Statins don't replace healthier eating habits

Amy Tousman July 20, 2009

Posted on: Thursday, May 17, 2007

Prescriptions

By Amy Tousman RD, CDE

Q. Since I am taking a statin medication to lower my cholesterol, does this mean I don't need to watch my diet?

A. Statin medications such as Lipitor, Pravachol, Zocor, Crestor, and Mevacor are effective weapons in reducing heart attack risk. However, don't assume that taking a statin makes you invulnerable. It won't cancel out a diet of frequent loco mocos and chicken katsu plate lunches. Statins complement dietary changes. They don't replace them.

Statins significantly reduce LDL cholesterol by blocking an enzyme needed to make cholesterol. Excess LDL is harmful because it deposits fat into the artery walls, forming plaques. These plaques reduce the elasticity of the artery and block the flow of blood to the heart.

Statins also reduce inflammation. Inflammation is an immune-system response to injury of blood vessel walls caused by plaques. Inflammation makes the plaques in the artery walls unstable. If the inflamed plaque bursts, it can block blood flow to the heart or brain, triggering a heart attack or stroke.

Inactivity, obesity, smoking and diabetes also promote inflammation. If you are prescribed a statin, addressing these issues by decreasing calories, getting active, controlling blood sugar and quitting smoking can further decrease your chances of suffering a heart attack. Eating fish also helps reduce inflammation.

Several studies have shown that cholesterol-lowering medications combined with lifestyle changes reduce the chance of heart attacks better than just taking medicine alone. These changes include cutting down on fatty meats, deep-fried foods and pastries. At the same time, increase fish, fruits, vegetables, beans, whole grains and soy. Also, try to include 30 to 60 minutes of physical activity most days of the week. In addition to making your medicine work better, these steps may allow you to take a lower dose of your cholesterol-lowering medication.

Heart disease isn't the only illness affected by diet and lifestyle. A heart-healthy lifestyle can decrease the risk for developing diabetes, high blood pressure, strokes and certain types of cancers.

Ideally, the answer to the heart-disease epidemic is not statins; it's prevention. We need to teach our keiki to choose foods that promote good health and to engage in physical activity so that they will not need these medications when they become adults. Statins could then be reserved for those whose risk for heart attack is due to genetics and family history rather than an unhealthy lifestyle.

Amy Tousman is a registered dietitian and certified diabetes educator with Nutrition Unlimited in Kailua. Hawai'i experts in traditional medicine, naturopathic medicine and diet take turns writing the Prescriptions column. Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; islandlife@honoluluadvertiser.com; or fax 535-8170. This column is not intended to provide medical advice.

Use a microwave to zap sponge germs

Amy Tousman July 20, 2009

Posted on: Thursday, July 12, 2007

Prescriptions

Use a microwave to zap sponge germs

By Amy Tousman RD, CDE

Q. What is the best way to clean kitchen sponges?

A. The kitchen sponge is a handy cleaning tool. Unfortunately, kitchen sponges can also become germ magnets. Since sponges retain moisture, bacteria that can cause food poisoning can stick to sponges after cleanup. Then, when you wipe something up, you're just spreading around the germs.

Recently researchers at the U.S. Department of Agriculture tested several methods of disinfecting sponges. They soaked sponges for 48 hours in a solution made from ground beef and a lab growth medium to attain a high level of microorganisms (about 20 million per sponge).

Next they treated each sponge in one of five ways: soaked in a 10 percent solution of chlorine bleach for three minutes, soaked in lemon juice, or de-ionized water for one minute, heated in the microwave on high for one minute, or placed in the dishwasher operating with a drying cycle. For comparison, some sponges were left untreated.

The treatments that killed the most bacteria were microwaving and running the sponges through the dishwasher. Both methods killed 99.99 percent of the bacteria.

Using the microwave or the top rack of a dishwasher with a drying cycle are convenient ways to sanitize sponges. Be sure the sponge is wet before putting it in the microwave (you can wet it and wring it out so it's not dripping). Microwaving dry sponges can start a fire! Don't use the microwave on sponges that contain metal. Only cellulose sponges (not natural sponges) can be sanitized in the microwave. Be careful when removing the sponge as it will be hot.

Although soaking sponges in diluted solutions of bleach didn't score as high as micro-waving or using the dishwasher in this particular test, it is still effective at killing many types of bacteria that make people sick.

Whether you choose to use the microwave, dishwasher or diluted bleach, it will be better than just rinsing your sponge in hot water.

If you spill juice from raw meat, fish or poultry, you can clean it up with a paper towel that can be discarded. Afterward, you should wash the area with hot soapy water, then sanitize it with bleach and water or a commercial sanitizer.

Ideally, sanitizing should be done each day that you cook food. Discard sponges after two weeks.

Soy products need not be avoided

Amy Tousman July 20, 2009

Posted on: Thursday, June 11, 2009

Prescriptions

Soy products need not be avoided

They won't affect your thyroid unless you lack iodine

By Amy Tousman RD, CDE

Q. Can eating soy products cause thyroid problems?

A. There is plenty of misinformation circulating on the Internet suggesting soy products can cause thyroid disease. Before throwing out your tofu, soybeans and soymilk, let's examine the facts.

There are two issues here: recommendations for folks who are healthy and recommendations for those who have hypothyroidism.

Hypothyroidism is when your thyroid gland cannot make enough thyroid hormone. Thyroid hormones control the way your body uses energy. The most common cause of hypothyroidism is an attack on the thyroid gland by the body's own immune system, rendering the thyroid gland non-functional. This type of hypothyroidism is thought to be genetic, rather than diet-related. Destruction of the thyroid gland through surgery or radiation treatment and iodine deficiency are other causes of hypothyroidism.

The connection between soy and the thyroid involves substances called isoflavones. Isoflavones have a similar chemical structure to thyroid hormone. Certain isoflavones in soy compete for the enzyme that is used to make thyroid hormone. This is where the rumor got started that soy is bad for the thyroid. However, this is not the whole story.

What the "avoid soy" Web sites fail to mention is that these effects are only seen when a person is iodine deficient. Iodine is also needed for thyroid hormone. Iodine deficiency is rare in the United States because iodine is added to salt and occurs naturally in dairy products, seafood and seaweed.

In folks with a healthy thyroid gland and adequate iodine intake, there's no need to limit soy. In fact, soy foods can promote good health by helping to lower your cholesterol, protecting bones against osteoporosis, relieving some symptoms of menopause and helping to prevent breast cancer.

For folks who have hypothyroidism and are being treated with synthetic thyroid hormones, some evidence suggests soy may interfere with the body's ability to absorb the medication. However, there's no evidence that adults with hypothyroidism need to avoid soy completely. If you eat soy foods often, consult your physician. He or she can use blood test results to determine if you need to increase your dose of medication.

If you have hypothyroidism, wait four hours after taking thyroid medication to consume soy products. This advice also applies to other products that may impair the body's ability to absorb thyroid medication, including high-fiber foods, iron and calcium supplements and antacids that contain aluminum or magnesium.

Amy Tousman is a registered dietitian and certified diabetes educator with Nutrition Unlimited in Kailua. Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; islandlife@honoluluadvertiser.com; or fax 535-8170. This column is not intended to provide medical advice.

Weight-loss product from TV requires YOU to cut calories

Amy Tousman July 20, 2009

Posted on: Thursday, May 21, 2009

Prescriptions

Remember, if it sounds too good to be true ...

Weight-loss product from TV requires YOU to cut calories

By Amy Tousman RD, CDE

Q. Do SlimShots really help you lose weight?

A. SlimShots are the latest late-night infomercial weight loss sensation. The ads claim SlimShots help you decrease your food intake up to 30 percent, without causing you to feel hungry or deprived of your favorite foods.

SlimShots are liquid appetite suppressants packaged like individual coffee creamers. They contain an emulsion of palm oil, oat oil, water, aspartame and artificial flavoring. They can be taken alone or mixed in foods or coffee.

SlimShots work by delaying digestion of the oily mix until it settles deep in the small intestine. Here, it triggers an appetite control mechanism known as the "ileal brake," which slows down the movement of food through the intestine. This causes the release of hormones that send an "appetite satisfied" signal to the brain, delaying hunger for several hours after eating.

There is some research supporting the use of palm and oat oil fat emulsions to control appetite. None of the studies actually used SlimShots, but they used the same active ingredients. Some of the studies show positive results in decreasing food intake and some show no benefit. Amazingly, the studies didn't measure whether or not the participants actually lost weight.

SlimShots alone will not produce weight loss. You must do your part, which is following a reduced-calorie diet. You also must get off your 'okole and move your body. And eating less food won't produce weight loss if you continue to eat foods high in calories.

This product may work for folks whose overeating is caused by excessive hunger. It won't be much help if your eating is triggered by stress, boredom or a co-worker bringing manapua or pastries into the office. In these cases, hunger is not the reason for eating.

Eating 10 to 15 walnuts with each meal and adding foods with soluble fiber, such as oatmeal and apples, will control your appetite with less expense.

Overall, SlimShots offer a short-term answer, but not a good long-term strategy. Do you plan to spend the rest of your life drinking shots of oil? Just some food for thought.

Lack of sleep tips scale toward weight gain

Amy Tousman July 20, 2009

Posted on: Saturday, December 18, 2004

PRESCRIPTIONS

Lack of sleep tips scale toward weight gain

By Amy Tousman RD, CDE

What role does sleep play in our weight?

Getting too little sleep on a regular basis can make it difficult to lose weight and may increase your risk for obesity.

Although we burn more calories when we are awake than when we are asleep, we also eat more during those extra hours we are awake. The effect of chronic sleep deprivation on the body's food-seeking circuitry offers new clues about our weight.

Losing sleep alters your metabolism in a way that sets the stage for weight gain.

Researchers from the University of Chicago Sleep Lab found that too little sleep over just a few consecutive days caused an increase in the appetite-stimulating hormones in the body and caused volunteers to crave more food.

A blood protein called leptin suppresses our appetite. This study found that sleep deprivation decreases the amount of leptin in the blood. Lower leptin levels lead to more hunger. Sleep deprivation also raises levels of grehlin, a substance makes people want to eat.

In another study, Researchers at Columbia University looked back at sleep patterns and obesity rates among participants in the government's National Health and Nutrition Examination Survey. They examined the records of 6,115 adults. Those who slept seven to nine hours were considered normal sleepers.

Here is a summary of their findings:

• People who sleep four hours a night or less are 73 percent more likely to be obese than those who sleep the recommended eight hours.

• Those who get five hours of sleep are 50 percent more likely to be obese.

• Those who sleep six hours were 23 percent more likely to be obese.

The researchers point out that these results show an association but do not "prove cause and effect."

Factors such as physical activity, depression, and gender were not considered in this study.

A Swedish study found that less sleep was linked to a higher body mass index, which typically correlates with excessive body fat.

The sleep/eating connection to obesity gives us another tool to use to help people lose weight. However, for some, obesity is more complex than simply looking at the amount of sleep we get. Even so, there is no denying that getting sufficient sleep is a good idea.

Instead of spending late nights trying to complete holiday projects, while munching on those holiday cookies sitting on the counter, try going to sleep.

Amy Tousman is a registered dietitian and a member of the Hawaii Dietetic Association. Send your questions to Prescriptions, Island Life, The Advertiser, PO Box 3110, Honolulu, HI 96802. This column is not intended to provide medical advice.

Sitting all day nixes exercise benefits

Amy Tousman July 20, 2009

Posted on: Thursday, August 14, 2008

Prescriptions

Sitting all day nixes exercise benefits

By Amy Tousman RD, CDE

Q. Can too much time sitting at my desk undo the health benefits of my 45-minute gym workout?

A. Exercise is extremely important for our health. Unfortunately, if the majority of our day is spent sitting at our desk, computer, or on the couch watching television, it might undo some of the benefits of structured exercise. When we sit for many hours, the enzymes responsible for burning fat actually shut down.

Physiologists analyzing obesity, heart disease and diabetes discovered that prolonged sitting shuts down circulation of a fat-absorbing enzyme called lipase. On the other hand, standing up engages muscles and promotes the distribution of lipase. Lipase prompts the body to burn fat and cholesterol, independent of the amount of time spent exercising.

The researchers found that exercising is not as beneficial if you are going to spend the rest of the day sitting. We have to pay more attention to what we are doing when we are not at the gym.

According to the lead researcher on the study, Marc Hamilton, a professor of biomedical sciences at the University of Missouri, "The existing data, by numerous studies, are starting to show the rates of heart disease, diabetes and obesity are doubled or even tripled in people who sit a lot." One reason is because when we stand or move, the enzyme lipase helps fat move into the muscles where it can be burned. When we sit, lipase virtually shuts off. This causes our body to store more fat and can also clog arteries and cause diseases.

Standing and moving lightly will re-engage the enzymes. Since people are awake 16 hours a day, if we spend most of our day sitting, we are losing an opportunity for optimal metabolism throughout the day.

Ideally a person should engage in moderate to vigorous physical activity for 30 to 60 minutes most days. However, in addition to your regular exercise routine, get up and move around while talking on the phone. Tidy up the house while watching TV. Take frequent breaks from that computer screen to stand and walk around. Any behavior you can perform while standing rather than sitting will provide a benefit.

For those who don't engage in regular exercise, movement throughout the day still offers benefits in terms of improved metabolism, disease prevention, and fat burning.

More time standing and less time sitting is good preventive medicine.

Sesame oil seems to benefit hypertension

Amy Tousman July 20, 2009

Posted on: Saturday, August 23, 2003

PRESCRIPTION
Sesame oil seems to benefit hypertension

By Amy Tousman RD

Q. Is it true that sesame oil helps to lower blood pressure?

A. A recent study found that cooking with sesame oil in place of other oils appears to reduce high blood pressure and lower the amount of medication needed to control it.

Researchers reported these results at the Scientific Meeting of the Inter-American Society of Hypertension. The study examined the effect of sesame oil on 328 people with high blood pressure who were already taking 10 to 30 milligrams daily of the blood pressure drug Nifedipine. This drug, categorized as a calcium-channel blocker, lowers blood pressure by relaxing the membranes of the arteries.

Study participants had moderate to severe high blood pressure. Their average reading at the start of the study was 166/101. Recent guidelines from the National Heart, Lung, and Blood Institute recommend blood pressure should be 120/80 or less.

Participants consumed an average of 2 tablespoons of sesame oil daily for 60 days. Using sesame oil as the sole cooking oil, along with drug treatment, lowered the top reading in participants' blood pressure from 166 to 134. The bottom number was reduced from 101 to 84.6.

The researchers also report that the dose of blood pressure medicine was reduced from 22.7 mg per day to 7.45 mg per day by the end of the study.

The oil's effect on blood pressure may result from a combination of its polyunsaturated fat and a substance called sesamin. Both compounds have been shown to reduce blood pressure in rats.

The research team previously reported that sesame oil helps reduce blood pressure in patients taking other types of blood pressure medications, diuretics and beta blockers. Now there's evidence this is also true for patients on calcium-channel blockers.

If more researchers can repeat these results, sesame oil may become part of the recommendations for treating high blood pressure.

Some questions that still need to be answered are: Would smaller doses of sesame oil produce the same effects? Does the oil need to be cooked, or could it be substituted in salad dressings?

In the meantime, if you have high blood pressure, it would not hurt to cook with sesame oil. Eating more potassium-rich fruits and vegetables and calcium-rich dairy products while decreasing salt also helps lower blood pressure.

Amy Tousman is a registered dietitian and member of the Hawai'i Dietetic Association.

Hawai'i experts in traditional medicine, naturopathic medicine and diet take turns writing the Prescriptions column.

Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; fax 535-8170; e-mail islandlife@honoluluadvertiser.com. This column is not intended to provide medical advice.

Seasilver claims unsubstantiated

Amy Tousman July 20, 2009

Posted on: Saturday, April 10, 2004

PRESCRIPTIONS
Seasilver claims unsubstantiated

By Amy Tousman RD

Q. Does Seasilver really cure more than 650 diseases?

A. Any product that claims to cure 650 diseases sounds too good to be true. Apparently government regulators are not impressed with these claims, either.

On March 17, the owners of the companies that make and distribute Seasilver signed a consent decree agreeing to stop manufacturing and distributing it. This is because of a complaint filed in federal court by the Food and Drug Administration and the Federal Trade Commission.

Seasilver is marketed as a dietary supplement which supposedly cures cancer, diabetes, arthritis, hepatitis, heart disease, AIDS and a host of other diseases. Claims such as "cleanses your vital organs," "enables 9 out of 10 diabetics to stop taking insulin" also are unsubstantiated. It is illegal to make these claims without proof.

Here are a few claims about some of Seasilver's ingredients:

Matrix Aloe Vera is claimed to "help clean morbid matter from the digestive organs" as well as "oxygenating the body's cells." The truth is aloe vera is a strong laxative but has not been proven to treat any disease. The body's oxygen levels are maintained by breathing and are not influenced by oxygen that enters the stomach.
Pau D'Arco is claimed to stimulate the immune system. The truth is this substance has no proven health benefits. It's main ingredient has some anti-cancer properties but is too toxic for practical use.
Phyto-Silver is said to have powerful antioxidant properties and phytonutrients in nature's perfect balance. It also functions as a second immune system . The truth is that silver has no nutritional value when taken by mouth and has no therapeutic usefulness.

Under the settlement, the Seasilver defendants agreed to pay $4.5 million in consumer redress. They are prohibited from making false or misleading claims about any dietary supplement. Lastly, they must destroy $5.3 million dollars worth of seized, misbranded Seasilver products.

According to Howard Beales, director of the FTC's Bureau of Consumer Protection, "the claims for Seasilver threatened consumer's health by encouraging delays and replacements for proven treatments."

I am glad to see the FTC and FDA taking action against dietary supplement companies that make false claims. At $39.95 for a month's supply, Seasilver is an expensive supplement that doesn't do anything more than a $10 multivitamin supplement.

Amy Tousman is a registered dietitian. Hawai'i experts in traditional medicine, naturopathic medicine and diet take turns writing the Prescriptions column.

Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; islandlife@honoluluadvertiser.com, or fax 535-8170. This column is not intended to provide medical advice.

Sea and table salt contain similar nutrition

Amy Tousman July 20, 2009

Posted on: Thursday, April 9, 2009

Prescriptions

Sea and table salt contain similar nutrition

By Amy Tousman RD, CDE

Q. Is sea salt healthier than table salt?

A. Believe it or not, sea salt and table salt are nutritionally similar. The main differences are in taste and texture. Since sea salt is usually more expensive than table salt, it is worth mentioning that it loses its unique flavor when cooked or dissolved. Still, when used at the table, or at the end of the cooking time, you may prefer its subtle flavor and crunchy texture.

Both sea salt and table salt contain about the same amount of sodium by weight. However, sea salt is lower in sodium by volume because the shape of its crystals make it less compact than the fine crystals in table salt. The coarser the grind, the more air spaces between the crystals, resulting in less salt on your spoon. In other words, a pinch of sea salt will give you less sodium than a pinch of table salt.

Sea salt is harvested through the evaporation of seawater. Table salt is usually mined from underground salt deposits. Both salts are refined into sodium chloride. Some folks claim sea salt has more minerals than table salt, however the amounts are too small to make a nutritional difference.

Table salt often contains added iodine, while sea salt does not. Iodine keeps our thyroid gland functioning normally. Since iodine is found in dairy products, seafood, and many processed foods, chances are you can get enough of it without using table salt.

Sea salt may clump up because it rarely contains the anti-caking agents that are added to table salt. If you plan to keep sea salt in a shaker, add some uncooked rice in as well to prevent clumping. With our humid climate in Hawai'i, you may even need to do this with table salt.

Sea salt is good to use for preserving meats because its large crystals draw moisture out of foods more effectively than other salts. This is why Hawaiian salt, a type of sea salt, is often used for making such local favorites as lomi salmon and kalua pig.

Whatever kind of salt you use, go easy. Too much of any type of salt can lead to high blood pressure, strokes, and kidney disease. The advantage with sea salt is that you may be able to achieve the desired flavor with a smaller amount.

Grapes have most of red wine's benefits

Amy Tousman July 20, 2009

Posted on: Thursday, October 25, 2007

Prescriptions

Grapes have most of red wine's benefits

By Amy Tousman RD, CDE

Q. I have heard that red wine is good for my heart. Since I don't drink alcohol, can I drink grape juice or eat grapes instead?

A. You will get most of the benefits of red wine by eating grapes. Some brands of grape juice also provide these benefits.

The main difference between red wine and grapes is the alcohol. Although moderate amounts of alcohol provide some benefit to the heart, red wine contains other healthful substances called phenols. Phenols are potent antioxidants that help prevent cell damage that contributes to heart disease, cancer, and other age-related conditions. Grapes have as much phenols as red wine.

One way red wine and grapes may help prevent heart disease is by protecting the lining of the blood vessels of the heart. It also seems to help reduce low-density lipoprotein, the so-called "bad cholesterol." Another benefit is a reduced risk of blood clots that can clog arteries.

Red wine contains far more phenols than white wine. This is because the skin of the grape is used to make red wine but is not used in white wine. A phenol called resveratrol is found almost exclusively in the skin of grapes and is responsible for many of red wine's health benefits.

When it comes to grape juice, some brands are better than others. Some commercial juices use grape varieties with a lower phenol content than grapes used in wine production. Your best bet is to choose a grape juice made from purple Concord grapes. Read the list of ingredients on the label carefully. Some purple-colored grape juices are diluted with white grape juice, which, like white wine, has very little resveratrol.

In addition to resveratrol, there are other healthful phenols in wine such as anthocyanins, quercetin and catechins. These phenols can also be found in other foods. For example, anthocyanins are in berries and plums, while quercetins are in apples, and catechins are in green tea.

When it comes to heart health, red wine, grapes, or grape juice represent only one piece of the puzzle. It is important to eat a variety of colorful fruits, vegetables, whole grains and lean proteins. We should never focus on just one food item. Also, drinking red wine will not make up for a lifetime of unhealthful habits such as a sedentary lifestyle, smoking and too much junk food.

The main difference between red wine and grapes is the alcohol. Although moderate amounts of alcohol provide some benefit to the heart, red wine contains other healthful substances called phenols. Phenols are potent antioxidants that help prevent cell damage that contributes to heart disease, cancer and other age-related conditions. Grapes have as much phenols as red wine.

Red face may be a warning

Amy Tousman July 20, 2009

Posted on: Thursday, April 30, 2009

Prescriptions

Red face may be a warning

By Amy Tousman RD, CDE

Q. My face turns red when I drink alcoholic beverages. Is this harmful?

A. A red face after drinking alcohol may be more than just embarrassing. According to a recent report published in the Public Library of Science journal, this red glow might be a warning sign of an increased risk for a deadly form of cancer of the esophagus. The esophagus is the muscular tube that connects your throat to your stomach.

Facial flushing that turns the face red when drinking alcohol is common in about one-third of Japanese, Chinese and Korean people. It is often accompanied by nausea and a rapid heartbeat. A genetic deficiency in an enzyme called aldehyde dehydrogenase 2 (ALDH2) is the culprit. As little as half a bottle of beer can trigger the reaction.

ALDH2 deficiency makes it difficult to break down alcohol completely, causing a toxin called acetaldehyde to accumulate in the body. People with two copies of the gene responsible for this reaction have such unpleasant side effects that they are unable to drink large amounts of alcohol. This actually protects them from the increased risk for cancer. However, those with only one copy of the gene can develop a tolerance to acetaldehyde and become heavy drinkers.

This type of esophageal cancer can be treated with surgery, but survival rates are low. It is considered one of the world's deadliest cancers. Even moderate drinking increases the risk, but risk increases dramatically in heavy drinkers. An ALDH2-deficient person who has two beers a day has six to 10 times the risk of developing esophageal cancer as a person who is not deficient in this enzyme.

Reducing drinking can decrease the incidence of this cancer among Asian adults. However, researchers say it is important to point out that the increased risk of esophageal cancer among ALDH2-deficient people is only in those who drink alcohol. Non-drinkers do not appear to have a higher risk of esophageal cancer.

Some young people treat flushing by taking antihistamines while continuing to drink. Ignoring the symptoms and continuing to drink is likely to increase the incidence of esophageal cancer.

If you drink alcohol regularly and have experienced the flushing response, you may want to ask your doctor to test you for esophageal cancer.

Amy Tousman is a registered dietitian and certified diabetes educator with Nutrition Unlimited in Kailua. Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, Hawaii, 96802; islandlife@honoluluadvertiser.com ; or fax 535-8170. This column is not intended to provide medical advice

Try stretching to relieve leg cramps

Amy Tousman July 20, 2009

Posted on: Thursday, February 26, 2009

Prescriptions

Try stretching to relieve leg cramps

Quinine is a popular remedy but can also be extremely dangerous

By Amy Tousman RD, CDE

Q. Can quinine relieve leg cramps?

A. You are sleeping peacefully when a sudden pain pierces your leg and jolts you awake. Nighttime leg cramps are often caused by involuntary contraction of the calf muscles while you sleep. They become more common with age.

Several studies have shown that people who regularly suffered nighttime leg cramps experienced fewer symptoms after taking quinine compared to a placebo. Most studies used a therapeutic dose of 200-300 milligrams quinine.

Quinine is the ingredient that produces the bitter flavor in tonic water. Tonic water, however, is unlikely to be effective against leg cramps because it contains too little quinine. To get a therapeutic dose of quinine from tonic water, you'd need to drink about a gallon in 24 hours!

Although many people do fine with quinine, for some it is extremely dangerous. Between 1969 and 2006, the Food and Drug Administration received 665 reports of serious adverse effects including 93 deaths. Complaints included severe allergic reactions, irregular heartbeats and liver damage. It also can cause birth defects and miscarriages. Quinine has a narrow margin between effective and toxic doses.

In 1995, the FDA banned over-the-counter marketing of quinine for leg cramps, however a scan of the Internet shows many companies still marketing products containing quinine. Many of these products list cinchona, a natural form of quinine, on their labels. It's unclear how much quinine these products contain. They are sold as "dietary supplements," while prescription-strength quinine is considered a drug. Dietary supplements are not as strictly regulated as medications.

Since 2007, the FDA has recommended that prescription-strength quinine be prescribed only for treatment of malaria. Malaria is life-threatening, so the benefits outweigh the risks. FDA noted that since leg cramps are not life-threatening, prescribing quinine for this condition is too risky.

If you are prone to leg cramps, it may be better to do stretching exercises such as wall pushups before bed. Applying a heating pad for 10 minutes every night may also help. When experiencing a leg cramp, try stretching by grasping your toes and gently pulling your foot toward you.

Sometimes dehydration or potassium deficiencies may be involved, especially in athletes or elderly people. If this is the case, drinking fluids and eating food sources of potassium may help. These include bananas, soybeans, cantaloupe, mangoes, potatoes and oranges.

Seek out good bacteria to stay healthy

Amy Tousman July 20, 2009

Posted on: Thursday, January 11, 2007

Prescriptions

Seek out good bacteria to stay healthy

By Amy Tousman RD, CDE

Q. Can probiotics prevent me from getting sick?

A. Believe it or not, some bacteria are actually good for you. Beneficial bacteria and yeasts known as probiotics assist in balancing the levels of microorganisms in the human body.

Some yogurts and milks contain probiotics. They are also available as supplements in capsules, tablets, beverages, or powders.

Typically, our intestines contain over 400 species of bacteria. Some of these bacteria are good for us, while others are not. Illness or antibiotic treatment can disturb the normal balance of these bacteria. Probiotics work by repopulating the small intestine with friendly bacteria while crowding out disease-causing bacteria. They produce substances that stimulate the body's own immune system. They also help keep our intestines acidic, making them inhospitable to unwanted germs.

Some of the best researched and most commonly used probiotic bacteria include lactobacillus and bifidobacterium. These bacteria can prevent diarrhea caused by antibiotics in adults and infections in infants and young children. They may also be useful in treating H. pylori infection, which can cause stomach ulcers.

Recent studies have found benefits of these same probiotic bacteria in combination with a steptococcus species in treating symptoms of irritable bowel syndrome. They reduce the pain, gas, and bloating associated with this condition.

Additional species of probiotic bacteria are being studied and show promise in areas such as preventing respiratory infections, improving constipation in Crohn's disease and enhancing immune system activity.

Probiotics may even be useful in reducing digestive problems caused by some chemotherapy treatments. More research is still needed in these areas.

ConsumerLab.com independently tests supplements for purity and quality. Recently they evaluated 19 probiotic supplements. Most products passed; however, four supplements failed because they contained less than 1 billion active probiotic bacteria per daily serving. This is the minimum amount of live organisms needed for effectiveness. These products were: Advocare Probiotic Restore, DDS Acidophilus with FOS, Nature's Secret Ultimate Probiotic, and Rite Aid Acidophilus. Another supplement, Florasource, contained less probiotic bacteria than the label stated. To see which products were tested, visit http://www.consumerlab.com/.

An advantage of using yogurts or acidophilus milk rather than supplements is that you get calcium, protein and vitamins in addition to the probiotics. Yogurts and dairy products that contain probiotics will say "contains live cultures" or "active cultures" on the label. Yoplait, Alta Denta, and Dannon Activa are some brands with active cultures.

Try peppermint oil for stomachaches

Amy Tousman July 20, 2009

Posted on: Thursday, May 22, 2008

Prescriptions

Try peppermint oil for stomachaches

By Amy Tousman RD, CDE

Q. Is it safe to take peppermint oil for stomachaches?

A. Peppermint oil can be a safe and effective treatment for digestive disorders as well as tension headaches. This is the conclusion of a review reported in the April 1 issue of American Family Physician.

Medicinal use of peppermint dates back to ancient Greece, where peppermint was used internally as a digestive aid. Most modern preparations of peppermint use its oil, which is extracted from the stem, leaves, and flowers of the plant. It can be taken as a capsule or in liquid form. Some folks make a tea from the leaves to soothe an upset stomach.

Several studies show peppermint oil to be mildly effective for the gas, bloating, and stomach pain caused by irritable bowel syndrome. Some evidence suggests peppermint oil combined with caraway oil may help relieve indigestion. Research has also shown that peppermint applied to the forehead and temples compares favorably with acetaminophen (the active ingredient in Tylenol) in reducing tension headache symptoms.

Menthol is the main active ingredient in peppermint oil. It is believed to relax the smooth muscles in the walls of the intestine.

It also relaxes the muscle that controls the opening between the stomach and the esophagus. This allows trapped air to be released. This muscle also helps keep the contents of the stomach from backing up into your esophagus.

If peppermint backed up into your esophagus, it would cause heartburn. This is why peppermint oil is often sold as enteric-coated capsules designed to dissolve in the intestine instead of the stomach.

Although peppermint oil is safe at the commonly recommended dosage, it may cause side effects at higher dosages. These effects include allergic reaction, heartburn, and nausea.

The recommended dosage for adults is 0.2 to 0.4 milliliters of peppermint oil three times daily in enteric-coated capsules. For children older than 8, 0.1 to 0.2 milliliters three times daily is recommended. For tea, use 1 tablespoon of leaves with 1 cup of hot water. Peppermint oil should not be given to infants or young children.

Peppermint oil can raise the blood levels of some blood pressure and cholesterol medications. It can also interfere with the action of antacids. Check with your pharmacist about possible interactions.

Folks with severe gastric reflux disease, hiatal hernia, or gallbladder disorders should not use peppermint oil.

Refined carbs aggravate polycystic ovarian syndrome

Amy Tousman July 20, 2009

Posted on: Thursday, December 4, 2008

Prescriptions

Refined carbs aggravate polycystic ovarian syndrome

Q. What foods are best to eat if you have polycystic ovarian syndrome?

By Amy Tousman RD, CDE

A. Polycystic ovarian syndrome is a hormonal imbalance leading to growths called cysts on the ovaries. PCOS can make it difficult for a woman to become pregnant. Over time, if not treated, it can lead to diabetes and heart disease. PCOS affects approximately 10 percent of women of childbearing age. Often symptoms begin during the teen years.

Many women with PCOS experience excess weight gain and difficulty losing weight. Many of the foods we eat break down into sugar after digestion. Normally insulin is released by the pancreas so the sugar can be used for energy. However, many women with PCOS also have insulin resistance, which can cause the levels of sugar and insulin in the blood to be too high. This extra insulin often leads to weight gain, while the extra sugar may cause diabetes.

A diet that minimizes insulin resistance and is also heart healthy is recommended for women with PCOS. Exercise also decreases insulin resistance.

Cravings for sweets can be intense in women with PCOS. Refined carbohydrates such as white rice, sweets and sodas break down to sugar quickly, which can aggravate the problem by causing high levels of insulin. Low-carbohydrate diets are not recommended, but neither are high-carbohydrate diets. One that is moderate in carbohydrates, stressing high-fiber, low-sugar foods such as whole wheat bread, brown rice, beans, fresh fruits and vegetables is best.

Small, frequent meals and snacks eaten every three to four hours are helpful. Each meal and snack should contain a high-fiber carbohydrate plus protein and/or fat. This may decrease sweet cravings, while increasing energy levels. Snacks such as whole grain crackers with tuna, edamame (contains carbs and protein) and apples with peanut butter are good choices.

Proteins that are low in saturated fat such as skinless chicken, tofu and fish are best. Choose heart-healthy fats such as nuts, avocados, olive, or flaxseed. Since hormonal imbalances can weaken bones, two to three cups of milk, yogurt, or a calcium supplement should be used. A fish oil supplement is also recommended.

To learn more about diet and PCOS, go to http://www.pcosnutrition.com/.

Eat nutritious papaya during any meal

Amy Tousman July 20, 2009

Posted on: Thursday, August 17, 2006

PRESCRIPTIONS
Eat nutritious papaya during any meal

By Amy Tousman RD, CDE

Q. Does eating papaya for breakfast provide any special health benefits?

A. Lucky we live Hawai'i. Papaya, widely grown in the Islands, is a fruit we can enjoy fresh anytime.

Low in calories and full of nutrition, papaya has more vitamin C than an orange! It's loaded with vitamin A, potassium, folate and fiber. It also contains lutein and zeaxanthin, substances which help protect our eyes from age-related blindness.

Papain, a substance in the sap of the papaya, has medicinal uses. Papain is especially plentiful in unripe papaya. Smaller amounts of papain are found in the leaves and ripe fruit.

Papain has been used for centuries to treat worms and parasites, especially tapeworms. Historically, it also was applied to the skin to treat psoriasis and to remove warts.

Papaya is often used as a digestive aid, because the papain it contains is an enzyme that helps digest proteins. Papain supplements also are commercially available.

Papain, combined with other digestive enzymes, is prescribed for folks with cystic fibrosis or diseases of the pancreas. These conditions interfere with the body's natural ability to make digestive enzymes. Papain also offers relief for less-serious digestive problems such as indigestion and bloating.

There can be risks in ingesting papain. Papain supplements and green papayas may increase the risk of miscarriage. Pregnant woman should only use them under medical supervision.

Ripe papaya is safe to eat during pregnancy.

Papain supplements shouldn't be used with medications that affect blood clotting such as Coumadin, Warfarin, or Heparin. This combination can cause uncontrolled bleeding.

Papain is an ingredient in most commercial meat tenderizers. When added to tough meat before cooking, it works by predigesting some of the fibrous animal protein.

Current research suggests papaya has antibacterial properties that may help heal injuries and reduce swelling after surgery. Papaya leaves can be made into a tea to relieve respiratory symptoms.

Papain is being studied for possible relief of cancer therapy side effects and rheumatoid arthritis. More study is needed before recommending papain for these uses.

Some folks who are allergic to latex have an allergic reaction to papayas. Latex is made from the sap of the rubber tree. A cross-reaction can occur due to similarities in the proteins in the sap of the rubber tree and that of papayas.

Eating fresh papaya is a healthy way to start off your day. Be creative by adding papaya to salads and smoothies. And don't forget my favorite, chicken papaya!

Amy Tousman is a registered dietitian and certified diabetes educator with Nutrition Unlimited in Kailua. Hawai'i experts in traditional medicine, naturopathic medicine and diet take turns writing the Prescriptions column. Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; fax 535-8170; e-mail islandlife@honoluluadvertiser.com. This column is not intended to provide medical advice.

No proof that noni juice cures ailments

Amy Tousman July 17, 2009

Posted on: Thursday, August 2, 2007

No proof that noni juice cures ailments

By Amy Tousman RD, CDE

Q. Can Tahitian noni juice help control my diabetes?

A. Tahitian noni juice comes from the fruit of Morinda citrifolia, a plant native to the South Pacific and Hawai'i. Noni has been used as folk medicine by Polynesians for at least 1,500 years. Rather than the juice, it was the leaves, bark and roots of the plant that were used medicinally.

There are no published studies showing a link between drinking Tahitian noni juice and improvement of diabetes in humans. For diabetes control, traditional uses involved chewing the leaves alone or in combination with other parts of the plant.

It is thought that the soluble fiber in the plant might slow the body's absorption of sugars and slightly reduce blood glucose after a meal. Soluble fiber in other foods has this effect; however, it is unlikely that a significant amount of this fiber is present in noni juice.

A February 2007 report in the Journal of Wound Care concluded that noni juice decreased blood sugar and hastened wound healing in rats. However, the rats in the study were not technically diabetic. Their high blood sugars were induced by medication. Whether this research translates to humans with diabetes is a big leap.

Noni juice is high in sugar. This could potentially aggravate a person's diabetes.

Noni juice is also high in potassium. This may pose problems for people who must restrict potassium intake. This includes people with chronic kidney disease and those who take potassium-sparing blood pressure medications.

People with pre-existing liver conditions or those using medications that may harm the liver are advised against drinking noni juice. There are some reports of liver problems linked to noni intake in this group. In most cases, the problems stopped when noni was discontinued.

When it comes to noni, you name it, they've claimed it. Proponents have claimed that noni can cure diabetes, HIV, cancer, asthma, arthritis, senility and many other health problems. These claims are unproven. Due to Food and Drug Administration actions, some companies have stopped making these unproven claims. Even so, these claims are still widely available on the Internet.

Although a few test tube and animal studies look promising, human studies are just beginning. Researchers may find some benefits to humans in the future. For now, I cannot recommend that noni be used alone to treat diabetes, cancer or any serious illness.

'Net carb' on a food label can be meaningless or misleading

Amy Tousman July 17, 2009

Posted on: Saturday, February 28, 2004

PRESCRIPTIONS
'Net carb' on a food label can be meaningless or misleading

By Amy Tousman, RD

Q. What does "net carbs" mean?

A. The words "net carb," "effective carb," or "impact carb" appear on the labels of many products marketed to low-carbohydrate dieters. They include low-carbohydrate versions of chips, candies and breads. Even Subway advertises "Atkins-friendly" sandwich wraps with 11 grams of net carb.

No legal definition exists for the terms "low carbohydrate" or "net carbs." Any food can be called low-carbohydrate, no matter how much carbohydrate it contains.

Some manufacturers have stopped counting the carbohydrates in fiber and artificial sweeteners. They call the remaining carbohydrates, "effective" "impact" or "net" carbs.

These terms deceive you into thinking a product contains less in carbohydrates than it actually does. Many so-called "low-carbohydrate" foods have as much carbohydrate as their regular counterparts. The logic is that certain carbohydrates have little effect on blood sugar and therefore don't need to be counted.

This is misleading. Although important to someone with diabetes, blood sugar is not the main issue for someone trying to lose weight. Carbohydrates in sweeteners such as sorbitol, mannitol and glycerine contain calories and should be counted.

Many foods marketed to low-carbohydrate dieters have as many calories as the regular versions of these foods. They have no special weight-losing properties. Many are low in fiber, a substance that is helpful for weight control.

Fiber has no calories and can be subtracted from the total carbohydrates.

Read the "Nutrition Facts" label to find a food's total carbohydrate and calorie content. If the front of a package lists only one or two grams of net carbs, the back of the package may show a different picture. For example, the Atkins Advantage diet bar claims two grams of net carbs, but the Nutrition Facts label shows 240 calories and 21 grams of total carbs.

Products labeled low-carb often cost more than regular products with similar carbohydrate contents. Michelob Ultra beer is marketed as a low-carbohydrate beer, has one less calorie and half a gram less carbohydrate than Miller Lite beer, and costs more. People buy these products because they want to lose weight without giving up their favorite foods.

Choosing low-calorie, high-fiber foods such as fruits, veggies, and whole grains is more important than counting carbs. Losing weight is not about replacing one empty calorie snack with another, it's about making healthy lifestyle changes.

Amy Tousman is a registered dietitian. Hawai'i experts in traditional medicine, naturopathic medicine and diet take turns writing the Prescriptions column. Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; fax 535-8170; e-mail islandlife@honoluluadvertiser.com.

Don't rely on mistletoe to help treat cancer

Amy Tousman July 16, 2009

Posted on: Thursday, December 25, 2008

Prescriptions

Don't rely on mistletoe to help treat cancer

By Amy Tousman RD, CDE

Q. Can mistletoe be used to treat cancer?

A. The Celts in Europe used mistletoe in religious rituals more than 2,000 years ago. They named the plant "mistletoe" to mean "all healer." It was used for treating high blood pressure, anxiety, arthritis and vertigo. Scientific evidence does not support these uses.

A liquid extract from the mistletoe plant has been used in Europe as a cancer treatment for 75 years. Commission E (Germany's equivalent of our FDA) has approved its use to treat some of the side effects of cancer therapy. It has not been approved as a cure for cancer. For cancer treatment, it is taken by injection.

The American mistletoe plant is not the same as European mistletoe. American mistletoe has no medicinal properties and is poisonous if eaten.

Experiments in test tubes and animals show evidence of mistletoe's anti-tumor activity. Experiments in people have shown mixed results. A review of 21 studies using mistletoe alone or with chemotherapy and radiation was recently completed. Researchers wanted to see if mistletoe increased survival times, enhanced tumor response to therapy, or reduced adverse effects of anti-cancer drugs. Some studies showed positive results, especially in improving quality of life during chemotherapy, but many used questionable methods and are not considered scientifically dependable.

The National Institute of Health is recruiting participants for a large clinical trial in which mistletoe will be combined with the chemotherapy drug Gemcitabine. Their study is designed to eliminate the weakness of previous studies.

Caution should be used in buying any over-the-counter mistletoe products. Mistletoe is not approved by the FDA as a treatment for cancer or any other medical condition. Over-the-counter products can vary in purity, type of mistletoe, and strength. It is not recommended that homemade cancer remedies be made from mistletoe extracts or berries.

Bottom line: There is some potential benefit to mistletoe, most likely in combination with chemotherapy agents. More research is needed before it becomes standard therapy. For now, it's best to stick to kissing under the mistletoe.

Amy Tousman is a registered dietitian and certified diabetes educator with Nutrition Unlimited in Kailua. This column is not intended to provide medical advice.

Peculiar cooking method flaws study on microwaved veggies

Amy Tousman July 16, 2009

Posted on: Saturday, June 5, 2004

PRESCRIPTIONS
Peculiar cooking method flaws study on microwaved veggies

By Amy Tousman RD

Q. I thought microwaving was a good way to retain nutrients in vegetables, but I recently read about a study saying that that this method "zaps beneficial antioxidants and nutrients right out of your food."

A. I recommend cooking vegetables in the microwave as a convenient, healthy option. When hearing about new studies, it is important to look at the details. The study you are referring was published in the November 2003 issue of the Journal of food Science and Agriculture. This well-publicized study had important flaws that most of the media never noticed.

The study compared several cooking methods including microwaving, pressure-cooking, boiling and steaming. The vegetable used in the study was broccoli. The researchers found that pressure-cooking, boiling and microwaving caused antioxidants to leak out of the vegetables and into the cooking water.

The results showed that the broccoli lost 74 to 97 percent of the three cancer-fighting antioxidants. The steamed vegetables lost up to 11 percent of these antioxidants.

Before jumping to any conclusions here, we need to look at how the broccoli was microwaved. Here is where the problem lies. One cup of raw chopped broccoli was microwaved in 2/3 of a cup of water. The vegetables were nuked at full power for 5 minutes.

I don't know about you, but when I microwave vegetables such as broccoli, I normally use only 1 or 2 tablespoons of water. I usually cook them just until they are tender-crisp, about 2 or 3 minutes.

In other words, these researchers used a lot more water than necessary and cooked the broccoli far too long. In fact, broccoli that is cooked for that long usually loses its nice color, turns mushy and develops an unpleasant taste.

All this study really shows is that using too much water and cooking vegetables for too long will cause them to lose much of their cancer-fighting antioxidants.

Contrary to this study, research done at the University of Illinois, soon to be published in the journal Phytochemistry, found that microwaving broccoli for 2 minutes in a little bit of water maintains nutrients as well as steaming.

Microwaving is a great way to preserve most vitamins, minerals, and antioxidants in foods because the food's exposure to heat and water is shorter than other cooking methods.

Amy Tousman is a registered dietitian and a member of the Hawaii Dietetic Association. Hawai'i experts in traditional medicine, naturopathic medicine and diet take turns writing the Prescriptions column. Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; fax 535-8170; e-mail islandlife@honoluluadvertiser.com. This column is not intended to provide medical advice.

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