Better School Nutrition
Diabetes Revisited
Diabetes Supplement
Update
Lutein and Macular
Degeneration
Ask Dr. J: Folic
Acid Safety
References
In the Health News
Diet and Disease
Recipe of the Month:
Seasonal Vegetables
Dear Friends,
Glimmers of hope have begun to
appear on the nutrition horizon.
Schools in Nashua, New Hampshire,
have banned vending machines that
dispense junk and soda beverages.
The new vending machine offerings
will include water, flavored water,
juices, and sports drinks (the
last only available after school).
The news article reported that
“the policy is meant to
offer healthy foods throughout
a school, as opposed to offering
a piece of fruit with lunch, and
a candy bar down the hall...”
Around the country, 75 to 85
percent of snacks are of poor
nutritional value, right in line
with the rise of obesity and diabetes
in young people, so to see this
shift is gratifying, even if it
is just a start. At the end of
July, the French parliament voted
to ban vending machines selling
junk (candy and soft drinks) in
all schools, partly due to the
rising obesity levels in children.
In Italy, Britain, Sweden, and
other European countries, concern
about obesity is growing, and
this is particularly important
to some Mediterranean countries
where the traditional diet of
fruits, vegetables, grains and
pastas, and fish is being threatened
by highly processed junk. Some
of these countries are taking
steps to curb advertising aimed
at children, and to educate people
about the value of maintaining
their traditional diets. In Britain,
a member of parliament introduced
a bill to ban preschool TV advertising
of foods high in sugar, salt,
and fat. I am sure this will help
not only their health, but their
school performance as well.
Watching television and playing
computer games has overtaken physical
activity for many children, but
at least many countries are recognizing
the danger of an increasingly
sedentary lifestyle. I remember
watching TV as a kid, but also
spending lots of time at recess
playing sports, and lots of time
after school playing outside,
as well as riding bikes, weekend
hikes, summers at the shore playing
baseball, swimming, and running
around in general (we had no TV
at the summer house).
It is true that I spend a lot
of time at the computer these
days, writing, researching, and
learning. Even though I also spend
a lot of time in the garden being
very physical, this is not enough,
so I feel the need for a specific
exercise program (running and
bicycling) to complement my more
sedentary activities. With cities
in the USA and with so many other
countries beginning to recognize
the problems brought on by poor
diet and sedentary lives, it is
refreshing to see that some of
them are doing something about
it, emphasizing traditional, less-processed
diets and increased physical activity
as important for overall health.
It is important for all of us
to contribute improving children’s
health, partly by setting the
example of healthy living. Everyone
will benefit from a healthier
society, and it will reduce health
care costs.
Adult onset (type II) diabetes
has been in the news extensively
in recent months, and it is clear
that the incidence of diabetes
and the complications from it
are increasing, and not only in
this country.
I reported last year (October,
2003) on the extent of diabetes
in developing countries and the
pandemic nature of the disease
(occurring over a wide geographic
region and affecting a large percentage
of people). In most developing
countries, infectious disease
associated with poverty is often
the leading cause of death. Now,
in Mexico, diabetes is the number
one killer.
Death from diabetes is increasing
in Mexico at three percent per
year, and is now the cause of
12 percent of all deaths. (Deaths
from heart disease, cancer, and
hypertension have also increased
dramatically in the past 50 years.)
It is clear that as developing
countries industrialize the food
supply the health of the population
suffers accordingly. It appears
that junk food is extremely popular
in Mexico, but obesity and diabetes
are also rising in other developing
countries.
While the sugar and soft drink
industries try to deny it, evidence
is mounting that dietary sugar,
particularly from soft drinks,
is related to the increasing rate
of diabetes. (In the U.S. it is
estimated that 18 million people
have diabetes, and it is increasing
at 1.3 million per year.) The
recent revision of the USDA dietary
guidelines falls short in recommending
the reduction of sugar and soft
drinks (perhaps because the panel
is influenced by the industry).
The Nurses’ Health Study
of 91,249 women shows a direct
relationship between the rise
in sugar drink consumption (during
20 years, adult consumption rose
61 percent, and children’s
intake more than doubled). In
this study, women who increased
their intake from less than one
a week to one per day nearly doubled
their risk of diabetes. They also
significantly increased their
weight with the increased sugar.
Fruit juice consumption was not
associated with an increased risk.
The highly absorbable sugars
in these drinks (as well as other
junk sweets) cause rapid blood
glucose elevations and subsequent
release of excess insulin. The
rise in sugar determines what
is called the “glycemic
index” or GI of the food
being studied. The GI can be misleading,
though, in other contexts, because
healthy foods with a high GI are
often not eaten alone. For example,
a baked potato has a high GI,
but if you add some olive oil
or flaxseed oil it changes the
effect. Studies of food combinations
would produce a different picture
of the GI than single foods. Sodas,
however, are often consumed by
themselves.
Recently, diabetes and pre-diabetes
have been linked with the loss
of mental function and dementia.
A study of 7027 post-menopausal
women showed that diabetes and
prediabetes almost doubled the
loss of cognitive function.
Of course, diet is not the only
contributor to diabetes and obesity.
Sedentary lifestyles also contribute
to diabetes risk. Exercise blunts
the rise in blood sugar after
meals, and it makes insulin more
effective by increasing muscle-cell
insulin sensitivity. Brisk walking,
jogging, cycling, and similar
activities are helpful in controlling
blood sugar (animals have to be
physically active every time they
want to eat). These also help
to reduce weight.
While diet and exercise are the
primary influences on blood sugar,
dietary supplements are also important
in the management of diabetes.
Recent studies confirm the value
of high-dose chromium in controlling
blood sugar. A study of elderly
diabetics showed that 400 mcg
of chromium reduced blood sugar
by 20 percent after only three
weeks. Lipid levels were also
lowered. Higher doses (1000 mcg)
are even more valuable.
Alpha-lipoic acid helps to control
blood sugar. A new animal study
shows that it improves insulin
sensitivity. Higher doses (1000
mg) help to reverse peripheral
neuropathy that is often associated
with chronic diabetes. Alpha-lipoic
acid is a potent antioxidant and
a cofactor for mitochondrial energy
production. It counteracts free
radicals, removes toxic metals,
and enhances vitamin C and glutathione
levels.
Recently, researchers have found
that cinnamon can improve sugar
control. A daily dose of up to
6 gms (about a teaspoon) reduces
fasting sugars by 29 percent.
It also improves lipids, lowering
total cholesterol, triglycerides,
and LDL-cholesterol by 25 to 30
percent.
New research suggests that lutein
is even better than previously
reported in helping age-related
macular degeneration (ARMD), a
deterioration of the most sensitive
area of the retina. A 12-month
study of 90 patients with ARMD
showed that lutein supplements
(10 mg daily) increased the visual
pigment in the retina, and was
associated with a significant
improvement in visual acuity (using
the Snellen eye chart). The ability
to detect contrast was also better
in the treatment group than in
the controls.
In another study, seven patients
with ARMD were treated for five
months with 10 mg of lutein. The
pigment was found to concentrate
in the macula, suggesting that
even diseased retinas can absorb
and accumulate visual pigment.
In addition to preventing ARMD,
as previous research has shown,
this is the first information
showing potential reversal of
the condition. Macular pigments,
such as lutein and zeaxanthin,
are carotenoids that come exclusively
from the diet. They not only provide
the visual pigment, but they are
antioxidants that protect the
macula from oxidative free-radical
damage.
Lutein in the diet is found in
spinach, other dark leafy greens,
leeks, peas, and egg yolks. Low
dietary levels are associated
with increased ARMD and also with
cataracts. Supplemental lutein
is derived from marigolds. Carotenoids
are fat soluble, and should be
taken with oil-containing foods
for better absorption.
Q. What do you
consider to be the safe limit
for folic acid supplements? I’ve
been told not to take more than
1000 mcg (1 mg).
—RG, Indiana, U.S., via
Internet
A. Folic acid (also called folacin
or folate) is a B vitamin with
a number of functions. It is essential
for cell replication and both
DNA and RNA production, as well
as protein synthesis. Tissues
that need a lot of folate are
those that multiply rapidly, such
as red blood cells, immune cells,
and the developing fetus.
A deficiency of folate during
pregnancy can lead to birth defects.
In others, it can cause anemia,
with abnormally enlarged red blood
cells. Vitamin B12 deficiency
also leads to anemia with enlarged
red cells, which is early evidence
of that deficiency. High doses
of folate can correct the enlarged
red cells seen with B12 deficiency,
hiding that deficiency from detection,
so folate has developed an unwarranted
reputation for causing B12 deficiency,
when it only masks it.
Increasing dietary or supplemental
folate is associated with a lower
risk of colon cancer, and may
also help to prevent lung and
breast cancer. Folate in larger
doses (along with B6 and B12)
has value in reducing the production
of homocysteine, a metabolic byproduct
associated with an increased risk
of heart disease.
If patients have high homocysteine,
I often recommend that they take
5000 mcg (5 mg) or more. Supplements
of vitamin B12 can prevent a hidden
deficiency while taking higher
doses of folate. Undetected B12
deficiency can lead to irreversible
nerve damage. B12 deficiency does
not always cause anemia, so independent
of folate, it is good to attend
to B12 intake and check levels.
I am unaware of any other folate
problems.
Nashua Schools
Remove Sodas, Keene (NH) Sentinel,
July 22, 2004.
France bans
junk food vending machines in
schools. Agence France Presse,
August 1, 2004.
Junk food supersizing
Europeans, USA Today, August 16,
2004.
Diabetes Now
Mexico’s Leading Cause of
Death (Report from Mexico’s
Health Ministry), Reuters, August
24, 2004.
Schulze MB,
et al., Sugar-sweetened beverages,
weight gain, and incidence of
type 2 diabetes... JAMA. 2004
Aug 25;292(8):927-34.
Marcus A, Though
diabetes epidemic worsens, researchers
make strides. HealthDay News,
August 22, 2004.
Yaffe K, et
al., Diabetes, impaired fasting
glucose, and development of cognitive
impairment... Neurology. 2004
Aug 24;63(4):658-63.
Dela F, Physical
training may enhance {beta}-cell
function in Type 2 Diabetes. Am
J Physiol Endocrinol Metab. 2004
Jul 13.
Bruce CR, et
al., Disassociation of muscle
triglyceride content and insulin
sensitivity after exercise...
Diabetologia. 2004 Jan;47(1):23-30.
Rabinovitz
H, et al., Effect of chromium
supplementation on blood glucose
and lipid levels in type 2 diabetes
mellitus elderly patients. Int
J Vitam Nutr Res. 2004 May;74(3):178-82.
[No authors
listed], A scientific review:
the role of chromium in insulin
resistance. Diabetes Educ. 2004;Suppl:2-14.
Smith AR, et
al., Lipoic acid as a potential
therapy for chronic diseases ...
Curr Med Chem. 2004 May;11(9):1135-46.
Khan A, et
al., Cinnamon improves glucose
and lipids of people with type
2 diabetes. Diabetes Care. 2003
Dec;26(12):3215-8.
Anderson RA,
et al., Isolation and characterization
of polyphenol type-A polymers
from cinnamon with insulin-like
biological activity. J Agric Food
Chem. 2004 Jan 14;52(1):65-70.
Koh HH, et
al., Plasma and macular responses
to lutein supplement... Exp Eye
Res 2004 Jul;79(1):21-7.
Richer S, et
al., ...lutein and antioxidant
supplementation in the intervention
of atrophic age-related macular
degeneration... Optometry. 2004
Apr;75(4):216-30.
Long term use of acetominophen
(Tylenol) is associated with a
decline of kidney function (Curhan
GC, et al., Lifetime nonnarcotic
analgesic use and decline in renal
function in women. Arch Intern
Med. 2004 Jul 26;164(14):1519-24.).
In this report, 10 percent of
1697 women showed a 30 percent
decline in the filtration ability
of the kidneys over 11 years.
Tylenol is used as a pain killer,
and other pain killers have been
associated with kidney damage,
but not in this study. Women who
took between 1500 and 9000 tablets
(averaging less than 1 to about
2 per day) had a 64 percent decline
in kidney filtration. For arthritis
pain, alternative treatments are
available.
a. Blueberries are known for
containing powerful antioxidant
phytochemicals. New research presented
at a meeting of the American Chemical
Society (Reuters, August 24, 2004)
shows that they can also help
control cholesterol levels and
blood sugar. Blueberries contain
a compound called pterostilbene,
similar to resveratrol (both are
also found in grapes). It protects
against cancer and heart disease.
Related compounds are found in
other berries.
b. Linoleic acid, one of two
essential fatty acids, found in
grains, legumes, seeds, and nuts,
appears to lower the risk of prostate
cancer. (Laaksonen DE, et al.,
Serum linoleic and total polyunsaturated
fatty acids in relation to prostate
and other cancers...Int J Cancer.
2004 Sep 1;111(3):444-50.) Researchers
following 2002 men for 13 years
found that those with the highest
intake had about half the prostate
cancer risk as those with the
lowest intake, possibly because
it displaced saturated fat in
their diets. Other cancers were
also reduced, but not as much
as prostate cancer.
(Or what to do with all of those
garden zucchini, yellow squash,
string beans, and tomatoes!) I
find that you can easily mix them
all in a variety of dishes that
are simple and tasty. I first
sauté some organic onions
and garlic in a mixture of olive
oil and curry powder. Then I add
diced potatoes and water, and
simmer with a lid for 10 minutes.
Next, I add cauliflower pieces,
cooked chick peas, tamari soy
sauce, and slices of the above
veggies, then simmer until all
the flavors suffuse the mixture.
I serve this over brown rice.
I also use the same vegetables,
but substitute oregano, thyme
and fresh basil from the garden
instead of the curry, use white
cannelloni beans instead of chick
peas and potatoes, and add fresh-ground
pepper. This combination gives
the mix more of an Italian flavor,
and it can be served over whole
wheat or buckwheat pasta.
