MIM Health - January 2008

This issue features several very important topics. First is inflammation, which is a major contributor to heart disease, cancer, dementia, osteoporosis and many other chronic degenerative conditions. In fact, inflammation may be more important than cholesterol in determining someone's risk for cardiovascular disease. Unfortunately, mainstream medicine has not picked up on this advance in medical knowledge and routine screening for inflammation is not done. This month's Natural Tip™ is Milk thistle, a plant that has been used medicinally for thousands of years. Current research supports some of these traditional applications, and it is incredibly helpful for conditions of the digestive tract, including liver and gall bladder conditions. In lieu of a recipe this month, I thought providing helpful shopping tips would be a nice way to start the year. There are many hidden saboteurs on the supermarket shelves that can wreck the healthy eating goals of even the best-intentioned shoppers. My wife Romi provides some useful information for avoiding these traps so that you can eat deliciously and be as healthy as possible.

And if you're ever interested in reading back issues of the newsletter, they're posted on the clinic website, at www.montanaim.com/newsletter.

Wishing you good health,

Dr. Neustadt

* * *

Upcoming Appearances

Dr. Neustadt will be interviewed on Monday, February 18 by psychiatrist, Leslie Lundt, MD, for her XM radio show, Reach MD, which can be heard on XM157. They will be discussing the underlying biochemical and nutritional abnormalities found in psychiatric conditions including depression, bipolar disorder and schizophrenia. Biochemical testing options for listeners will also be discussed.

* * *

Health Topic: Inflammation

The general public started hearing about the dangers of Inflammation in the fall of 2006, when it was the cover story on Time magazine (Sept. 1, 2006) issue. But if you haven't heard of the pivotal role inflammation plays in the development of cancer, depression, Alzheimer disease, osteoporosis, cardiovascular disease, and other chronic degenerative diseases, it's time to learn. And, more importantly, it's time to learn what you can do to quench the inflammation that may be raging in your body and stealing away vital years from your life.

Inflammation is a response of body tissues to injury or irritation. If it's caused by an acute trauma like spraining an ankle it can cause pain, swelling, redness and heat. In fact, medical students all learn that the characteristics of inflammation is rubor (redness), calor (heat) and dolor (pain). In acute traumas inflammation is the body's way of healing. However, inflammation can be more insidious. When inflammation is uncontrolled and long-term, it is a major contributor to cancer, heart disease, osteoporosis, dementia, diabetes depression and many other diseases. In these instances inflammation is occurring inside your body and there is no way to know it's going on without testing. It does not cause redness, heat or pain.

Risk factors

There are multiple risk factors for inflammation. A few of the more important ones are a poor diet, improper exercise and chronic infections. In August 2006 the journal, Integrative Medicine, published an article of mine entitled, "Western Diet and Inflammation," which you can download for free by clicking here. The bottom line as I discuss in my article is that the influence of diet on inflammation results from a combination of food quantity and quality and genetic susceptibility. These chronic degenerative diseases, often referred to as "diseases of aging," result from a diet and lifestyle at odds with our genetic needs. The Standard American Diet, appropriately referred to as a SAD diet, is largely comprised of refined, packaged foods that are rich in sugars and salt and low in fiber, vitamins and minerals; red meat that's loaded with damaging saturated fatty acids and fried foods that contain trans fats, which damage blood vessels and are a risk factor for heart disease, dementia and osteoporosis.

Inflammation is a major contributor to the development and progression of the most prevalent chronic, degenerative diseases in the United States, and diet is the major contributor to inflammation. Our ancestors evolved eating a predominantly plant-based diet that contained no processed foods. In contrast, the diet that predominates today is the opposite--low in fresh fruits, vegetables and fiber, and high in meat, processed foods and refined carbohydrates. The modern diet, also called the Western diet, is a pro-inflammatory diet, high in omega-6 fatty acids, excessive calories, and trans fatty acids. Deficiencies in specific proteins, vitamins and minerals can contribute to inflammation and it's deadly effects.

Immune system activations, which occurs with intestinal dysbiosis (overgrowth of pathogenic bacteria and fungus) and food allergies also causes inflammation. Testing is the best way to know if you have these, which are quite easy to eliminate once you get a proper diagnosis.

What can you do?

Diet and lifestyle habits create the foundation for health. Table 1 (below), lists healthy dietary changes you can take today to help prevent and reverse inflammation and reduce your risk for chronic, deadly diseases. Additionally, some antiinflammaotry botanicals, such as turmeric, are excellent, safe and effective. You can read about turmeric in the December 2007 MIM Health newsletter by clicking here.

Table 1: Healthy diet and lifestyle recommendations

Eat whole, natural, fresh foods.

Consume a diet high in fruits, vegetables, nuts, and berries and low in refined grains and sugars.

Increase consumption of omega-3 fatty acids from fish,  fish oil, and plant sources.

Avoid all trans fats and limit intake of saturated fats. Eliminate fried foods, hard margarine, commercial baked goods, and most packaged and processed snack foods. Substitute monounsaturated fats (eg, avocados, nuts and seeds) and polyunsaturated fats (eg, whole grains, fish--in particular herring, salmon, mackerel, and halibut--and soybeans) for saturated fats (eg, red meats and high-fat dairy products).

Increase consumption of lean protein, such as skinless poultry, fish, game meats, lean cuts of red meat and legumes. Avoid high-fat dairy and fatty, salty processed meats, such as bacon, sausage, and deli meats.

Incorporate olive oil into the diet.

Drink water.

Participate in daily exercise through various activities (incorporating aerobic and strength training and stretching exercises). Outdoor activities are ideal.

The only way to really know if you have inflammation and what may be causing it is to get tested. Call the clinic at 406-582-0034 or email info@montanaim.com to discuss this option for your health. After all, the first sign of heart disease is a heart attack, the first sign of cancer is cancer itself, and the first signs of dementia don't occur until you have dementia, so it's imperative you get tested early.

 * * *

Natural Tip: Milk Thistle Milk thistle (Silybum marianum) is an annual herb native to the Mediterranean region. It is a member of the aster family (Asteraceae or Compositae), which also includes daisies, artichoke, sunflower, and echinacea. Its importance in medicine has been recognized for more than 2000 years. In the first century C.E., Dioscorides, a Greek herbalist, declared the plant useful for the treatment of poisonous snake bites and by Pliny the Elder for "carrying off bile." Milk thistle (Silybum marianum), a relative of the artichoke. Historically milk thistle has most commonly been used to treat various digestive and liver ailments. Milk thistle has been called "the most well-researched plant in the treatment of liver disease." Recently, milk thistle has also been the focus of research into its potential to prevent and treat cancer. The part of the milk thistle plant used medicinally is the seed, which contains many different compounds. The most extensively researched of these chemicals are a class of compounds called "silymarins," which include silibinin, silidianin, and silicristin. These chemicals have significant antioxidant activities and also increase expression of genes in the liver responsible for repairing damaged liver cells. Most dietary supplements are standardized to contain 80% silymarin. Multiple clinical trials have evaluated milk thistle's usefulness in liver diseases. One such study administered 200 mg of milk thistle standardized to 80% silymarin three times daily for four weeks to 17 patients with hepatitis C. Another 17 volunteers with hepatitis C acted as the comparator group--they did not receive any milk thistle extract. None of the volunteers were taking antiviral medication for their condition. After treatment with the milk thistle, even though viral load was not decreased, liver enzymes (indicating liver cell damage) were significantly lower in those people who took the milk thistle compared to those who did not. A review of the research into the use of milk thistle for the treatment of acute viral hepatitis concluded that silymarin "decreases complications, hastens recovery, and shortens hospital stays." In animal experiments milk thistle has been shown helpful in gallbladder conditions. In one rat study in which 100 mg/kg body weight of silymarin was administered for 5 days, silymarin prevented experimental gallstone formation. This study also demonstrated that silymarin increased bile excretion, which is a frequent clinical goal in the treatment of different liver conditions and in situations where decreasing circulating hormones is important (e.g., estrogen excess in women). Research has also confirmed milk thistle's benefits for mushroom poisoning, for liver damage from environmental pollutants, and from toxicity from drugs.  Herb-Drug interactions The question of whether a dietary supplement interferes with drugs is an important consideration. Milk thistle has been evaluated in a human clinical trial for its effects on liver detoxification enzymes. These enzymes--cytochrome (CYP) 1A2, 2E1, 2D6, and 3A4--are involved in detoxifying drugs and other chemicals. In a randomized clinical trial, six men and six women were given 175 mg milk thistle standardized to 80 silymarins twice daily for 28 days. There were no differences in any of activities of any of the CYP enzymes. The researchers concluded in humans did not effect these detoxification enzymes. A second human clinical trial showed that taking 175 mg milk thistle (confirmed to contain silymarin 153 mg) 3 times/day for 3 weeks did not interfere with indinavir (a protease inhibitor used in HIV treatment) therapy. As with all dietary supplements, if you are taking any medications, you should first consult a healthcare provider knowledgeable in supplement-drug interactions before taking combining drugs with dietary supplements. Dosage Milk thistle is available in different forms, including whole seeds, capsules, and tinctures. Additionally, milk thistle extract is available as a highly concentrated silymarin extract (usually approximately 80% silymarin) or as a silymarin-phosphatidylcholine combination. Phosphatidylcholine is a type of fat that may increase the absorption and activity of silymarin. The following dosages are for adults.  Dried seeds: 12 to 15 grams herb (200 to 400 mg silymarin) per day Standardized extract: Silymarin-phosphatidylcholine complex: 100 to 200 mg twice daily (or three times daily for liver damage from alcohol, drugs, or chemicals). Silymarin: 120 mg silymarin twice daily. References Flora K, Hahn M, Rosen H, Benner K. Milk Thistle (Silybum marianum) for the Therapy of Liver Disease. Vol 93; 1998:139-143. Dhiman RK, Chawla YK. Herbal medicines for liver diseases. Dig Dis Sci. Oct 2005;50(10):1807-1812. Rodriguez-Perez F, Rodriguez-Serrano F, Toro D. The effect of Silybum marianum on the viral load of Hispanic patients with chronic hepatitis C. Am J Gastroenterol. 2002;97(9):S90. Crocenzi FA, Sanchez Pozzi EJ, Pellegrino JM, Rodriguez Garay EA, Mottino AD, Roma MG. Preventive effect of silymarin against taurolithocholate-induced cholestasis in the rat. Biochem Pharmacol. Jul 15 2003;66(2):355-364. Milk Thistle. [website] http://www.umm.edu/altmed/ConsHerbs/MilkThistlech.html. Accessed June 29, 2006. Gurley BJ, Gardner SF, Hubbard MA, et al. In vivo assessment of botanical supplementation on human cytochrome P450 phenotypes: Citrus aurantium, Echinacea purpurea, milk thistle, and saw palmetto. Clinical Pharmacology & Therapeutics. 2004/11 2004;76(5):428-440. Piscitelli SC, Formentini E, Burstein AH, Alfaro R, Jagannatha S, Falloon J. Effect of milk thistle on the pharmacokinetics of indinavir in healthy volunteers. Pharmacotherapy. May 2002;22(5):551-556. * * *

Recipe: Healthy Shopping
(Have a recipe you want to share? Email it to us and it may appear in a future issue of MIM Health.)

Instead of a recipe this month, we thought you'd benefit from healthy grocery shopping tips that will make it easier for you to get maximum nutrition and delicious choices throughout the new year.

• Always go to the store with a shopping list, and stick to it. Studies have shown that listless shoppers end up buying more and buying more unhealthy choices on impulse.
• Do the bulk of your shopping on the perimeter of the store. That means, stock up on lots of fresh fruits and vegetables, low-fat dairy, lean meats and fish, soy products and whole grain breads. The majority of the middle of grocery stores tend to be processed foods that are full of salt, sugar and little fiber or nutrition. Of course, there are exceptions, and throughout the year we'll let you in on some of our favorite finds.
• Every time you shop, fill your basket with a rainbow of fruits and vegetables, and try something new each time. The internet has abundant recipe sites that allow you to search for healthy recipes. Check out www.cookinglight.com, www.epicurious.com, and www.allrecipes.com to find great ways to prepare foods that are new to you.
• Don't let the words "Whole Grain" fool you. This term is ubiquitous these days, but you must read the nutrition label. Buy breads that have at least 4 grams of fiber per slice; the same with crackers. Choose pastas from Barilla and Ronzoni that have 6 or more grams per serving (and loads of protein, too). And don't forget the fool-proof whole grains -- brown rice, quinoa, barley, millet and buckwheat from the bulk bins. These delicious gems can be cooked ahead and stored in the refrigerator, ready to add to soups, salads or to serve as sides throughout the week.
• One interior aisle not to miss is the frozen foods section. Keep frozen veggies in your freezer (preferably organic) to make meal time assembly easy. They're great as a quick side dish, tossed into soups, salads, lasagna, pasta sauces, stir frys; etc. Our two-year old has been eating them almost everyday since he started on table food as a side dish with his lunch; we just thaw them using boiling water -- instant veggies!
• Finally, try not to go shopping when you're hungry. You will buy more, and you may just find yourself scarfing down a steering wheel-sized bagel as you comb the aisles. If you can't help it and get to the store starving, go to the deli where they always let you sample meats and cheeses. Get yourself a slice of turkey and low-fat cheese. You'll be ready to make smart choices with a quiet stomach and a sensible head.

Happy shopping!

 * * *

We hope you found this message to be useful. However, if prefer not receive future enewsletters, please visit the opt-out link here: http://www.montanaim.com/remove.asp. If someone forwarded you this newsletter and you'd like to sign up to receive future ones, visit our sign up page here: http://www.montanaim.com/newsletter.asp.

* * *

Montana Integrative Medicine
1087 Stoneridge Drive, Suite 1, Bozeman, MT 59718, tel. 406-582-0034