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Q: Can Ameal BP reduce blood pressure? Ads for this supplement are everywhere.

A: No one knows, but research on this product is interesting. Formerly sold as Ameal S, Ameal BP contains bioactive tripeptides, substances derived from milk proteins. These tripeptides may lower blood pressure in somewhat the same way as ACE inhibitors—prescription drugs that block an enzyme that causes blood pressure to rise.

The label on this supplement promises only "to maintain healthy blood pressure," though the ads also say that Ameal BP enables the user to "tackle hypertension aggressively." (Medical claims are prohibited for supplements, but this comes pretty close.) Ameal BP is marketed by Calpis, a Japanese firm that has funded most of the studies. Finnish researchers have also studied tripeptides. In Europe a fermented milk containing tripeptides is widely sold for reducing blood pressure.

But most studies of Ameal or the fermented milk have been inconclusive. Some have shown positive effects only in people with mildly elevated blood pressure. A recent short Dutch study in Hypertension found that tripeptides had no effect at all on blood pressure. It’s true, as shown by the well-tested anti-hypertension DASH diet, that low-fat dairy products can help lower blood pressure as part of a healthy diet emphasizing fruits and vegetables. Whether the benefits come from the tripeptides in the milk or from its calcium, potassium, and/or magnesium is uncertain.

If you have high blood pressure, you should follow your physician’s advice. If you need medication, supplements cannot substitute for it. More studies on tripeptides are needed. Meanwhile, it’s too early to recommend Ameal BP or similar products.

Q: I was told that my 65-year-old husband should not get the shingles vaccine because he never had chickenpox. Would it give him chickenpox?

A: No. He should still get the shingles vaccine—it won’t give him chickenpox. The vaccine is approved for people 60 and over. The CDC says that doctors need not ask patients if they ever had chickenpox before giving them the shingles vaccine.

The same virus, varicella-zoster, causes both chickenpox and shingles. After you have chickenpox, the virus remains dormant in nerve tissue, and if it reactivates, it causes shingles—a blistering rash, usually on the torso, that causes pain for weeks or months.

Though you can’t get shingles unless you have had chickenpox, it’s safe to assume that almost all older adults have had chickenpox, even if they do not remember. The shingles vaccine is a much stronger version of the chickenpox vaccine given to kids, so it will also protect against chickenpox.

Who should avoid the vaccine? Those with a weakened immune system (as a result of HIV, leukemia, or lymphoma, for instance, or treatment with chemotherapy or steroid drugs). Also avoid it you ever had a life-threatening allergic reaction to gelatin, the antibiotic neomycin, or any other component of the shingles vaccine; tell your doctor if you have any severe allergies.

Q: Does nonfat milk have a lot more calcium than whole milk?

A: No, just a little more. Milk averages 300 milligrams of calcium per cup, 30% of your daily needs. Whole milk usually has about 290 milligrams, nonfat about 310.
Processors do sometimes add extra milk solids to special nonfat milks to boost nutrients. Such milk typically contains 25 to 35% more calcium, and the labels usually boast about the added calcium. That means it takes about three cups of milk to get 1,200 milligrams of calcium a day, instead of the usual four. Such milks also taste richer.

These fortified nonfat milks often cost a lot more. You can accomplish the same thing by adding powdered nonfat milk yourself.

Q: Is it wise to ice a burn? If not, what should I do?

A: Ice might further damage tissue, according to the latest evidence. Cold running water, which also cleanses the area, is the best option. Cold compresses may help, too.

One burn myth is that applying butter or mayonnaise is helpful. Oil, including greasy burn ointments, may retard healing and promote infection. Over-the-counter burn ointments are ineffective and may make matters worse, since they trap heat. Some people find pure aloe helpful, but aloe-containing burn ointments usually don’t have much aloe in them and may be oily. It’s okay to use a first-aid spray containing benzocaine for a very painful burn.

Home treatment is fine for first degree burns (which affect the skin’s outer layer and produce small blisters, if any) and superficial second degree burns (which go deeper and may require medical advice, especially if large). Third degree burns, which may be painless at first because nerves have been destroyed, need prompt medical attention.

Q: What is carob, and is it a good chocolate substitute?

A: Carob powder comes from the roasted and ground "beans"—technically pods—of the Ceratonia siliqua tree. Because it tastes something like chocolate (from the pods of the Cacao tree), it’s sometimes used as a chocolate substitute in baking, beverages, and candy bars. Carob is also used as a thickener in some processed foods—as carob bean or locust bean gum.

Carob powder is low in calories (18 per tablespoon), with negligible fat, and is naturally sweet. It has no caffeine or other stimulants (chocolate has small amounts). When turned into candy, however, carob is not a health food. Carob bars have added saturated fats (often from palm kernel oil) and usually sugar in some form, often as the first ingredient. In fact, ounce for ounce, carob bars can have as many calories (155) as commercial milk chocolate bars and even more saturated fat (8 grams). That’s 40% of the recommended daily limit for saturated fat, if you consume 2,000 calories a day.

Traditionally, carob has been used as a digestive aid. Preliminary research suggests that—like oat fiber and psyllium—the fiber in carob has a cholesterol-lowering effect. But while the raw powder has 3 grams of fiber per tablespoon, carob bars have one gram or less per one-ounce serving.

Bottom line: If you like the flavor, mix carob powder with nonfat or low-fat milk, add it to smoothies, or use it in place of cocoa powder in baking (you won’t need as much sugar). Eat carob candy, however, as you would chocolate candy—in small amounts only.

UC Berkeley Wellness Letter, January 2009