Last week I had a post discussing immune-boosting foods. Here’s a semi-followup, discussing a nice article from the New York Time’s always informative Well Blog. This time they review The 11 Best Foods You Aren’t Eating. These foods all have an underlying similarity in terms of good nutrition and immune-boosting properties; many also taste really good (blueberries!). Here’s a sneak peek at their list:

Beets: Think of beets as red spinach, Dr. Bowden said, because they are a rich source of folate as well as natural red pigments that may be cancer fighters. How to eat: Fresh, raw and grated to make a salad. Heating decreases the antioxidant power.

Cabbage: Loaded with nutrients like sulforaphane, a chemical said to boost cancer-fighting enzymes. How to eat: Asian-style slaw or as a crunchy topping on burgers and sandwiches.

Swiss chard: A leafy green vegetable packed with carotenoids that protect aging eyes. How to eat it: Chop and saute in olive oil.

Cinnamon: May help control blood sugar and cholesterol. How to eat it: Sprinkle on coffee or oatmeal.

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The website WebMD is a bit too commercial for me to consider as my first-line source, but they often have informative articles that at least provide a good starting point for research and discussion. I wanted to share their recent slideshow on immune-boosting foods. It’s a quick review of 15 foods that have particularly good effects on your immune system, thus providing a good level of general protection. It’s an easy read for everyone and at least gets us all to think about our diets and what we can do to improve them. By the way, the photo on the right shows elderberry, rich in antioxidants and possibly effective against the flu.

I think immune system health is a particularly pressing issue in Beijing, as we daily face strong environmental toxins and pollutants which do indeed lower our immune systems. So, it’s always a good idea to be as healthy as possible regarding our diets.

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There’s a nice review of the best treatments for aging skin from the Natural Medicines Database. It’s a great and readable evidence-based review of what works and doesn’t work. They have a nice chart of the most effective natural treatments:

Aging Skin Treatments

Here’s my take on what works best:

1. Sunscreen, sunscreen, sunscreen. This is treatment #1 — and number 2, and 3, and so on. It’s by far the most important product you should use, since the best treatment for wrinkles is to avoid them in the first place. There is overwhelming evidence that most wrinkles are caused by sun-related damage, and all methods to avoid sun will help protect your skin. That means avoiding mid-day or summer sun if you can, and wearing hats with with brims. But of course the underlying method would be always using sunscreen on your face, even in the winter. Many moisturizers now have SPF15 or higher protection. Everyone should get themselves a basic sunscreen and just use it every morning. And no, you absolutely do not need to spend a lot of money on skin products; I like the Neutrogena or Loreal Mens brands, which are available at Watsons and very reasonably priced.

2. Don’t Smoke. Plenty of people will spend a small fortune on skin care products and yet still smoke. As with #1 above, there is clear evidence that smoking damages your skin both from toxic effects of the smoke directly on your skin as well as the internal cell damage from the inhaled carcinogens and free radicals.

3. Vitamin A Creams. The prescription versions of this (Retin-A and others) are probably the #1 doctor-prescribed treatment to help with wrinkles and keep your skin healthier looking. It definitely works well for some people — but only if you continue to take it, and there are some side effects as well.

4. Some OTC Creams May Work A Little. There was a very intriguing study last year, notable because it was well designed to prevent bias, which did show a statistically and clinically significant improvement in photoaging. The product is quite cheap, from Boots pharmacy, called No7 Protect & Perfect Intense Beauty Serum. Here’s part of their abstract:

Results: In the 12-day patch test assay, we observed significant immunohistological deposition of fibrillin-1 in skin treated with the test product and RA compared with the untreated baseline (P = 0·005 and 0·015, respectively). In the clinical RCT, at 6 months, the test product produced statistically significant improvement in facial wrinkles as compared to baseline assessment (P = 0·013), whereas vehicle-treated skin was not significantly improved (P = 0·11). After 12 months, there was a significant benefit of the test product over that projected for the vehicle (70% vs. 33% of subjects improving; combined Wilcoxon rank tests, P = 0·026). There was significant deposition of fibrillin-1 in skin treated for 6 months with the test product [(mean ± SE) vehicle 1·84 ± 0·23; test product 2·57 ± 0·19; ANCOVA P = 0·019).
Conclusions: In a double-blind RCT, an over-the-counter cosmetic ‘anti-ageing’ product resulted in significant clinical improvement in facial wrinkles, which was associated with fibrillin-1 deposition in treated skin. This study demonstrates that a cosmetic product can produce significant improvement in the appearance of wrinkles and further supports the use of fibrillin-1 as a robust biomarker for the repair of photoaged dermis.

The Bottom Line

The best defense is a good offense; avoid wrinkles and photo-aging in the first place by avoiding strong sunlight and always using facial sunscreen. The next best level is to not smoke. As for “cosmeceuticals”, a few may work a little bit but you do not need to spend a fortune on them. And doctors can give you the prescription vitamin A (retinoid) creams, but you need to keep taking them, and you need to review the risks and benefits with your doctor.

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Just a couple weeks ago I posted an article discussing the trendiness of vitamin D. Since then, there is even more press about this; last week I reported how sales of vitamin D are jumping. Now, the New York Times also reviews the literature, with a cautionary note (The Miracle of Vitamin D: Sound Science, or Hype?).

The crux of the article is that indeed there is a lot of recent information that vitamin D supplements can help decrease cancers and heart disease — among those with documented blood-level deficiency in vitamin D. What is less clear is whether the entire population would benefit from a high-dose supplement. In other words, if your blood levels are normal, there is yet not a lot of evidence that a supplement would help. A good quote:

“What we know is that there are a lot of people who are vitamin D deficient based on estimates from national surveys,” said Dr. Michal L. Melamed, assistant professor of medicine at Albert Einstein College of Medicine in the Bronx. “But we don’t know what happens when the curve shifts to the other end. There probably is a risk to having too much vitamin D in the system.”

I think that perhaps the best approach is to see if you first have a deficiency, which many do. In that case, there’s clear evidence that a supplement of 1,000-2,000 IU a day wiill benefit. As for the rest of use, we will have to wait for better studies — which will take many years to finish. In the meantime? I’m still personally debating whether I should start myself on extra doses…

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Here are some interesting quotes from the article (Kills 99.9% of Germs — Sometimes – WSJ.com):

To cite a 99.9% fatality rate, manufacturers don’t have to kill 99.9% of all known bugs. Regulations don’t require them to disclose which bugs they exterminate, just that the products are effective against a representative sample of microbes. For instance, many products can’t kill clostridium difficile, a gastrointestinal scourge, or the hepatitis A virus, which inflames the liver. Yet by killing other, more common bugs, they can claim 99.9% effectiveness…

To claim that other microbe-unfriendly products such as household cleaners and clothing kill 99.99% of germs, companies are permitted to show such deadliness less than 99.99% of the time, according to the EPA’s rules. The standard test is run on 60 slides inoculated with a specific bug, and 59 of them treated with the product must exhibit the claimed rate of germ death. The 60th can fail to allow for a mistake on the part of testers, according to Jean Schoeni, director of research at TRAC Microbiology, which conducts EPA testing. “It’s a very fussy, particular test,” Dr. Schoeni says. Furthermore, if fewer than 59 slides show the high kill rate, manufacturers get a do-over…

The bottom line? I still think alcohol gel sanitizers are great, and even better than soap and water, but you need to do it correctly: keep rubbing your hands for up to 20 seconds. Plus, if your hands are soiled (dirt, diapers…) you still need good old fashioned soap and water.

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Dr. Bibbins-Domingo said that for many people the decrease in blood pressure would be modest, which is why, she said, “many physicians have thrown up their hands and said, ‘I’m not going to advise my patients to reduce salt because it’s too hard for patients and the benefits for any individual are small.’

“But small incremental changes in salt, such as lowering salt in tomato sauce or breads and cereals by a small amount, would achieve small changes in blood pressure that would have a measurable effect across the whole population,” she said. “That’s the reason why this intervention works better than just targeting smokers.”

There’s an interesting graph below which shows the astonishingly high average salt intake by age group; males 14-50 ate on average of 10 grams a day! That rate was far higher than in women. This clearly is a health priority that involves the need for public measures, since most intake is from processed foods and not that tiny salt shaker on your table. People may have read recently that the NYC mayor is forcing massive reductions in salt in the city, and I think that momentum will carry to other cities as well.

One thing to note; yes, lowering your salt can lower your blood pressure by a couple degrees, but on an individual level it may not be very impressive or noticeable; however, on a population level that slight change will save a lot of lives.

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The findings? Those who ate the most leafy green vegetables as well as those who had high levels of folic acid, plus those who ate multivitamins had decreases in their methylation rates. No, we cannot automatically say from this study that this means they’ll get less cancers — but the underlying science is strong, and the methylation-cancer theory is well regarded. Here are some good quotes from the Medscape review of the original article:

“There was a dose response with consumption of vegetables and sustained vitamin use, and increased duration was associated with better protection,” observed Dr. Belinsky. “Multivitamins and leafy green vegetables have things other than folate, although that is the common link, and…the amount of folate varies by multivitamin and vegetable, so I don’t know that there is a simple yes or no answer [regarding dose dependence],” he said.

The report summarizes their findings: “Green leafy vegetables were the only food item in this analysis to exhibit protection against methylation status.” In addition, the use of multivitamins, which supply many of the same substances as leafy green vegetables, had a significant protective effect.

Should all smokers be told to increase their intake of spinach and kale? “Our findings certainly support yes for smokers,” said Dr. Belinsky. “Most cancers arise through inactivating genes by methylation, so I don’t think consumption of leafy green vegetables and a multivitamin would do anything negative, and it could help.” He noted, however, that further studies are needed to validate their findings.

The Bottom Line

Don’t ever start smoking! And if you do smoke, try again and again and again to stop. In the meantime, eat your veggies, especially the leafy green types — and add a multivitamin just to be safe. But keep trying to quit. Always. Did you know that the average smoker attempts to quit 7 times before they really stop? Did you also know there are some new ways for docs to help you stop smoking? We’ll talk more about this soon…

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To attain “ideal” cardiovascular health, a person needs to have never smoked or not smoked for at least a year; eat a healthy diet; get at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise a week; achieve a body-mass index of less than 25; maintain total cholesterol below 200, blood pressure below 120/80 and fasting blood sugar below 100.

How do you score? Don’t feel bad; under 5% of Americans would pass this exam.

Not sure where you fit on this risk spectrum? You can take a short survey on the AHA’s Simple 7 site to assess how close you are to ideal cardiovascular health at www.heart.org/MyLifeCheck. You’ll need to know your vital signs as well as recent blood test results for cholesterol and other basics.

Now’s also a good time to re-introduce my slide show on how to prevent heart attacks and strokes — without medicines.

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Epidemiologic studies, both prospective and retrospective, have shown that individuals who have serum 25-hydroxyvitamin D levels less than 20 ng/mL have an associated 30% to 50% greater risk of colon, prostate, and breast cancer as well as a higher mortality rate from these cancers. In addition, analysis of the Women’s Health Initiative showed that women who had a serum 25-hydroxyvitamin D level less than 12 ng/mL (30 nmol/L) had a 253% increase in the risk of colorectal cancer over an 8-year follow-up period.

This article is a bit technical but there are other websites which repeat the same encouraging findings. I found another good review from New England Journal of Medicine (free in China!) There have been many fads about vitamins and supplements, but this one may actually be useful. By the way, an average multivitamin usually only has 400 IU of vitamin D, which apparently isn’t enough to get the most protection. But don’t take too much, as super-high supplement doses can cause problems. I hear the Canadian health department now recommends all to take 1000 IU supplement daily; this article recommends 2000. Many women taking calcium supplements are probably getting 400-800IU extra in their combo pills; that may be good for bones but higher doses may be even better to prevent cancer. Here are more specifics:

Reports have shown that a large percentage of our population may have serum vitamin D concentrations that are considered suboptimal. Obtaining adequate amounts of vitamin D is important not only for bone health but also for decreasing the risk for several other diseases and conditions, including cancer. Data support the justification for supplementing vitamin D3 2000 IU/d in most adults to decrease the risk for several types of cancers and other conditions. Vitamin D3 is relatively inexpensive and can be found as an over-the-counter product in most pharmacies.

Yet another paper last year in Archives of Internal Medicine, a prospective observational study of 0ver 13,000 people, found that “those in the lowest quartile (25[OH]D levels <17.8 ng/mL) had a 26% increased rate of all-cause mortality (mortality rate ratio, 1.26; 95% CI, 1.08-1.46) and a population attributable risk of 3.1%. The adjusted models of CVD and cancer mortality revealed a higher risk, which was not statistically significant.”

The Bottom Line

It still isn’t rock-solid sure that everyone may benefit from a supplement; certainly children should already be taking their vitamin D supplements as recommended by their doctor; and perhaps most northern people and especially women should consider a supplement. Perhaps we need to do more routine vitamin D blood tests to see people’s vitamin D levels, and supplement only those whose levels are low. But it is very common to have low levels; it’s estimated that 41% of men and 53% of women in America have a deficiency and would benefit from supplements.

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Link: Really? – The Claim – Flu Viruses Live Longer on Surfaces Than Cold Viruses

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