How 'Super' Is This Fruit?

Over the past several years, we've been bombarded with hype about 'superfruits' - but what is a 'superfruit', exactly, and are they really better than our native fruits? Is eating an expensive superfruit more beneficial to your health than eating a balanced, vegetable-rich diet? Are they worth the ecological and social cost, as compared with locally-produced fruit and vegetables?

These are all questions I've been asking myself for the past several years, and have been thinking all over again as a result of this recent article in the LA Times on the topic. The article doesn't go into extreme detail, but it's worth a read to get you thinking on a Monday - perhaps the next time you reach for a mangosteen-goji juice, you'll ask if it's really the best option.

Speaking of mangosteens, I'm including this picture to make a point. Only the milky-white interior of the fruit is traditionally edible, yet mangosteen juice is purple - because the indigestible exterior skin has been included. True, the exterior is full of antioxidants (produced to protect the fruit from environmental stresses), but should we really be eating it?

Magnesium and Hypertension

When it comes to calcium and osteoporosis, everyone is agreed – NDs, MDs, acupuncturists, NPs, and chiropractors all recommend 1200 mg of calcium a day to help ward off the onset of osteoporosis. By contrast, there’s not as much discussion of magnesium when it comes to high blood pressure, despite an overwhelming amount of research into the topic, a fact at least partly explainable by inconsistent results in clinical studies. This week, I’m going to write on this topic, referencing select articles from the medical literature – there are thousands of articles on the topic of magnesium and hypertension, and it’s easy to get lost in the sea of literature.

Let me start by discussing briefly the epidemiological information on the topic. I won’t present studies here, though there are many, but in general, the research indicates that people who consume higher amounts of magnesium have, in general, a lower prevalence of hypertension, lower blood pressure in general, and lower incidence of stroke. Of course there are studies that have found no association, as is the case when you have enough studies devoted to a given topic, but a greater number of studies indicate that there is a relationship present, and the evidence is quite compelling.

One of the reasons that I’m inclined to believe the link is because there exist plausible mechanisms for magnesium’s ability to reduce blood pressure. A recent article published in the Journal of Clinical Hypertension elaborates on the biochemistry behind magnesium’s role in hypertension, indicating multiple pathways by which it acts to lower blood pressure, but primarily likening its action to that of a calcium channel blocker (a class of medication used for hypertension and chronic heart failure). Much like a calcium channel blocker, magnesium induces vasodilatation of arteries and regulates cardiac contractility, thus lowering blood pressure and improving the function of the heart. It’s also been suggested that the role that magnesium plays in reducing blood pressure is in part due to the action its presence exerts on other minerals in the body, including sodium, potassium and calcium.

As always, none of this should be taken without evidence that it actually lowers blood pressure in a clinical setting. A 2002 meta-analysis, which looked at 22 trials, including 1220 patients, found that magnesium provided mild benefit to hypertensive patients, although this benefit was dose-dependent, which suggests that greater benefit might be derived from higher doses of magnesium. Since then, further studies have been published that indicate benefit, albeit mild, from magnesium supplementation (1, 2). Taken together, these studies indicate that there is some benefit to be had from magnesium in regards to hypertension. However, all authors more or less agree that the benefit is somewhat inconsistent in clinical trials. The authors of the previously mentioned meta-analysis indicated that small studies and variable study design was a likely factor in the inconsistencies, and called for larger studies in order to more clearly define the benefit and role of magnesium in hypertension.

One piece of the puzzle that has as yet not been fully fleshed out, but which I believe is likely to answer many questions is that of magnesium deficiency. As early as 1983, a study published in the British Medical Journal showed that magnesium could reduce blood pressure significantly, and postulated that it was due to a correction of magnesium deficiency. However, this hasn’t been a major area of research in the intervening period, although a recent study showed that magnesium did produce surprisingly large decreases in blood pressure among a collection of hypertensive diabetics who also had low serum magnesium. This piece of information may give us clinical guidelines regarding when to prescribe magnesium for hypertension, and when to resort to other measures. There’s been some dispute in the past as to the best way to measure a patient’s magnesium status, but I think the clinical correlation here points the way forward.

So what’s the take home message? In all, magnesium does appear to provide some mild benefit in cases of hypertension, a benefit even more marked if the patient is demonstrably low in magnesium. As always, be in consultation with a healthcare provider about using nutritional supplements to help combat disease, especially one with consequences as serious as hypertension – additionally, magnesium is not without side effects, and it takes an experienced provider to help guide you through that.

A Graphic to Explain Snacking

It's Monday again. How about a good, old-fashioned graphic?

This one gives some information about understanding how a food's glycemic index influences whether or not it's a good snack choice. Unfortunately, they don't include nuts or seeds (my favorite snack foods), but this is still a great tool. Many thanks to the people at Massive Health for putting this together.

Is It Really Allergy Season Again?

Last year, I wrote a comprehensive blog entry about allergies in response to a friend's inquiries. If you're suffering from allergies this year, I suggest you click this link to get back to that article - it's extensive and discusses a variety of natural approaches to allergy treatment. This year, I'm going to discuss two more factors in treating seasonal allergies, one is a treatment and the other is a clinical pearl.

In my many years of working in natural health, not only in clinical practice, but in my time at a health food store, I have often heard patients say that they consume local honey during the allergy season in order to prevent the allergic symptoms. In theory, it would seem to make sense – consuming small amounts of allergen desensitizes the immune system to the offending allergen, so that the body doesn’t react as strongly. This is, after all, roughly how allergy shots are believed to work.

But what does the research say? In our modern world, we like to see the hard data and don’t necessarily believe everything we hear, no matter how plausible it may seem.

I was able to find only two articles on the topic of honey consumption to reduce allergic symptoms. The first, conducted in 2002, allotted 36 participants to receive either a local, unfiltered honey, a mass-produced commercial honey, or a honey-flavored corn syrup placebo – participants consumed one tablespoon per day, and reported their symptoms to researchers. The results were poor, and researchers concluded that local honey provided essentially no benefit. However, the study had significant limitations, and I’m not sure we can take this result as completely valid. A third of participants dropped out of the study because they didn’t like the taste of the honey, reducing the study’s size to only 23 participants. A group that small is very unlikely to produce statistically significant results, not to mention the fact that small groups may not represent the larger population. The study design, with three arms, each receiving a different type of ‘honey’, was ingenious, and it would be great to see this repeated using a larger group. (Interestingly, the drop out rate was highest in the corn-syrup placebo group, and lowest in the local honey group – perhaps because local honey tastes better?)

The second study assessed the ability of honey to reduce allergic symptoms among participants who suffered birch pollen allergies. This study also featured three arms – one consuming honey with birch pollen added, one consuming regular honey, and a control group using their usual allergy medication. The results here were stronger – the group was still fairly small at 50 participants, but the drop out rate was much lower. Researchers found that participants consuming honey had lower total allergic symptoms, more asymptomatic days, fewer severe days and less antihistamine use, indicating a significant benefit to honey consumption. No significant differences were found between the group consuming normal honey and honey with birch pollen, however, which makes us question the exact mechanism behind honey’s effect on seasonal allergies. Here’s the caveat – the honey-consuming participants started consuming the honey in November in order to reduce their springtime allergies, so if you’ve not yet started your honey consumption, you may have to wait until next year to try this out.

Taken together, these studies present a mixed view of honey and seasonal allergies. Honey has a number of additional benefits, and few would fault you for consuming local honey, but the science is mixed. Hopefully we’ll see more studies on this topic in the future.

So here’s part two – the clinical pearl.

Just a few days ago, a patient came to me asking about allergy prevention. I conducted an intake, as per my usual, and as it seemed she was suffering from seasonal allergies, as she did every year, I made recommendations along the lines of what I wrote about last year. This week, I heard back from her, and found out that she hadn’t gotten any relief from the supplement I’d recommended – in fact, she had gotten significantly worse!

Far from her sniffling, sneezing and watery eyes, a day or two after I saw her, she’d developed pain and some really thick mucus discharge – unable to reach me, she’d gone to her family doctor on short notice. It turns out that she’d developed a sinus infection in the day or two after I saw her. She’s on antibiotics now, and we’ll see how she fares. The important lesson is this – complementary therapies are extremely effective, but only for those conditions for which they are indicated! Always make sure you make a proper diagnosis before proceeding on to treatment. I was a bit unlucky because she’d not fully developed the sinus infection when I saw her, but the incident underlined for me the importance of not missing the diagnosis!

That’s all for this week, allergy sufferers. Here’s hoping you find some relief!

A Kefta Recipe

Made all over the Middle East and called by a variety of names, kefta are lightly spiced, aromatic lamb meat balls, and are a guaranteed hit with any audience (even the most lamb-resistant). Traditionally, kefta are grilled, but as many of us apartment-dwellers don't have access to grills, the following recipe has been adapted for an oven.

2 lbs ground lamb
1 medium onion, chopped
3-4 tbsp flat-leaf parsley
3-4 tbsp cilantro
1/4 tsp cumin
1/4 tsp coriander
1/4 tsp ginger
1/4 tsp cinnamon
1/2 tsp salt
1/4 tsp pepper
1/4 tsp dried red chili powder (I use chipotle, but cayenne is also acceptable)

Combine all ingredients except the lamb in a food processor and puree. The result should be very green and relatively thick.

Combine the vegetable and spice mixture with the lamb in a large bowl. I find that in order to get a consistent mixture, you need to mix by hand, which of course gets your hands very, very lamb-y. When you've mixed them fully, roll them into small meatballs about the size of a walnut. Evenly space them on a cookie sheet or in a baking dish.

Place in preheated oven and cook at 400 for 20-25 minutes, until meatballs attain a pleasant firmness. Finish under the broiler for about 5 minutes, or until the meatballs are lightly browned.

Though not a traditional topping for kefta, I find that they go very well with muhammara. The contrast of the sweet meat and light spices with the tang of the pomegranate is a guaranteed crowd-pleaser.

Three Things You Didn’t Know About Menopause

I spend a significant amount of time every week reading medical research abstracts. Most of what you come across while doing that is fairly typical, especially if you’re a naturopathic physician concerned with diet and exercise – study after study will show that regular exercise, not smoking, and a healthy diet prevents a large number of diseases and symptoms. Of course, each study examines a slightly different aspect of a healthy lifestyle, with one looking at omega-3 fats, another at fiber, and a third at moderate physical exercise, but in total, they more or less reinforce each other.

Occasionally, however, you come across really unexpected information, the sort of stuff that makes you stand up and say, ‘What?!’ Today’s column is devoted to three such articles relating to menopause.

The first is about night sweats. In a study of 867 women conducted over 11.5 years, it was discovered that women who had both hot flashes and night sweats had a 30% lower risk of all-cause mortality than women who did not have this combination of symptoms. Women who had hot flashes alone did not have this benefit. Adding further interest to the finding is the fact that women who had night sweats but not hot flashes had a similar protective benefit, though in this case it extended only to cardiovascular disease and coronary heart disease. The researchers controlled rigorously for a variety of risk factors, including hormonal therapy, further strengthening the finding.

The main question to ask ourselves with this study is – why could this possibly be happening? The causes of vasomotor symptoms associated with menopause are poorly understood, so we can really only speculate as to why night sweats apparently provide a protective benefit. I’ll be on the lookout for more info on this.

The second is about hot flashes. A team of Greek researchers found that women with increased subclinical atherosclerosis suffered from more severe hot flashes. You lay people are probably wondering what this means – here’s a brief explanation: researchers measured the amount of plaque in the carotid arteries of 110 women via ultrasound, and discovered that those women who suffered more severe hot flashes also had thicker deposits of plaque in their artery walls. Carotid artery plaque is routinely used as marker for atherosclerosis throughout the body. The increases in plaque were minor, and the study population was somewhat small, but the findings were statistically significant, and appeared to correlate to the severity of the symptoms – the women were classified as having no symptoms, minor symptoms, or moderate to severe symptoms, and it was clear that progressively severe symptoms were correlated to progressively severe plaquing.

Here again, because menopausal symptoms are so poorly understood, we can only guess at why atherosclerosis might play a role in their prevalence. What’s interesting though, is that hot flashes may help to alert clinicians to cardiovascular risk in the future.

Finally, severity of menopausal symptoms may be largely influenced by the time of year in which you were born. I’ll admit that this research left me astounded. A group of Italian researchers found that menopausal symptoms are significantly more severe in women born during the spring and summer, as opposed to women born the fall. Not only was this finding statistically significant, but the effect was also remarkably strong – the women born in the spring and summer had symptom scores that were more than twice as high as their counterparts born in the fall. This applied more strongly to symptoms of anxiety and depression, but also quite strongly to somatic symptoms as well.

Despite reading a lot of research, this really counts as one of the most surprising studies I’ve seen. I was tempted initially to dismiss the findings, but this study was done on quite a large group of women – over 2500 – and once you get groups that large, the chance of having fluke results diminishes. The clinical significance of this result has yet to be borne out, but for the time being, this is a fascinating result to read about.

Red Meat And Premature Mortality

Next week I'll be posting a recipe for kefta, a traditional lamb meatball from the Near East. It's a true specialty of the house, and a guaranteed crowd-pleaser. This week, however, I'm posting about the recent debate around red meat, to brace your enthusiasm for next week's recipe a bit.

Last week, an article was published in the Archives of Internal Medicine, a prestigious journal if ever there was one, which presented data showing a link between red meat consumption and an increased risk of premature death from all causes, especially, but not exclusively cardiac disease and cancer. The study followed over 120,000 men and women for more than 25 years, and while it was strictly an observational study, when you get this many people together for this long a period of time, you get pretty sound data.

The article was a hit in the media last week, with just about every main news source reporting on it. I myself read the reports published by both the New York Times and the Guardian. It's caused a bit of a furor, and people are weighing in about it left and right, many of which are apologies for the meat-eaters of the world.

While these authors say that perhaps the effect isn't as strong as it seems once you fiddle with the numbers and make it look like a smaller problem than it is, or that it's not the meat that's at fault, it's the way the meat is grown, I think apologies aren't helping anything - let's not sugar-coat this one, folks. Occasional red meat is fine - more than fine, in fact, it can be transcendent when served well - but the daily consumption of meat, the almost unconscious consumption of meat, is not. Given that the researchers found such significant benefits simply by substituting poultry, fish, or vegetarian sources of protein, we need to be strongly emphasizing that people eat significantly less red meat.

Just some food for thought on your Monday.

(And contrary to what the National Pork Board says, pork is a red meat, the same as veal, beef or lamb.)