Natural Foods Merchandiser

Nutrition Q&A with Dan Lukaczer, N.D.

Q: A customer with Crohn?s disease wants to know if it would be useful to take any vitamins, even though her doctor says her disease is under control. What should I suggest?

A: A cascade of inflammatory immunologic events occurs in the gut walls of individuals with inflammatory bowel disease—either Crohn?s disease or ulcerative colitis. As a result of these events, free radicals are produced at a much greater rate than in healthy individuals. These highly reactive free radicals can attack almost every cell component, causing further damage to surrounding tissue in a nonspecific manner. People with irritable bowel disease not only have increased free radicals, but their antioxidant defenses—the vitamins, minerals and enzymes that make up this system—can be depleted by this oxidative stress. Recently, researchers have confirmed that not only are oxidative stress levels higher in these patients, but levels of several antioxidant vitamins are significantly lower than in healthy controls.1

It is fine to show a relationship between antioxidants and oxidative stress, but can something be done about it? Researchers recently found the answer to be yes. In a randomized controlled trial, Crohn?s subjects were supplemented with vitamin E (800 IU) and C (1,000 mg) or placebo each day for four weeks. In the supplemented group, plasma levels of vitamin C and alpha-tocopherol increased and oxidative stress indexes decreased.2 These patients were on medications and had what would be termed inactive or mildly active disease. They were medically managed but clearly still not stable when examined more closely. There is good rationale to supplement with a broad spectrum of antioxidants, at the very least vitamins C and E, even when people with Crohn?s are not symptomatic.

Q: Will flushing out the nasal passages with warm water help with chronic sinusitis?

A: Nasal irrigation has been around for centuries. It actually has an important place in some yogic traditions in which cleaning and ?purifying? the nasal passages is an important aspect of cleaning inhaled air. From a Western medical perspective, this idea is gaining ground as an important therapy in treating many sinonasal conditions, from acute and chronic rhinitis to sinusitis and septal perforations.3 Nasal irrigation may work by enhancing mucus movement out of the nose and sinuses or by removing some inflammatory cells that exacerbate the problem. The best solution and delivery is still being debated. I have always recommended a saltwater nasal wash using a neti or neti lota pot. They come in many shapes and sizes but generally look like little teapots. You fill the pot with salt water and (leaning over a sink) tilt your head slightly back and to one side. The solution flows into one nostril, around the septum (the cartilaginous tissue separating the nostrils) and out of the other nostril. It is simple and inexpensive and can be used repeatedly throughout the day. The authors of a recent review suggest that further research is needed but note that nasal irrigation should no longer be considered a purely adjunctive measure; it is an effective and underused therapy for managing sinonasal conditions.

Q: Can lead have an effect on blood pressure?

A: There is now a significant body of evidence from animal, epidemiological and case-controlled studies supporting the association between lead exposure and elevations in blood pressure. In the most recent report involving peri- and postmenopausal women, researchers showed that a change in blood lead levels from the lowest (quartile 1: range, 0.5?1.6 mcg/dL) to the highest (quartile 4: range, 4.0?31.1 mcg/dL) was associated with small, statistically significant changes in systolic and diastolic blood pressure. This association was strongest in postmenopausal women, which may suggest that accelerated bone loss in menopause releases stored lead into circulation.4

The troubling issue is that blood pressure was correlated with blood lead levels well below the current U.S. occupational exposure limit guidelines (40 mcg/dL), and even below the Centers for Disease Control level of concern for preventing lead poisoning in children (10 mcg/dL). What this says is that even at very low levels lead has toxic effects; lead may be an underlying cause of hypertension to assess in individual patients, particularly when other diet and lifestyle measures have not worked; and we should continue to examine the cost/benefit ratio of lead in our industrialized society. It may be higher then we think.

Dan Lukaczer, N.D., is director of clinical research at the Functional Medicine Research Center, a division of Metagenics Inc., in Gig Harbor, Wash.

1. Wendland BE, et al. Lipid peroxidation and plasma antioxidant micronutrients in Crohn?s disease. Am J Clin Nutr 2001;74(2):259-64.
2. Aghdassi E, et al. Antioxidant vitamin supplementation in Crohn?s disease decreases oxidative stress. A randomized controlled trial. Am J Gastroenterol 2003;98(2):348-53.
3. Brown CL, Graham SM. Nasal irrigations: good or bad? Curr Opin Otolaryngol Head Neck Surg 2004;12(1):9-13.
4. Nash D, et al. Blood lead, blood pressure, and hypertension in perimenopausal and postmenopausal women. JAMA 2003;289(12):1523-32.

Natural Foods Merchandiser volume XXV/number 4/p. 49

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