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Dear Friends,
When I see parents about their children, they
frequently tell me how difficult it is to get
them to eat healthy foods; either they are fussy
eaters, don't like vegetables, won't eat anything
that is smooth, or anything that is lumpy, will
eat nothing raw, or nothing cooked, or dislike
many other food characteristics.
I think it must be a cultural phenomenon, because
in other countries it is hard to imagine similar
interchanges--a Chinese child who refuses vegetables,
rice, or tofu; a Mexican child who won't eat
tortillas and beans, or mangoes; an Indian child
who won't eat vegetable curry, chick peas, and
fruits.
In most cultures,the availability of foods
determines the dietary choices that children
make, (of course, we don't want to neglect the
possibility that a child refuses something because
of a food allergy). If junk is not as available,
healthy eating becomes the routine. A recent
study showed that parents and family situations
have a great influence on children's eating
habits.
The study of 3000 high school students showed
that those teens who had good communication
with and close supervision by their parents
were far more likely to have healthy eating
habits. The number eating a healthy breakfast
ranged from 12 to 24 to 32 percent among those
in foster homes, living with another family
member, or with a single parent, compared to
43 percent of those living with both parents.
Children were more likely to eat healthy breakfasts
and lunches if they spent more time with family
and less unsupervised time. While their healthy
breakfast might not be the same as mine, the
point is that parents can influence what children
eat. We need to pay attention to this because
our epidemic of obesity (and diabetes, heart
disease, cancer, and hypertension) starts with
childhood eating habits.
Curiously, in the better family situations,
the number of children eating healthy breakfasts
was still only 43 percent, meaning that on average
in those families, 57 percent of the children
did not eat healthy breakfasts. Those families
with the highest parental monitoring reported
that 80 percent of the children ate fruits and
vegetables at least once a day. As the recommendations
for fruits and vegetables is between 5 and 9
servings a day, this does not strike me as very
positive.
Nonetheless, the important point to take away
is that parents can have a great influence on
their children's eating habits, and they don't
have to despair. Many years ago I saw a report
suggesting that when children grow up they are
much more likely to eat what their parents ate,
even if they had poor eating habits when they
were growing up (if they refuse the asparagus
now, they may like it in their 20's). While
you can't completely control your child's eating
habits, you can influence them through communication,
having good foods available in the house, and
through setting a good example.
A large body of evidence shows that the antioxidant
vitamin E is beneficial for prevention of heart
disease, cancer, and menstrual pain, as well
as enhancement of immunity, and slowing the
aging process related to oxidative damage.
A lot of the research has been done with synthetic
vitamin E, referred to with the prefix "dl-"
before the alpha-tocopherol. However, it is
increasingly clear that natural vitamin E is
more desirable, better absorbed and more biologically
active. A plain "d-" before alpha-tocopherol
indicates the natural form.
Even more desirable is a combination that includes
not only the alpha form, but the "mixed
tocopherols," containing other isomers
called beta, gamma, and delta. In particular,
the gamma-tocopherol (GT) appears to be valuable
in both laboratory and human studies.
Most vitamin E on the market, even the natural
mixed vitamin E, has very little GT. However,
evidence is accumulating that GT is an important
nutritional antioxidant in addition to alpha-tocopherol
(AT). A December report shows that GT is an
effective scavenger of oxidative molecules in
lipid tissues, and both GT and its metabolites
inhibit an enzyme called cyclo-oxygenase, which
is a mediator of inflammation. GT provides an
anti-inflammatory activity not seen with AT.
High plasma GT is associated with reduced cardiovascular
disease and a lower incidence of prostate cancer.
Evidence also suggests that high intake of AT
can inhibit the accumulation of GT in tissues
and plasma (even though most studies with AT
show it is beneficial). Earlier studies suggest
that GT is a more effective detoxifier of the
pollutant nitrogen dioxide. Supplements with
40 to 50 percent GT are available, and may be
preferable to those with little or no GT.
Dietary E and Other
Antioxidants
GT is the predominant form of vitamin E in the
diet, and it seems prudent to take a balanced
vitamin E with higher levels of the GT. However,
most of the studies that show benefit from supplements
of vitamin E are done with the synthetic form
or the natural AT, with little or no GT. Recent
studies that cast some doubt on the value of
antioxidant supplements often use too low a
dose, such as 50 mg of vitamin E, but perhaps
they should be looking at using combinations
of effective doses of several antioxidants,
and including GT in the tocopherol mix.
With combinations of antioxidants they support
each other synergistically. These include selenium,
vitamin C, arotenoids--not just beta-carotene,
alpha-lipoic acid, coenzyme Q10, and flavonoids,
as well as others. Recent articles show that
alpha-lipoic acid supplements can restore youthfulness
to animals, improve the function of their cells'
mitochondria, and enhance their brain function,
especially when combined with a derivative of
the amino acid L-carnitine. These supplements
also help reverse the age-related memory loss
in older animals.
My recommendation is to take some vitamin E
in a multivitamin, with the natural d-alpha
form, and add some extra mixed tocopherols with
high levels of GT. In addition, get as many
dietary antioxidants as possible, from vegetables,
fruits, legumes, and whole grains, adding complementary
antioxidants for greater aging protection.
For Valentine's day, the World Heart Federation,
a collection of cardiology societies and heart
foundations, came out and said that love is
good for your health. Citing a study of 10,000
men, they noted that love and support can markedly
reduce the development of angina, even in the
face of numerous other risk factors.
It appears that marriage itself is not protective,
but a loving, supportive relationship. In one
report, lack of social support nearly tripled
the mortality from coronary disease, while marital
status was unrelated.
On the other hand, marital stress significantly
increases mortality. In other words, if you
are in a loving relationship, married or not,
you reduce disease risks, but a stressful relationship
makes things worse. Recent divorce has a significant
negative effect on health risks, but so does
staying in a stressful relationship.
Another study, the MRFIT, or Multiple Risk
Factor Intervention Trial, is a long term study
that has led to a report that both work and
marital stress can significantly contribute
to mortality from heart disease. The lesson
is not to go out and get married, but to strive
to find satisfying relationships and work, and
combine them with healthy lifestyle choices--exercise,
diet, and stress management.
It has been shown that psychological support
and stress reduction can improve the mortality
in people with heart disease. Support groups
and rehabilitation programs can help significantly.
In one study, mortality was reduced from 17
percent to 4 percent over a nine-year period
for heart attack patients in rehab programs.
In addition, the rehab patients had less stress
and depression than controls. I've reported
earlier on other studies showing that yoga and
meditation provide similar benefits.
Supportive relationships are usually the result
of giving support, not expecting it or searching
for it (D.H. Lawrence writes "...only the
loving find love, and they never have to search
for it."). Satisfying work comes from giving
every effort to whatever job you are doing.
If you are in difficult work or relationship
situations, they are likely to have negative
effects on your health, and you should consider
what is necessary to improve them or change
them.
Q. I have Raynaud's syndrome. My hands turn
very blue when exposed to the cold. Can you
recommend something? (FK, New York)
A. Raynaud's disease involves spasms of the
small arteries in the hands, and sometimes the
feet or face, triggered by cold. The syndrome
is sometimes associated with auto-immune diseases
such as scleroderma, lupus or rheumatoid arthritis
(when it is called Raynaud's phenomenon), and
it can be the first sign of such disorders,
but it often occurs alone with no apparent disease
association. It can also be triggered by reaction
to some drugs, including beta-blockers, chemotherapy.
It is much more common in women than men.
The extremities turn white with lack of blood
flow, and as it persists they can turn blue
and then bright red as the spasm abates and
blood rushes back in to the tissues. It can
cause numbness and tingling from lack of blood
flow, and then pressure and pain with the last
phase.
The obvious recommendation is to keep warm and
wear gloves and scarves in cold weather (not
everyone can move to warmer climates as a solution,
but it is a nice idea!) and get regular exercise.
Avoid all tobacco, a cause of arterial spasms.
While medications are sometimes used, a number
of dietary supplements may provide relief. Vitamin
B3, as timed-release niacin (250 mg twice daily)
or inositol hexaniacinate (800 to 1600 mg daily)
has been successful. Gamma-linolenic acid (GLA,
240 mg from borage oil) relaxes the blood vessel
muscles by rebalancing the prostaglandins that
affect smooth muscle contraction (reducing meat
and other animal fat in the diet may provide
similar benefit by reducing arachidonic acid
that leads to increased muscle spasm).
Ginkgo biloba improves blood vessel function
and can relieve Raynaud's symptoms (120 to 240
mg of standardized extract). Other supplements
that help include magnesium as a blood vessel
relaxant (400 to 1000 mg), fish oil (2000 to
10,000 mg), and L-carnitine (2000 to 3000 mg).
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a. Elevated levels of homocysteine in the blood
is a known risk factor for heart disease. Now
research shows that it is also a significant
risk for the development of dementia, including
Alzheimer's disease (Seshadri S, et al., Plasma
homocysteine and Alzheimer's disease. N Engl
J Med 2002 Feb 14;346(7):476-83). Information
from the Framingham study indicates that each
5-unit rise in plasma homocysteine leads to
a 40 percent increase in dementia incidence.
Levels above 14 units doubled the risk. Homocysteine
can be lowered with B vitamins, including folate,
B6, and B12.
b. Non-steroidal anti-inflammatory drugs (NSAIDS)
are contributors to the risk of gastrointestinal
bleeding, and now it appears that in patients
with congestive heart failure they can increase
the likelihood of relapse (Feenstra J, et al.,
Association of nonsteroidal anti-inflammatory
drugs with...heart failure. Arch Intern Med.
2002 Feb 11;162(3):265-270). Natural anti-inflammatory
agents curcumin, ginger, vitamin C are free
of this risk.
Diet and Disease
Insulin resistance, most commonly the result
of obesity, and a reflection of poor sugar metabolism,
is a risk factor for the development of heart
disease and diabetes. A recent study shows that
caffeine intake, even in moderate amounts, can
cause insulin resistance and thus increase disease
risks (Keijzers GB, et al., Caffeine can decrease
insulin sensitivity in humans. Diabetes Care
2002 Feb;25(2):364-9). Caffeine increased blood
levels of adrenal stress hormones, and elevated
blood fats and blood pressure. The editorialists
noted that this adds another risk from caffeine,
but they cryptically remarked that coffee drinkers
should not panic, because these were experimental
conditions with healthy people! They think you
should wait to become sick from caffeine, then
panic.
Nut loaf can be quite tasty, although often
ridiculed by non-vegetarians. In a mixing bowl,
combine 1 1/2 cups of walnuts or almonds ground
up in a blender, 2 cups of bread crumbs (toasted
whole wheat sesame bread is good), 1 1/2 cups
of minced tomato, 1 1/2 onions and 4 cloves
of garlic minced and lightly stir-fried in olive
oil, 2 beaten eggs, 1 Tbsp of soy sauce, 1 tsp
of lemon juice, 2 tsp each of thyme, oregano,
and chili powder, and 8 Tbsp of minced parsley
and cilantro. Mix well and fill into an oiled
loaf pan; bake for 35 minutes at 350º F. Slice
and cover with mushroom gravy (mushrooms, onions,
garlic and ground pepper, sautéed in olive oil,
with added organic vegetable broth--you can
buy this at a health food store). This is a
delicious main course with steamed veggies and
salad.
References
Editorial
Young EM, Fors SW, Factors related to the eating
habits of students in grades 9-12. J Sch Health
2001 Dec;71(10):483-8.
American Heart Association. 2002 Heart and Stroke
Statistical Update. Dallas, Texas: American
Heart Association, 2001.
Vitamin E
Cooney RV, Gamma-tocopherol detoxification of
nitrogen dioxide: superiority to alpha-tocopherol.
Proc Natl Acad Sci U S A 1993 Mar 1;90(5):1771-5.
Jiang Q, et al., gamma-tocopherol, the major
form of vitamin E in the US diet, deserves more
attention. Am J Clin Nutr 2001 Dec;74(6):714-22.
Ziaei S, et al., ...placebo-controlled trial...of
vitamin E in
treatment of primary dysmenorrhoea. BJOG 2001
Nov;108(11):1181-3.
Hemila H, et al., Vitamin C, vitamin E, ...
Beta-carotene in relation to common cold incidence...
Epidemiology 2002 Jan;13(1):32-7.
Liu J, et al., Age-associated mitochondrial
oxidative decay...Proc. Natl Acad Sci USA, 2002
Feb 19;99(4):1876-81.
Hagen T, et al., Feeding acetyl-L-carnitine
and lipoic acid to old rats significantly improves
metabolic function while decreasing oxidative
stress. Proc Natl Acad Sci, 2002 Feb 19;99(4):1870-75.
Love, Stress, and Mortality
Medalie JH, Goldbourt U, Angina pectoris among
10,000 men. Psychosocial...risk actors... Am
J Med 1976 May 31;60(6):910-21.
Tucker JS, et al., Marital history...: alternative
explanations to the protective effect of marriage.
Health Psychol 1996 Mar;15(2):94-101.
Welin C, et al., ...importance of psychosocial
factors for prognosis after myocardial infarction.
J Intern Med 2000 Jun;247(6):629-39.
Orth-Gomér K, et al., Marital Stress Worsens
Prognosis in... Coronary...Disease JAMA. 2000
December 20;284(23):3008-3014.
Matthews KA, et al., Chronic Work Stress...Marital
Dissolution
and...Mortality... Arch Intern Med 2002 Feb
11;162(3):309-315.
Denollet J, Brutsaert DL, Reducing emotional
distress improves prognosis in coronary heart
disease: 9-year mortality in a clinical trial
of rehabilitation. Circulation 2001 Oct 23;104(17):2018-23.
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