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Healthy Foods Abroad
Pandemic Diabetes
Diabetes Treatment
Gingivitis
and Heart Disease
Ask Dr. J:
Vitamin E Safety
References
In The Health
News
Diet and Disease
Recipe of the
Month: Rice Lentil Mujadara
Dear Friends,
I have just returned from a very rewarding
consulting and teaching trip to Japan. I was
impressed with the rapid expansion of interest
in nutritional medicine and chelation therapy,
among both doctors, dentists, and the public.
It was also exciting that a number of businesses
are interested in bringing better health to
the Japanese consumer.
They are increasingly aware of the relationship
between dietary supplements and health. I am
pleased to report that the American College
for Advancement in Medicine (ACAM) now has a
sister organization in Japan (Japanese ACAM),
and anti-aging medical societies are growing.
The Japanese are also advanced in their appreciation
of natural and organic foods. There is a growing
movement (pardon the pun) toward organic farming
and gardening, and a significant skepticism
of pesticides, food additives, and genetically
modified foods.
My hosts were aware of my very particular dietary
habits, and they made every effort to accommodate
my nutritional needs. I was again surprised
and delighted with the proliferation of organic
restaurants. Most lunches were “bento
boxes” with organic brown rice, tofu,
and vegetables.
Virtually every night we were able to go to
a different organic restaurant in many areas
of the city. They served whole, natural foods
that were elegantly and deliciously prepared.
I never recommend sacrificing pleasure for health,
primarily because it is unnecessary to do so.
Natural food preparation can provide a wide
variety of delights for the palate, and many
of these dishes are easy to prepare at home
with commonly available ingredients (although
sometimes organic foods are harder to find).
However, I was once again dismayed to see the
proliferation of a wide variety of North American
“fast junk” outlets. These are the
same restaurants we see all the time in the
US, but it always comes as a shock to me to
see how widespread they are when I travel abroad.
They are both the cause and the harbingers of
a looming medical and health catastrophe in
the US and worldwide. A few years ago I was
informed about a Greek government initiative
to educate the public about the benefits of
the traditional Greek (or Mediterranean) diet.
This diet is low in meats, and depends on vegetables,
fruits, beans, grains, yogurt, and nuts, and
is relatively high in olive oil as a source
of fatty acids.
As healthy as the Mediterranean diet is compared
with the US diet, the mortality from a variety
of ailments is still higher in these countries
than in Japan, where they also eat far more
vegetables, grains (brown rice is increasingly
available), fresh fruits, tofu, nuts, seeds,
and fish than are consumed in other industrialized
countries. In spite of the high rate of smoking,
longevity is high in Japan. I can only speculate
as to what will happen when smoking is reduced.
One of the consequences of the growth of fast
food outlets (as well as other poor dietary
choices and lack of exercise) in the United
States, Japan, Europe, and other countries is
the parallel growing rate of obesity and diabetes
around the world. In fact, diabetes is increasing
so much that it can now be considered pandemic
(a disease occurring over a wide geographic
area and affecting a high proportion of the
population).
At a recent meeting of the International Diabetes
Federation an expert analysis of the annual
cost of diabetes care came to $153 billion.
It is estimated that in 20 years, 333 million
people will be at risk of developing adult onset
diabetes, and the annual cost could rise to
almost $400 billion by that time. This is far
greater than the social and financial costs
of AIDS. Most of this disease rate is due to
modifiable lifestyle choices.
This is an enormous economic burden not only
for developing countries, but also in industrialized
societies. In addition, it is an extreme personal
and family burden for those who develop the
complications of diabetes. These can be debilitating
and lead to dependency on family, friends, and
society, and early death.
The complications of diabetes include heart
disease, loss of vision (from macular degeneration,
retinal atherosclerosis, and cataracts), premature
dementia, kidney disease, peripheral neuropathy
(numbness and tingling of the extremities),
and loss of limbs to gangrene from hardening
of the arteries. It is not a pretty picture,
especially considering that it is almost totally
preventable and reversible with lifestyle changes,
and a variety of dietary supplements.
Some of these experts were urging food companies,
and particularly those who make and sell fast
foods, to make healthier products. To paraphrase
my colleague, Bernard Rimland, this is like
promoting vegetarianism to a shark.
Considering the effects of fast foods and the
health damage from tobacco, it seems that the
most “successful” US export is disease.
(Now, in support of large US companies, the
goverment wants to force genetically modified
foods on the world’s population, in spite
of widespread public opposition, and without
any scientific studies to suggest that these
foods are safe.)
On the positive side, the United States is
one of the leaders in the development and expansion
of organic foods, and the enlightened, liberal
availability of dietary supplements is one of
the most important counterbalances to unhealthy
habits. It is also funding studies on nutrition,
health habits, and dietary supplements, as well
as alternative treatments such as chelation
therapy.
While diabetes is an increasing problem in
the US and worldwide, you can choose to prevent
and treat it with diet, exercise, and supplements.
This does not mean that you can be assured of
eliminating the need for medications or insulin,
but it usually makes it possible to at least
reduce the dose. Of course, good health habits
also prevent and treat other ailments.
As with so many health issues, a high fiber
diet, rich in vegetables, legumes, fresh fruits,
seeds, nuts, and whole grains is likely to provide
the most benefits. Being physical every day
is beneficial, and a regular exercise program
is essential to increase insulin sensitivity
and improve blood sugar control.
Several supplements help control blood sugar.
Chromium increases insulin sensitivity, but
you may need up to 1000 mcg per day, far more
than the nutritional dose of 200 mcg. Alpha-lipoic
acid (100 to 300 mg) improves sugar levels,
and higher doses (1000 mg) can treat diabetic
neuropathy.
Gamma linolenic acid (240 mg) also helps treat
neuropathy, as well as having numerous other
benefits. Increasing magnesium intake is associated
with a reduced risk of diabetes. It is also
beneficial to take vitamins C, E, and B complex
(including thiamine, which is associated with
reduced risk of diabetic kidney disease).
Gingivitis or periodontitis is the most common
cause of tooth loss. Inflammation of the gums
and surrounding tissues is the result of poor
diet and poor oral hygiene. Avoiding refined
sugar, eating whole foods, and regular flossing,
brushing, and irrigating are essential if you
want to maintain your teeth throughout your
life.
Chronic gingivitis has implications far beyond
the mouth. It may increase the risk of heart
disease, adverse pregnancy outcomes, diabetes,
and lung infections. Elevation of CRP, the inflammatory
marker, is associated with increased heart disease
risk, and many gingivitis patients have higher
CRP. In those patients, treating the gingivitis
and eliminating the infections helps to reduce
the level of the CRP in the blood.
Heart patients are more likely to have lost
their teeth or have antibodies to gingival bacteria.
In a study, of 159 men with heart disease they
were 50 percent more likely to have lost their
teeth or have antibodies to periodontal bacteria
than a comparable group without heart disease.
This suggests that the chronic gingival infection
could contribute to their atherosclerosis.
Another study shows an increased risk of heart
disease in gingivitis patients, and in addition
it suggested an association between gingivitis
and the risk of strokes, although this did not
reach statistical significance. The research
is not consistent, but the weight of evidence
suggests that gingivitis has serious health
implications.
Compared with just brushing, a comprehensive
multivitamin plus brushing can reduce signs
of gingivitis, such as bleeding index, pocket
depth, and gingival index. Antioxidant supplements,
including vitamins C and E and bioflavonoids,
help maintain healthy gums, partly becaue they
can reduce inflammation.
Some supplements are specifically helpful if
they are applied topically. Coenzyme Q10 helps
when taken as a supplement and when applied
to the gums. I usually recommend 100 to 200
mg of a chewable coQ supplement, which helps
in both ways (in addition to its benefits for
blood pressure, heart disease, and immune enhancement).
The B vitamin folic acid helps treat gingivitis
when it is applied topically. The usual dose
in studies is 5 mg, twice per day, as a mouth
rinse.
Diabetics and smokers have increased risks
and greater severity of gingivitis. It also
helps to strengthen the immune system to maintain
resistance to infections. Diet, exercise, and
many supplements all support immunity.
Lifestyle changes, careful oral hygiene, and
regular dental care can eliminate gingivitis
and the serious risks associated with it. Keep
healthy teeth and you will be able to continue
for many years to eat those foods that are essential
for your overall health.
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Q. Don’t recent studies
show vitamin E is not helpful in disease prevention,
and that gamma tocopherol may even be harmful?
RS, by Email.
This is misleading information. Evidence suggests
that you may need to take antioxidants, such
as vitamin E, for ten years or more to get the
most (and statistically significant) benefits.
In the study on vitamin E that associated gamma
tocopherol with potential harm, the authors
(but not the media headlines) indicated that
gamma tocopherol is a marker for trans fat intake.
Most people get little vitamin E, but if what
they do get comes from hydrogenated vegetable
oils with trans fats they are likeley to be
harmed by those fats, rather than the vitamin
E (including gamma tocopherol). This does not
mean that supplements of healthy sources of
vitamin E with gamma tocopherol are risky. I
continue to take large amounts of vitamin E,
including a high percentage of gamma tocopherol,
as numerous studies suggest that this is beneficial.
World Facing Diabetes Catastrophe,
Reuters, August 25, 2003.
Cameron NE, Cotter MA Metabolic
and vascular factors in ...diabetic
neuropathy. Diabetes 1997 Sep;46 Suppl 2:S31-7.
Liu S, Intake of refined
carbohydrates and whole grain foods in relation
to
risk of type 2 diabetes mellitus and coronary
heart disease. J Am Coll Nutr
2002 Aug;21(4):298-306.
Meyer KA, et al., Carbohydrates,
dietary fiber, and incident type 2 diabetes
in older women. Am J Clin Nutr. 2000 Apr;71(4):921-30.
Babaei-Jadidi R, et al.,
Prevention of incipient diabetic nephropathy
by
high-dose thiamine... Diabetes 2003 Aug;52(8):2110-20.
Anderson RA, et al., Elevated
intakes of supplemental chromium...in
individuals with type 2 diabetes. Diabetes 1997
Nov;46(11):1786-91.
Ziegler D, Therapy with antioxidants in human
diabetic neuropathy. J
Neurochem 2003 Jun;85 Suppl 2:15.
Jin LJ, et al., Are periodontal
diseases risk factors for certain systemic
disorders... Hong Kong Med J 2003 Feb;9(1):31-7.
Genco R, et al., Periodontal
disease and cardiovascular disease:
epidemiology and possible mechanisms. J Am Dent
Assoc 2002 Jun;133
Suppl:14S-22S.
Pussinen PJ, et al., Antibodies
to periodontal pathogens are associated with
coronary heart disease. Arterioscler Thromb
Vasc Biol 2003 Jul
1;23(7):1250-4. Epub 2003 Apr 24.
Morrison HI, et al., Periodontal
disease and...coronary heart and
cerebrovascular diseases. J Cardiovasc Risk
1999 Feb;6(1):7-11.
Mattila K, et al., Effect
of treating periodontitis on C-reactive protein
levels: a pilot study. BMC Infect Dis 2002 Dec
10;2(1):30.
Nishida M, et al., Dietary
vitamin C and the risk for periodontal disease.
J
Periodontol 2000 Aug;71(8):1215-23.
Munoz CA, et al., Effects
of a nutritional supplement on periodontal status.
Compend Contin Educ Dent 2001 May;22(5):425-8.
Hanioka T, et al., Effect
of topical application of coenzyme Q10 on adult
periodontitis. Mol Aspects Med 1994;15 Suppl:s241-8.
Pack AR, Folate mouthwash:
effects on established gingivitis in periodontal
patients. J Clin Periodontol 1984 Oct;11(9):619-28.
A study of elderly women shows that long-term
use of vitamins C and E can enhance cognitive
function. Of 15,000 women in their 70s, those
who had taken supplements for more than 10 years
performed better on tests of memory and mental
clarity than others who had not taken supplements
or had taken them for a shorter time. It is
never too soon to start taking antioxidant supplements,
as other studies also suggest that long-term
use has health advantages. (Grodstein
F, et al., High-dose antioxidant supplements
and cognitive function in community-dwelling
elderly women. Am J Clin Nutr. 2003 Apr;77(4):975-84.)
Long-term multivitamin supplementation is
beneficial in protecting health. Among 145,000
men and women, colon cancer was reduced by 30
percent among those regularly taking multivitamins
10 years prior to the start of the study, but
those who started them later or did not take
any were not so protected. (Multivitamin
Use and Colorectal Cancer Incidence in a US
Cohort: Does Timing Matter? Am J Epidemiol 2003
Oct 1;158(7):621-8.)
It is no surprise that fast food restaurants
serve unhealthy products (one of their defenses
against lawsuits is that everyone knows they
are unhealthy). Now a review of fast food habits
shows that 37 percent of adults and 42 percent
of children eat these foods (Paeratakul
S, et al., Fast-food consumption among US adults
and children.... J Am Diet Assoc 2003 Oct;103(10):1332-1338).
As a result, their diets are high in calories,
fat, saturated fat, salt, sugar, and soft drinks.
They are depriving themselves of fresh fruits
and vegetables and their nutrients, including
vitamin C and carotenoids. This contributes
to the high rate of obesity and related illnesses,
including childhood asthma.
This Middle Eastern dish is simple and tasty,
with few ingredients that cook fairly quickly.
Have cooked brown rice available (I use a rice
cooker, which is inexpensive and does a great
job in 45 minutes with little attention). Cook
green lentils in adequate water. They usually
take about 30 minutes, but they will finish
cooking later. Sauté onions in olive
oil until brown (one of my few dishes without
garlic, although you can add that too, if you
like), and add cumin (the main flavor) in liberal
amounts, and a small amount of sea salt. Mix
equal amounts of rice and lentils with the onions
in a sauce pan, and let them simmer until it
is a thick stew with all the flavors blended.
I add a little fresh cayenne, although this
is not traditional. Serve this dish with whole
wheat pita bread, and use it to dip into the
stew. |
