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Diets Revisited
Prescription
Mismanagement
Drug Abuse
Non-Drug Therapies
Ask Dr. J:
Metabolic Typing -- No Science
References
In the Health
News
Diet and Disease
Recipe of the
Month: Pan Fried Buckwheat
Noodles
Dear Friends,
A reader commented on my
last editorial on the value
of high-complex-carbohydrate
diets as opposed to the
popular high-protein diets
recently being promoted,
saying “carbs are
unnecessary and that meat
is good.” I do not
write to promote a vegetarian
philosophy, nor from a need
to control how people eat.
I simply report the science
behind various diet selections
so that my readers (and
patients) can make informed
choices.
The issue of whether eating
a mostly-vegetarian diet
is healthiest is no longer
a scientific question: the
science is quite clear on
this. It is now a personal,
emotional, and even a political
question. In spite of the
evidence, many people and
some doctors still promote
high-protein, non-vegetarian
diets, but the science consistently
says a mostly vegetarian,
high-fiber diet is best.
My reader’s comment
included a bit about two
explorers who lived in the
north pole for a year, and
“thrived on an all
meat diet.” What happened
to just two people for such
a short time on a radical
diet is irrelevant. Of more
concern is what happens
to large numbers of people
who consume various diets
over the long term. From
this perspective, mostly
vegetarian diets are clearly
healthiest. Paleolithic
diets are irrelevant to
modern humans, who live
decades longer than our
remote ancestors.
It is increasingly clear
that many medications are
overused in both hospitals
and in private medical visits
(see below). It is also
being reported that doctors
can safely prescribe effective
doses of medications that
are much lower than the
levels commonly used. This
would reduce both costs
and side effects.
Pharmaceutical companies
usually set the recommended
doses, and if lower doses
were just as effective,
they would see a reduction
in sales and profits. Often,
the drug company representatives
visit doctors offices and
make suggestions for drug
use. Medical journals frequently
have more ads for drugs
than they do research articles,
so the physicians reading
these journals may have
unscientific influences
on their prescribing habits.
You should be aware of
this and not be afraid to
ask questions of your doctor
to make sure that you are
receiving proper medications
based on good scientific
information. From a public
health perspective, antibiotic
overuse is a particular
problem, contributing to
the increasing appearance
of antibiotic-resistant
organisms. This problem
is only made worse by the
extensive use of antibiotics
in feedlot animals meant
for human consumption. If
you do use animal products
in your diet, you can avoid
these problems by choosing
organic sources. In any
case, it is important to
be cautious about dietary
choices or accepting any
prescription without an
adequate medical reason.
Recent evidence shows that
about eight percent of all
seniors’ doctor visits
resulted in inappropriate
prescriptions, leading to
side effects that could
be avoided. Pain relievers,
anxiety medications, anti-depressants,
and sedatives were particularly
overused.
The problem was greatest
among women. High risks
from multiple medications
were also a significant
problem as reported by a
researcher for the Centers
for Disease Control. Eight
percent amounts to about
20 million incorrect prescriptions.
About one third of the
time, visits by seniors
to physicians resulted in
multiple drug prescriptions,
compounding the risk of
side effects. It is always
important to let your doctor
know what drugs you are
taking, and to be sure to
ask questions about why
you need a particular medication;
often, you do not.
This problem is not confined
to the elderly, particularly
when it comes to antibiotics.
The use of antibiotics in
children and adults for
viral infections, unaffected
by such drugs, leads to
side effects, allergic reactions,
and the risk of developing
infections with resistant
organisms.
The real drug problem in
the US is not from illegal
drugs, but the overuse and
inappropriate use of prescription
medications. Even correct
prescriptions lead to side
effects that are responsible
for over 100,000 deaths
per year, and we are continuing
to learn of negative effects
from drugs.
An analysis of the anti-psychotic
drug Zyprexa shows that
in elderly patients with
dementia, this commonly
prescribed medication causes
increases in strokes and
overall mortality. Another
anti-psychotic drug, Risperdal,
was also shown to cause
the same harm. These two
drugs are often used in
elderly demented patients
to control behavior.
Although commonly prescribed
for this, Zyprexa is not
approved for use in dementia-related
psychosis. A warning letter
from the Zyprexa manufacturer
(Lilly) notes that overall
mortality risk is 133 percent
higher in the elderly taking
Zypreza compared with placebo.
While these specific effects
are not seen in younger
patients on the medications,
this new evidence follows
an all-too-familiar pattern,
in which a drug is approved,
hailed as an advance in
medical therapy, and later
found to have unexpected
long-term side effects.
By the time this happens,
many people have been harmed,
and the drug companies have
had time to switch their
financial dependence to
a newer drug, of which the
side effects have not yet
been discovered.
Another such drug treatment
is hormone replacement therapy
(HRT). Regarded for many
years as not only a symptom
reliever in menopause, but
also a way to reduce risks
of heart disease and brain
dysfunction, the combination
of Premarin and Provera
(Prem-Pro—estrogens
and a progesterone-like
drug) has now been shown
to increase the risks of
heart disease and strokes,
leading to a sharp drop
in its use.
This is in addition to
the known risk of breast
cancer, and a newly reported
side effect from HRT—an
increase in adult asthma.
Although development of
asthma in later life is
uncommon, that risk is more
than doubled in women who
take estrogen alone or in
combination with Provera.
(No such risks have yet
been described in women
who take bio-identical hormones.)
Another potential problem
with HRT is hearing loss.
In a small study (only 64
subjects), women between
60 and 86 years old who
were taking HRT had a 10
to 30 percent greater hearing
deficit than those not taking
the treatment. While not
a lethal problem, hearing
loss significantly affects
quality of life.
I am not saying that prescription
medications are not an important
part of medical care, or
that they should never be
used. I recommend them when
necessary, including heart
medications, antibiotics,
and others. They can be
lifesaving, and they can
improve the quality of life,
and modern medical care
would be almost impossible
without the use of many
drugs.
However, in many cases
drugs are prescribed when
they are unnecessary, sometimes
at too high a dose when
less would be effective,
or when safer natural products
will do the same job or
better, without the side
effects. Using coenzyme
Q10 for heart disease and
hypertension, vitamin B3
for mental illness, black
cohosh for menopausal symptoms,
and glucosamine sulfate
for arthritis are all examples
of safer approaches to health
care at lower expense.
St. John’s wort is
often helpful in mild to
moderate depression, and
safer than prescriptions.
Saw palmetto is equal to
or better than the prescription
drug, Proscar, for prostate
symptoms, and policosanol
is superior to statin drugs
for vascular disease and
cholesterol elevations.
It is apparent that many
people are already looking
for alternatives to their
medications, and not always
by taking supplements or
making other lifestyle changes.
In a recent poll by the
Associated Press, many people
reported that they either
stopped taking their medications
because they were too expensive,
or they reduced their dose
(in some cases, perhaps
unwittingly, giving themselves
both better medical care
and fewer side effects at
the same time, as many drugs
are prescribed in too high
a dose).
My advice is to manage
health problems with lifestyle
changes and dietary supplements
before medications, unless
the situation is urgent
or clearly responsive to
specific medications. Also,
try to avoid long-term use
of prescription or over-the-counter
drugs, at least without
frequent review of their
necessity. If the more benign
methods are not adequate,
it is always easy to add
medication later. Often
you won’t have to.
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Q. Do
you think a person needs
to find out their metabolic
type to know what foods
are healthy, or is this
just another fad?
—SR, New Mexico, via
Internet
I have been unable to find
scientific support for a
way to assess dietary needs
through metabolic typing,
variants of which have been
around since before I started
practice almost 30 years
ago. Many physicians would
like to find out precisely
what you need to eat (how
much protein, carbohydrate,
and fat) by analyzing your
metabolism, but evidence
is scarce.
One practitioner mentioned
as a researcher in the field
has no listings in the database
of medical publications.
The idea is that you can
divide people into protein
types, carbohydrate types,
and mixed types. Even the
so-called “carbohydrate
types” are supposed
to eat “only”
25 percent of calories as
protein, which is quite
high, at about 80 to 100
grams. This makes typing
seem more like a promotion
of protein diets, even for
the “carb” types,
while a healthy carbohydrate
intake is 65 to 70 percent
of caloric intake.
People clearly differ in
size, shape, personality,
digestion, hormones, and
biochemistry, but their
similarities are far greater
than their differences.
Individual differences have
not yet been typed. Your
protein, carbohydrate, and
fat needs are more dependent
on your activity level than
your metabolism.
The need for micronutrients
to achieve optimal health
(vitamins, minerals, essential
fatty acids) is much more
varied. However, the amount
that will prevent serious
deficiency is probably similar
for most people with minor
variations.
While we have differences,
no one has published reasonable
studies that show how to
determine what an individual
needs. Most species have
a fairly consistent dietary
pattern between individuals,
and humans are probably
much the same. Avoiding
food allergens is a different
and very important issue.
McKeown
NM, et al., Carbohydrate
nutrition, insulin resistance,
and ... metabolic syndrome...
Diabetes Care. 2004 Feb;27(2):538-46.
Hays
NP, Effects of an ad libitum
low-fat, high-carbohydrate
diet on body weight, body
composition, and fat distribution
in older men and women:
a randomized controlled
trial. Arch Intern Med.
2004 Jan 26;164(2):210-7.
Goulding
MR, Inappropriate medication
prescribing for elderly
ambulatory care patients.
Arch Intern Med. 2004 Feb
9;164(3):305-12.
Lilly
Warns of Zyprexa Risks for
Elderly Patients, Reuters,
Feb 20, 2004.
Wooltorton
E, Risperidone (Risperdal):
increased rate of cerebrovascular
events in dementia trials.
CMAJ. 2002 Nov 26;167(11):1269-70.
Scott
JG, et al., Antibiotic use
in acute respiratory infections
and the ways patients pressure
physicians for a prescription.
J Fam Pract 2001 Oct;50(10):853-8.
Zdziarski
P, et al., Overuse of high
stability antibiotics and
its consequences... Acta
Microbiol Pol. 2003;52(1):5-13.
Garbutt
J, et al., Diagnosis and
treatment of acute otitis
media: an assessment. Pediatrics.
2003 Jul;112(1 Pt 1):143-9.
Barr
RG, et al., Prospective
Study of Postmenopausal
Hormone Use and...Asthma...Arch
Intern Med. 2004 Feb 23;164(4):379-386.
Hormone
Therapy May Affect Hearing,
Study Shows, Reuters, Report
on the meeting of the Association
for Research in Otolaryngology,
February 24, 2004.
AP Poll:
Drugs Costly for U.S. Families,
Associated Press, Feb 23,
2004.
Cohen
JS, Do standard doses of
frequently prescribed drugs
cause preventable adverse
effects in women? J Am Med
Womens Assoc. 2002 Spring;57(2):105-10,
114.
McPherson
K, Hemminki E, Synthesising
licensing data to assess
drug safety. BMJ 2004
Feb 28;328(7438):518-520.
No references
are available, as none appear
in the medical literature
The National Center for
Health Statistics reviews
the disturbing but familiar
lifestyle habits in the
U.S. (www.cdc.gov/nchs/releases/
04facts/healthbehaviors.htm).
Only one in ten adults engaged
in vigorous physical activity,
and only 25 percent in any
physical activity. While
60 percent of the population
was overweight, only two
percent were underweight
(concerns that weight obsession
has led to anorexia are
overstated). One fifth of
adults smoke a pack of cigarettes
a day, making it important
for everyone to protect
themselves from second-hand
smoke by taking appropriate
antioxidant supplements
and flavonoids.
Light alcohol intake (1
to 8 drinks a week) reduces
inflammatory markers (CRP
and IL-6) associated with
higher heart disease risk
(Volpato S, et al., Relationship
of alcohol intake with inflammatory
markers...Circulation. 2004
Feb 10;109(5):607-12). It
would be interesting to
know if within the 1-to-8
group risk varied from the
lowest to the highest intake
(that is, is it better to
be in the lower or higher
category?). It is likely
that flavonoids and antioxidants
from non-alcoholic sources
could provide similar benefits,
as could supplements of
curcumin, ginger, coenzyme
Q10, niacin, policosanol,
and omega-3 fatty acids.
Diabetes risk is reduced
if you consume more antioxidants.
A study of 4300 subjects
showed 30 to 40 percent
lower risk in the group
with the highest compared
to those with the lowest
intake of vitamin E or carotenoids
(Montonen J, et al., Dietary
antioxidant intake and risk
of type 2 diabetes. Diabetes
Care. 2004 Feb;27(2):362-6.)
Avoid diabetes by watching
your diet and weight, exercising,
and taking chromium and
other supplements.
I’ve mentioned buckwheat
noodles (called soba
in Japan) made from a combination
of whole wheat, kamut, or
spelt plus the buckwheat
(an organic brand is Sobaya
from health food stores)
as a base for pesto, but
I also like other recipes
with them. Boil the noodles
in adequate water and drain
them in a collander. Meanwhile,
stir fry some onions and
garlic in olive oil, add
tofu cubes until they sizzle,
and then add half of some
very dilute soy sauce with
cider vinegar. When that
is stirred in, add broccoli
florets and any green vegetable
that you like (be aware
of the different cooking
times, for example, the
broccoli should be added
before any chard or spinach
as they cook so fast). When
all of this is stirred together,
add the noodles and sauté
the mixture, add in the
remaining soy sauce-vinegar
mix, and turn off the flame
before folding in some chopped
cilantro. Delicious.
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