful?

Mental Illness and DSM - Who do you trust for your mental health?
Most Americans probably don't realize that the majority of doctors who contribute to the Diagnostic and Statistical Manual of Mental Disorders, known as the DSM, have direct or indirect financial ties to the pharmaceutical industry. A new study found 56 percent of 170 psychiatric experts who worked on the most recent edition, published in 1994, had at least one financial link to a drug maker. The relationships included speaking or consulting fees, ownership of company stock, payment for gifts and travel and funding for research. All of the experts who developed sections defining mood disorders, schizophrenia and other psychotic disorders had such links. It appeared that the connections were especially strong in those diagnostic areas where drugs are the first line of treatment for mental disorders. The American Psychiatric Association, which publishes the DSM, has said it would require financial disclosures for the next version, due out in 2011.
   Many of the writers for DSM are respected in their field and are involved in writing articles in medical journals or giving lectures. It is quite obvious that if there is such a strong link between the writers and the drug companies, that natural supplements used for mood disorders, such as St. John's wort, 5-HTP, tryptophan, SAM-e, etc, would not likely be mentioned in a favorable light or not mentioned at all during their lectures or in journal articles. To borrow a term now being commonly used in Washington, D.C., these doctors may "cherry pick." They may mention studies that found negative outcomes with natural supplements rather than being enthusiastic about discussing the positive outcomes.


Homocysteine, Heart Disease, Stroke, and B Vitamins
Homocysteine is a derivative of the amino acid methionine. It received a great deal of media attention in 1997 following publication of articles in medical journals indicating that a high homocysteine blood level is a potential risk factor for stroke and heart disease. Kilmer McCully, M.D., a pathologist at the Veterans Affairs Medical Center in Providence, Rhode Island, had been claiming for at least two decades that elevated homocysteine is as important a risk factor for heart disease as cholesterol, but few in the medical profession paid serious attention to his claim. Dr. McCully appeared to be vindicated with the publication of additional scientific articles in the 1990s, most of which confirmed the dangers of elevated homocysteine levels. However, recent studies have disputed the role of homocysteine in cardiovascular disease.
   In two studies published in the New England Journal of Medicine, lowering of homocysteine levels with B vitamins did not result in any significant reduction in stroke or heart disease. In fact, in one of the studies, those who received 0.8 mg folic acid plus 0.4 mg vitamin B-12 and 40 mg vitamin B6 had a higher rate of myocardial infarction. You can find more details at http://www.raysahelian.com/homocysteine.html
High blood homocysteine levels can be easily lowered by taking supplements of B vitamins, particularly folic acid, B6, and B12. Unfortunately, at this time, having reviewed many studies the positive results and the negative results regarding homocysteine, no definite statements can be made regarding the benefits of supplementing with B vitamins in regards to stroke and heart disease prevention or treatment.
   So, what's the bottom line? Should you or should you not supplement with B vitamins? I still say yes. B vitamins have many benefits including support of mental health and providing more physical energy. But, I don't think high doses are required. One, two, or three times the RDA should be fine. I don't think the B50 or the B100 products, which supply 25 to 50 times the RDA for certain B vitamins, are necessarily beneficial. It may be a good idea to just take a multivitamin supplying one, two, or three times the RDA for all the Bs. Higher amounts of B vitamins, or taking too high a dose of just one or two of the B vitamins (such as the study I mentioned above where 40 mg of B6 was given without providing the other B vitamins such as B1 and B2) may be counterproductive. In a study published in JAMA in the year 2002, homocysteine-lowering therapy with folic acid, vitamin B12, and vitamin B6 significantly decreased the incidence of major adverse events after percutaneous coronary intervention. This study used 10 mg of B6 as opposed to the 40 mg used in the study published by the NEJM. Could lower dosages of B vitamins actually be healthier?
Unfortunately, as with many simple nutritional questions, such as the role of calcium supplements in osteoporosis, more research will be needed over several more years to sort out the real answers.

Yogurt and Friendly Bacteria for Stomach Ulcers
The stomach bug Helicobacter pylori is the cause of most stomach ulcers, so doctors often try to eradicate this bug with antibiotic therapy. When this doesn't work, as is the case 10 to 20 percent of the time, yogurt may help. Eating yogurt containing the beneficial bacteria Lactobacillus and Bifidobacterium before trying a second round of antibiotic therapy can improve the outcome. In a new study, the eradication rate of H. pylori was 91 percent in the yogurt-plus-quadruple therapy group compared with 77 percent in the group that did not get the yogurt. For more information, see http://www.raysahelian.com/ulcer.html

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Vol. 3, Issue 8 -- April 18, 2006
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Are calcium supplements helpful in osteoporosis? You would think that after decades of research scientists would have a clear answer to this simple question. But apparently they don't. For decades women were told to take calcium supplements in order to reduce the risk of fracture. Now, new research disputes some of these established recommendations and the public is confused. I'll discuss this topic later.
In the next issue of the newsletter I will address the role of B vitamins in terms of homocysteine reduction and the effect of B vitamins on heart disease and stroke. Are B vitamins helpful or harmful? Are low doses better than high doses? Stay tuned.

Does Calcium Reduce the Risk of Bone Fractures?
Another New England Journal of Medicine study creates confusion -- and misleads the public -- regarding the role of calcium and bones. The abstract starts out, "The efficacy of calcium with vitamin D supplementation for preventing hip and other fractures in healthy postmenopausal women remains equivocal." (Equivocal means open to two or more interpretations; ambiguous.) And the article concludes, " Among healthy postmenopausal women, calcium with vitamin D supplementation resulted in a small but significant improvement in hip bone density, did not significantly reduce hip fracture, and increased the risk of kidney stones."
   Now, if you just read the headlines on TV or newspaper articles, and read the conclusion of the researchers, you may be tempted to throw out your calcium supplement bottle. But, I suggest you hold on to it. Let's dig deeper and find the hard facts.
   Here's the basics: 36,000 postmenopausal women, 50 to 79 years of age were randomly assigned to have either 1000 mg of calcium carbonate with 400 units of vitamin D daily or placebo. The study went on for 7 years. Women who took the calcium with vitamin D supplementation had a small but significant improvement in hip bone density. When all the women were included in the statistics, the overall study did not show a reduced rate of hip fracture. But, when the researchers limited their analysis to women who had consistently taken the supplements, the results showed a nearly 30 percent reduced risk of hip fracture. The side effect was an increased risk of kidney stones. Muddling the results of this study was that over half of study participants were on hormone replacement therapy, which is known to reduce fracture risk. Another complicating factor is that calcium intake from diet and other sources — in addition to the supplements given as part of the study — were not accounted for.
   The study's lead author, Dr. Rebecca D. Jackson of Ohio State University in Columbus, says, "Calcium is the foundation for helping to ensure bone health, but women 65 and older and those with osteoporosis, or risk factors for the condition such as cigarette smoking, may need more aggressive treatment to keep their bones strong. We have a host of options available that have been approved by the FDA as effective agents for the treatment of osteoporosis."
This statement immediately makes me suspect. Is she trying to push the new, expensive drugs made by pharmaceutical companies. Since studies came out a few years ago pointing out the potential dangers of estrogen and progestin, drug companies have been more aggressive in pushing drugs to treat or prevent osteoporosis. These drugs fall into four categories: bisphosphonates (alendronate and risedronate sodium), calcitonin, selective receptor molecules (raloxifene hydrochloride) and the newest category, the bone formation agents (teriparatide). Osteoporosis drugs may slow bone loss, promote bone growth, reduce the risk of fractures but at what short term and long term cost? Not only are these drugs expensive, but we have no idea on the long term dangers that they may pose. It's quite possible to take a drug and have a lesser risk for fracture, but then die sooner from a side effect of the drug.
My suggestions: I still favor the use of calcium and vitamin D supplements to maintain healthy bones, both in older men and postmenopausal women. Since there could be an increased risk for kidney stones, my thought is to not take more than 1,000 mg of calcium a day, but limit calcium supplement intake to 500 to 1,000 mg for women and 200 to 800 mg for men. This is a wide range since the amount of a calcium supplement you may need depends on how much you get in your diet. Men can lose bone mass, too, but not as much as women. I also recommend 400 to 800 units of vitamin D. Drink plenty of water or fluids in order to reduce any potential risk for kidney stones. But, most importantly, if you are concerned about osteoporosis, you have to be physically active, preferably throughout life. Walk, dance, do pushups, do yoga or stretching for flexibility, reduce smoking, and, if possible join a gym where you lift weights using all muscle groups. If you can't join a gym, buy a few cheap barbells and lift weights at home, do gardening, or lift rocks in your backyard... anything to make your muscles work. When muscles contract, they pull tendons that are attached to the bones, and this tells the bones to deposit calcium and thus bones become stronger and less apt to fracture. Bone is a living tissue that responds to exercise by becoming stronger. Just as a muscle gets stronger and bigger with use, a bone becomes stronger and denser when it is called upon to bear weight. Taking lots of calcium without being physically active is not going to be as effective. Take preemptive action and reduce your chances of having to rely on osteoporosis drugs. I am not totally against the use of the osteoporosis drugs. It is possible that they may help some people who have very brittle bones but I think they are being overprescribed and doctors are not making their patients aware of the full risk of short and long term side effects.
For more information, see http://www.raysahelian.com/calcium.html and http://www.raysahelian.com/osteoporosis.html 

 

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Vol. 3, Issue 7 -- April 1, 2006
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This past weekend I visited the largest supplement and natural foods health expo in the world and did a book signing at my publisher's booth for Natural Sex Boosters. Each year this expo is held in Anaheim, California (a few blocks from Disneyland) and more than 20,000 individuals in the supplement and natural food industry from all around the world gather to display their goods and walk around the show to see the latest products introduced to the market. The number of visitors seemed to be much larger than I remember in the past. This indicates to me that the natural health field continues to grow and thrive.
This expo is not open to the general public, but only to those who are in the business of vitamins and whole foods. I very much enjoy walking the aisles to see and feel the buzz on what's new and exciting. A year or two ago the buzz was "low carb" but this has practically disappeared now. This year, what struck me was the number of companies selling goji, acai, mangosteen, pomegranate, and noni juices and extracts. Everywhere I turned, it seemed there was a booth offering a free sample cup of these juices. The benefit most often touted is the high antioxidant content within these fruits, which actually is true. Chocolate and cocoa products were quite popular too, and I enjoyed sampling a few morsels. Soy products were present everywhere, as they have been for several years.
I have been asked many times whether it is better to ingest the juices of these fruits or whether the capsules are a good substitute. I think both forms are good options. The advantage of the capsules is that the fructose and calories are removed, and these would be appropriate to those who are limiting their calories and sugar intake. In some fruits, such as mangosteen, many of the active ingredients, the xanthones, are found more in the rind that in the fruit; hence, the capsules could include extracts of the whole fruit and the rind as opposed to the juice which mostly has the fruit. Some fruits are not very pleasant tasting, such as noni and mangosteen, and companies will mix other fruit juices in order to make them palatable. Drinking these fruit mixes could be healthy, particularly if the other juices are from berries, since you would be exposed to lots of additional beneficial plant compounds. It is very difficult to compare the equivalencies of the capsules to the juices since each company making the juices has a different extract concentration and raw material source.

Fish Oils and Prostate Cancer
Eating foods rich in omega-3 fatty acids, such as oily fish, and decreasing intake of omega-6 oils, may help prevent the spread of prostate cancer. The types of fats we consume do influence the function of our organs. In laboratory studies, scientists at Christie Hospital in Manchester, England found that fish oils could block the spread of cancerous cells. Omega-6 oils, found in vegetable oils, nuts and seeds, apparently increased the spread of tumor cells into bone marrow. This invasion was blocked by omega 3 fats -- the ones found in oily fish. The researchers believe omega-3 fatty acids interfere with functions of omega-6, which cancer cells may use as a source of energy, and prevent them from spreading beyond the prostate gland. Since most Americans eat a diet which has a much higher proportion of omega-6 fatty acids to omega 3 fats, it is possible that eating more fish, taking fish oil capsules, and reducing intake of omega-6 fats may well help to reduce the spread of prostate cancer cells.
See http://www.raysahelian.com/prostate.html of http://www.raysahelian.com/fishoils.html for more information.

Research Follows the Money Trail
From the early 1990s to 2003, medical research funded by pharmaceutical and biotechnology companies steadily increased and now has a larger budget than research funded by government or public institutions. When a sample of nearly 300 published articles was evaluated, 76% of the studies featured at least one author with a university affiliation, while 57% featured at least one with a hospital affiliation. Moreover, 65 of the 77 most cited randomized controlled trials involved pharmaceutical industry funding. British Medical Journal, March 17, 2006

Cocoa Can Cut Risk of Disease
In a group of elderly men, those who consumed the most cocoa had a 50 percent lower risk of dying from heart disease or any cause compared to those who did not drink cocoa or eat cocoa-containing foods. Cocoa is known to lower blood pressure but this may not be the whole reason. Instead, antioxidants and flavonols found in cocoa lessen the risks from cholesterol and other compounds that can cause heart attacks, cancer and lung diseases. Flavonols are a class of healthy flavonoids that are found in many vegetables, green tea and red wine. The 15-year study of 470 elderly men aged 65 to 84 in Zutphen, the Netherlands, found one-third did not eat any cocoa, while the median intake was 4 grams per day among the third who consumed the most cocoa. From 1985 to 2000, 314 of the men died, and the biggest cocoa eaters were at half the risk of dying compared to men who did not eat it. For more information, see http://www.raysahelian.com/cocoabean.html 

Questions From Subscribers -
Herbal Extracts versus the Whole Herb. Which is Healthier?
Q. I've been wondering whether herbal extracts are really such a good idea since herbal extracts, as I understand it, contain isolated and concentrated components of herbs, these components being considered the "active" ingredients. My concerns are:
1) when these so-called "active" herbal components are isolated and concentrated in this way, are we not possibly excluding other important synergistic components that would normally work with these components in the natural situation, i.e. in the whole herb? and
2) when the components are concentrated in this way, is this not now bordering on being like an artificial drug where the active herbal components are present in amounts not normally found in the natural whole herb? Add to that the fact that other components are excluded which otherwise (at least I wonder) maybe would have somehow "balanced" these active components. Is this then safe?
Basically I've been wondering these things, comparing whole herbs to herbal extracts. I hope your highly knowledgeable staff will enlighten me as usual. Thanks much.

   A. This is an excellent question. There is no blanket statement that can be made. Each herb has to be evaluated individually to see whether the whole herb or the extract is preferable. With some herbs, it may be better to take the whole herb, and with others, an herbal extract may be preferable. Sometimes the active ingredients are too minimal within the herb, or they may be toxic or unwanted substances within the herb that need to be removed in order to obtain the active ingredients without toxicity. As a rule, I prefer the whole herb, but I have no problems using extracts when appropriate. Sometimes, in order to elicit a benefit, the active ingredients have to be concentrated in order for the therapeutic amount of the active herb to fit in a small capsule.
   We have to keep in mind that nature did not produce herbs with the idea that these would be beneficial to human consumption or to treat a human medical condition. Herbs evolved in order to protect themselves from microbes, insects and animals that would eat them or to protect themselves from harsh environmental conditions. It just happens that certain herbs have some beneficial compounds that we find helpful. But this does not mean that every molecule or substances within an herb is beneficial.
    As to whether they are considered a drug when herbal extracts are concentrated, it depends on how one defines a drug. I consider a drug any substance that is not normally found in the body. By this definition most herbs are drugs, whether whole or extracted. However, there are substances within herbs that are useful to the body and are normally found in the body. For instance, goji berry has zeaxanthin, a carotenoid, which is found in the retina and other tissues. Hence, certain components of some herbs are not drugs but supply crucial molecules to the body. One advantage of standardized herbal extracts is that different research labs can compare their results using the exact same herbal extract. One example is ginkgo biloba extract, another is saw palmetto.
   Bottom line: no sweeping statements can be made that apply to all herbs. Each herb and herbal extract needs to be evaluated individually in different dosages for each person who is using them, and also how they interact with other supplements and medicines. There are too many variables that prevent a simplistic answer. Furthermore, different raw material processing companies may have different ways to make herbal extracts, and one batch from one company may be slightly or significantly different from another company. Add the fact that soil conditions, temperature, and season of harvesting all influence an herb's composition. You can see why no simple answers can be given.

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Vol. 3, Issue 6 -- March 15, 2006
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I'm starting to suspect the New England Journal of Medicine (NEJM) has a strong bias against supplements. This bias may either be a purely philosophical viewpoint or perhaps it is due to money reasons. Over the past couple of months this so called "respected" medical journal has published several studies downplaying the importance of supplements. Yet they only infrequently publish articles supporting the use of vitamins and herbs. Is there a conspiracy? I don't know. I was never a conspiracy theorist in the past, but in the last few years I have begun to be much more skeptical in believing what our governmental institutions or the medical establishment says. When I was in medical school, I rarely questioned the information I read in medical journals, and I trusted the government. I think I was naive back then. I never thought money (in the form of advertising dollars or perhaps even bribes?) would influence what I read in these journals. Yes, I, along with most of my fellow medical students were naive. But more doctors are realizing how billions of dollars spent by the pharmaceutical industry does influence opinions. Are some of these medical journals just a marketing tool for the drug companies? Dozens of free medical magazines are mailed monthly to doctors for free, and they are full of drug ads. The majority of these magazines would not be able to survive if their income was solely based on subscription fees.
   In this issue I tackle the results of a study published last month in the NEJM regarding saw palmetto and prostate enlargement. I interviewed Dr. Bent who was the lead author of the study. I also discuss a positive finding on herbal menopause treatment.
   On a follow up note... remember in the first two issues of the newsletter I mentioned that I had added a few extra pounds around my waist and that I was trying to shed them as part of my New Year's resolution. Well, it finally happened. In the last two weeks I started taking longer daily walks and eating less at night. That's all it took. Maybe part of it was winter hibernation or maybe even a slight seasonal affective disorder. Now that daylight is longer, I feel better and have become more active. It feels good. Are you taking your daily walks?

Supplement use tip: It's a good idea to take at least one day off each week and not take any supplements (unless you need them for a specific medical condition). The effects of many supplements accumulate with time, so it's good to give your body a break. Especially if you notice that your sleep is more shallow. The herbs could be stimulating you more than you really need.

Herbal Combo for Menopause - Finally some good news
The combination of black cohosh and St. John's wort reduces the physical and psychological symptoms of menopause. St. John's wort is used to treat mild to moderate depression, while women have taken black cohosh for menopausal complaints. To see if a fixed combination of the herbal medicines could benefit women with depression and menopausal symptoms, researchers studied 300 women. Of these women, half took the St. John's wort and black cohosh combination, while the other half took placebo pills. After four months, women who took the two-herb combination showed a 50 percent reduction in symptoms such as hot flashes and sweating, compared to 20 percent for those on placebo. The women who were on the herbs also had much better mood. There was no significant difference between the groups in the number of side effects. The improvement in menopausal symptoms was similar to that seen among women taking hormone therapy for three months. Source: Obstetrics & Gynecology, February 2006.
   My comments: Treating menopausal symptoms effectively with few side effects is not easy. Estrogen works but it has potential long term side effects. Only half of the women benefited from the herbal combination, but that's better than nothing. If women are interested in taking black cohosh and St. John's wort, I would suggest they discuss with their doctor first who may agree to this dosage. Two capsules of black cohosh in the morning along with one capsule of St. John's wort 300 mg. There may be women who respond to half this dosage while others may need more. You can experiment for yourself and take more or less depending on your symptoms. Be a little careful with St. John's wort since the effects can accumulate after several days and you may need to take less with time. If you get insomnia, you may be taking too much.
See http://www.raysahelian.com/menopause.html  for more information.

Saw Palmetto and Enlarged Prostate - Another Study to Deflate?
Email from a newsletter reader: Dear Dr. Sahelian, I recently read a article in the newspaper that quoted the New England Journal of Medicine that after much testing it was found that saw palmetto was not effective in treating or helping prostate enlargement. I have been taking saw palmetto for years and it seems to help me, what are your thoughts about their findings. Thanks.
Here's a recent Newspaper headline: A popular herbal pill used by millions of men doesn't reduce the frequent urge to go to the bathroom or other annoying symptoms of an enlarged prostate.
Let's take a closer look.
This was a double-blind trial that lasted one year and involved 225 men over the age of 49 years who had moderate-to-severe symptoms (not mild symptoms) of prostate enlargement. They were given saw palmetto extract (160 mg twice a day) and compared to a group that received placebo. Results: There was no significant difference between the saw palmetto and placebo groups in maximal urinary flow rate, prostate size, residual volume after voiding, or serum prostate-specific antigen levels. The incidence of side effects was similar in the two groups. The researchers conclude: In this study, saw palmetto did not improve symptoms or objective measures of benign prostate hyperplasia.
This study was also published in the New England Journal of Medicine (the journal that published the glucosamine and chondroitin study that I reviewed in the last issue). However, the menopause study that showed the black cohosh and St. John's wort to be effective, was NOT published in the NEJM. Why would it? The supplements worked. I know I'm being hard on the NEJM, and perhaps they are very honest, but I can't help but suspect that they have a strong anti-supplement bias.

Stephen Bent, MD, Assistant Professor of Medicine, UCSF, said he and his colleagues picked saw palmetto to study because of its widespread use and positive findings from previous studies. Here's an interesting tidbit: some of Dr. Bent's research colleagues have received fees or support from drug companies. Hmmm....

Problems with the study:
There have been dozens of studies done in the past with saw palmetto, and the majority were done on men who had mild to moderate prostate symptoms. In a vast majority of the previous studies, saw palmetto was effective in improving their symptoms. I interviewed Dr. Bent:
Sahelian: Why weren't patients with mild BPH also included in the study?
Bent: Good question. There are several reasons for not including patients with mild symptoms: 1) patients with mild symptoms have less "room" to improve - so it is harder to detect a benefit and requires more patients and a larger study, 2) most prior studies included patients with moderate to severe symptoms - so we chose to use a similar patient population, 3) most patients do not present to doctors or complain of symptoms until they are at least moderate, so therapy of any kind is usually not used for mild symptoms.
   My comments: I'm going to disagree with Dr. Bent: 1. If patients with mild symptoms have less room to improve, why was the glucosamine study I reviewed last time done mostly on patients with mild symptoms and why did the media and the editorial board of the NEJM declare that glucosamine and chondroitin were not effective for mild arthritis pain when it appears that it is difficult to detect a benefit in cases of mild symptoms? 2. Most saw palmetto studies in the past actually were done in patients with mild symptoms to moderate. 3. Many patient with mild BPH do try to use saw palmetto or other herbs, so it does not appear to be correct when the doctor says "therapy of any kind is usually not used for mild symptoms."

Sahelian: Were the capsules taken with or without food?
Bent: Participants were instructed to take the capsules twice a day with meals.
My comments: We don't know if the results would have been different if both capsules had been taken at the same time to allow for higher blood levels, or if the capsules were taken on an empty stomach the results would be different. I find that sometimes when herbs or nutrients are taken with a meal, the herbs get diluted and "lost" with the rest of the meal and perhaps absorbed so slowly over several hours that they practically become ineffective. I know that when I take herbs for libido with a full stomach I don't feel the effects as well as if I take them on an empty stomach. Therefore, this is something to consider as a possible factor in the outcome.

Sahelian: What was the extract potency? You mentioned 160 mg twice daily but I cannot find the % of liposterolic extract.
Bent: The extract contained 92 percent total fatty acids before the study and 90 percent total fatty acids with 0.33 percent sterols at the midpoint of the study.
My comments: I wonder if using a higher dose, perhaps twice the amount, would have made a difference since the patients being treated had moderate to severe prostate enlargement. Actually Dr Bent agrees, he says: "Now that this study is negative, I think it's reasonable to try a higher dose."

My Overall Opinion
Over the past two or more decades, dozens of studies have indicated that saw palmetto is effective in mild to moderate symptoms of BPH. A comprehensive analysis of 21 trials involving over 3,000 men found saw palmetto provided "mild to moderate improvement" in symptoms with fewer adverse events than finasteride (Proscar). The multistudy analysis was performed by the Cochrane Collaboration, a nonprofit group that specializes in reviewing medical literature. (By the way, did the researchers purposely choose men with moderate and severe symptoms in order for the saw palmetto results to fail?)
For the time being I am still confident that this herb has a role to play in prostate health. Maybe saw palmetto does not work well in severe cases of prostate enlargement. But, we have to look at the totality of experiments and not rely on the results of the latest study, otherwise we would feel like ping pong balls shifting from one side to the other based solely on the latest results. Also, it is quite possible that a blend of several herbs that have an influence on prostate health would potentially work significantly better than saw palmetto alone.
Prescription drugs that treat BPH have many side effects, for instance finasteride causes sexual problems and terazosin causes dizziness.

See http://www.raysahelian.com/prostate.html  for more information.

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Vol. 3, Issue 5 -- March 1, 2006
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Remember my caution in the last issue where I said, "NEVER believe the headlines of a health story in the news" ? That caution was quite prophetic. There have been several well publicized studies in the last few weeks that deserve a more thorough analysis than what headlines provide. One of them is the glucosamine study. I have come to believe that some media outlets are more interested in a sensational headline to sell their news than they are in depicting accuracy. After all, they are in the business of selling news, not truth.
Here's a quiz. Choose the correct answer regarding the recently published study in the New England Journal of Medicine about the role of glucosamine and chondroitin in knee arthritis:

a) Supplements Fail to Stop Arthritis Pain (New York Times)
b) NEJM Study Shows Supplements Relieve Mild Forms of Arthritis (NNFA - the National Nutritional Foods Association)
c) Supplements lose luster after studies question claims (MSNBC)
d) Supplements May Not Help Arthritis (CBS News)
e) Headlines are not fully accurate. Since I am a reader of Dr. Sahelian's outstanding newsletter, I have learned by now not to rely on the headlines of health articles (or headlines of any article on any topic). I only trust the wise opinion of Dr. Sahelian :)
My guess is that practically all of you did well on this quiz by choosing the correct answer, e. I was planning to review the saw palmetto study that I mentioned last time, but we have had so many emails on the glucosamine results that I will bump the saw palmetto analysis for the next issue. In the meantime, I do wish to mention that I am still a believer in saw palmetto. If there's room in the next issue, I will also discuss the calcium and osteoporosis study.

Glucosamine and Chondroitin - One Study, Dozens of Interpretations
We have had many emails requesting my opinion on this topic. Here's a typical example:
"I really respect your opinions and find your site VERY informative. I just read an article on WebMD putting down Glucosamine and Chondroitin. If possible, I'd like to know your opinion. I take both of these nutrients plus MSM and they have been beneficial for me. I'm thinking it's typical conventional medicine thinking-because they can't make money from prescribing these, they put it down. You should write about this and similar "studies" on your site-thanks."

Let's go over the basics of the study. Close to 1600 patients with painful knee osteoarthritis were divided into five groups for a six month study; group A received 1500 mg of glucosamine, group B received 1200 mg of chondroitin sulfate, group C received both glucosamine and chondroitin sulfate, group D received 200 mg of celecoxib (Vioxx), and group E received placebo. The patients were divided into those with mild, moderate and severe arthritis pain but the majority had mild pain. Up to 4000 mg of acetaminophen daily was allowed as rescue analgesia, meaning that patients had the option to take Tylenol if they wanted additional pain relief (to me, this could easily confuse and complicate the findings). Results: For patients with moderate-to-severe pain at baseline, the rate of response was significantly higher with combined glucosamine and chondroitin therapy than with placebo (79 percent vs. 54 percent). (By the way, the fact that 54 percent of placebo patients had a reduction in pain indicates something was not right with this study, perhaps the inclusion of Tylenol for pain relief. Fifty-four percent is too high for a placebo effect and makes me question how well the study was designed.)
This is what the researchers conclude: "Glucosamine and chondroitin sulfate alone or in combination did not reduce pain effectively in the overall group of patients with osteoarthritis of the knee. Exploratory analyses suggest that the combination of glucosamine and chondroitin sulfate may be effective in the subgroup of patients with moderate-to-severe knee pain."
Now, it appears quite clear that these nutrients were effective even at 6 months. Previous studies with these nutrients have indicated that sometimes it takes a year or two for the cartilage in the knees to repair more fully. Why, then, did the media put out headlines that said these supplements did not work? I don't get it. Is it stupidity, lack of ability to read and interpret the results of a study, or just plain and purposeful misleading of the public due to conspiracy with drug companies? I just don't know.
Here is some additional details regarding the interpretation of this study published in the media. It all reminds me of the children's fable of three blind men who are examining an elephant by touch. One blind man, while touching the elephant's side, declares that it was a wall. The second touching its leg, declares the elephant was a tree, and the third blind man, while holding on to it's tail declares the elephant was a snake.

NNFA
This is what the National Nutritional Foods Association (NNFA), a leading trade organization that speaks for vitamin companies, says, "Popular over-the-counter supplements found to provide significant pain relief. A study published in today’s edition of the New England Journal of Medicine (NEJM) suggesting that two very popular supplements— glucosamine and chondroitin sulfate—provide significant pain relief is very positive news for thousands of arthritis sufferers.
CBS News (AP)
Two hot-selling supplements used by millions of Americans are of little help to most people with mild arthritis, concludes a large government study that is part of an effort to scrutinize unproven health remedies. For most arthritis patients with aching knees, the health food store supplements glucosamine and chondroitin sulfate turned out to be no better than dummy pills. People who had more acute knee pain seemed to show some benefit.
A press release from Leiner, a vitamin company that sells supplements
Results of a National Institutes of Health (NIH) study published in the February 23rd issue of The New England Journal of Medicine (NEJM) found that taking popular nutritional supplements, glucosamine and chondroitin sulfate in combination, is more effective than pain medication, Celebrex®, in treating moderate to severe osteoarthritis knee pain. For the 21 million Americans suffering from osteoarthritis, the results provide hope to osteoarthritis sufferers in search of pain relief and alternate options to expensive pain medications.
Associated Press - Despite Tests, Many Consumers Swear by Remedies
Last week, major government-funded research indicated that two wildly popular arthritis pills, glucosamine and chondroitin, did no better than dummy pills at relieving mild arthritis pain. While most people taking the arthritis pills in the study got no significant benefit, the pills did appear to help those with more severe pain.
NEJM editorial
An actual editorial published in the same journal that found these nutrients helped with moderate to severe pain, says, "On the basis of these results, it seems prudent to tell our patients with symptomatic osteoarthritis of the knee that neither glucosamine hydrochloride nor chondroitin sulfate alone has been shown to be more efficacious than placebo for the treatment of knee pain."

My Interpretation:
I just don't understand how the NEJM editorial can make a statement that contradicts the findings of the study. Is it because their advertising dollars come from drug companies? The NEJM does not have ads for arthritis supplements but they have ads for arthritis drugs. Case closed. If someday the NEJM starts publishing ads involving arthritis supplements, you will likely see a more positive spin by the editors. Money influences opinions whether in Washington DC or the editorial office of a medical journal.
I think this is a positive study and deserved a more positive spin than what the major media reported. I wonder why the researchers allowed the study participants to use acetaminophen since this drug may damage cartilage tissue, is not very effective in osteoarthritis pain, has liver toxicity potential and may have masked the pain relief obtained by glucosamine and chondrotiin.
Nevertheless, this and dozens of previous studies that support the use of these nutrients for osteoarthritis, continue to convince me that they are a great addition or a good alternative to current NSAIDs, Cox 2 inhibitors or acetaminophen. For more information, see http://www.raysahelian.com/osteoarthritis.html 

MSM Makes Sense
Methylsulfonylmethane, or MSM, has become a popular dietary supplement for arthritis pain relief, but few studies have been conducted involving actual human patients. Researchers from the Southwest College of Naturopathic Medicine in Tempe, Ariz., and the Arthritis Health Center in Scottsdale, Arizona, gave 3 grams of MSM twice a day to 25 knee arthritis sufferers in a randomized, double-blind trial. The study lasted 3 months. The age of the men and women ranged between 40 to 75 years. The patients taking MSM reported significant decreases in pain and improvements in their physical function, compared with a control group taking a placebo. However, no notable differences were found in stiffness or aggregated total symptoms.
   My thoughts: 6 g of MSM daily is a very high dose, and I would suggest using a smaller amount since most people will probably take MSM longer than just 3 months. Also, if MSM is combined with other nutrients and herbs used for arthritis, the dosage would have to be further reduced. For more information, see http://www.raysahelian.com/msm.html

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Vol. 3, Issue 4 -- February 15, 2006
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NEVER, yes, NEVER believe the headlines of a health story in the news.. or, in my opinion, any story. The media uses attention grabbers when they cover a story (just as I did), but the real results are far more involved than what the headlines indicate. For instance, we had two studies published that made big news since my last newsletter. The headlines read, "Eating Low Fat Offers Little Disease Protection," and "Saw Palmetto Fails in Prostate Study." Now, if you did not have time to read the whole articles and look deeper into this, you may form an opinion that could turn out to be inaccurate. In this issue I offer my thoughts on the Low Fat study and inform you why the news media headlines are clearly misleading. In the next issue of the newsletter in 2 weeks will I present a review of the saw palmetto study and my interview with Dr. Bent, the lead researcher who conducted the saw palmetto trial. The headlines, again, do not tell the whole story.

We Lost a Few Hundred Million Dollars -- But no Fat
According to the headlines, a low-fat diet fails to decrease cancer and heart risks in older women. With such an important announcement, it behooves us to take a closer look at this 415 million dollar study funded with your tax dollars. Perhaps we can find flaws that may get it nominated for the "Worthless Research of the Year," award. This is an award that I created this week, motivated by this study. I know it's still early in the year 2006 and another study could still trump this one.
Here are the basic facts about the study published in the February 8, 2006 issue of the Journal of the American Medical Association. It involved 48,000 postmenopausal women with an average age of 62. These women were advised to cut overall fat consumption and increase vegetables, fruits and grains. The women in the study had 18 sessions in small groups with a trained nutritionist in the first year and four sessions a year after that. Women in the intervention group were instructed to reduce their intake of total fat to 20 percent of their energy intake and to increase their consumption of vegetables and fruits to at least five servings daily, and to increase their grain consumption. All fats were supposed to be reduced without distinction between various types of fat. The results were compared to women (the control group) who continued their usual eating habits. Supposedly, and according to the headlines, the eight-year study showed no difference in the rate of breast cancer, colon cancer and heart disease among those who ate lower-fat diets and those who didn’t.

SuperSized Study Flaws
1. It is naive and simplistic to categorize all fats as having the same health benefit or risk. There are good fats, neutral fats, and bad fats, and the ratios can make a huge difference. The scientific thinking on the role fats play in disease prevention has evolved since this study was designed back in the early 1990s. We now know that not all fats are bad. Some fats, like the kind in fish, olive oil and nuts, are healthier than the saturated fats and trans fats found in processed and fried foods, cookies, cakes, and junk foods. Study participants probably reduced intake of all kinds of fats, assuming that all fats carried the same risk.

2. The women started this diet too late, an average age of 62. Most cancers take years or decades to form and be detected. For breast cancer in particular, earlier eating habits may have the most influence on risk. Hardening of the arteries takes years and decades to form.

3. The researchers mentioned that in the study women did not reduce the fat content of their diet to the extent that the study required. They admit the low fat diet was difficult to follow. The diet they were told to follow meant, for example, no butter on bread, no cream cheese on bagels, no oil in salad dressings. The researchers did not differentiate between trans fats (for instance in baked goods), saturated fats, monounsaturated fats (found in olive oil), and polyunsaturated fats. They told the women to reduce all fats.
4. Both groups started out with about 37 percent of daily calories from fat. The goal was to cut that to 20 percent for the low-fat group; the women managed about 24 percent on average in the first year, but it climbed to about 29 percent later on. We all know how difficult it is to follow a particular diet for prolonged periods without cheating. And, by the way, not overtly mentioned by the media, the subgroup of women who reduced their fat intake the most, did have a lower rate of breast cancer and heart disease.

5. Most of the women in the study remained overweight. Excess pounds increase the risk for heart disease and cancer, whether the pounds come from fats or carbohydrates. Both groups had on average a similar weight at the end of the study and they consumed about the same number of calories.

6. When a person is asked to lower their fat intake, guess what they often substitute: carbohydrates. Carbohydrates, particularly simple carbohydrates from sugar, fructose, and pasta, get converted into saturated fats, one of the worst kinds of fats. If you are not getting enough fat in the diet, your body may crave simple carbs, and simple carbs are probably worse than saturated fats.

7. Some of the women in the control group who ate their regular diet may possibly have changed their eating habits with time by just following recommendations mentioned in the media and women's magazines over the past few years on how to eat healthier. Therefore, their diet may not have been significantly different than those in the study group as the researchers would have hoped. It appears that both groups had relatively low rates of heart disease, about 2.5 percent compared with just over 4 percent among postmenopausal women nationally.
Who and What to Believe
Certain comments by so called researchers and pundits regarding the results of this study were clearly.... how shall I say... eh... stupid. Yes, that's the word I'm looking for, Stupid.
Dr. Timothy Johnson, the medical commentator on ABC nightly news, said, "This is a wake up call. This study shows we can't rely on lifestyle changes, like weight loss, exercise, diet changes, to reliably reduce the risk of disease. I say to people to take advantage of testing, colonoscopy, blood tests, and mammograms. We can get these diseases even living a good lifestyle."
Yes, Dr. Johnson, it is very true that we can get these diseases even by living a good lifestyle, but I am shocked that you would minimize the role of food choices on health and disease based on this flawed study.
Barbara V. Howard, an epidemiologist at MedStar Research Institute, a nonprofit hospital group, and a principle investigator in the study, is quoted in a newspaper article saying "People should realize that diet alone is not enough to stay healthy. We are not going to reverse any of the chronic diseases in this country by changing the composition of the diet."
I wonder if she said this while wolfing down a double cheeseburger sandwiched with two large empty calorie white buns along with a 64 ounce sugared soda refill cup and a side order of deep fried onion rings.
No one denies that genetics, smoking and exercise play a crucial role in health and disease, but to minimize and dismiss the role of diet is just plain.... what's the word... (you fill in the blank).
Summary
We did learn a few things from this 415 million dollar study: a) Most people find it difficult to stick to a low fat diet for prolongrd periods, b) Scientists, even with the best intentions, may design a study with a poor understanding of nutritional knowledge, ie, not recognizing that different fats have different health effects, and c) After several decades of nutritional research the consumer, and researchers, are as confused as ever about the role of diet in health and disease.
My suggestion is that you try your best at eating a variety of foods, increase your intake of fresh vegetables, fruits, whole grains and beans, spices, and fish, and reduce your intake of simple sugars and trans fats, along with reducing intake of pastry and junk food. It's not that complicated.
A friend of mine commented recently that she learned more about the influence of diet on health from seeing the movie Supersize Me than learning the results of this study.

For suggestions on a reasonable diet you can follow for long term health maintenance, see http://www.raysahelian.com/diet.html 

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Vol. 3, Issue 3 -- February 1, 2006
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Valentine's Day is coming up in a couple of weeks. Are you ready to rekindle the passion you felt a long time ago with your partner or ready to find a new partner? There are quite a number of aphrodisiac herbs that are quite effective in enhancing intimacy for both men and women. It's truly amazing to me that even though many cultures for centuries have known about local herbs that stimulate sexual passion, most doctors in the US have little clue on how potent some of these herbs or combinations can be. Many herbs work slower than drugs and that may be one reason. As Americans we like pills that give an immediate effect. We want to take a drug like Viagra and get a quick response in an hour or two. Most aphrodisiac herbs take 2 or 3 days to begin to work and their effects improve over time, but there are some herbs or combinations that work quicker. For instance, Passion Rx with yohimbe often enhances sexuality within a couple of hours and the effects are even more pronounced the second or third day.
Although Viagra and its cousins Cialis and Levitra work very well for erectile function, they have little effect on sensation or libido and they hardly work in women. Herbs generally are not as potent and quick in terms of stimulating an erection, but with time they can be as good as the drugs. Most people prefer the overall sexual enhancement that comes from the herbs in terms of the whole package -- sensation, libido, intensity of orgasms, climaxes, lubrication, and erection. Herbs also have the advantage of causing fewer side effects. I discuss in more detail at the bottom of the page on how to best use herbal aphrodisiacs.

Melatonin Lowers Blood Pressure at Night
Taking a pill containing melatonin, a natural hormone that regulates sleep, at bedtime may enhance the drop in blood pressure that occurs at night. The normal decline in blood pressure at night may be related to the rise of melatonin levels in the body. Therefore, treatment with a melatonin supplement may lower lower blood pressure further. To evaluate the effect of melatonin on blood pressure changes in women, Italian researchers recruited nine healthy women and nine women who were being successfully treated with drug therapy for high blood pressure. The ages of the women ranged from 47 to 63 years. For three weeks, one hour before bed, the women were randomly assigned to pills containing 3 mg of sustained release melatonin or inactive "placebo." After the three weeks, the women crossed over to the alternate treatment. Melatonin treatment decreased nighttime blood pressure. Melatonin had no effect on daytime blood pressure or on heart rate. For details, see http://www.raysahelian.com/melatonin.html and http://www.raysahelian.com/highbloodpressure.html
  My comments: This is good news for those with hypertension. However, i prefer a lower dose to be used, perhaps 1 mg, and since we don't know the long term effects of nightly melatonin use for years and decades, I think the maximum dose and frequency should be 1 mg of melatonin every other night.

Caution with Impotence Drugs - Viagra, Cialis, Levitra and Eye Disease
Impotence drugs such as Viagra and Cialis can increase the risk of vision loss in men who have a history of heart disease or high blood pressure. In a small study, scientists at the University of Alabama in Birmingham found that men who had suffered a heart attack were 10 times more likely to have optic nerve damage if they had been taking leading anti-impotence pills.
  See http://www.raysahelian.com/impotence.html for details.
My thoughts: If you are planning to take these impotence drugs, always start with a third or half of the recommended dose, and use them infrequently. Many people, especially older men, who have erectile dysfunction may have an underlying heart or vascular disease.

How to Take Passion Rx or Individual Sex Herbs Safely and Efficiently
Taking an aphrodisiac herb or a herbal sex product is not as simple as taking a Viagra pill. If you know how to use these herbs, you can maximize your sexual enjoyment while minimizing side effects. Here are a few tips:

Take the herbs in the morning before breakfast so they are absorbed well without food in the stomach.
Herbs have side effects, too, although less serious than the drugs. Common side effects from high doses of sex herbs include overstimulation, restlessness, insomnia, headache, and rapid heart beat. If you get insomnia one night, skip a dose the next day, and next time take less than you did the day you got the insomnia.
Be patient. Most herbs take anywhere from 2 to several days to start working. Except for Yohimbe which can work within an hour or two.
Start with a small amount your very first time, even if it means opening the capsule and taking a portion. Some herbs are quite potent, for instance Tongkat ali. Use a smaller amount over several days rather than a high amount for a quick effect.
Passion Rx is best used half a capsule 2 days on and one day off. On the fourth day you can increase or decrease the dosage based on your initial response. You may notice a sexual enhancement even on the days that you don't take it.
Other supplements can cause stimulation, including certain mind supplements, Eyesight Rx, ginseng, many adaptogenic herbs, certain amino acids such as tyrosine.
Use caution if you are taking medicines since sometimes the interactions between herbs and medicines is not predicable.
Be cautious using sex herbs if you have a heart condition or a tendency for high blood pressure or heart rhythm abnormalities.
Take breaks. Don't take these herbs every day.

Questions From Subscribers
Q. I had a skin rash from taking hyaluronic acid for my arthritis. Is this common?
A. I have not seen any studies with oral hyaluronic acid supplements tested in humans. Thus far we have had several people mention a rash after taking hyaluronic acid, therefore people should keep this in mind if they intend to use this nutrient. In my opinion, there is much more evidence supporting the use of glucosamine, chondroitin, and other nutrients for arthritis pain.
Q. I am a type II diabetic and use no insulin or prescription drugs. I keep my morning glucose readings in the 80-120 range with diet and supplements. In your most recent newsletter, you discussed R-form alpha lipoic acid. Other sources recommend more ALA for diabetics that for "normal" people. Do you agree with that recommendation? They recommend 600mg (equals 300mg R-form) for diabetics which greatly exceeds you recommendation of 50mg R-form three days a week! How can I reconcile these disparate recommendations? What is your advice for diabetics?
A. There is a difference in the dosage of a supplement as to whether it is meant for long term preventive maintenance or for the treatment of a medical condition. Also, when research is done, they use high amounts of the tested nutrient or drug for short period of time just so they can elicit a statistically measurable effect. This does not mean that people should be taking these high amounts forever. We have no idea what would happen to people if they took 300 or 600 mg every day for years to come.
If you have diabetes, first inform your doctor of your interest in using ALA, then start with half a capsule of 50 mg R-ALA. With time you can increase the dose gradually while monitoring your blood sugar. One side effect to look out for is insomnia. If you notice being too alert when you go to bed, it may be that you are taking too much ALA, or perhaps too many other supplements.

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SUPPLEMENT RESEARCH UPDATE
Vol. 3, Issue 2 -- January 16, 2006
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In the previous issue I mentioned my New Year's resolution was to be more physically active since I have a few extra pounds around my midsection that has accumulated since reducing my sports activity. I have a confession to make.  I get so immersed in my work and reading herbal research information that hours go by and I forget to go out and take a walk, or bicycle or visit the gym as much as I should. So, I plan to reaffirm my resolution and try again.
Perhaps you, too, are trying to improve an area of your life -- whether it be a better diet, reducing smoking, drinking, overuse of substances, or doing more exercise. Perhaps you have fallen short of your own resolution. I suggest you not despair -- nor feel guilty. Studies show that many people who try to quit smoking are not able to do so the first time they attempt, but are able to do so on subsequent attempts. So, just keep trying and hopefully sooner or later you will achieve your objectives.
 

Estrogen-Like Compounds in Plants and Breast Cancer
Research in monkeys suggests that the natural plant estrogens found in soy - called isoflavones - do not increase breast cancer risk in postmenopausal women. In fact, they may provide a protective effect. Even at high doses, there was no evidence that isoflavones stimulate cell growth or other markers for cancer risk in breast tissue. Women who have higher levels of estrogen hormone may actually gain a protective effect from higher doses of soy isoflavones. Population studies show women who consume diets high in soy generally have lower rates of breast cancer. You can consume isoflavones from soy, other plants, or take a supplement. It is very difficult to estimate a good amount to take as a supplement since no long term human trials are available. For details, see http://www.raysahelian.com/isoflavones.html  This page also defines the terms isoflavones and phytoestrogens.

R Alpha Lipoic Acid - Good For Your Brain and Eyes
For many decades people associated the word antioxidant with vitamins E and C. In recent years it has become apparent that there are literally thousands of nutrients and herbs that have antioxidant activity. One of the new stars is alpha lipoic acid (ALA). And it now appears that a form of ALA, called R alpha lipoic acid, is actually the active form.
If you're taking a conventional ALA supplement, you're only getting half or less of the benefit. The reason for this is that most ALA products on the market have both the S form and the R form. The S form is chemically the mirror image of the R form of lipoic acid and cannot be used by the body, hence it is useless. Thus, 50 mg of R ALA is equivalent to 100 mg of regular synthetic ALA which includes both forms. 
Scientists are now starting to focus their attention on R lipoic acid. Two recent studies shed additional light on the benefit of the R form. At the University of California in Berkeley, researchers discovered that R alpha lipoic acid protects cultured human retinal pigment cells when the cells were exposed to oxidants. The researchers say, "The present study suggests that the protective effect of R alpha lipoic acid involves multiple pathways and that R alpha lipoic acid could be effective against age-associated increase in oxidative stress and mitochondrial dysfunction in retinal cells."
In a second study completed at Oregon State University in Corvallis, Oregon, rats were supplemented with R alpha lipoic acid to determine if any changes occurred in iron accumulation in the brain. Accumulation of iron and copper has been proposed to contribute to additional oxidative stress in aging and certain neurodegenerative disorders. Results showed that brain iron levels in old R alpha lipoic acid fed animals were lower when compared to controls and were similar to levels seen in young rats. See http://www.raysahelian.com/lipoic.html  for details.
My thoughts: Most R alpha lipoic acid capsules come in a 50 mg dosage. For long term use, I think one capsule 3 times a week is adequate. Some people may prefer using a quarter, third or half a capsule since high doses may cause shallow sleep, even if the supplement is taken in the morning.

Questions From Customers
Q. Why do you sometimes recommend taking half or a portion of a capsule of some supplements? I subscribe to other health letters and none of them mention this.
A. I learned early in my medical career that one dose does not fit all. During my residency, while working in the emergency room or on the medical floors, I encountered countless patients who had side effects from drugs carelessly prescribed by their doctors. And most of the time these side effects could have been minimized if the doctor tailored the dosage to the patient. A 80 year old with high blood pressure may not need the same dose as a 30 year old. The dose for a petite woman is likely much different than that of a husky large male. There is quite a wide range of responses to drugs and supplements, sometimes 10 fold. For instance, some people notice acetylcarnitine at 50 mg, while others need 500 mg to realize they have taken something. Same with Passion Rx. Some people find a quarter or a third of a capsule is effective, while others need a full capsule. For this reason, and to be cautious, I often recommend people start with a low dose and gradually increase it to the point where they get the benefit while avoiding or minimizing the side effects. And natural supplements have side effects, too. Most people don't realize this. Don't be shy opening a capsule and taking a portion of the contents or breaking a tablet in two or more pieces. This is particularly true if you are sensitive to supplements or you are already taking other pills or medicines.

Customer Feedback, testimonial
I have purchased Mind Power Rx last November and I am really really happy of the positive effects it has. To begin with, I am a software engineer with a commercial background but unfortunately I had a car accident 4 years ago and thus suffered from a moderate to severe head injury which I think caused the chemicals inside my brain to be tremendously unbalanced. This is such an annoyance because I had no emotions anymore and only my logic and analytic behavior helped me to be partly who I was before my car accident. I had to study a little bit how the brain worked to seek out an effective solution towards this problem because although I have a good background in my domain, emotions are very important when going through an interview. Therefore I have failed many interviews despite my competence. Moreover, I have looked everywhere in local drug stores but never found anything. But when I saw your solutions when querying Google with "dopamine" and other important brain cells chemicals, I was so happy to find Mind Power Rx. I just wanted to congratulate your work and the company you formulate for! You got yourself a lifetime customer.

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SUPPLEMENT RESEARCH UPDATE
Vol. 3, Issue 1 -- January 3, 2006
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Happy New Year, everyone! Have you made your resolution yet? Mine is to be more physically active. My work sometimes keeps me so busy that I don't go out as much to walk, bicycle, hike, or do yoga. If I don't work out a few days in a row, without a doubt I start getting small love handles around the belly. And within a few days of starting physical activity again, the extra flab disappears. So, my resolution is to be more consistently active. Interestingly, yesterday I read the results of a new study that may motivate a few couch potatoes to get moving in the New Year. Using data from the Framingham Heart Study, which has followed some 5,200 residents of Framingham, Massachusetts over the past 46 years, researchers calculated the differences in life expectancy in subjects associated with different levels of physical activity. They found that life expectancy is 2.3 years longer for moderately active individuals and at least 4 years longer for highly active individuals.
I wish you all a healthy and happy 2006.

Cacao and Heart Disease
A few squares of dark chocolate every day might cut the risk of serious heart disease by helping to stave off the hardening of arteries. Researchers from University Hospital in Zurich studied 20 male smokers, who are at greater risk of hardening arteries characteristic of coronary heart disease, to see the effects of dark and white chocolate on arterial blood flow. The subjects, who were asked to abstain from eating foods rich in antioxidants for 24 hours, were given 40 grams (2 ounces) of chocolate to eat. After two hours, ultrasound scans revealed that dark chocolate -- made up of 74 percent cacao solids -- significantly improved the smoothness of arterial flow, while white chocolate, with four percent cocoa, had no effect. see http://www.raysahelian.com/cocoabean.html 
My comments: The problem with chocolate is the excess sugar and cocoa butter that add on unnecessary calories. Fortunately, cacao (or cocoa) powder is now available in capsules that minimize the calories and provides a hefty amount of the flavonoid antioxidants.

Green tea and Leukemia
Doctors at the Mayo Clinic in Rochester, Minnesota found that of four patients who started drinking green tea or taking green tea extracts, three showed clear improvements in their condition. The patients all had chronic lymphocytic leukemia, or CLL, a form of leukemia that usually arises during or after middle-age and typically progresses slowly. CLL is a cancer of the blood and bone marrow, in which abnormal white blood cells replace healthy blood cells. The patients all started using green tea on their own after hearing media reports about a lab study that study showed that a compound found in green tea, known as EGCG, was able to kill cancer cells that were taken from CLL patients and put in a test tube with the tea compound. In interviewing the patients and reviewing their records, the doctors found that three showed signs of a regression in their cancer after they started to drink green tea or take green tea capsules. See http://www.raysahelian.com/leukemia.html  or http://www.raysahelian.com/greentea.html  for more information.

Fish Oils Reduce Tendency for Heart Rhythm Problems
Daily supplementation with omega-3 fatty acid ( fish oils ) prevents a potentially-deadly decline in heart rate variability associated with exposure to indoor air pollution. Heart rate variability measures the variability in the intervals between heartbeats, with lower variability being associated with higher risks of heart disease and death. A normal heart does not always have the same time intervals between beats, but every so often (in cycles) the interval between cardiac beats changes; i.e. a little shorter, or longer. How frequent these variations occur are a measure of the effect of the nervous regulation of the heart. A sick heart losses this fine tuning. See http://www.raysahelian.com/omega3.html   
My comments: There are many causes for heart rhythm abnormalities, and one of them is taking too high doses of certain herbs that have a stimulating effect. I recommend you keep your dosages of supplements to the minimum that works for you, and also to take occasional breaks, for instance one or two days off each week to allow your system to come back to normal from potential overstimulation. See http://www.raysahelian.com/arrhythmia.html  for details.

Caution: Stomach acid drugs could make you sick
Popular anti-heartburn drugs, such as proton-pump inhibitors that block stomach acid production, heighten the risk of an increasingly common infectious form of diarrhea. Taking such drugs as Nexium and Losec or their generic versions tripled the risk of diarrhea blamed on the Clostridium difficile bacteria, a study concluded. Zantac was found to double the risk of the bacterial diarrhea. The drugs reduce gastric acid, opening the way for the bacteria to grow in the digestive system. For details, see http://www.raysahelian.com/heartburn.html
My comments: I truly think these drugs are being overprescribed, thus lowering the pH of the gastric juices and allowing more bacteria and germs to pass the gastric acid barrier. Doctors should use these drugs only when truly needed and for as brief a period as possible.

Feedback From Customers on Passion Rx, testimonial
Your latest Passion Rx really lives up to the claims. I had an amazing sexual response with intense pleasure and strong erections on the third day. I took one capsule the first day and the second day. The third day I did not take any.